So good news! I passed my first medical school course, ensuring that I am a little bit closer to becoming a medical doctor. That pressure, coupled with the fact that I wrote a 50,169 word novel in the month of November (for NaNoWriMo), is why I have neglected this blog for the most part. I really would like to get my novel published one day, as it was an attempt to make primary care physicians sexy. Improving people's opinions for primary care physicians is my primary goal.
Regardless, I would like to get back on point. Yesterday all the first year students, across all the disciplines, had our HMTD course (nobody knows what HMTD stands for). We were split up in groups, and my group got to hear from a man in his seventies who had had a hemorrhagic stroke about five years ago. A doctor, a pharmacist, and a physical therapist talked to him about his recovery since the incident. The doctor was my community leader, Dr. Senno. Dr. Senno is a really loud man, a neurologist who deals with traumatic brain injuries. He also has an accent of medium thickness (which means its detectable, but you can understand pretty much everything he says).
At one point, he began talking about how easy it is to develop a rapport with your patient--asking the man questions pertaining to the day (it was Pearl Harbor Day), the man's hobbies, the man's career. When it was discovered that the patient and his first doctor treating him during and after his stroke had both gone to the same undergraduate institution, Dr. Senno had noted that he had done rotations at the very same hospital. Dr. Senno then proceeded to go on a tangent about how important it is, especially for doctors with foreign sounding last names, to establish credentials.
Should I change my last name? What would I change it to? No. I like my last name, even if people tend to pronounce it as Abandagu, even though my last name is phonetical and clearly Apantaku. It scares people. I don't want to scare people. But things should change, if only because the majority of the students in my class aren't white. But until then, I guess I could be Dr. A.
Dec 8, 2011
Dec 4, 2011
MANDATORY
In undergrad, I helped organize events for our Biological Honor Society, TriBeta. One of these events was the Chili Cook Off, and to get people excited about the event, I created a ton of flyers that made the event seem mandatory for select groups of students who might be Biology majors:
One of the fourteen or so different flyers I made caused a lot of problems, however. It read:
The professor who organized TriBeta got an angry cease and desist e-mail from the women who organized the pre-meds. The reason? She was getting a lot of e-mails from freaked out students asking whether or not they had to attend. A lot. Our professor told us to immediately remove the flyers. I was saddened. If people had just been logical, they would have realized that not only did it make no sense for TriBeta to have the authority to interfere with pre-med going ons, but that the high variability in the signs would suggest that there was no way the event could be mandatory. Sarcasm in print is hard to understand, yes, but it should be easy to understand if you get a lot of helpful hints. Or even if you just think with a discerning mind. I wanted to scribble on the flyers, "Relax STIFFS!" Thankfully, I did not. I just removed them, defeated.
Later our professor told me that he thought they were very amusing, but, leave it to the pre-med students to be driven into a tizzy by clearly humorous signs (he was an ecology professor).
I now go to medical school, and these people I am surrounded by, many of them behave with the same freaked-out tizziness of the pre-med students from my young adulthood. It is hexing. But also pretty funny. I wonder if I could increase readership by putting up signs around Rosalind Franklin University that read:
MANDATORY for all students enrolled in Physics 101 who would rather not be.
MANDATORY for all students going abroad to either Uganda or Costa Rica next semester.
MANDATORY for all students who know what Isoamyl Acetate smells like.
MANDATORY for all students who are Nolan Sheppard.
One of the fourteen or so different flyers I made caused a lot of problems, however. It read:
MANDATORY for all pre-med students.
Later our professor told me that he thought they were very amusing, but, leave it to the pre-med students to be driven into a tizzy by clearly humorous signs (he was an ecology professor).
I now go to medical school, and these people I am surrounded by, many of them behave with the same freaked-out tizziness of the pre-med students from my young adulthood. It is hexing. But also pretty funny. I wonder if I could increase readership by putting up signs around Rosalind Franklin University that read:
"LESS THAN CLINICAL" is MANDATORY READING FOR ALL M1s.
Nov 28, 2011
Histological Freak Out
We have to prepare slides for histology. I think it's a fairly decent review tool. Although it is one that takes a really long time, and when you also have to study for other things, it can be quite detrimental to one's sanity.
But sometimes it's just detrimental to your sanity because it is.
I was looking for stacked red blood cells in a methylene blue kidney when I suddenly felt like I was snorkeling in the ocean and forty-times too close to something poisonous underwater...
like this...
a poisonous, blue ringed octopus
I could not breathe for a few seconds, looking at the picture of the blue ringed octopus even now makes me feel incredibly uncomfortable, so I tried to think about what else methylene blue stained kidney could look like... With all those little plasma cells... with their interesting staining patterns....
They kind of looked like eyes.
That was not much better.
Nov 22, 2011
Sore Throat
I went back to my undergraduate institution last weekend to watch this years final home football game, as well as a hockey match. I came back to North Chicago with a sore throat. After spending any amount of time on a college campus, I always fear I have mono. That's right: I worried that I had mononucleosis every time I was sick for four years.
Looking at my throat in the mirror wasn't working, so I grabbed my otolopharyn-o-scope (sp?) and peered inside. I realized that there is something in my throat that I had never thought of before. You know that thing that hangs down in the center of your throat? I had no idea what it was. Was it the epiglottis? That was the only thing I could think of that would be situated back there, but it could not have been, because it was small and insignificant, unlikely to block food from entering the lungs, which is the epiglottis's main responsibility.
So what was that thing?
I became even more perplexed when I discovered that yelling at it made it disconnect from the roof of my mouth after I swallowed. Curiosity drove me to Bates' Guide to Physical Examination and History Taking. That thing is called a Uvula. There was significant redness on my soft palate, but the posterior pillar of my throat seemed splotched, with faintly white pigmentation. Could this be a bacterial infection? Or was it simply mild dehydration presenting itself at the farthest reaches of my throat? Where even my light couldn't clearly illuminate it?
My self-diagnoses are still short of perfect. But they are getting better.
Looking at my throat in the mirror wasn't working, so I grabbed my otolopharyn-o-scope (sp?) and peered inside. I realized that there is something in my throat that I had never thought of before. You know that thing that hangs down in the center of your throat? I had no idea what it was. Was it the epiglottis? That was the only thing I could think of that would be situated back there, but it could not have been, because it was small and insignificant, unlikely to block food from entering the lungs, which is the epiglottis's main responsibility.
So what was that thing?
I became even more perplexed when I discovered that yelling at it made it disconnect from the roof of my mouth after I swallowed. Curiosity drove me to Bates' Guide to Physical Examination and History Taking. That thing is called a Uvula. There was significant redness on my soft palate, but the posterior pillar of my throat seemed splotched, with faintly white pigmentation. Could this be a bacterial infection? Or was it simply mild dehydration presenting itself at the farthest reaches of my throat? Where even my light couldn't clearly illuminate it?
My self-diagnoses are still short of perfect. But they are getting better.
Oct 31, 2011
Poetry Assignments in Medical School
Poetry is too easy. I know this because five minutes ago I turned on my brain* and I wrote a poem. It was quick. It was too easy. People always seem to think "poetry" is a mysterious art form. It's not. It just allows less analysis than other forms of expression (read: actual writing). Less analysis is bad, because it inhibits us from seeing how poor poetry is.
Why am I all of a sudden angry about poetry? Because apparently there is poetry in medical school. And it is atrocious.
*Let me explain. I spent my entire day (more than that because I walked out thirteen hours later) in the anatomy lab, looking at dead bodies and absorbing formaldehyde. We are a visual species, humans, so now, when I close my eyes, I see dry fascia being peeled away from faint pink, striated skeletal muscle. If I fixate long enough, I hear the sound of my hemostat and probe, hacking away at accessory connective tissue, like vultures ripping into a Saharan carcass. It is haunting, and yet, because of the time spent and formaldehyde, strangely calming. My brain, right now, is all about anatomy. When I am not thinking about anatomy, I am hating myself for not thinking about anatomy. I will periodically glance down at my hands and re-affirm that the giant line that extends from your thumb into your forearm when you arch your hand into a thumbs up, is really just your english premier league--mnemonic--your extensor pollicis longus. Below that, or slightly more medial and anterior to that, is your ... wait, wait... what the hell is that again? Your... your... the other component of your snuff box... is it an extensor pollicis or a abductor pollicis? It is the extensor pollicis brevis--thanks Wikipedia--and the abductor pollicis is on the border of your palmar surface.
But back to poetry. So we the first year medical students are enrolled in communities. I think this is a wonderful opportunity. We are afforded a real, practicing doctor contact. We get to see patients. We get to talk about some big issues. I am actually really glad that the communities exist, despite the fact that they, unfortunately, use up time I do not want to give up. Anyway, it's coordinated by a new dean who either attended Northwestern University or Northwestern Medical School, but either way, manages to exude a liberal arts vibe. So are assignments for this course, is to write.
And sometimes people write poetry.
Sometimes people write crappy poetry.
Other times we have to read poetry.
Not as crappy, but not critically acclaimed stuff.
So let me explain how I think poetry should be written. At its best, poetry is really just like normal writing, except it's shorter and thus easier to sustain.
1. Avoid cliches
This is what you have to do whenever you write. Unfortunately, most people who didn't align themselves with more than a few english courses won't know this. I swear to god (cliche) that if I have to pour through (cliche) one more poem that incorporates a line as melodramatic as "the bright light of day" I will shoot myself in the foot (cliche).
