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.


Wednesday, August 24, 2011

I must be out of my mind

So...somehow I got roped into trying out for some Acapella group next week. Do you all know the last time I sang? Yeah, I was in middle school. Boys were still new and exciting back then.

Seriously, I was in seventh grade. No joke.
And yet here I am, all hunky dory at the Activities Fair, when I made the mistake of telling the Acapella group that I used to sing. They were on me like flies on honey. Oh God, no, I don't want to audition with my little seventh grader voice.

But I found myself saying, "Oh, alright, I guess I can sign up...I'm not making any promises though..." and was rewarded with much cheering. They wouldn't be cheering if they knew I hadn't sang for 12 years.

And apparently, I signed in blood, because the second I got home, I was inundated with Facebook friends, a new event and an personalized email detailing when my audition time is. Gulp.

Let us be your friend. No harm will come to you. We promise....
I think I went a bit overboard at the Activites Fair. I signed up from everything from almost every specialty interest group there was to helping kids with chemotherapy to teaching middle schoolers about the health care professions to volunteering with pregnant teenagers to a physician minority group. I'm not even a minority. I just couldn't say no; they were so excited and there was no commitment to signing up for emails, right?

Pwease sign up for my group. I'll love you foreverz.
*sigh* And now I find myself singing.

Speaking of out of my mind, we keep hearing the analogy "drinking from a fire hose", and, boy, they weren't kidding. In the past 3 days, I'm fairly certain I learned more than in several weeks of lectures during undergrad or my postbacc. Must cram it all. in. my. brain.

Also, have our first test in 2.5 weeks! What?

To add insult to serious studying, I'm sick. In fact, while writing this post, I coughed unexpectedly and a huge wad of phlegm landed on my computer screen. Excellent. Better there than in my professor's face I suppose.

In my haze of Sudafed and Advil delirium, I promptly forgot my locker combination the first day of school. Of course I wrote it down and left it...yep, you guessed it, at home. So I spent the first day carrying around two giant duffel bags of books and laptops and clothes, plus my purse. Oh, and did I forget to mention, I was in heels. Because I want to look professional. Silly me. And my eyes may have been watering from the random sneeze attacks I've been getting. I was a pretty pathetic sight.

I was carrying so much stuff that random strangers on the street asked if they could help me. The homeless guy was concerned about me. The shuttle driver physically got out of his seat to help me out of his van.

You know, that's probably why I signed up for singing. I blame the drugs.

PS. I'm going to sing "Part of Your World" from The Little Mermaid. Seriously out of my mind.

Monday, August 22, 2011

Adding to my blog roll

Kind of a housekeeping-type post, but I wanted to give a shout out to the bloggers I've recently been following and enjoying. I've added these to my Other Blogs section.

Those of you who aren't on my blog roll, post in the comments! I'd be happy to read (although I can't promise I will add you to my Blog Roll). Also, I post a lot of comments even when I have nothing useful to say, so be prepared!

Also, sort of an embarrassing note to add, I've only been reading these blogs about a month. If I totally butcher my description of your blog, please let me know. I'll be happy to use the "Edit" button, just for you, for a nominal fee of a few thousand dollars.

Lastly, for those of you whose blog I read who don't see your name here, do not fear! Chances are that you haven't posted recently, thus I've only read a few articles. When you start posting more as the school year gets into full swing, I will update this page again.

Asystole is the Most Stable Rhythm: A female medical student who is rotating in Ireland this semester. She's charming; very girl-next-door in my opinion. Writes about rotations, Ireland culture and random foot ailments. Very honest with her posts.

The Long Road to Medical School: A female MD/PhD student who goes by the call sign "OldMDGirl". Her name kind of gives it away. She's older, mature, married (or maybe just committed?) and seriously sarcastic (which I love). Her and I sometimes wittily banter back and forth. She writes about everything, but mainly about her current PhD experiences as of August 2011.

I am Not House: A male Canadian medical student currently in the midst of rotations. He writes about life outside of medical sometimes, and more often, about his rotations. He has no affiliation with the show "House" though (as his title suggests), so don't click for the wrong reasons. However, his blog is funnier and, in my opinion, better than the last season of House. It's really gone down hill. I am sadface. I kind of hope Not House doesn't read this; he'll probably ban me from his blog.

Anonymous Doc: As his title so eloquently states: "Third year internal medicine resident at a big city hospital. Or not." So either he's a really good faker, of he actually is a resident. Funniest patient conversations ever. Cracks me up every time I read his posts. His posts mainly focus on sarcastic analysis of crazy patients. Which include just about everyone. I just started reading, but I love it.

Random Acts of Medicine: Female doctor, wet-behind-the-ears intern working at a large US hospital. She says she looks like Lexie Grey (from the show Grey's Anatomy), which sort of makes me put Lexie's character onto the blog writer. Fortunately, I like Lexie Grey (except she really should be with Mark), so it's all good in the hood. I could read her posts every day; I love them. They are relevant to how she feels about medicine, her intern year and the patients she sees, and most interestingly, the things she is learning along the way.

Doctor Grumpy in the House: A blog dedicated to whining. No really, it's in the description of the blog! Doctor Grumpy is the proverbial fed-up doctor (he really could be anyone). His blog is a bit of a hodge-podge about everything from his family vacations (in which he tore Legoland a new one) to his encounters in his practice to funny links his readers send in to him. Sometimes, I get the feeling that he just may not be as Grumpy as he seems though. I can totally see him pulling a Grinch move and giving free healthcare for all on Christmas. I see through you Dr. Grumpy.

Table for One: Female doctor becoming an internist. Not exactly sure where in her education she is. She writes about everything; I find her posts very emotionally charged. I like that she writes about being single as well; I think it's so important to be comfortable with yourself.

Saturday, August 20, 2011

I am now orientated (Part 2)

Day 3

Looking at the schedule, I saw we had a two and a half hour block scheduled for "Student Diversity Panel" and I wanted to slam my head into a wall. But actually, it was probably one of the best lectures we had all Orientation.

