Sunday, November 20, 2011

See the new tab?

I've decided to completely copy other medical school bloggers and begin my own medical book opinion page on my website.

I'm not quite using the same books as I have seen reviewed before, so I figured I would throw my 2 cents into the interwebz. 

I have a lot more books to add (like all the things purchased recently for Pharm, Physio, Physical Exam, Anatomy and Pathology), but I'm going to give it a few months to marinate. I'll periodically post little reminders when I've updated that page. 

Also, I have two exams this week. So I should probably stop procrastinating on my blog and get back to studying. 

By the way, since I don't want to start a new post for this, here it is: 

I PASSED ALL OF MY CLASSES FOR THE FIRST SEGMENT OF MEDICAL SCHOOL. 

Got my grades back on Friday. Victory is mine. It was touch and go for a while, but I pulled through.

I bet my loan lenders are having a party right about now. They are counting down the days until repayment. 2021 is right around the corner; only 9 1/2 years away!

Keep telling yourself that, K8.

Wednesday, November 16, 2011

Vicious circle of happiness


So as you may or may not know, I read a lot of books. Not like "Medical Physiology and You", but more like FUN books. Pleasure reading. You remember that?

Anyways, for the past four years, I have been using Russ Allbery's reviews for Science Fiction and Fantasy (my genre of choice):

http://www.eyrie.org/~eagle/reviews/

So I sent him an email in July.

I have been reading your reviews for several years now; I love them! I rarely disagree with your ratings, and it is so fantastic how you've set up your website so that I can see the ratings without any of the spoilers. I just read Kushiel's Dart, something I never would have picked up had it not been for your reviews. It was amazing!

I know you probably get a lot of mail, but I just wanted to let you know how appreciative I am for your reviews. I recommend you to all the other science fiction readers I know.

Have a nice day,
AndromedaMed


For those of you wondering, Kushiel's Dart is amazing, and I highly recommend it. Don't let the cover fool you; it is not some cheap Harlequin romance novel. Also, you cannot quit until you've read at least 100 pages. If you don't like it by then, we probably can't be friends.



Anyways! In November, a mere six months later, he emailed me back!


Hi! I'm sure you weren't expecting a reply to this after all these months. :)

Thank you for this note! I was going to reply to it immediately when it came in, but then got distracted by something, and it then got lost in my mail backlog and I never did. But I ran across it today and figured better late than never.

I'm really glad you've enjoyed them! And I'm particularly delighted that you found a book that you'd never otherwise read because of them; I think that's particularly rewarding.

Thanks for taking a moment to send your email; it made my day brighter (a couple of times!).

Russ



Well, Russ, I'm here to tell you that YOUR email made MY day brighter (a couple of times!). It's a never-ending cycle, because now I'm going to pass on the happiness:

There is nothing better than a gleeful, clapping otter. Except Russ Allbery's reviews.
So all my science fiction/fantasy readers, check that site out! It's bananas!

Anatomy has begun.

Woah Nellie!

And they're off! The first person who can identify 10,000 new structures and vocabulary words that sound like gibberish is the winner!

(I mean, seriously, who came up with iliopsoas? Trochanter?)

We met our temporary cadaver on Tuesday. Temporary because she is really the dental school's cadaver; they've already dissecting everything above the waist. We are simply dissecting her legs. In January, when we finish the legs, we will get a fresh cadaver. That's the one I plan on getting attached to.

Our anatomy course will extend from now until March sometime. We dissect two days a week, while the other three days are filled with the appropriate physical diagnosis, physiology, pathology and pharmacology for that body part.

So many "P"s
We get a quick 50 minute lecture on the femoral triangle (anterior/medial portion of the thigh) and we are kicked into the anatomy hall for 2.5 hours of dissection. I'm working with a group of 6; all of them are awesome. None of us know what the heck is going on.

"Ummm, so what do we do now?"

"I don't know. Should we start?"

"All the groups around us have started."

"Uh, okay, let's start."

"Huh. We probably need a scalpel. Does anyone know how to put a scalpel blade on?"

*crickets*

"Alright, I'll try."

"Where do we cut? Maybe we should wait for an instructor?"

The group next to us yells, "Nah, don't bother waiting. Just starting cutting stuff up."

"Ooookay. I mean, we do have two legs. If we screw one up, we'll dissect the other one."

"How deep do I cut here?"

"Is that still even skin?"

"Who the heck knows."

"What is that white stuff? What's the yellow stuff? Where are we?"

"Is that the femoral vein? No, wait, maybe it's an artery. You know, it could be nerve. Maybe a lymph node?"

45 minutes in, with only two cuts made, and our group still floundering about above the fascia lata, our instructor shows up.

"What are you guys doing here? Where is your reference point? What are you even looking for?"

"Dear God, we have no idea. We thought that's what you were for."

"Where is her iliac crest?"

"Ummm...?"

"Oh no! You cut the Saphenous vein. Your patient is bleeding out! Oh, too late. She's dead."

He pauses.

"So, now that you've killed your patient, let me show you what is going on here."

Turns out that our Saphenous vein didn't get filled with embalming fluid, so even the instructors had to do a big of digging to make sure it was actually the Saphenous vein. He explained what the fascia lata was, and that we should look for fat. When we stopped seeing fat, we were through the fascia lata and into muscle.

Fortunately for us, our patient had fat in her muscles. SO DIFFICULT TO TELL WHAT IS GOING ON.

Also, females are fatty. It wasn't fair. All these people around us had nice, lean, male cadavers. Their muscles and tissue were smooth, clean, crisp lines. Ours looked like a squidgy mess of custard and spaghetti. And no matter what we did, we couldn't really clean it up well.

The smell didn't really bother me, which was a welcome surprise. Maybe it will in another few weeks. We'll see.

I will say this: holding/using a scalpel was very natural for me. I had a really good grasp of the spatial-ness of the body, and it was SUPER FUN to cut. Surgery is back in, folks!

And now I have an appreciation for why general surgery residency is 5 years. It would be a long time before I would be comfortable doing something like a saphenous cutdown.

PS. Wow, are the models used in anatomy books attractive. Not the cadavers, stop it, gross. I'm talking about the nude models they use to show you an overlay of muscles or something.  That guy has buns of steel.

Thursday, November 10, 2011

Not my week

Alright, so let me break this down for you.

1. My family is planning a trip and it's been super stressful. We've had some problems this week.

2. I have two exams this week (one for interviewing; the other a nice 4 hour chunk of histology, molecular biology, biochem and immuno).

3. I was supposed to get a free weekend after these massive exams, but my other classes like ethics and stats gave us homework. No free weekend for me.

4. I'm on my dag nab period.

5. I applied for a position with a volunteering organization that I REALLY wanted. I actually had to rank my preferences from 1 to 20 on what I'd prefer to have as a job on my application.

Here is how I applied:

.....
_1__ Administrator
_2__ Staff coordinator
_3__Volunteer coordinator
......
_20_ Dog catcher
_Not interested___ Fundraising

I put a note in my application that said, "I'd really not like to do fundraising. Anything else works fine."

Well, I found out this week that the position I was offered was created especially for me. Guess what it was?

Fundraising Advancement

Yes, they created a special position for me specifically in the ONE area (out of 20) I asked not to get put into.



It is a perfect storm.

So I don't know if I told you all, but I got into that singing thing I applied to. Yay! And I'm super psyched to be a part of it; we have a lot of fun.