2. Don't be melodramatic
Medical school is heavy stuff. You don't realize the emotional baggage (cliche) you're holding onto while you're going through it, because you have so many more cerebral things to worry about. But if you just stand in the anatomy lab long enough, surrounded by sixty or more unwilling dead people, it will occur to you just how serious medical school can be. You are never allowed to get to that point, however. So I don't recommend you go delving into the deep, emotional end (adapted cliche) and pour out your feelings. You must be desensitizing yourself to absolute dread, otherwise, you'd never get past your first term. Don't pretend you're not.
3. Use pretty words
This step is an important confluence of both a big vocabulary and rhyming schemes. Modern day poetry doesn't require sonnet-esque rhymes. But it is important to make sure you have a rhythm in your prose. Sadly, even writers must do this, so I don't know why poetry gets all the praise for "sounding cool." Using big words is helpful, but only if it helps the flow and only if its a word that your audience will understand. Iliopsoas is a beautiful sounding muscle, but it's not that attractive in the human body. Thus, Iliopsoas is a poetical term, but it is not a pretty picture.
4. Say something new
I had this drilled into my head (cliche) by an English teacher in seventh or eighth grade: New or novel. Otherwise, no, don't say it. I guess that's my biggest problem with poetry. How do you make something new or novel in twenty lines that hasn't been done before? Hell, most poems probably could be found paraphrased in Facebook status updates. I'm not impressed, but my theory still remains: get a crazy angle on your story, and you and your listeners will benefit. Yes, anatomy lab is creepy, yes, you feel guilty for saying that anatomy lab is creepy. Now, take it to the next level. Or else, all other medical students will be bored with your thoughts. And when people are bored with your thoughts... well, not good.
5. Consider your audience
Your potential audience is different once you enter medical school. Your knowledge and your fears, they change tremendously**. If I am writing to an average American, I have to take several steps back in order to be able to communicate effectively. If I am talking to a physician, I need to fact check my affirmatives, make sure I haven't said anything that would be embarrassing if proved false.
6. **Don't use adverbs
Adverbs like, totally, ruin a good story. Absolutely avoid adverbs whenever possible. They are not verbs and they are not nouns. They ruin good story lines by instituting a framework in which subjects and verbs are separated unnecessarily, or without necessity. Which of the previous clauses do your ears enjoy more (tip 3).
So that is it, but I will throw in one last hint. The reason why I hate poetry is because people naturally think that things they don't understand are profound, like the profundus flexor digitorum... apologies. But this isn't always the case. You can say several pleasant sounding words together, and they'd make no sense. This theory can be proven by talking with someone afflicted with Wernicke's aphasia or by listening to Jack Johnson. In order to be a good poet, you have to be aloof and yet somehow understandable. Think about it. Finally (adverb), the best writing always comes from pleasantly (cliche) thorough thinking and re-editing. Or should I say: superb, ecstasy-filled writing arises from cerebral endeavors made spectacular by the mundane process of editing.
Why am I all of a sudden angry about poetry? Because apparently there is poetry in medical school. And it is atrocious.
*Let me explain. I spent my entire day (more than that because I walked out thirteen hours later) in the anatomy lab, looking at dead bodies and absorbing formaldehyde. We are a visual species, humans, so now, when I close my eyes, I see dry fascia being peeled away from faint pink, striated skeletal muscle. If I fixate long enough, I hear the sound of my hemostat and probe, hacking away at accessory connective tissue, like vultures ripping into a Saharan carcass. It is haunting, and yet, because of the time spent and formaldehyde, strangely calming. My brain, right now, is all about anatomy. When I am not thinking about anatomy, I am hating myself for not thinking about anatomy. I will periodically glance down at my hands and re-affirm that the giant line that extends from your thumb into your forearm when you arch your hand into a thumbs up, is really just your english premier league--mnemonic--your extensor pollicis longus. Below that, or slightly more medial and anterior to that, is your ... wait, wait... what the hell is that again? Your... your... the other component of your snuff box... is it an extensor pollicis or a abductor pollicis? It is the extensor pollicis brevis--thanks Wikipedia--and the abductor pollicis is on the border of your palmar surface.
But back to poetry. So we the first year medical students are enrolled in communities. I think this is a wonderful opportunity. We are afforded a real, practicing doctor contact. We get to see patients. We get to talk about some big issues. I am actually really glad that the communities exist, despite the fact that they, unfortunately, use up time I do not want to give up. Anyway, it's coordinated by a new dean who either attended Northwestern University or Northwestern Medical School, but either way, manages to exude a liberal arts vibe. So are assignments for this course, is to write.
And sometimes people write poetry.
Sometimes people write crappy poetry.
Other times we have to read poetry.
Not as crappy, but not critically acclaimed stuff.
So let me explain how I think poetry should be written. At its best, poetry is really just like normal writing, except it's shorter and thus easier to sustain.
1. Avoid cliches
This is what you have to do whenever you write. Unfortunately, most people who didn't align themselves with more than a few english courses won't know this. I swear to god (cliche) that if I have to pour through (cliche) one more poem that incorporates a line as melodramatic as "the bright light of day" I will shoot myself in the foot (cliche).
2. Don't be melodramatic
Medical school is heavy stuff. You don't realize the emotional baggage (cliche) you're holding onto while you're going through it, because you have so many more cerebral things to worry about. But if you just stand in the anatomy lab long enough, surrounded by sixty or more unwilling dead people, it will occur to you just how serious medical school can be. You are never allowed to get to that point, however. So I don't recommend you go delving into the deep, emotional end (adapted cliche) and pour out your feelings. You must be desensitizing yourself to absolute dread, otherwise, you'd never get past your first term. Don't pretend you're not.
3. Use pretty words
This step is an important confluence of both a big vocabulary and rhyming schemes. Modern day poetry doesn't require sonnet-esque rhymes. But it is important to make sure you have a rhythm in your prose. Sadly, even writers must do this, so I don't know why poetry gets all the praise for "sounding cool." Using big words is helpful, but only if it helps the flow and only if its a word that your audience will understand. Iliopsoas is a beautiful sounding muscle, but it's not that attractive in the human body. Thus, Iliopsoas is a poetical term, but it is not a pretty picture.
4. Say something new
I had this drilled into my head (cliche) by an English teacher in seventh or eighth grade: New or novel. Otherwise, no, don't say it. I guess that's my biggest problem with poetry. How do you make something new or novel in twenty lines that hasn't been done before? Hell, most poems probably could be found paraphrased in Facebook status updates. I'm not impressed, but my theory still remains: get a crazy angle on your story, and you and your listeners will benefit. Yes, anatomy lab is creepy, yes, you feel guilty for saying that anatomy lab is creepy. Now, take it to the next level. Or else, all other medical students will be bored with your thoughts. And when people are bored with your thoughts... well, not good.
5. Consider your audience
Your potential audience is different once you enter medical school. Your knowledge and your fears, they change tremendously**. If I am writing to an average American, I have to take several steps back in order to be able to communicate effectively. If I am talking to a physician, I need to fact check my affirmatives, make sure I haven't said anything that would be embarrassing if proved false.
6. **Don't use adverbs
Adverbs like, totally, ruin a good story. Absolutely avoid adverbs whenever possible. They are not verbs and they are not nouns. They ruin good story lines by instituting a framework in which subjects and verbs are separated unnecessarily, or without necessity. Which of the previous clauses do your ears enjoy more (tip 3).
So that is it, but I will throw in one last hint. The reason why I hate poetry is because people naturally think that things they don't understand are profound, like the profundus flexor digitorum... apologies. But this isn't always the case. You can say several pleasant sounding words together, and they'd make no sense. This theory can be proven by talking with someone afflicted with Wernicke's aphasia or by listening to Jack Johnson. In order to be a good poet, you have to be aloof and yet somehow understandable. Think about it. Finally (adverb), the best writing always comes from pleasantly (cliche) thorough thinking and re-editing. Or should I say: superb, ecstasy-filled writing arises from cerebral endeavors made spectacular by the mundane process of editing.
Oct 29, 2011
End Game
I've recently had to change my entire outlook on life. For the first six weeks of medical school, half of the first quarter, I was enraged that anyone would ever expect a person to learn so much… unimportant information. I hesitate to say unimportant, but that's exactly how I felt. Fortunately, I recently had an epiphany.
It happened in Biochemistry, which is probably the second or third most pure rote memorization course we have. One of our main biochemistry professors even has a study question website with "ByRote" as part of its URL. I suppose rote memorization isn't bad, per se, but my entire life I have been taught that real intelligence is critical thinking. (Incidentally, this same Biochemistry professor also informed our class in his first lecture hour that Wisdom comes from facts, implying that we would someday be thinking critically, so he seems very well intentioned as opposed to some who seem to be lecturing in a vacuum and not a nearly empty auditorium.)
Anyway, this week in biochemistry we began learning about heme metabolism. Thankfully, the physiology of blood is really straightforward from a chemical point of view, so it's ability to be understood is less "by rote" and more by the greatness of Chemistry. During the first lecture hour, our professor mentioned P450, and it hit me:
The reason I'm learning everything right now, the reason why the amount of information I'm processing feels like it could kill me, the reason why I'm suffocating under lecture notes and text books… it's because this is the last time I will actually be learning this stuff. This is graduate school. This is the end game.
It's taken me until the third month of medical school to realize that this will be the end of my heavily structured learning.