Six students who will graduate in 2014 (M14 for short) shared their life stories with us and how their background enabled them to be better doctors and even further, how their stories had enriched the experiences of their classmates around them.

The stories were incredible, emotional and unique. They spoke of losing a family member, being immigrants, being married, being a minority, coming out of the closet, homelessness, extreme poverty, working with underserved populations, and discrimination. It's rare to see people speak with such candor. All of my classmates were riveted for the entire two hours; the student panel got a thunderous round of applause.

Then, we changed gears and learned super fun topics like materials data sheets, hazardous materials, and what to do if we get an accidental needle stick. The PowerPoint slides were DENSE with information....and boring. I'm fairly certain I fell asleep right around the point at which the lecturer was explaining what objects go in a "Sharps" container: pointy objects, needles, scalpels, other pointy objects. Did she mention pointy objects?

Then, for a full 3 hours, we had Orientation Olympics in the boiling sun. I know most of you are probably rolling your eyes, but I had a blast! It was a lot of fun to play games with each other, lots of ice-breakers. The award "medal" we were all fighting for at the end was a garbage can lid laced through with rope. I badly wanted to win. But we came in last place. Ah well, they kept telling us that everyone was a winner. Except for those people who lost, of course.

Oh how I wanted you, garbage can lid
Day 4

Today was our shortest day, consisting of presentations about our community service requirement. I have absolutely no idea what activities I'm going to get involved in, but they all sounded rewarding.

Pairing up with a pregnant teen sounds incredible. From the description, it looks like I'd get to attend the doctor's appointments, be a mentor, and maybe even be at the delivery! But then another panelist spoke about his time volunteering teaching seventh grade students about health care professions, and that sounded great too. Decisions, decisions.

I know I can't do everything, but I REALLY want to. It all sounds so much fun. Perhaps my enthusiasm will wane in a few months, but I don't really see that happening. I can already see I'm going to be one of those annoying students who says, "Hey guys! Wanna go study?" while wagging my tail.

Then, we got a tour of the library. It was pretty silly because the tour consisted of us going up floor to floor:

"And on this floor, we have books. And over here, some more books. And guess what's on this floor? Journals and books. You guys are never going to guess what is on the final floor."




So thus ends orientation.

And Monday we hit the ground running. Next week we have 8 classes on Biochemistry, Genetics and Cell Biology, we start interviewing patients on Thursday, an activities fair (for sign-up) is on Monday, and we also have a medical equipment fair on Wednesday. Not to mention some small group and clinic stuff mixed in.

We got our course outlines. My biology book is on the left for reference. Take a guess how long those booklets are supposed to last us?

A. 1 hour
B. 3 weeks
C. You have to memorize that?
D. A semester


If you answered "3 weeks" pat yourself on the back! Yes, we get a new giant pile of these in 3 weeks. Victory for me. My wish for stimulation has been granted.

Those of you who have advice about medical equipment, please leave a message at the beep:

Friday, August 19, 2011

I am now orientated (Part 1)

Orientation for medical school is finally, finally over. Longest 4 days ever.

The best part of orientation was the people, hands down. They are really fun! I'm excited to start with my class. They are all down-to-earth, friendly, smiley, open people. I have yet to meet someone I didn't like or get along with.

Weirdly though, our entire class looks like rock stars. About 80% of our class look like they could be models. Most of the women have really long luxurious hair, and almost everyone is rail skinny. The men are all handsome, in shape and have great smiles. Is this coincidence? And it's not just me, because I've had 15 other students (both male and female) comment the same thing to me.

I'll only give you the highlights of Orientation - otherwise you'll be bored out of your mind as well.

Day 1

In the "Safety" course, we learned that we should use common sense. Comments were made like "Do not enter the building when the fire alarm is going off". I'm super glad they went over that, because I was confused. Other gems out of this course included making sure we pack up our laptops before evacuating for a fire and making sure to post Facebook status if there is an emergency.

I hate to break it to my school, but if Godzilla surfaces off the coast and sets the city on fire, I'm not going to update my status on Facebook: "OMG, giant dinosaur just ate my advisor! gtg pack up my laptop ttyl"


But who knows, maybe Godzilla uses Facebook too? So he will be too busy updating his status to eat me.

Status Update: No longer hungry.

During the computer setup portion, I knew more about setting up email forwarding than the person giving the talk. I stayed quiet until they started floundering, then I inconspicuously offered my services, and somehow got roped into coaching half our class on how to setup email forwarding. But being a computer engineer is a double edged sword; I can already see that I will be the go-to person when someone's computer is broken.

We did get to try on our white coats though (for sizing). That was pretty neat. The men were in and out in five minutes flat. The women...not so much.

How does this look on me? Is it too white?
Day 2

The first part of the day consisted of the staff preening our feathers. It is a big change from undergraduate to be in a school whose entire reputation in 2015 rests with our class of 200 people. I'm so happy to be at this school; I'm convinced they truly care about us.

If we start to slip with our grades (overall it's Pass/Fail, but they still keep track), we get contacted to see what's wrong. We have on call counselors, tutors and support systems for just about everything you can imagine from thoughts of suicide to family planning to having problems studying to losing a family member.

Then, we got certified in Basic Life Support (BLS). I asked our instructor whether we were actually ever going to do CPR, and he looked at me incredulously, "Yes, that's why we are teaching it to you! By the way, be proactive about your first time. When you go into rotations, elbow your way to the front of the line to switch in for compressions."

Did he just give me permission to tackle others to the ground so I can break someone's ribs?

8 hours later, my newly BLS-certified friends Jackie and Barry (yeah, not their real names) were walking in a nearby neighborhood when they heard a pop-pop-pop noise and rushed around the corner to find a victim of a drive-by-shooting. He was shot 3 times, so, I kid you not, they followed the steps. Scene safe, check. Are you okay, sir? Well, no, I've been shot 3 times and I'm bleeding profusely. Check for pulse: little weak, but he regained consciousness.

Less cool in real life
They waited with him until the police and ambulance arrived (he was stable when he left). Never know when you're going to need those skills!

Wednesday, August 17, 2011

Talk of the retirement community?

