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."

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?"


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.