I've learned about cytochrome P450 once or twice before. In fact, during my last semester at Colgate University, I wrote an entire paper on how one could use the gene that codes for cytochrome P450 to determine how a population of Lake Michigan fish had evolved in response to manmade pollutants. And yet, despite writing an entire paper, do you know how much I knew about cytochrome P450 in undergrad? Nothing--besides the fact that the gene coding for it is under heavy selection in fish that live in the Hudson river. Now I know almost everything about P450 that would ever be relevant to anyone caring to know… Like a really curious patient.
I don't know when this would ever be necessary, but let's say a teenager comes in who is currently enrolled in AP biology and has recently started drinking. Let's say she asks me about why drinking is bad, and I take a look at her chart, and notice that she's anemic. I could easily tell her:
"Listen Maggie, your body as it is doesn't produce enough hemoglobin to carry oxygen around. If you start drinking, your liver will need to up-regulate its production of cytochrome P450 to process the alcohol. P450 is derived from the heme protein, which constitutes hemoglobin. Your liver will preferentially up-regulate P450 in favor of hemoglobin. You will be weak and drunk if you drink excessively all the time. Do you want that?" (For the record, I'm not entirely sure that this would have any visible affects on Maggie, but it's true in theory, so it's true enough for a moral lesson.)
"Also, you may want to have sex at your age, and you might think alcohol is the best way to go about doing that, but you should probably wait until you're old enough to make smart decisions. Because even though you may be ready for sex, are you ready for teen pregnancy? Also, Maggie, there's only a 12% chance you will marry the first guy you have sex with, FYI, so be wary." (Maybe I'll be a cool doctor who makes up statistics. I don't know.)
I accept that I will have to learn everything now. But it really is terrifying and exciting to finally be learning the minutia of all the things you've learned superficially, several times in the past. It also doesn't help that I am in graduate school for human-centered medicine, a field that is studied much more intensely and is weighed down with a lot more information than the academic field of deep sea mussels, if only because humans are a highly self-involved species that neither wants or needs to care about the deep sea mussel. Every day it seems I read something and my understanding shifts, snapping into place, and I feel several different little things from all the science classes I've ever taken in my entire life--from fourth grade to evolutionary biology--correcting themselves and informing me a little bit more about how humans work. It's amazing. I think with a little more practice, this feeling may turn into wisdom. And for that, I am finally very excited.
Oct 22, 2011
Overdramatic Politics
So no surprise, the Federal government wants to cut $60 billion from Graduate Medical Education. That's pretty upsetting. The only important things in life are education and health--trying to impede health education is against the only principle I have. I took advantage of a link to send generic e-mails to my congressional and senate representatives by making the e-mail a little less generic:
As a medical student from Wilmette, Illinois, currently attending Chicago Medical School, I write to urge you to protect Medicare funding for graduate medical education (GME) and indirect medical education (IME). While I recognize the importance of budget cuts, I am truly shocked that my government would actually try to make it even harder for medical students who only want to help people. Good health is happiness; threatening future healthcare providers seems like a good way to make the future a sad and virulent place. Right now I am attending school in the tenth congressional district of Illinois. I've lived in the tenth district my entire life. I've grown up here. I was diagnosed with diabetes here. I am now proud to go to medical school here. But did you know that there are only two primary care physicians accepting new patients in this district? This district is huge. It touches Wisconsin and descends all the way into the hinterlands of Chicago. Two. Two physicians. This will be an epidemic. This is an epidemic. I don't want to see the people I've grown up with and love fall prey to easily preventable diseases because they literally could not get a part of the best health care in the world.
Physicians take an oath to do no harm. Do politicians?
As a medical student from Wilmette, Illinois, currently attending Chicago Medical School, I write to urge you to protect Medicare funding for graduate medical education (GME) and indirect medical education (IME). While I recognize the importance of budget cuts, I am truly shocked that my government would actually try to make it even harder for medical students who only want to help people. Good health is happiness; threatening future healthcare providers seems like a good way to make the future a sad and virulent place. Right now I am attending school in the tenth congressional district of Illinois. I've lived in the tenth district my entire life. I've grown up here. I was diagnosed with diabetes here. I am now proud to go to medical school here. But did you know that there are only two primary care physicians accepting new patients in this district? This district is huge. It touches Wisconsin and descends all the way into the hinterlands of Chicago. Two. Two physicians. This will be an epidemic. This is an epidemic. I don't want to see the people I've grown up with and love fall prey to easily preventable diseases because they literally could not get a part of the best health care in the world.
Physicians take an oath to do no harm. Do politicians?
Oct 15, 2011
Intrinsic Motivation
I have not tried to write anything for this blog in a very long time. The reasoning behind this decision is heavily influenced by the fact that I am failing the majority of my classes at the moment. It is altogether an incredibly stressful situation. I have stress headaches when I wake up that make me believe my blood sugar is elevated, and for about four or five days I smelled absolutely atrocious and inhumane. I am living through hell. As a type B personality, I have never been strung tighter. It is a very unnatural situation I find myself in at this moment.
But I've come to reconcile this. Very few people would ever be smart enough to be smart enough to get through medical school without studying. I tried to be that type of person. But alas, I am more or less just like everyone else I have ever met in my entire life.
Anyway, it's been hard for me to think about my life objectively while this has been going on. I've questioned myself a lot. I've wondered if I deserved to be a doctor. I guess because both of my parents made it, and because both of my parents seem relatable, I assumed that medicine was an accomplishable field. And I suppose it still is, but I have something to say…
In my thesis, I start off, early on, proclaiming that "some physicians suck." I immediately apologize. If you could get through this material then I trust you to treat me…
But do I really?
So I have spent the last two weeks thinking about why I deserve to be a physician, and I believe that I can explain why I should be a practicing doctor even though I am currently failing many classes at this point…
It's all about humanity.
Or at least, it's all about relating to other people and appearing human.
I have been diabetic for nine years. In that time, I've learned many things about myself. But I have not learned, not once, why diabetes is bad for me. I mean, I know the complications, and I know them in excruciating detail. Blindness, amputations, early death. But why is diabetes actually bad for you, instead of just being an annoyance?
I learned this, even when I was failing biochemistry. Will the majority of my patients want me to explain what regulates the Kreb Cycle? Or will the majority of my patients want me to tell them why having elevated blood sugars will severely affect their health?
Exactly.
Though to be fair, I love biochemistry. And I love all the classes I am taking right now. But to know that I am borderline failing them? I am not excited about that. Because who else could sit down with a patient and really hammer this out? Who could have the highest adherence rate around? Would it be me? A first year medical student who tests poorly? Or someone else? Who does really well on exams but is static in conversation and who never thinks about other people, other people's thoughts, or being an important pillar of society.
Clearly I am "just saying" at this point. I have started to improve my test scores. It is looking less plausible that I will "fail" all my classes. But I may not do super well in all of them. All I know, is that I am a damn good teacher. And I see my role as primary care physician as being very similar to that of an excellent grade school teacher. I need to know the topic well enough to instruct small children on it. I need to tell a diabetic why high blood glucose is bad for them, instead of scaring them with the associated affects.
And if that's what required of me, I will respect my responsibility. I didn't get into medicine to become smarter than everyone else. I got into medicine to help people like me, nine years ago, when I was scared and threatened yet excited by my prognosis, and still willing to waste the next nine years of my life joshing around and eating whatever the hell I wanted because I didn't really truly understand what was happening inside my body. That's not right.
I was a teenager when it happened. I attended one of the best schools in Illinois. I won a state wide competition in Science Olympiad. I was intelligent. I was curious. Hell, it was my body, and I had a right to know. You should have told me. You shouldn't have scared me with how serious it was, with threats of amputations and blindness. You just should have told me in ways I would have understood. I wasn't an idiot. I could have followed you. You should have at least tried.
I won't fail my patients, if only because I know what nine wasted years can mean.
But I've come to reconcile this. Very few people would ever be smart enough to be smart enough to get through medical school without studying. I tried to be that type of person. But alas, I am more or less just like everyone else I have ever met in my entire life.
Anyway, it's been hard for me to think about my life objectively while this has been going on. I've questioned myself a lot. I've wondered if I deserved to be a doctor. I guess because both of my parents made it, and because both of my parents seem relatable, I assumed that medicine was an accomplishable field. And I suppose it still is, but I have something to say…
In my thesis, I start off, early on, proclaiming that "some physicians suck." I immediately apologize. If you could get through this material then I trust you to treat me…
But do I really?
So I have spent the last two weeks thinking about why I deserve to be a physician, and I believe that I can explain why I should be a practicing doctor even though I am currently failing many classes at this point…
It's all about humanity.
Or at least, it's all about relating to other people and appearing human.
I have been diabetic for nine years. In that time, I've learned many things about myself. But I have not learned, not once, why diabetes is bad for me. I mean, I know the complications, and I know them in excruciating detail. Blindness, amputations, early death. But why is diabetes actually bad for you, instead of just being an annoyance?
I learned this, even when I was failing biochemistry. Will the majority of my patients want me to explain what regulates the Kreb Cycle? Or will the majority of my patients want me to tell them why having elevated blood sugars will severely affect their health?
Exactly.
Though to be fair, I love biochemistry. And I love all the classes I am taking right now. But to know that I am borderline failing them? I am not excited about that. Because who else could sit down with a patient and really hammer this out? Who could have the highest adherence rate around? Would it be me? A first year medical student who tests poorly? Or someone else? Who does really well on exams but is static in conversation and who never thinks about other people, other people's thoughts, or being an important pillar of society.