My Grandma called me today. She only had one thing to tell me. She is "so excited" that I'm starting medical school because "no other grandchild in her retirement community got into med school" and she can "brag about me to the other grandmothers." She then laughed, relishing having the only medical student granddaughter in her circle of friends.

Well clearly, Gram, that's why I did it. So I could be the talk of Florida and make you proud.

Who would have thought little old ladies would be so competitive?

Keep in mind this is the same Grandma who regularly asks me about my sex life, will tell her children how to redecorate their houses (fully expecting her advice to be heeded), and told my mother growing up that if she didn't sleep with a guy by the second date, she'd never hold his interest.

My grandma rocks.

Closest picture I could find to how young my Gran looks, even though she's 80!
As a side note, who would have thought Googling "Grandma" would get so many photos of cute grandmothers flipping the bird? Wait, what's this other image?....awesome Google.

The Terminana

Tuesday, August 16, 2011

Women be crazy

Several weeks ago, I had the privilege of helping a friend pick out her wedding dress.

She is a tiny thing, only about 5'4" with her waist fitting a size 4 to 6. She's of Middle Eastern descent which bestowed her with curvy hips and a milky skin tone.

But when we went dress shopping, I was amazed at how critical she was about herself. In dresses that hugged her hips, she'd worriedly look in the mirror pointing at her perceived flabby thighs saying, "Look how horrible that dress makes me look!" The saleswoman and I exchaged quizzical glances and asked her what the heck she was talking about:


But no matter what we said, my friend refused to budge or believe us. She was insistent that even the shape of her thighs should never be shown in public lest everyone be disgusted. And while I encouraged her to buy the dress she felt most secure in and excited to wear, I couldn't help wonder what was behind this new insecurity.

My friend is not a pushover and doesn't lack self-confidence. She has earned degrees from very competitive schools and is about to receive her PhD. And frankly, she is staggeringly smart and motivated; her thesis is above and beyond a normal PhD (not that I'm biased or anything). She has an amazing fiance who could not love her body more. She has a solid group of friends and an active social life. 

Yet all it takes for her to be quivering with fear and indecision is a dress that hugs her thighs. 

I can hardly blame her though. I don't like my stomach. I've always wanted the lean, tight and fit Jillian Michaels of stomachs, but will probably have to settle for a bit of baby fat on the top. And every time I pick up a magazine, browse the internet, watch a movie, watch TV, see the news, view any type of advertisement, I am reminded that my stomach is not "up to par". 

Oh, I've made my peace with it. I will still wear a bikini, and I think I look good. I exercise, eat right, don't smoke, and I revel in how I've maintained my body. But my awesome body type doesn't look anything near what I'm exposed to every day. I'm more muscular, stockier and paler than the "models" I see. And intellectually, I know that my husband is attracted to me, being healthy is more important than looking good, and that the models I see on TV should not be role models. But it is hard to see something every day, almost hourly and not idealize it. If I, as a self-confident, powerful, smart, educated, loved woman has some insecurities because of this exposure, how much worse must it be for our teenagers?

But maybe things are changing ever so slightly. 

Vogue put three plus-sized models on their June 2011 cover, although it's worth noting this was only for Italy, and not for America. 



Plus-sized, you say? They all look pretty skinny to me. 

Here are some different shots of the same women: 

While we can debate about whether these women are truly plus-sized as it should be defined (which in the fashion world is anyone over a size 8), one cannot deny that these women are much bigger than anything Vogue has put in it's magazine for a long time. And while I do not want to encourage childhood obesity, I do want to let every girl know that everyone's body is different. Not everyone will be a twig who is a size 00. Some people will be more curvy. Like my friend, and like me. Some people will be over a size 8 and will BE IN SHAPE.  And that's okay.

I'm sure most of you have heard about Dove's real beauty campaign. They now show real women (not models at all) in most of their advertising: 
Finally! Women who look like me! (This is basically what my tummy looks like)
Sephora recently did a magazine advertisement for makeup with no Photoshop touch-up.

For those who can't see, the asterisk just certifies that a notary public ensured this was not retouched by Photoshop
These little steps forward give me hope. I do enjoy looking at beautiful women in movies and TV. But I want to look at healthy, in shape, beautiful, and above all, REAL, women. Not Photoshopped to perfection, not starved half to death, but real women. Let's hope this movement gains some traction.

Monday, August 15, 2011

Medical school starts tomorrow!!!1!ONE!

I. AM. EXCITED. if you couldn't tell by my post title.

Did I mention how excited I am? I've already picked out my outfit, my bag, got a case for my IPad, know where I'm going to park and am leaving 1.5 hours early just in case traffic is crappy. Which means leaving at 6:30AM. I don't care. Bring it on!

To make up for my insect post from last week, here are some pictures that should make you explode with warm fuzziness.

PS. Upcoming posts include taxidermy, female body image and an update of other blogs I read. I've been reading a lot of truly excellent writers. Stay tuned!

I know you've seen this, but I love it
Om nom nom nom

Everything is cuter upside down
Fuzziest egg ever
What's cuter than a poisonous, viscous mammal? Two of them. I'm so funny.


Sunday, August 14, 2011

Sweet home Alabam...crap, wrong state.

I visited Durham, North Carolina last weekend. Where is that, you ask? Yeah, it doesn't really matter.

My friend took me to this place that used to be a tobacco factory, known as the American Tobacco. At least they were good for something other than killing millions of Americans, because their factory-gone-out-of-business turned into a really nice area with lots of shopping, dining and an inadvertent water park.

All I have to say is: best water slide ever. I have never wanted to grab and inter-tube and risk arrest more than when I visited this place.



Just ignore those rocks; your tailbone could take the punishment

Saturday, August 13, 2011

If you are scared of insects, this is not the post for you

Do you think the ants would have overrun me if I stepped on them?
Fair warning.

Last week, I saw pavement ants at war. Yes, a giant battle (relatively speaking) raged on the sidewalk outside of house for about an hour.

It started as just a little cluster of ants. I sort of imagine it as a bar fight gone wild. After about 10 minutes, it was about a foot long (see picture to the right). I've shown my feet for perspective. You can assume I do not have giant feet.