Our first gig was this week. And it was pretty prestigous gig. At an art museum. We sang in front of 500 doctors and medical staff.

We arrived at about 4:30pm, and began warming up (in a freakin' art gallery!). I'm pretty sure we sounded the best we're ever going to sound with those high ceilings. Sound check was at 5:30pm. Awesome.

We go back to the room to wait. We were told that we'd get some food before the show. We ask for food.

"No, no, see, you get food AFTER you sing. The whole idea is that you will sing to us, and then you will join the party for drinks and food. Everyone will want to meet you and shake your hands. You'll see."

"No, but see, we're pretty hungry and none of us have eaten, and our performance isn't until 7:20pm, and that's if everything goes on time..."

I ate lunch at 11 AM. Now, normally, not a big deal to not eat until 7 PM, but, uh, I went weight lifting that afternoon. For two hours. Serious lifting. Then I came to the gig. Where we were supposed to get food.

Someone shares a Fiber One bar with me, and someone sneaks into the event to grab a plate full of food that is shared between 20 people.

7:20pm rolls around and we are brought backstage, waiting and ready. Where we wait until 8:45pm. Mostly in silence because we didn't want to ruin the LONGEST SPEECHES EVER. Also, did I mention we are standing? And I'm wearing Cole Haan shoes? Sure, they have Nike air in them, but come on! Also, I haven't eaten in 10 hours now. Let me reiterate. Standing. 1.5 hours. Silence.

Now, start referring back to #1-5. The pressure is building.

So we sing, yay, everyone claps. I don't really give a crap though, because I'm pretty hungry and I can smell the buffet from the stage. We leave the stage, shake some hands and finally make it to the buffet table.

I get a (tiny appetizer) plate of food (which was more like appetizers, but whatever) and scarf it down. It's been about 7 minutes since we left the stage now.

I go back up to get a second helping. I grab a plate and turn to find the catering staff there. A woman rips the plate out of my hand and says, "You can't have anymore." Then, they proceed to pack up the entire buffet line of food in front of me.

So by invited "to share in the party", you meant "haha, just kidding, you should see your face!"


I'm pretty livid now. All I want to do is go home.

When we came to our performance, we were told to park in the staff parking lot. I asked the parking lot attendants, "Which parking lot is the staff parking lot?"

"Oh, this one is, come on in."

Gate opens, I go in.

So now, it's dark, I'm hungry, weak and semi-delirious. I stumble out to my car (along with other people who are leaving the party) and drive my car to the gate.

"Where's your ticket?"

"What ticket?"

"Your parking ticket."

"Uh, I don't have one."

"That'll be $14."

"Wait, what? I just sang in there, I'm a performer, not a guest."

"I can't let you out without a ticket."

.....

She actually makes the line of 10 cars behind me BACK UP, one by one, so that I can pull back into my same exact parking spot I just left, and look for my non-existent ticket.

I'm back where I started and KABOOM.


I completely lose it.

I begin ranting across the parking lot, yelling, "I need to get out of this parking lot. For God sakes this is ridiculous. I just performed at this event and now you want $14 D*MN DOLLARS? FINE, YOU WANT THE STUPID MONEY? TAKE IT. TAKE IT!

JUST LET ME OUT OF THIS PARKING LOT. I'LL DO ANYTHING TO GET OUT OF THIS PARKING LOT. HOW CAN I PROVE TO YOU THAT I DESERVE TO GET OUT OF THIS PARKING LOT? HERE, LET ME GO GET SOME PROOF THAT I JUST SANG AT A FREAKIN CONCERT AND THAT I BELONG HERE. OR, YOU KNOW, YOU COULD KEEP ME TRAPPED HERE FOR-GODD*MN-EVER."

I'm now screaming. And then I start sobbing. I'm standing outside of my car, in my white coat, papers strewn all over my car as I tried to find a ticket.

I'm fairly certain I scared the crap out of the attendants.

"Okay, miss, let us get you a ticket. Hold on a sec."

I'm shaking and completely defeated. I don't even care anymore. If I hadn't gotten a ticket, it's a toss up whether I would have slept on the grass near my car, or drove through the botanical gardens to get out of that parking lot. I'm not sure which one my deranged mind would have latched onto.

Anyway, I drove home, cried a bit, and went to bed.

And that ladies and gentlemen, has been my week.

Sunday, November 6, 2011

Oh medical school exams, you think you're soooo funny, don't you?

So our most recent test was...insane.

So picture this. Our exam is integrated, meaning that all of our classes have a section in the exam. So we have BioChem, Histology, Molecular Biology and Immunology together. So picture this. I'm 1.5 hours into a 3.5 hour exam, and I begin the Molecular Biology part of the exam.

First, this part of the exam is short answer, NOT multiple choice. I'm not quite sure why. The board exam is multiple choice. Step 2 is multiple choice. In fact, no where in our medical testing will we face short answer type questions. But okay, whatever.

I open the booklet. 

There are two questions, each worth 50% of our grade in Molecular Biology. 

1st question: straightforward, fair question. I answer, thinking I probably did alright.

The 2nd question stem is about a page long. I read the story about bacteria and the different experiments performed. This is way more complicated than anything we've ever seen.

Alright, I think to myself, I got this. I studied every single lecture, I read the syllabus, I did all the practice problems. 

And then I read Part A of the 2nd question:

a) What is an arginine auxotroph? 

Well, crapbox. I have no clue. We never discussed that in class, syllabus or practice problems. Should I have randomly Googled arginine auxotroph in my spare time? Okay, forget this, maybe part B will be better. 

b) What is a prototroph?

....okay...apparently I was supposed to use my super psychic powers and read up on prototrophs earlier. Well whatever, part C should be better.

c) Why are the bacteria in Experiment 1 arginine auxotrophs? 

Oh God. The questions are going to stack on top of each other. My lack of outside knowledge has destroyed me for this exam.

d) Explain why the bacteria in Experiment 2 are prototrophs.

You know what would help? IF I KNEW WHAT PROTOTROPHS WERE. 

e) Draw the bacterial genes for Experiment 3 bacteria being sure to include the arginine auxotroph genes. 

We've never been asked to draw a genome before. I drew a circle. I was so proud of myself. Got that part down.

BOOMSHOCKALOCKA! I got +2 for this!


f) How are the enteroaggregative genes and the arginine biosynthesis genes related?

Dear God, what is going on? What does enteroaggregative mean? Have I entered some alternate reality ?

I stare at the questions, hoping that some BS will surface in my head that sounds even remotely plausible. I spend the next hour and a half making up answers. 

I left that exam convinced I was going to need to take Molecular Biology over the summer. But I wasn't even upset. I had studied my butt off for that exam.

Two weeks later, word on the street is that the exams have been graded. Our average was BELOW A 50%. 

Ouch. 

I got my grade back:


Out of a 200 point exam, 60 points were dropped. So I wound up getting an 85.71%, woot!

But even better, before the curve, I had a 133/200.

Which puts me at 66.5%. And what is passing? A 65%! I would have passed by 1.5% without the curve! Victory is mine.

You know what they say: P(ass) = MD!

Wednesday, November 2, 2011

Why did the settlers stay in the north?

Sorry for dropping off the grid there.

I sort of mean that literally since we lost power back on Saturday. But fortunately, we got it back late Monday evening!