Clearly I am "just saying" at this point. I have started to improve my test scores. It is looking less plausible that I will "fail" all my classes. But I may not do super well in all of them. All I know, is that I am a damn good teacher. And I see my role as primary care physician as being very similar to that of an excellent grade school teacher. I need to know the topic well enough to instruct small children on it. I need to tell a diabetic why high blood glucose is bad for them, instead of scaring them with the associated affects.
And if that's what required of me, I will respect my responsibility. I didn't get into medicine to become smarter than everyone else. I got into medicine to help people like me, nine years ago, when I was scared and threatened yet excited by my prognosis, and still willing to waste the next nine years of my life joshing around and eating whatever the hell I wanted because I didn't really truly understand what was happening inside my body. That's not right.
I was a teenager when it happened. I attended one of the best schools in Illinois. I won a state wide competition in Science Olympiad. I was intelligent. I was curious. Hell, it was my body, and I had a right to know. You should have told me. You shouldn't have scared me with how serious it was, with threats of amputations and blindness. You just should have told me in ways I would have understood. I wasn't an idiot. I could have followed you. You should have at least tried.
I won't fail my patients, if only because I know what nine wasted years can mean.
Oct 5, 2011
BRCA1 or BRCA2? Either way, whatever this is, it's definitely new.
Sometimes it's hard to study. I desperately need to study today, and tomorrow, and the next day up until Tuesday. We have a test next Tuesday, and half of its question are from Biochemistry, a class I would love to not be failing right now. But I am. I feel well prepared, but I also feel like this is the first time in a long time that I will not be pleased with anything less than one-hundred-percent. It's possible. But a 92% is also possible, and I would find that devastating.
Has medical school turned me into a type A personality?
Perhaps. While I was studying tonight, I noticed something odd. Mind you, I was ready to go to sleep, lying in bed reading a clinical medical cell biology text book. It's a good book--and by good, I mean it has a serif font. I started reading chapter four. And somehow, I ended up sitting in front of my laptop looking up how often nipple discharge is associated with breast cancer.
Yes. That's right. Somehow I went from studying, which is important, to discovering that my right nipple is capable of discharging fluid. I believe in self-examination, sure, but what this should really tell you is that I'm studying way too much. I don't even like my breasts. To find something wrong with them should only indicate how much I hate reading text books.
I hate it a lot, I guess.
Turns out there are about five illnesses that can cause nipple discharge, and very rarely does a malignant breast tumor indicate itself through fluid production. I just wasted twenty minutes googling that information and then posting the good news to my Facebook.
This is what being a first year medical student is all about. You can know something is wrong, but you have little idea how bad it is, and no idea how to fix it.
And it's probably always cancer.
Has medical school turned me into a type A personality?
Perhaps. While I was studying tonight, I noticed something odd. Mind you, I was ready to go to sleep, lying in bed reading a clinical medical cell biology text book. It's a good book--and by good, I mean it has a serif font. I started reading chapter four. And somehow, I ended up sitting in front of my laptop looking up how often nipple discharge is associated with breast cancer.
Yes. That's right. Somehow I went from studying, which is important, to discovering that my right nipple is capable of discharging fluid. I believe in self-examination, sure, but what this should really tell you is that I'm studying way too much. I don't even like my breasts. To find something wrong with them should only indicate how much I hate reading text books.
I hate it a lot, I guess.
Turns out there are about five illnesses that can cause nipple discharge, and very rarely does a malignant breast tumor indicate itself through fluid production. I just wasted twenty minutes googling that information and then posting the good news to my Facebook.
This is what being a first year medical student is all about. You can know something is wrong, but you have little idea how bad it is, and no idea how to fix it.
And it's probably always cancer.
Sep 28, 2011
Correction: I've had a heart attack.
I have to make an important correction to last night's post entitled "Drug Surplus": Putting me on Lipitor, a drug that decreases cholesterol production by inhibiting the enzyme 3-hydroxy-3-methylglutaryl CoA (HMG-CoA) reductase, was the right thing for my endocrinologist to do. The literature approves of the treatment and medication I received. Because I've been reviewing my medical biochemistry notes, I can tell you that HMG-CoA reductase forms 3-hydroxy-3-methylglutaryl from acetyl CoA which is only a few mind boggling steps away from becoming cholesterol--which is bad. Unless it's the good kind (HDL).
But more importantly, I can tell you how I misread the risk assessment flow chart. I thought diabetes was simply a serious additional risk factor for the development of cardiovascular heart disease (CHD). I wish. Our lecturer today--a "diabetologist"--informed our lecture hall that diabetes was equivalent to having a heart attack. This was surprising to me, as I regularly do not grip my chest and yell, "Elizabeth, I'm comin'."
An equally attentive student asked whether type I and type II diabetes were considered equally dangerous in terms of cardiovascular disease. The diabetologist said "yes" and continued on with his lecture. I threw my hands up. Really? I've had a heart attack? Well, in that case, I guess being on Lipitor isn't that bad, because clearly I'm going to die any day now. Imagine having your first heart attack at age 13. Fascinating.
After lecture, a girl in my same row remarked that during one of our clinical correlation anatomy lectures, the doctor had innocuously stated that women with congenital sclerosis were eight times as likely to develop breast cancer. Just rolled right over that. Didn't say much more about it after that. Just thought it would be a fun statistic for everyone to know--not to be tested on it, but to let that information sink in to some of us with the unpleasant likeness of an unwanted guest or a recurrent nightmare.
Ignorance is bliss.
It's like our professors don't realize that while we all want to be physicians, we are also human. It's not just a flaw in the schools of medicine. It's a problem with our society. Doctors need to be flawless. We expect more of them than we expect of our own family members. They need to know everything and they need to tell us everything. They are omniscient, otherwise they aren't worth going back to. In this way, we expect them to be less like traditional professionals and to be more like gods. Unfortunately, they have problems too. I can't say for sure, but I'm guessing about a third of my class went into medicine because they either had a close relationship with a friend or a relative who had a serious illness, or because they themselves had or continue to have a life altering medical condition.
But we're just people. We don't like being reminded of our imperfections. Especially when our imperfections are highly correlated with increased morbidity and mortality, death and disease.
I know we have to know all the intricate details of disease and life and how the one influences the other, but sometimes, just every once in a while, it'd be great if it was understood that we were human and, just like most of humanity, scared of our own passing. So instead of getting widely-believed, sadistic statistics crammed down our throats, perhaps those sadistic statistics could be sugar coated? Not too much, though. Or at least, not too much for me.
I'm diabetic and apparently I have to watch my cholesterol.
But more importantly, I can tell you how I misread the risk assessment flow chart. I thought diabetes was simply a serious additional risk factor for the development of cardiovascular heart disease (CHD). I wish. Our lecturer today--a "diabetologist"--informed our lecture hall that diabetes was equivalent to having a heart attack. This was surprising to me, as I regularly do not grip my chest and yell, "Elizabeth, I'm comin'."
An equally attentive student asked whether type I and type II diabetes were considered equally dangerous in terms of cardiovascular disease. The diabetologist said "yes" and continued on with his lecture. I threw my hands up. Really? I've had a heart attack? Well, in that case, I guess being on Lipitor isn't that bad, because clearly I'm going to die any day now. Imagine having your first heart attack at age 13. Fascinating.
After lecture, a girl in my same row remarked that during one of our clinical correlation anatomy lectures, the doctor had innocuously stated that women with congenital sclerosis were eight times as likely to develop breast cancer. Just rolled right over that. Didn't say much more about it after that. Just thought it would be a fun statistic for everyone to know--not to be tested on it, but to let that information sink in to some of us with the unpleasant likeness of an unwanted guest or a recurrent nightmare.
Ignorance is bliss.
It's like our professors don't realize that while we all want to be physicians, we are also human. It's not just a flaw in the schools of medicine. It's a problem with our society. Doctors need to be flawless. We expect more of them than we expect of our own family members. They need to know everything and they need to tell us everything. They are omniscient, otherwise they aren't worth going back to. In this way, we expect them to be less like traditional professionals and to be more like gods. Unfortunately, they have problems too. I can't say for sure, but I'm guessing about a third of my class went into medicine because they either had a close relationship with a friend or a relative who had a serious illness, or because they themselves had or continue to have a life altering medical condition.
But we're just people. We don't like being reminded of our imperfections. Especially when our imperfections are highly correlated with increased morbidity and mortality, death and disease.
I know we have to know all the intricate details of disease and life and how the one influences the other, but sometimes, just every once in a while, it'd be great if it was understood that we were human and, just like most of humanity, scared of our own passing. So instead of getting widely-believed, sadistic statistics crammed down our throats, perhaps those sadistic statistics could be sugar coated? Not too much, though. Or at least, not too much for me.
I'm diabetic and apparently I have to watch my cholesterol.
Sep 27, 2011
Drug Surplus
I am perusing the notes for tomorrow's clinical biochemistry lecture. We are going to be discussing high cholesterol and how to properly assess risk for the condition. I love cholesterol.
Let me tell you why:
High cholesterol runs in my family, on my mother's side (German). My great-grandmother, who passed away recently at the age of 101, lived most of her life with a total cholesterol level greater than 200 mg/dL. The healthy average is around 160 mg/dL. Hypertension runs on my dad's side of the family (Nigerian). His blood pressure was 200/140mm Hg (normal 120/80), before he cut salt out of his diet and it fell back to normal. My generation, a chimeric mix of German and Nigerian traits, is now at a high risk of getting both conditions, which is a well studied recipe for early death.