I've included some of the action shots below.

Holy crap, that's a lot of ants


Watching this war of ants, I decided to find some interesting facts about ants. I listened to an interview on NPR with Mark Moffett (coined as the "Indiana Jones of entymology") and, wow, ants are a little crazy.

How many of those ants in the previous pictures are male? Before this interview, I thought they all were. I mean, haven't you seen the movie Antz or A Bugs Life? The worker and warrior ants are all male.  But no, turns out every single ant in those pictures are females. Way to mislead us, kid movies.

Male ants are winged and look like wasps. Plus, they are sissies. According to Mark Moffett, male ants "have no social life" and are "only good for sex". Woot! Females are awesome. Moffett continues to say "ants are groups of females without males doing a thing".

Credit to Mark Moffett for the bus shot
These females ants are awesomely smart. They use larger ants as transportation. What, you ask, do I mean? Check it out:

Yes, that is a larger ant transporting like 20 smaller ants. She'll carry them into battle, to food, to the borders, all over the place. She's like a bus except she gets paid nothing and is highly prized. Colonies protect their best, biggest warriors at the expense of hundreds of little expendable ants.

Some types of ants catch their prey by ripping off their legs. Yes, they tear off their prey's legs and antennae, carry the prey back to their nest in one piece and slowly consume them alive. Awesome, ants. Also, again, kids movies are not very accurate.

Hi, I was created solely to mislead you
As if you didn't have enough fuel for your nightmares, let me add some. Moffett also describes Bulldog ants from Australia which are about an inch long apiece. They have excellent vision. Moffett says that if you ever see one of these ants look up to you, recognize you and proceed to CHASE you, you should run. Run fast because they can run just as fast as you. Also, they are excellent jumpers. And they can call for reinforcements incredibly quickly. All of whom are as fast as you and excellent jumpers.

Oh God. I don't like where this is going.

Moffett goes on to describe the reason you don't tie up your cattle in Africa. Because you might come back in the morning and find only your cattle's skeleton.

Now, combine these three anecdotes, and you know why I am not heading to Australia anytime soon.

But as I'm listening to this interview, riveted to my computer, sort of like watching a train wreck, you just can't tear your eyes away, I realize that Mark Moffett is just as nuts as the ants he's describing.

He tells a story about him trying to get the queen of a marauder ant nest. He takes his ax and splits open the top of the nest. Ants FLOOD out of the nest and begin to climb him. You heard me right. He continues to ax until they reach his neck, at which point he "runs like the dickens scraping ants off of him as he goes." Then, he repeats the entire process until he excavates the nest. As if that wasn't enough, somewhere near the end of the interview, a botfly hatches out of his head. Does this sound like a balanced individual?

I leave that answer to you, psychiatrists.

I can just hear my husband, after reading this post, asking me "Wow, so you still think an all female society would be awesome?" I actually think ant dynamics model what it would be like if society was almost all female quite well. We would create some fearsome warriors and be incredibly efficient, but have insane battles and territorial disputes between tribes. Ants never retreat, and from my experience, neither do human females.

Friday, August 12, 2011

Appendix: Fun facts about melanoma

And here is the preachy post I promised. Just as a reminder, I am not a doctor. No seriously, not a doctor.

What is melanoma?

Melanoma is a type of cancer that originates in our pigment cells. Melanoma is also the most deadliest form of skin cancer. One person dies from melanoma every hour. [1]

How do I recognize melanoma? 

Here is a handy dandy chart the National Health Institute came up with. They made it easy because it is the ABDCE's of melanoma. It's so much more fun when there is an acronym.


You're thinking to yourself, wait a second, there was no E on this chart. The E is a relatively new addition and means "Evolving". Basically, it means if any mole is changing on your skin that is also a sign of skin cancer. See the pamphlet at the bottom of my post for more info on this.

DO make an appointment with the dermatologist if:
  • Your mole looks like any of the melanoma pictures above (or has any characteristics of ABCDs above)
  • Your mole looks different from any other mole on your body (maybe a very different color)
  • Your mole is changing (size, shape, color)
  • Your mole is oozing or bleeding
Especially pay attention to your mole if it is larger size (like over 0.5 cm).

No joke, I have told a person in a hot tub and another person on an elevator they should get a suspicious mole checked out. They probably thought I was crazy, but if they catch any skin cancer earlier, it will be well worth the weird looks I got.

Is tanning really that bad for you?

Yes, dear God, yes. This is probably the biggest misconception my friends and family have that puts them at risk. There are countless studies undeniably linking UV exposure to cancer.

Let me highlight one for you from "The Causes of Skin Cancer: A Comprehensive Review"
Ultraviolet radiation (UV) from sun exposure is the most important cause of skin cancer.
There are countless more studies highlighting the horror that is the legal tanning salons in the United States: one calls for a ban on tanning, another highlights that European tanning beds often give our more UV radiation than is approved for, and another, I don't even need to describe. It is called:  "Ultraviolet Radiation: a hazard to children and adolescents".

Those of you heading on vacation, use sunscreen! Use it every 1 to 2 hours while you are in the sun, especially if you go in the water. I know you won't look as awesome when you come back all pasty, but your skin and body will thank you.

Common places to forget to apply sunscreen: your ears, the top of your head (yes, even those of you with hair should protect the top of your head with a hat or spray sunscreen), your lips, and the top of your feet.

What are some great resources to learn more? 
  • YOUR DOCTOR. I know; crazytalk.
  • National Cancer Institute: http://www.cancer.gov/cancertopics/types/melanoma. Has fantastic detailed information about how melanoma scientifically and medically works, as well as prevention tips, clinical trial information, melanoma statistics and resources for those who have been diagnosed. Also, this is a reputable source of information. No Wikipedia for me. They also have one of the best pamphlets I have ever read about melanoma called "What You Need to Know about Melanoma and Other Skin Cancers. Read it. http://www.cancer.gov/cancertopics/wyntk/skin
  • American Academy of Dermatology has a made a great Body Mole Map to help you look for moles and track any suspicious ones you find. Also, it has good skin protection tips.