Let's list the worst things about losing power:
  1. It's 30 degrees outside. Our house was 53 degrees. It was motherflippin' cold. It's not so bad when you are under four giant comforters fully clothed. But it is bad when you have to get up to use the toilet. Holy mother of that is cold. I am jealous of men.
  2. Our hedgehog could have died. They start to hibernate in cold weather, and we read in our "Hedgehog Manual" that hibernating domestic hedgehogs could die from it.
  3. No internetz.
  4. No phone (land line was down too).
  5. Our Halloween was cancelled. You heard me. Cancelled! Too bad kiddos, the big bad snowstorm has taken your fun and joy away, replacing it with shivers and hunger pains.
  6. Our refrigerator and freezer are decimated. I don't even want to look inside them. But I have to clean them out today.
  7. No video games. And seriously, I was in the middle of an awesome video game when we lost power. And of course it didn't save. So now I have to play the entire sequence AGAIN.
  8. Your nutrition goes to crap. Mmm, I love peanut butter and jelly sandwiches for 3 meals a day. You don't really need anything else in your diet, right med school?
But the absolute worst part:
THE DVR STOPPED WORKING. Oh the horror! No Simpsons Halloween special, no Kitchen Nightmares, NO DESPERATE HOUSEWIVES. #firstworldproblems
I called the gym to ask if their hot tub was working.

"Yes, it's working, we didn't lose power."

Sweet! So I head to the gym, and there is a sign at the front desk: "Attention members: we are sorry for the inconvenience but the hot tub is colder than usual."

I look deadpan at the front desk woman and said, "So when I just called asking you about the hot tub? You told me it was working."

Without blinking the woman says, "It is working. It's just cold."

....thank you. Thank you for making my 3 days of miserable cold so much better.

It's all okay though. Happy badger thing is happy.


Tuesday, October 18, 2011

If I attacked you right now, would you win?

Yesterday, I was walking down the street, about half a block behind two of my medical school classmates (Dan and Clara).

A man walks past Clara and Dan on the street. Dan, who had a cold, coughed.

Man: "If you cough one more time, I'll kill you."

Dan keeps walking, trying to ignore him. The man grabs the back of Dan's jacket, pulling him backwards. Dan drops his bag and squares up on the man.

At this point, I've stopped and am fumbling out my phone to call 911.

The man is saying things to Dan I can't hear, and then he pushes Dan. Dan punches him in the face, and the man goes sprawling. Clara is screaming "Dan! Oh my God! Dan!"

The man loses his hat as he falls, and Dan backs away slowly, hands still raised.

The man mutters under his breath, collects his things and begins walking directly at me. All of this has happened in about 5 seconds; I haven't even dialed 911 yet. I begin walking in another direction to get away from the crazy person.

I catch up with Dan and Clara to make sure they are both okay.

Phew, crisis averted.

Now, the scary part.

It was 1:30 PM. In the afternoon. Bright sunny day.

Multiple people were watching the altercation without doing anything. I was the only one dialing 911. Two doctors walked past a medical student swinging at a random guy without a second glance. What if the man had pulled a gun out? What if he had knifed Dan? One of them could have easily been killed had this gone another way.

I remarked as I was dialing 911, "I need to call the police!" and two women next to me saw the fight and shrugged, walking back into their building.

So two points about this.

1. Don't be a coward. Don't just walk on by like those doctors did. Either help Dan, or call 911 (there's no shame in not physically helping). But for Pete's sake, don't just ignore the situation! If someone is screaming in panic, or if someone is fighting, this isn't really an ambiguous situation. Someone needs help.

2. I'm going to start carrying some pepper spray. Seriously, stuff happening at 1PM in the afternoon is not cool. And we can already see how helpful passersby will be.

I've already had my husband show me a bunch of ways of getting out of holds. He is great to practice with because he is tall and strong. He really gives me an idea of what it would be like to fight someone 10 inches taller than me, who is STRONG. It's not easy, but we'll be practicing, and I'll get better at it.

I hope I'll never have to use what I learn, but what if I did?

If I was being attacked, what is the appropriate level of force? These are things I have never thought about before yesterday, but I think they are important questions.

There are obvious situations: like I'm being choked on the ground while a guy tries to rape me. Obvious fight for your life situation. But thinking about stabbing someone, or breaking their arms is a lot different than actually doing it.

But what about if I get pushed? I'm alone and it's late at night, guy brushes past me, hitting my shoulder hard. What do I do? Pull out my knife and stab him? A little overkill.

What about if the fight between the man and Dan hadn't gone well? Dan was now on the ground, with the guy punching him from overhead. What would you do then?

What if the man had a knife? Would you know how to block yourself from a knife stroke?

What is your goal? My goal, I discovered yesterday, would be to incapacitate the attacker with groin hit, elbow-to-face-hit or a myriad amount of other moves I have learned over several years, and then run like the dickens.

Also, women, don't kid yourself: men are really strong. Even those nerdy looking ones. And if you are attacked, you are probably going to get hit several times and be pretty disoriented. You may want to consider learning some moves if a guy is on top of you to get them off of you.

Also, for those of you who carry knives and/or guns, are you prepared to use them? I have no idea if I'd be confident in my ability to know when to use those weapons or not. It's an awful lot of responsibility.

If you ever do need to use them, tell the police you feared for your life and wait for your lawyer. A jury will not convict if you were being attacked, but it's very important to only use lethal force when you are in fear for your life.

So just some thoughts to consider as you go about your day today: what would you do?

Thursday, October 13, 2011

Oh the awkwardness

I had a patient interview today that went fantastically. I really feel better about interviewing and have almost all the main parts of the history memorized.

All except for one part of it.

Him (dark-skinned): "I have a lot of family back home."
Me: "Home being India?"
Him: "....."
*angry silence*
Him: "Noooo, actually, I come from Venezuela."
Me: 


I squirm in my chair now, just thinking about it. Why would I say that? The instant it came out of my mouth, I was like, "What the heck, K8?"

Luckily, not making sweeping generalizations for the rest of the interview seemed to save me.

Dag nab it.

Monday, October 10, 2011

Lions, tigers and the terminal illness known as AIDS

I was 7 when I finally understood what was happening.

I didn't grasp what my biological dad was trying to tell me before then. I didn't understand the concept of life and death. And I certainly didn't understand the concept of sexuality.

I remember exactly where we were. When he told me. We were in his Camry, in front of a park. I still remember vividly the families playing on the park equipment. It was evening. He must have really thought it out how he was going to break this to me. I don't know how many times he tried to break it to me before.

I didn't get it back then.

I remember being confused when he told me that he "liked men" in the same way that my mother and step-father liked each other. He told it to me with gravity. Like it was a big deal. I inwardly shrugged. Why would I care?

It wasn't even a surprise to me. I'd never really told anyone, but I found some....questionable reading material in the bathroom. Let's just say that is where I learned male anatomy.

He went on to explain his homosexuality as the way he'd been born. He'd always been more attracted to men than women.

I made the connection: "So, you didn't ever love mom then?"

Ah, how simple things seem as a child. I smile thinking about that question now. Life is complicated. I think that's how he answered me: "It's complicated, Katie."

I remember squirming in my seat, wondering when he would let me play in the park.

Adults can be so dull.

"Katie, I caught a virus. It's called AIDS."

No reaction. The name meant nothing to me.

"It's not like a cold or the flu. It's something else. You know that your body is made up of a bunch of little particles, cells, right?"

I nodded.

"Good. So there are little cells that help us fight off bad cells. when you get sick, your fighter cells attack the bad cells making you sick. Eventually, your fighter cells kill those bad cells and you get better. But see, the AIDS virus attacks your fighter cells. So when bad cells come into your body, there is no one to fight them off."