But so far, at age twenty-two, I'm pretty healthy. My blood pressure has always been normal. I exercise a lot. I am slightly overweight, but that's just because BMI is useless for people afflicted with big bones. My diet is pretty healthy; I eat many more servings of fruits and vegetables than the average American my age. But I am at an "increased risk" for heart disease because I have diabetes mellitus. I still do not understand why I am at an increased risk if I am a type I diabetic. I don't think I've ever been told or have ever read that type I diabetes puts people at an increased risk for cardiovascular disease. So why do I have to worry about my cholesterol?
Well, first, my cholesterol actually was a little high. The first time I can recall being conscious about my cholesterol was when my lipid panel was reviewed by my adult endocrinologist. She immediately put me on Lipitor. At the time I thought whatever would make me healthier, I'd do. As a "lay person," I trusted my physician entirely. When I did my lipid panel screening again, about a half year later, my numbers were lower--they were better--and she kept me on Lipitor. I became suspicious. So I checked my numbers. The lab results always provide a normal range, so I reviewed it. Both times, my numbers were excellent. I mean, not excellent, but they were normal and I was healthy.
So why the Lipitor?
A risk assessment is used to judge whether or not a patient should consider changing their lifestyle (eating, exercising) habits or if they need to be more pro-active and be placed on a drug-enhancing regimen (Lipitor), Diabetes--but they never say which type--is considered a high risk factor. But that's the only risk factor I have. The risk assessment formula says that if I have 0-1 risk factors, my low density lipoprotein (LDL, the bad cholesterol) goal should be: <160 mg/dL. Guess what? It was! HIPPA be damned, I'll tell you what my LDL cholesterol was: 132 mg/dL. If it had been above 160 mg/dL, according to the assessment chart, a lifestyle change would have been recommended. Only at 190 would I need a more intensive pharmaceutical intervention. So why was I put on Lipitor?
Well, it helped. My total cholesterol was 190, my HDL was 43, and my Triglyceride was 77. A year later with Lipitor, my total cholesterol was 195, my triglyceride was 56, as was my HDL. And my LDL was a greatly reduced 128 (sarcasm).
But you know what made me even healthier according to the scale and charts and assessments? First, I gave up on Lipitor after my second lipid panel screening. Why? Because the pharmacy said I didn't have any more prescriptions and I didn't feel like calling my doctor to get me more. Second, I turned twenty-one. And around six months into being twenty-one, I realized that I loved red wine. I also started cooking more often and realized that olive oil is a good substitute for butter in almost everything. At age twenty-two I had another lipid panel screening. This time, my total cholesterol was 167, HDL 64, triglyceride 55, LDL 92.
Hmmm....
I know they're just numbers, but "statistically" I was much healthier.
What am I suggesting? That diabetics be given red wine earlier than age twenty-one? No. Never. Although...
In all seriousness, drugs are great. But they aren't a cure-all. Especially when it's something that can be heavily modulated by simple lifestyle choices. Look at America. There are serious health issues we need to address. But should we prescribe drugs after a problem arises? Or should we try to tell people what they can change in their kitchen and in their lives to make them healthier by their own volition? Drugs are great, and I don't want to argue against their over prescription in America, but when I'm placed on a drug to lower cholesterol, it would be great if I was told how this problem arose and what I can do, myself, to make it better.
Boiled down, what happened to me was simply a problem with patient empowerment. If you give your patients advice that is comprehensive but also understandable, their adherence should be higher, and as a result, they should be healthier. Doctors are important. We need more of them. But perhaps what's even more vital than quantity is quality, specifically as it deals to communication. A patient should know that sometimes, they are their own best medicine.
Let me tell you why:
High cholesterol runs in my family, on my mother's side (German). My great-grandmother, who passed away recently at the age of 101, lived most of her life with a total cholesterol level greater than 200 mg/dL. The healthy average is around 160 mg/dL. Hypertension runs on my dad's side of the family (Nigerian). His blood pressure was 200/140mm Hg (normal 120/80), before he cut salt out of his diet and it fell back to normal. My generation, a chimeric mix of German and Nigerian traits, is now at a high risk of getting both conditions, which is a well studied recipe for early death.
But so far, at age twenty-two, I'm pretty healthy. My blood pressure has always been normal. I exercise a lot. I am slightly overweight, but that's just because BMI is useless for people afflicted with big bones. My diet is pretty healthy; I eat many more servings of fruits and vegetables than the average American my age. But I am at an "increased risk" for heart disease because I have diabetes mellitus. I still do not understand why I am at an increased risk if I am a type I diabetic. I don't think I've ever been told or have ever read that type I diabetes puts people at an increased risk for cardiovascular disease. So why do I have to worry about my cholesterol?
Well, first, my cholesterol actually was a little high. The first time I can recall being conscious about my cholesterol was when my lipid panel was reviewed by my adult endocrinologist. She immediately put me on Lipitor. At the time I thought whatever would make me healthier, I'd do. As a "lay person," I trusted my physician entirely. When I did my lipid panel screening again, about a half year later, my numbers were lower--they were better--and she kept me on Lipitor. I became suspicious. So I checked my numbers. The lab results always provide a normal range, so I reviewed it. Both times, my numbers were excellent. I mean, not excellent, but they were normal and I was healthy.
So why the Lipitor?
A risk assessment is used to judge whether or not a patient should consider changing their lifestyle (eating, exercising) habits or if they need to be more pro-active and be placed on a drug-enhancing regimen (Lipitor), Diabetes--but they never say which type--is considered a high risk factor. But that's the only risk factor I have. The risk assessment formula says that if I have 0-1 risk factors, my low density lipoprotein (LDL, the bad cholesterol) goal should be: <160 mg/dL. Guess what? It was! HIPPA be damned, I'll tell you what my LDL cholesterol was: 132 mg/dL. If it had been above 160 mg/dL, according to the assessment chart, a lifestyle change would have been recommended. Only at 190 would I need a more intensive pharmaceutical intervention. So why was I put on Lipitor?
Well, it helped. My total cholesterol was 190, my HDL was 43, and my Triglyceride was 77. A year later with Lipitor, my total cholesterol was 195, my triglyceride was 56, as was my HDL. And my LDL was a greatly reduced 128 (sarcasm).
But you know what made me even healthier according to the scale and charts and assessments? First, I gave up on Lipitor after my second lipid panel screening. Why? Because the pharmacy said I didn't have any more prescriptions and I didn't feel like calling my doctor to get me more. Second, I turned twenty-one. And around six months into being twenty-one, I realized that I loved red wine. I also started cooking more often and realized that olive oil is a good substitute for butter in almost everything. At age twenty-two I had another lipid panel screening. This time, my total cholesterol was 167, HDL 64, triglyceride 55, LDL 92.
Hmmm....
I know they're just numbers, but "statistically" I was much healthier.
What am I suggesting? That diabetics be given red wine earlier than age twenty-one? No. Never. Although...
In all seriousness, drugs are great. But they aren't a cure-all. Especially when it's something that can be heavily modulated by simple lifestyle choices. Look at America. There are serious health issues we need to address. But should we prescribe drugs after a problem arises? Or should we try to tell people what they can change in their kitchen and in their lives to make them healthier by their own volition? Drugs are great, and I don't want to argue against their over prescription in America, but when I'm placed on a drug to lower cholesterol, it would be great if I was told how this problem arose and what I can do, myself, to make it better.
Boiled down, what happened to me was simply a problem with patient empowerment. If you give your patients advice that is comprehensive but also understandable, their adherence should be higher, and as a result, they should be healthier. Doctors are important. We need more of them. But perhaps what's even more vital than quantity is quality, specifically as it deals to communication. A patient should know that sometimes, they are their own best medicine.
Drug Shortage
Perhaps a continuing theme of my writing's will be concerned with how few doctors there are. As previously noted, there is a shortage of primary care physicians in America. There is also a shortage of podiatrists. But did you know, that there is also, right now, a shortage of drugs in America?
I was just watching the national news last week when Diane Sawyer told me that the lack of prescription drugs in America was having real health consequences in America, with an estimated 15 deaths caused from drug shortages in the last year. Fifteen deaths. It doesn't sound that terrifying or even wrong if it's applied to something expected to be deadly in America, like Swine Flu or even just the regular type of influenza. But fifteen is a lot of lives lost if you consider that these afflictions were 100% treatable. I know morality and ethics tend to devolve into an annoying morass of public opinion sometimes, but if these people wanted to be alive yet couldn't make it because their health care providers couldn't provide the appropriate medicine, and then they died, that's wrong. Blatantly, offensively, inexcusably wrong. If I want to live, I should be afforded as much help as medically possible.
And do you know some of the theories behind why there are suddenly drug shortages in the nation that has the best health care in the world? Like everything else that's wrong with this country's politics, it's because of money. One of the suspected reasons drugs are suddenly hard to come by is because patents for some of the largest drugs have run out, which means they can start being manufactured and sold as cheaper generics from the non-original company. This means that the original company stops making as much of their product because they know they will lose profit as other pharmaceutical companies increase supply by mass producing generics. Except when they don't. And then, well, you know, people die.