[1] American Cancer Society. Cancer Facts & Figures 2010. Link. Accessed August 8, 2011.

Wednesday, August 10, 2011

What would Courage Wolf do?

PS. Wow, I have written this disclaimer too many times. This is the millionth installment of a long blog saga. Start with "Breaking The Ice" and read chronologically if you want to know what's going on. 

The biopsy came back clean. Of course it did. I wasn't really worried; I felt pretty invincible at that age.

My mother on the other hand... I found out later that she stopped eating sometime in August when I had the initial biopsy until my sentinel node biopsy came back sometime in November. She lost somewhere around 10 pounds. My dad was pretty worried about her. Of course, they kept this from me. She never showed how scared she was to me. She's a good mom.

I still remember where I was when I got the call from the lab. Sentinel node biopsy was completely clean. Follow up with a dermatologist every year. No chemotherapy for me. Of course, I immediately called my mom who didn't pick up her phone. Of course. I left a message.

My mom called me back crying. She had been visiting my post-maternity sister in the hospital, which is why her phone was off. When she got outside, she checked her messages and started bawling.

And thus concludes the story of how my mom once saved my life.

Of course, I still get regular dermatology check-ups. I've been naked in front of more dermatologists and medical students than you'd believe. I'm one of those crazy patients who invites all the shadow-students at the teaching hospitals in to watch my exams. They're always interested in seeing my scar: it healed irregularly. Plus, it is a giant scar, which is awesome.

I've had several moles removed, including a Spitz Nevi (which is really hard to distinguish from melanoma apparently and very uncommon) as well as a skin tag that just wouldn't stop growing.

My husband takes pictures of my back to make sure that no moles change on us. My entire extended family has gotten check-ups to make sure they don't have anything. Two of them have had the same surgery I had, while many others have had suspicious moles removed. Hello, runs in the family.

Hello, Mr. mole
I get my eyes checked for moles every few years (yes, there is melanin in your eyes). The eye doctor takes pictures of the one mole I have in my eye to make sure it doesn't grow (yes, pictures of my eye, how sweet is that?)

Moles can grow in the craziest places, in nail beds, on the bottom of your feet, on your nether regions (both ends), in your mouth, or digestive tract.

Hence why bleeding stool calls for a stupid colonoscopy. It all comes full circle and you realize why I had a colonoscopy several weeks ago. Dag nab you, potential melanoma!

All in all, it was a crazy, harrowing, amazing, scary experience that I hope not to repeat. The best medicine is prevention, and that's what I'm all about now. The slightest hint of an irregular border and I have an appointment with my dermatologist.

My friends are super jealous, because it takes many months to get into a dermatologists office around here. But the words "wide local excision" "potential melanoma" "sentinel node biopsy" and "new changing mole" get you a next day appointment. Totally worth it.

I hope my vantage point from the patient perspective will make me a good doctor. I know what it's like, and I know how amazing it was to have concerned nurses, doctors, PAs, heck, even the receptionists, pulling for me. I've seen doctors in 3 states and 6 different institutions related to skin things, and every one of the was professional, caring and helpful.

I know I got lucky, both in my healthcare and my biopsy results. I hope you enjoyed reading about it. And thus ends the longest blog saga in history. I was going to post it all as once piece, but I figured I would never see any of you again.

For those of you facing health struggles of your own, just remember:

Credit to troll.me.com

Tuesday, August 9, 2011

I now feel a strange kinship with the Tyrannasaurus Rex

PS. This is a continuation of a blog saga. Start with "Breaking the Ice" and read chronologically, otherwise this story will make no sense.

The morphine drip finally got the pain under control and I was allowed to go home with lots of prescriptions for post-op pain and instructions for making sure I didn't get an infection.

By far, the worst part of the recovery was the incisions under my arms. Every time I moved my arms, they hurt. When I breathed they hurt. When I talked or laughed they hurt. You don't realize how often your underarms are stretched in every day life until you feel horrendous pain every time your stitches move.

To add insult to injury, my two female roommates thought that this was Hilarious. They likened me to a squirrel, or a T-Rex, because there was only one comfortable position for my arms.

Most stubbiest arms ever; the T-rex arms can't even reach his face.
It wasn't very fun either because there was so much I wanted to do with my time off from school. I thought, "Sweet, at least I'll catch up on homework and be able to give myself a pedicure/manicure, maybe play some video games..." My arms allowed me to do none of this.

I know how you feel Mr. TRex. (Credit for comic goes to www.quantz.com)
I couldn't even hug people. =( There is a facebook group dedicated to almost this exact problem called: "Hi, I'm a dinosaur and I'm always angry cos my arms are too short to hug people" except it has less punctuation and capitalization. (I'm sorry, my OCD just won't allow me to type that any other way. I died a little inside when I typed "cos".)

My roommates capitalized on my inability to get my hands higher than my chin and would hide my food on the top shelves in our kitchen and watch with glee while I tried to get at it until we all dissolved into giggles. I know this probably sounds cruel to those of you reading, but it helped me stay sane. They didn't baby me, pity me, or patronize me; they treated me like everything was normal. We always played jokes like this on each other, and major surgery was no excuse for not participating.

We also laughed (maybe a bit too loudly) at insensitive cancer jokes like:
Doctor: I've got your test results and some bad news. You have cancer and Alzheimer's.
Man: Boy, am I lucky! I was afraid I had cancer!
My mom stayed with us for a week. I couldn't wash my hair, or dress myself, so she was in heaven. She loves to cuddle and misses that I will no longer snuggle with her like when I was 5. But I didn't really have much of a choice being drugged and barely able to move. So she got to blow-dry my hair, brush it, dress me however she liked: it was basically like having a grown-up doll for a week.

Eventually, my mom finally went home, and my roommates got their comeuppance. They had to clean the drain in my back. Mmm, nothing better than lymph, blood and bodily fluid. How's that for true friendship? I couldn't put on bras or shirts by myself. I flashed them so many times, I think they probably dream about me sometimes.

