Teaching

The silence is deafening.

Even more so following the non-stop rush and crush of people over the past two hours, now all gone their hundred separate ways.

The small room remains hot from so many bodies packed in together. My shirt is sweat-soaked beneath my corduroy sport coat. In the center of the room are four long tables pushed together to form a larger rectangle. I survey the mess and sigh.

Time to clean up.

Strewn across the tables are pen needles, caps, needle sheaths, infusion set tubing, disposable inserters, and syringes. It looks like the refuse from a diabetes orgy.

Time to clean up.

I start sorting. No one bothered to bring a sharp’s container. I very carefully re-sheath naked needles and throw them into the center of one table. I’ll box them up when I’m done and take them to the clinic for disposal on Friday. Needle caps, paper debris, dead infusion sets go on another table, destined for the trash can. Stuff I can use again goes on a third table.

I undo the brown leather belt that holds my father’s briefcase closed. The right side latch is broken off and long lost, but it’s a still nice college-professor case. Deep reddish-brown leather. Smooth and soft to the touch.

There’s a brief burst of group laughter down the hall. From the pharmacology lab, oddly enough.

Yep, I’m in Albuquerque, at the University of New Mexico’s School of Medicine. And I just finished doing one of the things I enjoy most. Teaching.

Teaching runs in the blood. I grew up a “faculty brat,” both my father and grandfather were college professors. And as such I’m no stranger to college campuses. I’ve spent a lot of time on college and university campuses, both large and small. Some of my favorite memories of my father from my early 20’s was meeting him for lunch every Wednesday at the Faculty Club at the University of Northern Colorado, on the old campus.

The old campus and the new campus were literally side by side. Crossing a two-lane road took you from one to the other. The new campus was a place of wide open spaces and funky modern buildings. It would have been a great location for a sci-fi movie. The old campus was a place of tall, thick trees and solid stone buildings covered with climbing ivy. The type of place that would have been a great location for a movie about academicians.

The Faculty Club itself had an old-world quasi-Victorian feel to it. The food was good too, as I recall they made a killer Monte Cristo Sandwich.

But in my experience, the University of New Mexico campus, where I am today, stands in a league of its own.

It’s simply gargantuan.

The main campus encompasses 350 buildings sprawling over 769 acres of central Albuquerque. These buildings add up to almost 11 million square feet, the equivalent of 600 Wal-Mart Super Centers. The main campus’ libraries hold two and a half million volumes. Fourteen thousand people work here, and another fifty-four hundred man University Hospital.

Most of the work I do for the University—thank God—is via telemedicine, either from the comfort of my home library or my clinic office du jour (I’ve had three offices in six years, and rumor has it I’ll be moving again in the coming months).

About once a month or so, I actually do have to drive the two and a half hours to the University in person, but it’s often to the offices of Project ECHO, which sit in a building of their own just outside the main campus and just off the freeway—in, out, and on my way again. There’s an out-of-business car dealership right next door, so parking is never a problem.

But a couple or three times a year, I’m required to go to into the heart of the main campus itself, either to the School of Medicine or the University Hospital.

When I come here it is with a mix of dread and thrill. Remember that I live on 20 acres in the middle of nowhere. If I’m not working from home I’m working at a clinic in a town that has no stop lights. I’m not really a country bumpkin, but I might have been bumpkinified a little bit over the years. So coming to the heart of this mighty campus is both exciting and nerve wracking; a bit like riding roller coaster.

As I drive through swarms of traffic and fight for parking places I always swear I’ll never come again. But once I’m here, the rarified air is stimulating and I end up having a good time. Plus, there’s a Starbucks not too far away.

Today I was teaching diabetes technology: pens, pumps, and CGMs. It’s ultra quick intro time for student doctors finishing up their second year. They are young and smart and energetic. Pretty much everything I’m not. There are one hundred of them, in groups of 25, rotating every 20 minutes between my class room and three others.

Speed learning.

I’ve brought lots of hands-on goodies, and a super-quick Power Point. The School of Medicine loves, loves, loves Power Points. I, however, do not. I suffered near death by Power Point too many times. That said, used right, it has its place.

The students crowd in, a hush falling over them as they spy needles, strange devices, and tubing scattered across the tables. I introduce myself, then it is time for fun.

Like a ring master, standing in the spotlight of the laptop projector, I hold an insulin pen. I point it upwards and click-click-click-click-click-click-click-click the plunger home with my thumb, squirting a stream of expired insulin into the air, sparkling droplets glisten, liquid diamonds floating like butterflies, like rain descending through shafts of sunlight. We dive in.

Why do we tap the air bubbles out of our syringes?

“To avoid an embolism?” asks one boy.

You’re over thinking it. The shot goes in the subQ tissue, you can shoot as much air as you want with no risk. What problem can the bubble cause us?

“Could it displace the volume so you wouldn’t get the right amount of insulin?” asks another boy.

Bingo!

This is how you put the pen needle on. I throw the paper in one direction, the needle cap in another, and the sheath in a third direction. How often do you think patients are supposed to change the needle? How often do you think we actually do?

And then it’s time for the next group.

Why do we need a quick disconnect on our infusion sets?

The guesses flow in: in case you go too low; for taking a bath; in case you get your hose caught; in case…

What else?

“Sex?” asks an embarrassed female voice near the back of the room

We have a winner.

“Wow, I would have never thought of that,” says another girl near the front.

You study too much, I tell her. She blushes.

And then it’s time for the next group.

I snap an old CoZmo infusion set onto a red blood cell stress ball, then pull it off so they can see the cannula. I tell them insulin pumps are just fancy syringes, they don’t replace your brain. I show them a dismembered Omni Pod and explain how it is different from traditional pumps.

“All those circuit boards and batteries get thrown away every three days?” asks a student.

Yup. And do you think we D-folk care?

And then it’s time for the next group.

My CGM is passed around the room, complete with an embarrassing three hour trace, while I show them a projection of a sensor daily over lay report. What it can tell us and why they don’t have time to look at it during a 15 minute office visit.

You need to trust your educators.

And then, sadly, it’s over. Their excited voices echo down the hall as they head off to other classes.

And the silence is deafening.