I was just watching the national news last week when Diane Sawyer told me that the lack of prescription drugs in America was having real health consequences in America, with an estimated 15 deaths caused from drug shortages in the last year. Fifteen deaths. It doesn't sound that terrifying or even wrong if it's applied to something expected to be deadly in America, like Swine Flu or even just the regular type of influenza. But fifteen is a lot of lives lost if you consider that these afflictions were 100% treatable. I know morality and ethics tend to devolve into an annoying morass of public opinion sometimes, but if these people wanted to be alive yet couldn't make it because their health care providers couldn't provide the appropriate medicine, and then they died, that's wrong. Blatantly, offensively, inexcusably wrong. If I want to live, I should be afforded as much help as medically possible.
And do you know some of the theories behind why there are suddenly drug shortages in the nation that has the best health care in the world? Like everything else that's wrong with this country's politics, it's because of money. One of the suspected reasons drugs are suddenly hard to come by is because patents for some of the largest drugs have run out, which means they can start being manufactured and sold as cheaper generics from the non-original company. This means that the original company stops making as much of their product because they know they will lose profit as other pharmaceutical companies increase supply by mass producing generics. Except when they don't. And then, well, you know, people die.
Sep 16, 2011
PMI
So the place on my chest where I sometimes hold my right hand to feel my heart beat to calm me down after I've been crying or after I've been shocked or if I'm bored and tired but can't go to sleep or if I simply want to know that I'm still alive, and if I am I'll just sit and wonder a little bit about life and death before the discussion loses me to delta wave sleep, that's the Point of Maximal Impulse, or PMI. It's where your stronger left ventricle strikes your chest wall when it pushes blood through your aorta, shortly after systole, your first heart sound. It is usually located in the mitral area of the heart, so named because the mitral valve separates the left atria from the left ventricle.
Sep 14, 2011
Writing for Anatomy
The first thing we knew about our cadaver was that we should not call it a cadaver. It was a person. But it wasn't alive. We didn't know how to use that in sentences, so we'd begin to refer to it as a cadav--, before catching ourselves and saying, "Our body," instead, like it was something we owned, which felt worse.
The second thing we knew about our body was that it was a she and that her name was Debbie. This helped, because now in reference, we could say something like, "Thank God Debbie looks fit," which simply meant we wouldn't be elbow deep in adipose tissue half way through the dissection. This taught us how to say “Thank You.”
The third thing we knew about our Debbie was that she died at age 46. We did not like knowing this. We tried to escape our feelings by immersing ourselves in a cerebral game of pursuit for a suitable cause of death. Subdural hematoma. Car accident, perhaps. Congenital heart failure. Aortic rupture. An uncommon medical malady? Someone in our group suggested cancer, said that one of their favorite professors had just been diagnosed with late stage breast cancer, absolutely devastating. That brought us back to our feelings.
We did not like knowing that Debbie died when she was 46.
The rest of the things we knew about Debbie we learned slowly. I noticed a hideous blue-green iridescent shade of nail polish on her fingernails. I wondered if she had decided on that color herself or if it was chosen by an out of touch mortician for the funeral service--if she had had one. But I learned I would always give Debbie the benefit of the doubt. The formalin she was awash in probably soaked into her nails and leached the original color, just as the 10% formaldehyde solution found its way under my nails, despite the barrier of vinyl gloves, and stayed with me.
We learned from Debbie that the process of cutting open a human body is not horrifying. We learned from Debbie that the skin on the middle of the back is thick, but not so thick that a fresh scalpel needs much pressure applied to it to get where it needs to go. I learned from Debbie that I am very good at removing fascia. I learned from Dr. Oblinger that fascia is only connective tissue. I learned that you can feel really good about yourself that first day for helping your group with the dissection, but when you look down at your hands and see off-white gloves covered in flecks of skin, hair, and connective tissue, you will no longer feel right. That day, I learned that the urge to drop scalpel and run, the fear of death, would reaffirm my own life. But thanks to Debbie, I soon realized that I would learn a lot about life from death.
So thank you Debbie.
Sep 13, 2011
Is Nothing Sacred Anymore?
It finally happened. I dreamed about the things I spent all week learning. Most surprising, it wasn't material that would easily translate into a traditional dream--like dissecting a human body or telling a patient they have inoperable cancer. Even moving through the trans-Golgi network would seem somewhat plausible. No. This dream was about biochemistry.
A small group of stock medical students and I completed biochemistry pathway challenges:
"We need to find the glyceraldehyde 3-phosphate dehydrogenase!"
"I don't think it exists."
"It should exist; we're hypoglycemic."
"I told you it doesn't exist!"
"Don't give me that crap Jenkins!"
And then most bizarre, at the end, Jay Leno or David Letterman would summarize the pathway for me.
I think I screamed out fructose in my sleep. I hate fructose. Has medical school devolved into a never ending nightmare?
A small group of stock medical students and I completed biochemistry pathway challenges:
"We need to find the glyceraldehyde 3-phosphate dehydrogenase!"
"I don't think it exists."
"It should exist; we're hypoglycemic."
"I told you it doesn't exist!"
"Don't give me that crap Jenkins!"
And then most bizarre, at the end, Jay Leno or David Letterman would summarize the pathway for me.
I think I screamed out fructose in my sleep. I hate fructose. Has medical school devolved into a never ending nightmare?
Sep 7, 2011
Hobbies
I've decided I won't be productive tonight. I don't feel bad about this. So I'm watching CSI on CBS. I get two "normal" channels: CBS and ABC. I also get the Korean Broadcasting Channel. But regardless, I saw a commercial for Lyrica. Lyrica is a prescription drug designed to treat Fibromyalgia. The commercial's heroine was a woman who worked at a jewelry store as a beader. Her selling statement, about why people who have chronic tenderness and pain in their muscles and joints should ask their doctors about Fibromyalgia was: "... So I can get back to what's really important in life."
Okay. I love beading. I regularly think of it as one of my preferred hobbies, next to creative writing, cooking, and sleeping. But I found this drug commercial absolutely ridiculous.
Keep in mind, I'm a pretty cynical person, and I'm aware that commercials are excellent manipulators, so I like to point out their unavoidable logical fallacies. When would beading ever be what's really important in life? It was the woman's job to make jewelry, to bead, but even then... what a lame job.
And then I realized something. It wasn't that I hated the fact that Fibromyalgia wouldn't allow someone to get back to "what's really important in life." It totally, maybe, probably can. What really bothered me about this commercial is that something as fun, yet unimportant, as jewelry making, could be someone's main reason in life...
Okay. I love beading. I regularly think of it as one of my preferred hobbies, next to creative writing, cooking, and sleeping. But I found this drug commercial absolutely ridiculous.
Keep in mind, I'm a pretty cynical person, and I'm aware that commercials are excellent manipulators, so I like to point out their unavoidable logical fallacies. When would beading ever be what's really important in life? It was the woman's job to make jewelry, to bead, but even then... what a lame job.
And then I realized something. It wasn't that I hated the fact that Fibromyalgia wouldn't allow someone to get back to "what's really important in life." It totally, maybe, probably can. What really bothered me about this commercial is that something as fun, yet unimportant, as jewelry making, could be someone's main reason in life...
Sep 3, 2011
This is only my Heart Beat
I was listening to my heart tonight. The first year medical students and podiatrists had the essentials of clinical reasoning lab this week, and we all had to mock running through a complete cardiac exam with a partner. What I learned in lab strengthened the self-taught lesson I've been constructing this week: everyone's different. This is obvious in anatomy lab during our dissection of a once living person when we become so careful with our scalpels we are frozen in stasis, not just because we are trying to be respectful of the human body lying before us--though we initiate each lab with protocols permeated with gratefulness--but because the bodies given to science look nothing on the inside like the computer model--also of a once living person. I also discovered during our clinical reasoning lab that my femoral artery is really close to my leg, as opposed to being more ventrally lateral... or laterally ventral.
So I was listening to my different heart tonight. In lecture we were told that there are usually just two heart sounds, S1 and S2. But sometimes, there are other noises that can be categorized as S3 and S4. I was shocked--as I held the bell of my stethoscope over my aorta--that I could definitively hear the S2 split.
S1 is the first heart sound, created by the closing of the mitral and tricuspid valves, the borders between the left and right atria and ventricles, respectively. This is the low beat that haunts miscreants and murderers. S2 is the softer of the heart sounds, created when the aortic and pulmonic valves close, successfully closing off re-entrance to the heart by expelled blood. S2 heart sounds are often split. But in my heart, it almost sounded as if there were three heart beats. Am I so musical that even my organs fill with syncopation? Or maybe I'm still very young. Splitting disappears in advanced age, apparently. Just like I had a heart murmur when I was little--noticeable in the slight whoosh sounded by blood passing through my intraventricular septum--that ultimately disappeared.
When I moved my stethoscope to the mitral auscultatory area, which in most people centers over their left ventricular wall, the S2 split disappeared. Physics. The distance from the base of the heart to the pulmonary artery and aorta split is not huge, but it makes a difference, especially when you consider the medium that sound is traveling through isn't air--it's mostly water. The closing valves, a quarter of a second off each other before, are now almost synchronized. My heart, antagonized for years by swimming, asthma, anemia, and a minor septal defect, is now a little large. Not too large. But it's hypertrophic. Its beating is resplendent.