Soon after my mother left, I decided it was time to return to class. I was still in a lot of pain, and taking 2-3 Vicodin every 4-6 hours. I don't know what possessed me to go to my chip design class. To this day, I have no idea what was taught in that class. I vaguely remember sitting in the front row, lolling my head to the side and mindlessly staring at the PowerPoint slides until suddenly the room was empty. Where did everyone go? Maybe I should go home. Good plan, K8.

We didn't get the biopsy results for another couple of weeks...

Monday, August 8, 2011

You did remember that I'm resistant to lidocaine, right?

PS. This is a continuation of a blog series starting with "Breaking the Ice". You should read them in order because otherwise this will probably make no sense. Now, on with the saga.

Waking up, I remember being thoroughly confuzzled as to where I was and what I was doing there.

There was a woman's voice, talking to me soothingly. I could hear her voice as if she was at the end of a long tunnel. I slowly became aware that there were bright lights affronting my eyes. I finally woke up in a hospital bed, in the recovery room, a nurse's smiling face over me.

"Hi there! Everything went great, you are all done. You're going to stay in here for a while while you recover from the anesthesia."

A wave of relief came over me. But that was quickly followed by confusion. I struggled to speak, "How'd the surgery go?"

She patiently said, "Everything went great, you are all done. You're going to recover here for a while."

Five minutes later, I asked the same question. The nurse told me I asked the same few questions about 10 times. Each time, she answered me. She laughed and told me it was very common.

As I became more aware of my surroundings, I realized I was spectacularly uncomfortable. My back throbbed, under my arms hurt, and my throat was scratchy and sore.

During the procedure, the surgeon had taken a fist-sized chunk from my back, leaving an awesome six-inch scar with a small hole for a drain. Let me repeat that. Make a fist. That is how much skin was taken from my back. That is what is known as a "wide" local excision even though the initial size of the mole was less than 2 cm. The incisions under my arms were only about 1 inch, but every time I moved, they stretched. I had been intubated during the procedure because the surgeon needed to roll me a bunch to get at my arms and back: hence the sore throat.

Eventually, I became coherent enough to be rolled into what I like to call "Least Thought Out Room Ever". I've just had back surgery and what do I get to sit in? This:

Most uncomfortable chair ever

There is no good way to sit in a recliner that doesn't involve laying on my back. No, see, that really hurts because I JUST HAD BACK SURGERY.

My mom was there, looking haggard, relieved and worried all at the same time. By the time I lay awkwardly on my side in the recliner, I am in significant pain. Not the normal, "you just took a giant chunk out of my back" pain, but serious pain.

My breaths were coming ragged and I started to cry uncontrollably. At some point I started thrashing, trying any movement I could to get rid of the pain. For a while, I moaned. Then, I remember whimpering, immobilized with the pain, while the nurse came over at mom's behest. She agreed with my mother, this level of pain wasn't normal. While less intense than the lymphoscintigram pain, my back pain just wouldn't let up. It was a giant crushing weight with no relief. On the pain scale (not being a hypochondriac), I would probably rate it a 9.

I flashed back to my conversations with Dr. E during my consultation:

Dr. E: "After I remove the skin from your back, I put a long-lasting local anesthetic into the excision site before I sew you up."

Me: "Oh, I have this weird resistance to the -caine family. It doesn't work really well on me. You should talk to the person who did the initial biopsy. Is there any way you can use something different?"

Dr. E (looking confident): "I'll just put some extra in. You won't be in too much pain coming out of the operating room, don't worry."

Me (unsure): "Okay, but I think you are going to need to put a lot of extra in."

Then, we had the exact same conversation right before my procedure, with me warning: "Don't forget, Dr. E, I need extra local anesthetic in my back." He blinked and said, "Sure thing."

Sure thing, my butt.

So that's how I got to go on my first ever morphine drip. The nurse hooked me up and It. Was. Amazing. Words don't do it justice. Going from a 9 pain to a euphoric state was the most incredible feeling I've ever had. To date. Nevermind that the nurse and my mom kept shaking me awake to make sure I kept breathing. The important thing was that the pain was gone and the dancing butterflies were so pretty.

I felt like Charlie the Unicorn going to Candy Mountain. Surreal, awesome, confusing then ultimately crashing back to reality. No wonder people get addicted to Morphine.



PS. Don't get me wrong; I love Dr. E. He'll for sure believe me next time. And who knows, he might have put in extra. My body probably just giggled maniacally and ignored it.

Sunday, August 7, 2011

Playing "Operation" was the best as a kid; not so much as the patient

PS. This is the longest blog saga ever: start with "Breaking the Ice" and keep readings my posts chronologically or you probably won't know what's going on. 

"What the heck was this guy doing?" Dr. E puzzled over my lymphoscintigram. "It's clearly in both underarms." My mom and I nodded in agreement. Dr. E wrinkled his brows, "Well, I'm going to biopsy both armpit lymph nodes to be sure."

He smiled and placed his hand over mine, "Everything is ready for you in the operating room. You'll be in the recovery room before you know it."

Already dressed in a gown, with my IV already starting a cocktail of drugs, I was feeling very calm. Dr. E's easy-going demeanor calmed me further; he's got this. This was how to calm down a patient. Take some notes Mr. Lymphoscintigram Radiologist.

My journey to the hospital had been anything but relaxing.

Dr. E was, of course, at the most prestigious hospital we could find near my college. The hospital spread for several miles with different buildings, schools and clinics peppered throughout the campus.

I assumed that Dr. E would be performing the operation in his main hospital office, and that's where we showed up. My mom and I got there, and were immediately informed that he was at his other set of ORs. On the other side of the campus. It was already 7:55AM, and I was flipping out. We were supposed to be there at 8AM. What if they gave my spot away? Would they be angry at me? I hated when they were angry at me, all glowering with disapproval.

And of course, it was my fault. Looking at my pre-op packet, I saw the address was different. Duh, K8, maybe you should check the address before showing up for major surgery. I plead insanity; the stress warped my brain.

To make matters worse, the hospitals were in the middle of a city. And it was 8AM, full rush hour traffic hour. I was agitated the entire way to the other hospital. I hate being late.