I guess I started to realize the seriousness of the situation about then.

"So I don't have as many fighter cells as you do, so I get sick much longer and much worse than a normal person. A cold can make me very sick. Whereas when you get a cold, you recover for a few days."

I interrupted, "But dad, why don't you just go to the doctor and get some medicine?"

He smiled sadly, "There isn't any cure for this, Katie. It's a newer virus and the doctors...well the doctors aren't sure how to fix it yet."

I remembered not liking where this conversation was heading.

"Katie, I need you to be prepared. AIDS is a terminal illness. Do you know what that means? It means that I'll die from it."

And there it was. I fully grasped it, and wished I hadn't. AIDS was going to take my father away from me.

I remember being so certain that this was going to be the last time I ever saw him. Like just saying those words had some power to take him away right then.

And I distinctly remember the feeling of aging. As if I had just accelerated somehow. Like I needed to be brave now. Because my biological dad was dying.

And truly, we thought he was. It was 1992 and he'd had AIDS for 7 years now. There was minimal treatment, and lots of people were dying. Scratch that, everyone with AIDS was dying.

I found out everything about the disease that day. How it was transmitted. What the symptoms were. How it killed people. How my cold could kill my father. And I felt a sobering surge of responsibility. He wouldn't get sick from me on my watch. No siree.

So my point with this story: if you ever need to tell a child about death, be frank. Well, that's my opinion anyways. It does no good to beat around the bush. I got to start coping with my biological dad's illness early. And it took a really long time. I was probably in college before I really stopped worrying about it.

And honestly, it brought my entire family and I closer together. My dad (actually my step-dad, but I call him dad now) and my mom were like immovable objects. They never really wavered. They'd buy me books from a coping bookstore, and we'd play games where I'd talk about my feelings until I'm sure my parents ears started bleeding. My best friend and I grew closer. We both had the crazy in our lives, and it was nice to have someone to talk about it with.

And it brought my biological dad and I closer together. We shared things that no one else in the world knows about. We had hours of conversation driving back and forth to school. Looking back at my life, he has influenced me so much. Had my biological dad let me, I think I could have been good for him when I got older.

I don't really know how he dealt with it mostly on his own.

Saturday, October 8, 2011

How do you people find me?

I've been quite amused throughout the past few months of what search keywords bring readers to my blog.

Sometimes, it is people looking for pictures, but sometimes not.

Here is a list for you:
  • Operating room
  • Female weightlifter - just looking for pictures
  • Google beer - I don't even
  • Fun facts about melanoma - I get the feeling these people do not have melanoma
  • http://andromeda-med.blogspot.com - Yes, people have been Google searching using my entire blog address
  • Operating room images
  • "I stepped on" ants 
  • Andromeda awesome facts - I presume looking for the galaxy?
  • Bikini "flabby thighs" - I'm sure my friend will be pleased that her fatty thighs bring readers to my blog
  • Amazing facts about the appendix - Have I even written anything about the appendix?
  • Andromeda skin swelling - Wha?
  • Cancer courage quotes
  • Fun pamphlets on skin cancer - Again, I get the feeling these people do not have skin cancer
  • Lymphoscintogram
And my least favorite:
  • Metastatic lymph sentinal node biopsy male

Whoever you are, I hope you are doing well.

Thursday, October 6, 2011

I wish we had more public service announcements featuring Big Bird

For the past several weeks, we have been presented different cases of fake patients. This is more for the purpose of exposing us to things we don’t know and teaching us how to research and reason to find out information. The diagnosis isn’t even important.

Well, for most groups. For our group, the diagnosis is important. And boy do we get excited about it. Other groups meeting in rooms around us said we were the loudest group they’d heard. And it’s true. We were yelling and cheering the first time we met about the diagnosis. Basically, our group is awesome.

When I went to shadow the transplant surgeons this week, they were excited about the diagnosis for our latest patient. I have been ordered to deliver a full report next week.

To give you a taste of our excitement, I will give you a sample case, so you can play along at home.

I give you PATIENT #5.
“28 year old woman comes into the ER with weakness, fever and weight loss. Her boyfriend was sick several weeks ago. Patient admits to use heroin regularly; it’s unclear how much. She is also a sex worker.
Yeah, this really doesn't have anything to do with the case
Pulse = 100/min
BP = normal
Temp = normal 
The physical exam only yielded a few irregularities. The woman is extremely emaciated. Her sclerae are slightly yellow. The liver is palpable. The woman seems nervous and keeps tapping her foot. She has obvious needle marks on both arms.
She has an elevated WBC, Bilirubin, AST and ALT. She is positive for Hep B and Hep C antibodies, but not for Hep A. Her hemoglobin is normal. 
Her rapid HIV test is positive. "

Your diagnosis?


PS. And no mocking me because I don't know anything. You can only play along if you play nice.

Wednesday, October 5, 2011

Diagnosis: alien in chest?

You know how sometimes you think you will be really good at something, and then you aren't?

That feels like a lot of my experiences at medical school. And I'm only 6 weeks in! I study a bunch for my exams, feel like I rocked them, but then only do mediocre. Good thing it is pass fail.

We had a patient simulation several weeks ago. This consisted of 8 actors who were pretending to have symptoms. We had 15 minutes with each patient to interview them.

Now, before this exercise, I would have told you that I would nail this! I was really excited, and I'm fairly decent with people. So why would there be any problems?

Here's how my first interview went:

"My name is K8, how are you today?"

"Eh, I'm doing alright." *silence*

"What brings you into the clinic today?"

"Well, my vision's been a little blurry. Like when I'm trying to read." *silence*

"Tell me more about that."

"Well, you know, just blurry. Like fuzzy lines."

Now, thoughts are racing through my mind: what the heck do I ask about eyes? I don't know ANYTHING about eyes. I don't even have glasses. The last time I went to the eye doctor was to be checked for moles. Nothing vision related.

Oh crap, oh crap, oh crap.

"Er, anything else unusual?"

"No."

Oh crap, oh crap, oh crap.

So I began asking about lifestyle habits. Eventually, she said:

"I've had to go to the bathroom a lot."

"Oh yeah? #1 or #2? I mean...er, peeing or...ummm"

*interrupted* "Urination, yes."

I wanted to facepalm. Yes, I actually used the word pee in front of a very "upper class" acting patient.

Finally, something to latch onto!

"How often do you urinate?"

"Like 3 times a day."

"Do you wake up at night to urinate?"

"No, it doesn't wake me up."

Ooookkay. So am I just super weird, or is this the norm? Because I use the bathroom about 7 times per day, and get up NO LESS than twice a night to go pee. And I'm not even pregnant.

Alright, so now I have two symptoms.

1. Frequent peeing
2. Blurry vision

Honestly, I had no idea what this indicated. None. Not even the slightest hint. For all I know, it could have meant metastatic cancer, or an alien growing in her chest.

So go ahead, shout out the answer to me.....OOOOHHH DIABETES.



Well the interview just went downhill from there.

But the good news is that my second interview went very well. An elderly woman came in for a follow-up from her hip replacement surgery. She started to cry when I asked her about her husband, but now I was in familiar territory. It's much easier for me to ask and council about psychological state of mind than physical things at this point.

Since I don't even know that frequent urination and blurry vision = diabetes.

So much to learn. And so humbling.