How weird it was for me to hear my heart, to feel it push against my stethoscope--forcing my hand up into the wiring of my bra--as strong as a magnet or gravity or some other force which is strong but invisible. For the last week, we've been talking about the heart--how it forms in embryos and further develops in fetuses, how it can be used to explain many confusing differential diagnoses. I've seen the inside of a baby's heart beating rapidly, around one-hundred-and-twenty beats per minute, as a laser pointer indicated where the ventricular septum didn't grow fully through the heart's chamber, sectioning off right from left. I wonder if the images we saw were from babies who made it. I'm committed to being pro-choice and plan to stay that way for the rest of my life--it seems like the only rationale position to take as a physician who respects her patients. But, in silence, I wished that the babies that graciously allowed us to learn from their ultrasound videos made it fully into life. After all, I have seen into their hearts. Defective or not, a beating heart is rather miraculous. Especially if you believe that evolution, and only evolution alone, got us to this point where there are a mere 20 heart defects in 1000 births.
So I was listening to my different heart tonight. In lecture we were told that there are usually just two heart sounds, S1 and S2. But sometimes, there are other noises that can be categorized as S3 and S4. I was shocked--as I held the bell of my stethoscope over my aorta--that I could definitively hear the S2 split.
S1 is the first heart sound, created by the closing of the mitral and tricuspid valves, the borders between the left and right atria and ventricles, respectively. This is the low beat that haunts miscreants and murderers. S2 is the softer of the heart sounds, created when the aortic and pulmonic valves close, successfully closing off re-entrance to the heart by expelled blood. S2 heart sounds are often split. But in my heart, it almost sounded as if there were three heart beats. Am I so musical that even my organs fill with syncopation? Or maybe I'm still very young. Splitting disappears in advanced age, apparently. Just like I had a heart murmur when I was little--noticeable in the slight whoosh sounded by blood passing through my intraventricular septum--that ultimately disappeared.
When I moved my stethoscope to the mitral auscultatory area, which in most people centers over their left ventricular wall, the S2 split disappeared. Physics. The distance from the base of the heart to the pulmonary artery and aorta split is not huge, but it makes a difference, especially when you consider the medium that sound is traveling through isn't air--it's mostly water. The closing valves, a quarter of a second off each other before, are now almost synchronized. My heart, antagonized for years by swimming, asthma, anemia, and a minor septal defect, is now a little large. Not too large. But it's hypertrophic. Its beating is resplendent.
How weird it was for me to hear my heart, to feel it push against my stethoscope--forcing my hand up into the wiring of my bra--as strong as a magnet or gravity or some other force which is strong but invisible. For the last week, we've been talking about the heart--how it forms in embryos and further develops in fetuses, how it can be used to explain many confusing differential diagnoses. I've seen the inside of a baby's heart beating rapidly, around one-hundred-and-twenty beats per minute, as a laser pointer indicated where the ventricular septum didn't grow fully through the heart's chamber, sectioning off right from left. I wonder if the images we saw were from babies who made it. I'm committed to being pro-choice and plan to stay that way for the rest of my life--it seems like the only rationale position to take as a physician who respects her patients. But, in silence, I wished that the babies that graciously allowed us to learn from their ultrasound videos made it fully into life. After all, I have seen into their hearts. Defective or not, a beating heart is rather miraculous. Especially if you believe that evolution, and only evolution alone, got us to this point where there are a mere 20 heart defects in 1000 births.
Aug 30, 2011
Cardiac Examination
Did you know that when giving a cardiac exam, you are supposed to "First palpate for heaves, lifts, or thrills, using your fingerpads"? I didn't know this. But it does make me feel like my medical school band should be named: Heaves Lifts and the Thrills.
Bates' Guide to Physical Examination and History Taking. Tenth Edition. page 356.
Bates' Guide to Physical Examination and History Taking. Tenth Edition. page 356.
Aug 29, 2011
The Effects of Stress on Blood Glucose
First test went poorly. How do I know this? I know this because my initial blood sugar prior to the onset of the test was 104 mg/dL. Five hours later, with only the consumption of a cookie with approximately 25g of carbohydrates, my blood sugar was 345 mg/dL. If my current corrective factors are 1 u insulin per 10 g carbohydrate and 1 u insulin for 25 mg/dL over a normal baseline of 125 mg/dL, my blood glucose was off by around 180 mg/dL. It was off because of stress. The stress was equivalent to 88 g of carbohydrates. 352 Calories. 5 shots of Tanqueray or a Quarter Pounder with cheese or two cups of Lucky Charms.
It went that bad.
It went that bad.
Aug 28, 2011
Studying for Anatomy
Our first test is tomorrow.
I have a great sense of direction but I'm pretty terrible at solving spatial puzzles. For this reason, the following paragraph means nothing to me, although I'm pretty sure it's important:
The superior borders of the transversely elongated bodies of the cervical vertebrae are elevated posteriorly and especially laterally but are depressed anteriorly, resembling somewhat a sculpted seat. The inferior border of the body of the superiorly placed vertebra is reciprocally shaped. The adjacent cervical vertebrae articulate in a way that permits free flexion and extension and some lateral flexion but restricted rotation. The planar, nearly horizontal articular facets of the articular processes are also favorable for these movements. The elevated superolateral margin is the uncus of the body (uncinate process).
"Clincally Oriented Anatomy: Sixth Edition. Moore, Dalley, Agur. Lippincott Williams & Wilkins 2010; page 445."
The what now?
I have a great sense of direction but I'm pretty terrible at solving spatial puzzles. For this reason, the following paragraph means nothing to me, although I'm pretty sure it's important:
The superior borders of the transversely elongated bodies of the cervical vertebrae are elevated posteriorly and especially laterally but are depressed anteriorly, resembling somewhat a sculpted seat. The inferior border of the body of the superiorly placed vertebra is reciprocally shaped. The adjacent cervical vertebrae articulate in a way that permits free flexion and extension and some lateral flexion but restricted rotation. The planar, nearly horizontal articular facets of the articular processes are also favorable for these movements. The elevated superolateral margin is the uncus of the body (uncinate process).
"Clincally Oriented Anatomy: Sixth Edition. Moore, Dalley, Agur. Lippincott Williams & Wilkins 2010; page 445."
The what now?
Aug 26, 2011
Subdural Hematoma
I think subdural hematoma was the first doctor phrase I learned. It has a nice rhythm to it. I think I was watching late night television with my parents, maybe a sister, when my dad got a call and then he conferenced with my mother about whether or not to go in. I don't know; apparently, most of your memories are completely constructed by the time your an adult.
Today I learned that the subdural space is a "potential" space that is not meant to be used. Except by hematomas. Which are bad and you don't want those.
Today I learned that the subdural space is a "potential" space that is not meant to be used. Except by hematomas. Which are bad and you don't want those.
Aug 25, 2011
Patient History
So last Friday, things got real. This is, of course, an overstatement, because as a first year medical student, the misnomer "real" simply implies that the activity is modeled after the "real" thing, "real" here being clinical rotation.
[A brief aside: There are a lot of extraneous words in medicine. To excel at most of these courses, you need to understand how the English language, and its romantic predecessor, work. You also need to know an astronomically huge number of words. During the briefing for anatomy we were told we'd learn 5,000-7,000 new terms just by cutting apart the human body--which I guarantee you is a finite object. Today I found myself looking up terms during our embryology lecture. I believe I have an intermediate grasp of vocabulary. But when I had to look up "occlude", I felt like an idiot. At least when I leave medical school, I won't feel embarrassed pursuing conversation with my peers, intellectuals who went on to pursue graduate studies in English, at cocktail parties: Oh yes, I feel like this 1999 Cabernet Sauvignon is occluding the citric taste of these gourmet Chipwiches. Closing aside: What is the exact definition of clinical rotation?]
The session I had on Friday was an introductory lesson on how to take down a complete patient history, including chief complaint. I was observed on a computer screen by my partner, taking brief notes, in another room. I was judged on several metrics, and I knew this as I sat across from someone and talked to them about their health. The whole thing was fake because the patient was standardized. There are actually professional patients. The pain they explain is not actually real. Their names and their lives are fictitious. But they are "technically" alive, and this is where it got tricky for me.
I love doctor-patient communication. I find communication fascinating. And it's important. Learning how to say the right thing is sometimes more important than knowing what the right thing is. I firmly believe I have a handle on the way doctors and patients should interact. I wrote a thesis on the topic, and I am convinced my final solution, crafted out on pages thirty-eight through forty-two, would work wonders for the field of primary care... if we lived in a theoretical world. Unfortunately, undergraduate institutions love idealizing things. Everything seems more "right" or "wrong", "effective" or "useless" when you're reading hundreds of papers and looking at statistics and analyzing everything from a safe distance.
Put me face to face with an actual human being, who is alive, and I no longer care that I am supposed to ask them about their lives or that I need to know the exact quality of their pain. I no longer know that perhaps the way I speak is too fast, too convoluted... nonsensical. I'm palpitating just thinking about it.
If the professional patient/actor had been a robot, with non-judgmental eyes, maybe I would have calmly proceeded to ask it a lot of seemingly irrelevant but pertinent questions. Maybe I would have done well. But I wanted to become a human doctor. Serves me right. I shook the entire time. I started sentences I was unsure how to finish. I never did get around to asking questions about family history. My notes are a jumbled mess.
I wonder in what situations meeting someone for the first time won't be nerve-racking. Will that time occur when I'm a full-fledged doctor and my status crushes fear? Or will it always be stressful trying to think with a first time patient why they feel as bad as they do.
My professional patient said I did a good job of sounding coherent and making eye contact, but I know that's not good enough. She said I needed to do a better job of setting up an agenda from the get go. I wonder what's the best way to do that?