We arrived at 8:15ish, and I ran all the way up to the surgery check-in area. I was out of breath and flustered when I handed the receptionist my surgery papers. With my luck, it probably wasn't even the right day.

But it was, and she seemed completely disinterested in my reasons for being late. In fact, she didn't seem to care that I was late at all. She stamped a few things on my forms and said, "Have a seat."

I have never worked so hard to get somewhere on time before and then waited for 3 hours.

The wait was long. I didn't want to read, study, flip through a magazine, or play with the giant colored block cube in the corner.

I would typically be all about this
At the time, I just felt a sense of restlessness. But looking back on it now, I was nervous. I'd never had general anesthesia before, nor had I ever had any sort of operation. I knew the risks of general anesthesia, and I was trying not to think about that. But we all know how well not thinking about the white bear works. Let's think about something besides death from general anesthesia, K8. I mean, even if you died, there isn't much you can do about it. Your parents would take care of everything. Hmm, I wonder what coffin size I would be.

Awesome, brain. Thanks for that gem of a thought.

So those of you reading this who are medical students, or doctors, nurses, PA's, pretty much anyone in the healthcare field: remember that this is what some of your patients are thinking. And we can't help it. Anything you can do to ease our fear is well appreciated.

So finally, I was accepted to the pre-op area. I was undressed, gowned, IV-ed and asked a million and a half questions. My mom and I had to circle the mole and the underarms with a big purple marker. It's a good precaution, so he made sure he excised the right mole. And of course, we all know the story of the doctor who cut off the wrong leg of the patient. Can never be too careful.

The prep nurse then informed me that I would need to remember my name, my date of birth and what operation (wide local excision of a mole AND sentinel node biopsy of both under arm lymph nodes) I was getting while being put under. Yes, let me repeat that for you. I need to somehow remember my entire operation, my name and date of birth while on the edge of consciousness.

It was hard. I'm staring up at giant mesmerizing OR lights, with about 10 faces around me, all with bated breath waiting for me to explain to them what operation they are performing on me. Excellent. I got this. The "What is your name?" question threw me at first, took me about 10 seconds to remember that one, but after that, it was smooth sailing.

I thought to myself, "Wow am I sleepy", and I was out.

Friday, August 5, 2011

Lymphoscintigrams can bite me

PS. This is a continuation of the last several blog posts in August. Start with "Breaking The Ice" and keep reading for the whole saga.

So, several weeks later, I found myself getting a lymphoscintigram. 

A lymphosincti-what?

Yes, it is as awesome as it sounds.

When cancer spreads from my mole site, it would travel through the lymph system (sort of like a sewage system) to a hub, namely a lymph node. The problem is that the doctors aren't sure which lymph node my mole site drains to; could be my neck, under my arms or in the groin area. So this procedure injects a radioactive dye into my body at the mole site and follows the progress of the dye until it reaches the lymph node. Then, the surgeon will take out a piece of this lymph node and check for cancer. For a more thorough explanation, check out this radiology site.

So I found myself in a large lead-padded room with a giant gamma ray camera machine. Seriously, it looked like something from the future. The nurse told me to strip and lay on the table.

Now, I get that there should be warnings on dangerous materials, and I also get that the nurses and doctors get exposed this material 30 times a day, whereas I will only be exposed to it for a few days during my entire life.

But do they really have to make the radiotracer look so deadly? The doctor enters the room carrying a metal canister between his two fingers (as if he is carrying something extremely distasteful or contaminated). Printed on the side of said canister are the words: DANGER: RADIOACTIVE MATERIAL. The doctor and nurse are wearing turtleneck lead aprons with lead gloves. Lead gloves, people.

They've even put a lead apron over me, with a slight opening by my mole. Does it really matter at this point? You're about to inject that INTO MY VEINS.

So I'm already worked up as the doctor and the nurse bring over the canister of death.

The doctor begins to open the canister and says: "I need you to remain absolutely still while I inject the dye. This is going to hurt."

What's wrong with this picture? Isn't the doctor supposed to say something like: "You won't feel a thing" or "It'll be over before you know it" or "This'll be just like a shot; quick and painless". I'm pretty sure the line "This is going to hurt" is not in the "How to Calm Patients Down" handbook.

As if that wasn't enough, suddenly the nurse puts her arms across my shoulder blades and presses her entire weight down on my back, locking me in a death vice between her body and the table. Whatever, this can't be that bad...

OH, HOLY MOTHER...

I've read that lymphoscintigrams aren't supposed to hurt. I'm typically not bothered by shots, IVs, or mild scalpel work. But maybe I'm just a baby. I'll admit it: I cried. That injection was the single most excrutiating, vibrant, intense pain I have ever experienced. The injection seemed to drag interminably (much longer than a normal shot). I couldn't move. I couldn't breathe. My world narrowed down to the icy fire spreading through my back and I distinctly remember having the thought, completely seriously: the cancer can stay if you stop injecting that into my back.

When they finally finished, I laid in stunned silence for the next hour while the machine of the future whirred around me following the progress of the dye.

Here is a re-creation of the results of my lymphoscintigram with MS Paint goodness:


Looks like tracer is in both armpits to me
The radiologist handed me a copy of his report with the note: "Left side biopsy only". I puzzled over the lymphoscintigram; it seemed pretty obvious to me that both armpits had evidence of radiotracer in them. Shouldn't I be getting biopsied in both under arms? My mom was also stymied. We shrugged; after all, we weren't doctors. I'm sure he knew what he was doing.

Thursday, August 4, 2011

It's a good thing those three prestigious labs disagree...right?

This is a continuation of "Breaking the Ice" followed by "Was gonna leave you hanging..."

The biopsy took foreverz. My mom was frantically wondering why it was taking so long. Simultaneously, I was desperate to get my mother to stop calling me. Arg, why has it taken six weeks already?