Tuesday, October 4, 2011

I didn't know lectures came in that format

Action Potential did a series about how crazy the lecture slides were at medical school.

Here is my rendition.

This is an actual slide from lecture:
To be fair, at least 25% of the slides had pictures on them. But the other 75% in this lecture were just straight text.

While you were learning glycolysis, did you think to yourself, "Man, I really wish I had all these reactions written out in words?" Well, if you did, then you would enjoy our lectures. Because that is what we get for 50 straight minutes.

But now you are thinking to yourself, "Oh she's just being melodramatic, I'm sure her written study guides / syllabus (whatever you call them) were really good."

Here is an example of our hierarchy in our syllabus:

I. The Anomeric Carbon (several pages)
II. Disaccharides and Polysaccharides (several pages)
III. Proteins react with carbohydrates (several pages)

Alright, doing good so far...

IV. The enzyme addition of carbohydrate can be either modest, even a single sugar, or massive, as in the case of proteoglycans which can be as much as 95% carbyhydrate.

Wait, what? Is that a complete sentence in place of a header?

Yes, yes it is. Let me elaborate on the full text encompassed by Section IV:

"Aggrecan is an example of a proteglycan."

That's it. Then we move onto Section V.

V. There are two major types of carbohydrate linkages: N-linked to asparagine and O-linked to serine or threonine, but less commonly on residues such as hydroxylysine in collagen

And this time, there is no actual text after that heading. We simply move right onto Section VI.

To change gears a bit...what font do you think of when you think "MEDICAL SCHOOL"?

How about some Calibri action? The default for Windows computers?

Or, maybe Times New Roman? After all, doctors are supposed to be scholarly.

But nooooooooooooooooooooooooooooooooooooooooooooooooooooo.

Every. single. lecture. EVERY. SINGLE. LECTURE. is presented with:

Oh the horror! Anything but Comic Sans! Make it stop!
Why don't we just use Jokerman font instead? Please, make my eyes bleed more.

Yay or nay? I definitely think life and death with this font.

Oxidative phosphorylation has never looked so fun!


Okay, I can deal with all of the above. Microsoft has a neat feature that replaces all the fonts. I can ignore the lack of pictures and teach myself from established, well-written textbooks.

But the final straw was this week.

One professor presented us with a video. Of herself. Clicking through her slides. Instead of giving us the slides as a PowerPoint or PDF.

When I asked her if we could get slides or a PDF, she shook her head saying, "Oh no, I can't do that! A PDF takes up too much space!"

Really? Really? Bigger than A FREAKIN MOVIE?

For those who aren't computer savvy (it's okay, I still love you), you can almost certainly assume that a movie will be larger in size than a PDF. By a lot. 

So the end result is that we have our lecture format as a movie. With no possible way to get notes other than to screenshot every single slide and paste it into a document. But don't worry, Professor, I have plenty of time to waste doing that! I wouldn't rather be eating, sleeping, spending time with my husband, studying the other bazillion things I need to know, shadowing a physician, going out to dinner with friends. 

Oh wait. I would rather be doing any of that than mindless tedium.

But then again, this professor also used words like "Correctomundo" and "Okeedokee"...

*heavy ragged breathing*

*breathing slowing down*

*zen-like countenance*

But I'm not frustrated. Not one bit, no siree bob. I'm going to go do some Yoga, bbl.

Saturday, October 1, 2011

It takes all kinds

Ethics are truly fascinating because everyone views things very differently. And most people are fairly passionate about their views; I know I am.

Many of our lecturers have been very candid about their ethical views. One professor made it clear he has bias towards women’s rights. And every time he presented his views, he made them clear that they were his views.

....not all professors are like this.

For example, in our genetics class, we were told that it is totally appropriate to deny pre-symptomatic testing for Huntington’s disease (and many other diseases) to an adult or child. It was not presented as “an opinion”, but as the ethical thing to do. I disagree, and I know I’m not the only person in the room to disagree.

Both sides of this argument were never shown in class. What about women who would like to get pregnant? Should we deny them Huntington’s testing so they can pass that horrible disease onto their progeny? What about a parent who wants to prepare their child for what may be coming?

It was presented a bit too much like playing God for me. “No, trust me, even though I’ve never had Huntington’s, I know you are going to deal with this poorly. Oh, and by the way, I know what’s best for your child too. Nevermind that we trust you to make decisions about abortion, you are not allowed to find out if your child is going to die a horrible death. No taking him to Disney World early for you. I’ll make these hard decisions for you. That’s right, I will mount my high horse.”

Now, I know that not all the people who agree with not pre-symptomatically testing are like this. And furthermore, it is a perfectly valid position to take. I have no problem with people who take this stance. Please don’t take offense; it does not anger me. I completely understand your choice, and am supportive of trying to lessen undo pain on a patient. I get it.

But Mr. Genetics professor: don’t present it as the obvious ethical choice to make. It’s not obvious. Just like abortion isn’t obvious.

And especially don’t present it as the obvious choice in a medical school class. It’s not so much a problem for the older people in our class who have had a chance to be in the “real” world. But those students just coming out from college, who haven’t had time to develop their ethical and political view of the world free from academia bias, are impressionable.

Instead, perhaps it would be better to present the lecture as YOUR ethical choice. 

It’s a bit disappointing to me to see our school blithely bias these lectures to align with their view of the world. It’s angering to me that our professor presented the material like this.

And it saddens me that someone in the future may be denied testing they need for their peace of mind, family planning or whatever valid reason they have because some physician was imprinted with a biased lecture from the first year of medical school.

Friday, September 30, 2011

My first love has lost a bit of its luster

Last week, I watched a live donor liver transplant.



Well, I watched 6 hours of it anyways. They had just transferred the liver when I left.

Woah, talk about invasive surgery.

I got to hold a gall bladder. When I squeezed it, all the bile came out. I was not able to hold the transfer liver. But I could poke the cirrhosis-ed liver.  I saw my first portal vein, first stomach, first spleen, first intestines and first hernia. All of that was super neat.

You know how you keep a patient alive while they don't have a liver? You hook them up to this machine that acts like their liver, cleans all their blood outside of their body and then returns it through a vein back to the body.

And the surgeons! Incredibly smart, talented and focused. All 7 of them.

But, and you knew there was a but. Since when did it become cool to completely neglect your basic needs as a physician, in favor of 8 or 9 hour surgeries? Maybe it has always been cool, and this was the first time I saw it in action?

We went into the surgery at 9, and by 2:30, I was REALLY hungry. And the scrub nurse and circulating nurse laughed and said, "You'll get used to not eating." Mmm....no....no, I don't think I will. See, I need food TO LIVE. It's especially bad when you consider that I lift weights regularly, so my metabolism is a bit amped up. I get fairly uncoordinated without food. By 2pm, I had a raging headache from not drinking any water for 6 hours, and I'm pretty certain I would have given up with those fine veins and arteries left over in the donor abdominal cavity. Props to the surgeons that completed that surgery and stitched the patient up.

OMG, food, nom nom nom
Also, I don't know about the other women around here, but I need to pee at least once every 8 hours. And, shhh, I don't think that's too crazy to ask.

So maybe I'm not cut out to be a long-surgery type person. I mean, as the patient, I wouldn't want my surgeon to leave and eat some lunch while I'm lying open on the table. Well, unless they are a diabetic or something. What do diabetic surgeons do? Maybe they just don't exist.

There are still short surgeries. And maybe that is better anyways. I'm not a fan of getting a call at 3am in the morning that a liver has become available. On my way to an 8 hour surgery with no food or water, woot!

I guess I'm not hard core enough to be a crazy cool surgeon like the ones I observed.

But that's alright. There are lots of other fish in the sea. Maybe I am more cut out for medicine. Third year is going to be really interesting.

Anyways, I have plenty of time, so I'm not worried. I'm just surprised that the live donor liver transplant and what has to be one of the coolest surgeries in the world turned me off from surgery a bit.

Protip: Introduce yourself to the circulating nurse whenever you enter an OR for the first time. They really liked that.

Monday, September 26, 2011

Fallen off the face of the earth?

No! I haven't, I promise. I'm working on writing some posts for this week. Never fear. I will be posting soon enough. In place of a post, here is a picture of dogs surfing.

You heard me.


Wednesday, September 21, 2011

Got my camouflage today

Here, have a stock photo of some white coat ceremony

I got my white coat today. I now blend in with the medical crowd.

It feels...weird.

The ceremony was uneventful. And long. 200 students putting on jackets takes a lot longer than you might think.

And yet, I was inexplicably excited the entire time. And I'm excited now that I have my jacket. I can't wait to wear it this week for the first time. Like I'm a legitimate medical student now. As if my tuition disappearing into the coffers of my medical school wasn't enough.

But no, the white coat gives me something a little more solid.

As our keynote speaker said, "Your white coat should feel heavy." We assume quite a mantle of responsibility with it.

I have to reproduce our keynote's speech here for you, because it was excellent. By far one of the better commencement-ey type speeches I have heard.

At times like this, I curse my anonymity a bit. She deserves to have her name known with this speech.

She spoke about attention. About a painting of Icarus falling into the sea, but no one in the painting notices. She urged us to take the time to notice our patients. She insisted that our training would try to stamp that urge out of us: attendings will be in a rush, we'll be tired and run-down from long hours and little sleep. She warned that we multi-task so much right now - doctors have the urge to bring this into the patient room. She said, "Don't. No matter what you think, you cannot pay attention, real attention, to someone when you are doing something else."

She quoted Robert Carver from "What the Doctor Said" delivering news of metastatic lung cancer:
...he said I'm real sorry he said
I wish I had some other kind of news to give you
I said Amen and he said something else I didn't catch
And not knowing what else to do
And not wanting him to have to repeat it
And me to have to full digest it
I just looked at him for a minute
And he looked back...
The doctor returned his gaze. How powerful that can be.

She spoke about curiosity. About a physician asking an old frail woman about her medical history, even though everyone in the hospital thought she was a pain and disinteresting. About the physician discovering this little old woman had been on the Titantic.

Our speaker segued into everyone being a survivor of something. Whether it was cancer, kidney failure, diabetes, a shoulder injury, loss of a loved one, emotional abuse, the list goes on. Everyone has something to tell. And as doctors, we can learn something from every patient.

And finally, she shared with us her own struggles. How her two oldest sons were born severely brain damaged. How her middle son died unexpectedly when he was four years old. How her and her husband just had another child several months ago.

She's been on the other side of the table from the physicians. And those who failed in their compassion did nothing to help her, or her sons. In her opinion, our greatest tool as a physician is our compassion. And you cannot care for someone without it.

She urged us: "Trust me on this. I know."

She got a standing ovation until she cried.


Monday, September 19, 2011

Best trade ever

Check out my new bling at the top!


I even have a new favicon logo!


Courtesy of Tyler Louie. Unfortunately, you'd probably have to be friends with his fiance to get him to design a logo for you.

And you may or may not have made a deal to channel all his fiance's girly wedding talk to you, instead of him. Because he was listening to her indecision about earrings for hours on end. And let's be honest, Tyler doesn't care about earrings.

But I do need some type of catch phrase. I've been unsuccessfully trying to think of one. Anyone have any ideas? I'll give you a cookie if you come up with one.

"Medical school. Family. Life." was what I was using before. Did you all like that?

I was also thinking of "An overshare of medical school life" or "Space Fighter Pilot. Doctor. Close enough."

Please give me ideas for tag lines. I'd be so grateful. My brain just refuses to work most of the time anymore unless I am thinking about glycolysis, TCA, birth defects or histology slides.


Sunday, September 18, 2011

It's not called the Mercedes scar anymore; it's a Lexus


SMBC comics are awesome

So last week was my first time shadowing a transplant surgeon.

One of the first things she told me was that liver transplant scars used to look like this:

See the Mercedes?
But now, they don't make the third incision to the side, so the scar is just called the Lexus.

 It was completely different to be shadowing a doctor as a medical student instead of a premedical student. Suddenly, I was almost like part of the team. I shadowed the doctor during clinic, and she briefed me on every patient before we saw them. She explained the difference between fibrosis and cirrhosis, how liver tumors are treated, what influence Hepatitis C has on the liver - everything! I got to see labs and radiology reports (even though I had no idea what I was looking at). I did recognize a liver tumor on a CT scan though - before the doctor told me what it was. I win! Alright, I admit, it was pretty obvious.

 I saw a bunch of things I'd never seen before. I saw some jaundice, with significant yellowing of the whites of the eyes, and spots. I can't remember what they are called now, but there are some spots that occur with liver failure.

 I saw pitting edema for the first time ever. That's so neat! Not so neat for the patient, but I'd admit to being SUPER excited ABOUT EVERYTHING. Pitting edema is swelling that when you depress the skin, the skin doesn't bounce back like normal. Instead, a depression forms in the skin.

 The surgeon was incredibly candid with me. She told me that she'd much rather be in the operating room, but clinic was a fact of life.

 Watching her interview, I thought I was watching something out of "doctor blunders" in our interviewing class. Everything we've been told repeatedly not to do, was done by this doctor. She would click her pen throughout the patient talking. She typed into EMR the entire time the patient was talking, and rarely looked at them. She didn't ask for permission to touch the patient, etc, etc.

 But for all her "flaws" interviewing, her patients really seemed to like her. She had a way of paying very close attention to the patient when she wasn't on the computer. And she always made sure she was at the same level as the patient. If they were laying on the table, she was standing next to them. If they were sitting in a chair, she was sitting in a chair.

 In the middle of one appointment, a husband and wife started fighting. The husband began screaming at the wife, and the doctor just calmly talked over him until he paid her attention. I certainly learned a lot.

 But the most exciting part is yet to come. Wait for it, wait for it.....

 You probably didn't guess it. This week I get to watch a live donor liver transplant. You heard me. I have to miss class for it. Psh, whatever, I'm there. Color me excited.

Monday, September 12, 2011

The first exam is the hardest part?

I took my first medical school exam today. It was actually a very non-stressful day. I woke up at 7:30am (sleeping in for the win!), had a nice commute in (40 minutes), took the exam, and got out of class for the day at 11:30am!

Woah! An entire day without work and without being behind? What will I do with this gift?

Have a party? (Wait for it...kudos to you if you get it)
(Those who don't get this picture, don't go looking it up) (Credit to Zeke)

Drink heavily?
Jump up and down? Probably not, my knees hurt.

Instead, here is how my day actually shaped up:


Now, I suppose it's a little unfair to say the test was not stressful. Here is an example of one of our practice exam questions:

 1.   A six year old girl is brought in for evaluation of short stature. She is of normal intelligence, but upon further work-up is found to have a coarctation of the aorta, a single kidney, short fourth metacarpals and widely spaced nipples. Karyotype is most likely to show:

a.      47,XX,+21
b.     47,XXX
c.      46,XX
d.     46,X,del(Xp)
e.      45,XX,der(13,14)(q10;10)

Here is an example of a question from our exam today:

Pedigree from here
If C10 carries the Cystic Fibrosis gene, and A14 is a rainbow unicorn, what is the probability N4 will buy a red car? 