We found out soon enough. Turns out, the first lab (University of Pittsburgh) they sent it to was a little weirded out by my mole. They thought it definitely had markers of melanoma, but it wasn't something they had seen presented in this way before. So off to Harvard and Duke my samples went. Harvard insisted it was malanoma without question. Duke disagreed, saying it wasn't melanoma, but whatever it was, it wasn't good. (Later, my samples were sent out to the University of Michigan, who was also curiously puzzled by it. I wound up signing a release with my doctor so that my mole could be published.)

The clinic finally called me with the results and said, "You need to get this taken out with larger margins." I was confused; wasn't that what they did during the biopsy?

So that's how I wound up sitting in a surgeon's exam room with my parents worriedly wringing their hands besides me. I didn't know why they had driven the six hours to be at this appointment. I mean, I did know: they were nervous. And that was touching in a way. But it just wasn't a big deal. It was just a tiny mole for goodness sake. I wished they wouldn't get so worked up about it.

So we met with Dr. E.

He had been briefed on my case, and he recommended an agressive plan: a local excision with wide margins and a sentinel node biopsy. In layman's terms (because I had no idea what he was talking about): take a large chunk out of my back at the site of the mole and make sure the cancer didn't spread to my lymph nodes.

He was very convincing with his reasoning; all 3 labs had recommended removal with extreme prejudice. My mother (the critical care nurse for 20 years) had sooooo many questions. Dr. E answered them all patiently and with ease. He spent well over 40 minutes with us; which in surgeon-time must be equivalent to years.

My mother started quizzing him on his background, "How many surgeries like this have you done?"

"What, you don't already know?" Dr. E joked. "I see my picture in your notes; it looks like you've done your homework."

My mother flushed. It was true. She had printed out a veritable biography on Dr. E. She knew where he attended undergrad and medical school, where he did his residency, where he had lived since medical school, and what his patients thought of him. She had called in every favor she could think of with her nursing contacts to check on this guy. She had a binder with all her information, and on the cover was a giant picture of his face staring up at us. Just to make sure this was "the" Dr. E, I guess?

When Dr. E found out where I went to college, he looked surprised and exclaimed, "My son goes there!"

I responded with enthusiasm and somewhere in the midst of our chat, I realized his son was one of my students.

At the end of our appointment, I looked to my parents and to Dr. E and asked, "What would you do if it was your son? If I was your son?"

He paused for a second and really thought about it. I mean, really thought about it. I firmly believe he wasn't just placating us or trying to get some money out of advocating an needless procedure. He said, "I would do exactly what I recommend. The risks of surgery are minimal and you don't seem like the type of girl to care about aesthetics. But it looks a heck of a lot like melanoma, and if it spreads, you are in real trouble."

I'll definitely do a factoid sheet on melanoma at some point in the future, seeing as it's a bit of a sore (oh my puns are funny) subject, but for right now, here is a quote from cancer.org:
Stage IV: The 5-year survival rate for stage IV melanoma is about 15% to 20%. The 10-year survival is about 10% to 15%.
Moral of the story: don't f*** with melanoma. It is the most deadliest form of skin cancer. Someone at my engineering office died from melanoma last year. He was 43.

I sighed and said, "Alright, Dr. E, let's do it then. But know this. If anything goes wrong, your son fails my class."

Dr. E smiled, "Deal."

Tuesday, August 2, 2011

Was gonna leave you hanging...

...but I'll be nice and give you some context for yesterday's post.

This is a continuation of "Breaking the Ice" for those who haven't read it. 

My mom was the one who caught the mole. I was home from junior year of college for the summer, and was wearing a tank top. She came over asking, "What's that? How long have you had it? Does it hurt? Has it gotten bigger?"

Golly mom, I don't know because it is in the middle of my back. I would need a system of mirrors to even see that spot, let alone know how long something had been growing there.

She called me almost every day until I made an appointment with a dermatology clinic.

So I'm sitting in the waiting room and the dermatologists office is packed. There was at least 30 people sitting and waiting. I finally got in, and a disinterested resident greeted me, "What seems to be the problem?"

I explained that my mother was a little paranoid, and there was this little mole on my back, but it was black and blue, pretty ugly looking, could you just take a look at it so she stops bugging me?

The resident lifted up my shirt and suddenly became very interested. She rushed from the room, mumbling something about getting more doctors. And get more doctors she did. I'm fairly certain the entire clinic staff packed into my tiny exam room. They had a Polaroid camera and were clicking pictures like there was no tomorrow while chattering excitedly amongst themselves.

Finally satisfied they had documented the crap out of my mole, she says, "Alright, that mole needs to be biopsied."

I sighed inwardly, thinking I would need to waste valuable study time coming back to the clinic, "When should we schedule it?"

She shook her head, "No, that mole needs to come out today. Wait five minutes, we'll prep the room for you."

So I waited, and in the promised five minutes, a resident was ready to take out the mole. The mole was fairly tiny, about 1 cm in diameter. The resident was going to carve out a football shape to try and see how deep the mole went.
Wow, you can tell that drawing took all of 30 seconds to make
So she injected the site with lidocaine. Ha! Good joke, I told her, lidocaine doesn't work on me. She scoffed at me and left the room.

No, but really, the -caine anesthestics don't work on me for some reason. Getting a cavity filled is torture. My body must do something to it, either metabolize it quickly or the -caines don't quite penetrate all the way down my nerve branches. Or maybe that is total BS; I'm not a doctor. But the end result is that doctors are always surprised when I turn out to be right about my own body.

She came back and started slicing into my back. Holy crap did it hurt. Yeah, I can feel that. Yeah, your scapel is right there. Now you are cutting deeper, owww, stop, no more. I'm done. I will give you money to stop cutting into my back. She was shocked that I accurately related her scapel movements to her.

She had to give me more anesthetic and seemed miffed that she couldn't cut into my back on schedule. I told you so. And even though my back hurt, I felt some small sense of accomplishment. It's rare I can get a doctor/dentist to believe me about the -caines.

So after a long time laying on my stomach, disappointed that I couldn't watch the surgery, the mole was finally out and put in a little jar. I got to look at it; it was neat.

And off to the labs it went.

My mom was less than thrilled about how that appointment went. Apparently it isn't good when doctors get all excited like that...