Alright, maybe I exaggerate. But not by much.

I hope this isn't a pattern.

PS. As an aside, we are the first med school class that does not have to *purchase* practice exams. You heard me correctly. Previous classes had to pay $40 for practice exams last year (which went to charity). As if my tuition isn't enough. We calculated it out, and our entire class is paying $17,000 per lecture. But no practice exams for med students. I can just imagine last year: "Oh man, should I pass my exam or eat this week? Decisions, decisions." Is it just me, or should our school be forced to attend our ethics class?

Sunday, September 11, 2011

Good riddance, last week

Last week was an emotional week.

We had a patient presentation about HIV/AIDS. During the presentation, our professor told us that most people who had AIDS in the 1980s had died. The patient who spoke with us had had AIDS for 20 years! 

He started the talk by asking if anyone would give him a hug. It took a minute, and then someone got up. He laughed and said, "Thanks, it's not necessary. I just wanted to show you all that the stigma of AIDS isn't quite gone."

He spoke candidly about being diagnosed, sharing the news with his family, and how it had affected him. It brought back a lot of memories for me. 

My biological dad was diagnosed with AIDS in 1985. 26 years ago. I'd imagine he's one of the oldest surviving AIDS patients in the world.

As if hearing about living with the disease wasn't hard enough, the patient looked JUST like my dad, right down to his mannerisms and style of speaking. 

I think it was so important for our class to understand the gravity of having a disease like AIDS and how it changes your entire life. But at the same time, I'd already been through it, and let me tell you: it wasn't fun.

At this peak, my dad took 74 pills a day. 

 

Yeah, he used something like this, but it was for ONE DAY. He had to take medication every four hours, whether he was sleeping or not. 

I remember going to school with him in the morning. Snow would be streaming in our car windows from outside. I'd be in my jacket, wrapped up in a blanket and still be shivering. My biological father would be wearing shorts and a T-shirt. And he'd be sweating.

I remember being in Disney world, and my biological dad was wheeling around an IV with him. 

The side effects are not done justice by any description I have ever heard. My biological dad became emaciated. He had uncontrollable nausea, diarrhea, sometimes both at the same time. He was always tired and sick. Sores opened on his body and never closed. He's had a heart attack, and is suffering from congestive heart failure. He would waste, losing weight incredibly quickly. Then, he would gain it all back in his abdomen area. His limbs suffered weird muscular problems that he couldn't get to go away. He was in and out of the hospital at least 5 or 6 times a year. 

But you can't be scared all the time. I mean, after the fifth hospitalization, you just become desensitized to it.

The bottom line is: he lived. Against all odds he lived. I came to terms with his (what I thought would be) imminent death a long time ago. So now, thinking of his battle with AIDS isn't as painful as remembering our estrangement when I was 16. 

But after thinking about all of this for much of the week, I also found out that a family member may be fighting against a serious disease. Let's hope they aren't.

And then, to pour salt on my wounds, I got trapped in an elevator for 45 minutes on Friday! With 12 other people all crammed against me. I could barely move. After I told them not to get on the elevator because it was too many people. Dag nab it, life.

I'm sure next week will be better. Although I do have an exam tomorrow...

Monday, September 5, 2011

Oh humanity, how are you still successfully propagating?

So my husband and I are thinking about when would be a not-totally-suicidal time to have children during medical school and residency.

Well, at least we were. Until I started taking Genetics.

Oh dear god, what is that? A child, you say? I don't believe you. Holy cow, soooooooo much can go wrong. Can't unsee; can't unsee!

Last week, we spent almost every day looking at dead, dying, or several deformed pictures of fetuses or small children. Awesome.

Our genetics professor:

"Trisomy 18 is characterized by mottled skin, small stature, rocker bottom feet, congential heart disease and small mouth. 95% of these children die within the first year. But hey, it's better than Trisomy 13 which is characterized by facial clefts, abnormal spinal and head defects, extra fingers/toes and cardiac anomalies. Most of these babies don't even make it out of the womb! 95% of Trisomy 13 babies die within 6 months instead of a year."

Wow, genetics prof, that IS a relief to be diagnosed with Trisomy 18 over 13. I'll be sure and let the parents of a Trisomy 18 child know that.

If I see one more picture of a cleft lip or a progeria patient, I'm going to make my husband get a vasectomy.

I purposely did not put links to Trisomy 18, 13 or cleft lips and left this post devoid of inline pictures. You can Google those yourself if you are determined to feel depressed or you need the willpower to avoid a one night stand. Just Google "birth defects" and you'll lose your appetite. Best way to diet ever.

On a bit of a serious note, I can't imagine forcing a woman to deliver a child who was certain to die within 6 months. Gives me a new perspective into the choice versus life debate. I don't know what I would do myself, but I do know that watching my child slowly die would be one of the worst things imaginable.

But you know what?

It's all okay, because swans don't have these problems. Look at those cute swans.

She had like 5 babies at the same time and none of them are horrifically deformed. Sweet.
Focus, dag nab it! Must forget Genetics....

Oh wait. I have an exam on this material in a week. *sigh* Maybe I'll have forgotten about it by the time I'm trying to get pregnant.

The only thing stopping me from being too fearful to get pregnant is that nothing is worse than ADVANCED MATERNAL AGE! WARNING, WARNING, ADVANCED MATERNAL AGE HAS BEEN DETECTED. DO NOT PASS GO, DO NOT COLLECT $200.

Be back later, I need to go find my husband.

Sunday, September 4, 2011

I will wrangle a medical symptom out of you if it is the last thing I ever do

Our instructions for patient interviewing day:

"Try to get their chief concern. Ask abut any pain; try to get them to describe it. Really bore into the illness or complaint they have. Work on taking a medical history including past illnesses, medications, allergies. Then, if you have time, get some social history including home life, marital status, diet and exercise."

Here's how my interview went:

"Hello! My name is K8 and I am a first year medical student. We are learning how to interview; would you mind if I asked you some questions?"

"That's fine."

"Great. Can you tell me about if you have any medical concerns today?"

"No."

"Okay, perhaps you could tell me about the last time you went to the doctor?"

"I don't go to the doctor."

"Have you ever been to the hospital?"

"No."

"How old are you?"

"87."

(And you've never been to the hospital or the doctors....okay....)

"Do you take any medications?"

"Yes, I take medications for high cholesterol and for my eye."

(How did you get medications for high cholesterol?)

"Oh, what is bothering you with your eye?"

"Nothing. I take a vitamin to help it."

"Does the vitamin help it?"

"No."

25 minutes later, getting no further information about the high cholesterol or eye:

"What do you do for work?"

"I volunteer at the hospital. Ever since I had TB, and the hospital fixed me right up, I've volunteered there because they were so wonderful."

*facepalm*

"Tell me about having TB."

"No, I don't talk about that. I tried to forget it ever happened."

"Alright then, thank you for your time. That's all the questions I have for you."

----------------------------

Don't get me wrong, I really appreciate these volunteers helping us hone our interviewing skills. But I could not get ANY information out of this person that my preceptor wanted. My preceptor said I gave it a gallant effort, and unfortunately, this type of conversation is very similar to what I will deal with as a physician.

Excellent.

In other news, let's mock the first year medical students interviewing skills, because seriously, this is how I feel:



Tuesday, August 30, 2011

Disapproval dog is not amused by your ethical dilemma

Our ethics lecture was really interesting yesterday. As a disclaimer, I have made a lot of this information up. But the concept we discussed is still viable.

The case we were given was...controversial. A HIV-positive woman tells her doctor that she doesn’t want to tell her husband about her HIV-positive status. 

....

I disapprove.

However, this woman is pregnant. And her child will need to take anti-viral medication for 6 weeks after birth. And, of course, she wants to hide the reason that their child is taking medication for 6 weeks. So, she asks the doctors to prescribe the baby medication without telling the father.

When I first heard this, I was appalled. And a bit angry. What is she doing hiding her HIV+ status from her husband? And as our class got going, I realized there were things I hadn’t even thought of.

What are the father’s legal rights? Does he have a right to know what medication his child is taking? Is it ethical to give medication to a child without telling both parents (especially when both parents are in his life)?

While it is legal for the woman to have sex with her husband without disclosing her HIV+ status – what do you do as her doctor? It rubs me the wrong way to just let him go about his merry way. After all, one of our “callings” as a doctor is to “prevent” right? Not doing a great job of that if we don’t tell him. But is it even legal for us to tell him? Should we be compelled to tell him?

The case becomes more complicated when you consider that the woman feared for her life. Her husband had been violent in the past with her. She was convinced that if her husband found out, he would kill her. Undoubtedly bad for the baby’s health. Even if he didn’t kill her, she was certain she would be disowned from her multi-generational home. Her family was extremely Catholic, located in a Southern state and associated HIV+ with promiscuity. Also, bad for the baby.

My brain is about to explode now. Who is my loyalty to? The baby, the mother, or the father? What if all three of them are my patients? Should we just side with the baby since it’s, well, a baby, and they are different than adults? They need more protection than mom and dad. But if we don’t take care of dad, he might get complications from untreated HIV. If we take care of dad, then we no longer take care of mom because she is either dead or excommunicated (supposedly). And if either parent is incapacitated, the baby is unlikely to get the care it deserves. Well, crapbox.


The decision that was made left me feeling uncomfortable, but convinced I had no better answer. The decision was to not tell the dad. The rationale was that he probably already had HIV. The wife had no other risk factors for HIV, so it was probable that she originally contracted it from her husband.

And the questions didn’t even stop once the decision is made!

What if the dad asks a doctor directly: “What is this medication I am giving my child?” Should the physician lie? And if the physician doesn’t lie and tells the dad the truth – can you imagine the dad’s reaction? He’d probably go get a lawyer and sue the pants off any doctor/hospital he could find involved in withholding this information from him. What would your reaction be to information like that?

Intellectually, I knew that everything was grey, but not this grey. Making decisions that leave me feeling crappy does not sound fun. But I’m actually really excited for ethics. I can’t believe I’m going to be allowed to make decisions like this. Really scary and really awesome all at the same time.

Sunday, August 28, 2011

I couldn't make this stuff up if I tried

Last Friday was something out of the Twilight Zone.

Our first lecturer for the day had the idea that she was going to fit 97 slides into a 50 minute lecture. Can you guess how well that went?

Slide 56-97 were a blur. Because of "time constraints" (SHOCKING), she covered 40 lecture slides in less than 5 minutes. Which mainly consisted of her advancing 8 slides, saying one sentence, and advancing 8 more slides. But, oh yeah, we're still expected to know that stuff for our exam.

And worse, yes, that material will be on the boards. Details.

Then I went to the butcher where I saw the sign:

"Get 10% off if you come in with your child wearing a backpack"

What does that even mean? Do I just need a child and a backpack? Do I need to be wearing the backpack to get the discount? Or does my child need to be wearing a backpack? Does it have to be my child?

I'll admit, I was pretty tempted to ask to borrow a child briefly from a fellow shopper.

And weirder still, what do children and backpacks have to do with buying meat? Is it some weird back-to-school promotion?

At the butcher management meeting: "You know what? I bet parents will start feeding their children again now that school has started."

And really, why would you want children in your butcher shop? I feel like that's an insurance nightmare waiting to happen.

Still shaking my head from the butcher shop, I walked outside to find two people walking precariously on a thin wooden guard rail:

Like this, only MUCH thinner
And they are walking while carrying 20 lb bags of dog food....

ON THEIR HEADS.

You heard me.

To top it off, I went to the gym to take a cardio kickboxing class. At the end of our class, we practiced punching a person after they already went down. Yes, we practiced holding them in place while pummeling them. Thankfully we didn't use actual classmates or anything...but still. A little extreme for an exercise class isn't it?

And thus ended one of the weirder days I've had in a long time.

Saturday, August 27, 2011

Amazing melanoma video

Since we're on a skin-cancer roll, I figured I would post this video about melanoma. Solitary Diner from "A Table For One" pointed it out to me:


Skin cancer everywhere!

We had a patient presentation this week on skin cancer. A 65 year old woman candidly told our entire lecture hall about her experience getting a local excision, a sentinel node biopsy and eventually radiation. She had no family history of skin cancer.

Hey-oo! Talk about hitting home.

Her doctor found the mole, and before she knew it, she had an appointment with an oncologist. Stage II, and treatable. She has been cancer free for several years now, but it haunts her a bit. She described to us:
Cancer is like the mafia. You live, but you're always looking over your shoulder.
I'll be coming back for your lungs.
That is honestly the best description of having cancer I've ever heard.

Her emotional experience dealing with cancer was much different than mine. She was terrified waiting for the initial biopsy results. And then she was terrified again waiting for the sentinel node results. She doesn't remember anything from many of her doctor's appointments during her ordeal. Her family took notes so she could read them over later.

I didn't have the same worry. I remember the most minute details from my doctor's appointments. I posted about this before; as I get older, I find myself worrying more. Maybe her age makes her more susceptible to worry? Or maybe I felt a bit invincible, so it just didn't worry me? But our stories are remarkably similar. So why was she so recognizably scared and I wasn't?

And after listening to this lecture, I realize that I probably did have something to be scared about. I mean, after all, what if it had metastasized?

It's weird hearing your ordeals being clinically described:
"It's possible that sentinel node biopsy is too optimistic. We may find out in several decades that we've gotten too confident. It is possible we missed some of the cancer with this technique."
Tell me more about the risks of sentinel node biopsy. I'm all ears.
Yes, that's exactly what I wanted to hear. And I use my sarcasm, but actually, I'm still not worried. Is that strange?

The woman went on to tell us that she had no interest in getting her doctor's opinion. Even though she had no medical experience, she had educated herself about skin cancer. She even corrected the physician who was interviewing her several times.

But then I wonder, as a doctor, how does it feel to be asked by a patient: "What would you do?" And worse, you know they will take your advice. Is the responsibility ever overwhelming?

Which brings me to my next point: is it every okay to cry in front of your patient? I've heard fifty conflicting opinions on this during the past week alone. Some physicians feel that patients really feel touched that physician can be so emotionally involved. Others feel it communicates compromised ability to view the patient objectively.

But it's only a matter of time before I run into something that triggers something from the myriad of health crises my family and I have had. As my husband says, "You need to work on that." Yes, indeedy.

I'm not a crier normally, but I can imagine nothing worse than crying when your patient is not crying.