So right now I am putting my theories on hold. The funny thing is, all this dread and apprehension was caused by a clinical setting that was highly controlled and entirely fake. The real world is waiting for me, not too far away. Real patients. Real problems. Real communication issues. Now that's terrifying.
[A brief aside: There are a lot of extraneous words in medicine. To excel at most of these courses, you need to understand how the English language, and its romantic predecessor, work. You also need to know an astronomically huge number of words. During the briefing for anatomy we were told we'd learn 5,000-7,000 new terms just by cutting apart the human body--which I guarantee you is a finite object. Today I found myself looking up terms during our embryology lecture. I believe I have an intermediate grasp of vocabulary. But when I had to look up "occlude", I felt like an idiot. At least when I leave medical school, I won't feel embarrassed pursuing conversation with my peers, intellectuals who went on to pursue graduate studies in English, at cocktail parties: Oh yes, I feel like this 1999 Cabernet Sauvignon is occluding the citric taste of these gourmet Chipwiches. Closing aside: What is the exact definition of clinical rotation?]
The session I had on Friday was an introductory lesson on how to take down a complete patient history, including chief complaint. I was observed on a computer screen by my partner, taking brief notes, in another room. I was judged on several metrics, and I knew this as I sat across from someone and talked to them about their health. The whole thing was fake because the patient was standardized. There are actually professional patients. The pain they explain is not actually real. Their names and their lives are fictitious. But they are "technically" alive, and this is where it got tricky for me.
I love doctor-patient communication. I find communication fascinating. And it's important. Learning how to say the right thing is sometimes more important than knowing what the right thing is. I firmly believe I have a handle on the way doctors and patients should interact. I wrote a thesis on the topic, and I am convinced my final solution, crafted out on pages thirty-eight through forty-two, would work wonders for the field of primary care... if we lived in a theoretical world. Unfortunately, undergraduate institutions love idealizing things. Everything seems more "right" or "wrong", "effective" or "useless" when you're reading hundreds of papers and looking at statistics and analyzing everything from a safe distance.
Put me face to face with an actual human being, who is alive, and I no longer care that I am supposed to ask them about their lives or that I need to know the exact quality of their pain. I no longer know that perhaps the way I speak is too fast, too convoluted... nonsensical. I'm palpitating just thinking about it.
If the professional patient/actor had been a robot, with non-judgmental eyes, maybe I would have calmly proceeded to ask it a lot of seemingly irrelevant but pertinent questions. Maybe I would have done well. But I wanted to become a human doctor. Serves me right. I shook the entire time. I started sentences I was unsure how to finish. I never did get around to asking questions about family history. My notes are a jumbled mess.
I wonder in what situations meeting someone for the first time won't be nerve-racking. Will that time occur when I'm a full-fledged doctor and my status crushes fear? Or will it always be stressful trying to think with a first time patient why they feel as bad as they do.
My professional patient said I did a good job of sounding coherent and making eye contact, but I know that's not good enough. She said I needed to do a better job of setting up an agenda from the get go. I wonder what's the best way to do that?
So right now I am putting my theories on hold. The funny thing is, all this dread and apprehension was caused by a clinical setting that was highly controlled and entirely fake. The real world is waiting for me, not too far away. Real patients. Real problems. Real communication issues. Now that's terrifying.
Aug 22, 2011
Clinical Medicine
I learned something today. This is very exciting. Up to this point, all material presented in lecture and in notes has been review or ignored by me.
Today I learned that "most fractures are identified by cortical interruption." Dr. Waxler informed the packed Rhoades auditorium of this today. He is a radiologist. I didn't think radiologist's would be funny. I was surprised. Good thing, too. Today was also the first day we had four straight hours of lecture.
Today I learned that "most fractures are identified by cortical interruption." Dr. Waxler informed the packed Rhoades auditorium of this today. He is a radiologist. I didn't think radiologist's would be funny. I was surprised. Good thing, too. Today was also the first day we had four straight hours of lecture.
Aug 20, 2011
Professionalism
I recently had a terrifying thought. I can no longer afford to be a "child." Sociologists have been talking about the prolonged period of childhood that young Americans are currently enjoying. Unfortunately for me, my mother, the perpetuating essence of childhood, works at the institution where I am attempting to become a "professional." Why should I worry about anything that may deal with being a professional when I can have my mom tell me what to do? What to wear? What to say? and whom to talk to?
This afternoon I had an exercise that thrust me into the position of mocking an actual doctor. A doctor. All my life, no matter how close I got to the field, I guess it never occurred to me that I'd ever actually become a physician. There was always a way out. A way to be less responsible. Jail time. Artistry. Hell, even suicide. But no. I am twenty-two years old and I am still alive. And I still want to help people discover health for themselves. I will talk more about my experience in the EEC lab, but for now I will just say, the entire practice slapped some sense into me. Dreadful sense.
I have an apartment now. I have a dishwasher. I still haven't put all my clothes, the few clothes I've brought with me, onto hangers. And as I laid in my living room, next to a basket holding my clothes, looking at a ceiling that belonged to me for the next two years, I realized I could no longer just put off "cleaning my room" for a later date, for the next Wednesday when my mother would walk in, arms akimbo, telling me that the cleaners were coming and if I wanted the crumbs and dirt vacuumed up off my floor, I better get at it.
The problem is, I don't know if I'm ready. I went back home tonight, to pick up some things... things to help me study. I have a giant Anatomy book now. The pictures are fantastic. And I have my dad's old chemistry set so I can build the twenty amino acid structures like so many lincoln logs or legos, stacked on top of each other. I am a child. I love learning. I always will. But am I ready to learn for the betterment of other people? Or am I still a selfish, small child?
I need to become a pediatrician. I need to work among my peers.
This afternoon I had an exercise that thrust me into the position of mocking an actual doctor. A doctor. All my life, no matter how close I got to the field, I guess it never occurred to me that I'd ever actually become a physician. There was always a way out. A way to be less responsible. Jail time. Artistry. Hell, even suicide. But no. I am twenty-two years old and I am still alive. And I still want to help people discover health for themselves. I will talk more about my experience in the EEC lab, but for now I will just say, the entire practice slapped some sense into me. Dreadful sense.
I have an apartment now. I have a dishwasher. I still haven't put all my clothes, the few clothes I've brought with me, onto hangers. And as I laid in my living room, next to a basket holding my clothes, looking at a ceiling that belonged to me for the next two years, I realized I could no longer just put off "cleaning my room" for a later date, for the next Wednesday when my mother would walk in, arms akimbo, telling me that the cleaners were coming and if I wanted the crumbs and dirt vacuumed up off my floor, I better get at it.
The problem is, I don't know if I'm ready. I went back home tonight, to pick up some things... things to help me study. I have a giant Anatomy book now. The pictures are fantastic. And I have my dad's old chemistry set so I can build the twenty amino acid structures like so many lincoln logs or legos, stacked on top of each other. I am a child. I love learning. I always will. But am I ready to learn for the betterment of other people? Or am I still a selfish, small child?
I need to become a pediatrician. I need to work among my peers.
Aug 18, 2011
An Interesting Aside: I'm Diabetic
Today one of the lecturers for one of my classes decided to tell everyone an exciting "diabetes-related" finding. I no longer remember how it related to Embryology, but the point was something like this: EVEN DIABETICS WITH GOOD CONTROL OF THEIR SUGARS END UP SUFFERING THE COMPLICATIONS OF DIABETES IN THE LONG RUN. WHY? OH, WELL, BECAUSE THE INITIAL SPIKE IN BLOOD GLUCOSE CAUSES METHYLATION OF THE DNA WHICH LEADS TO COMPLICATIONS SUCH AS BLINDNESS, AMPUTATIONS, LOSS OF HEARING, LOWER QUALITY OF LIFE, ETCETERA. Why the hell did this professor feel like this was a necessary sidenote? I don't know. Maybe because he talks like someone raised firmly on the Mason-Dixon line and cutting to the point doesn't make a whole lot of FUCKING SENSE to those people. So yes. Elora Apantaku, the beautiful, kind of hilarious, kind of lovely ELORA APANTAKU, will be losing her long legs and her perceptive …
I started crying. No sense in continuing. Fuck.
I started crying. No sense in continuing. Fuck.
Aug 17, 2011
America's Screwed
I am enrolled at Chicago Medical School. It's in glorious North Chicago which is twenty miles from the harrowing Wisconsin border. The first two years at CMS are spent embedded in the Rosalind Franklin University of Medicine and Science. But RFUMS is composed of four institutions besides CMS. Most famously, the Scholl College of Podiatric Medicine resides here, named after the man--the podiatrist and legend--who achieved commercial success with his shoe inserts.
During orientation last week, the dean for CMS stood in front of all the first years in all five programs and told us that this was an exciting time to be getting into medicine. Why? There's a shortage of doctors in America. I disagreed with his use of the word "exciting" when "important" seemed more accurate. But no matter how anyone chooses to describe the situation, it's still a problem. I've read about the issue extensively, and the number of doctors America will be missing in the next decade is startling. Even the most modest estimates claim that the American health system will be missing 91,000 doctors by 2025. As I sat in the middle of Rosalind Franklin University's largest auditorium, surrounded by one of the larger medical school classes in America--boasting almost two hundred students--it occurred to me: this country is screwed.
I tried to run the numbers through my head. There aren't thousands of medical schools in America. There are 159. If the average class size is fifty... that's about 3,000 new medical students per year. If they all practice for about forty years before retiring, then that's about 120,000... but then the population of America will probably keep increasing... and you have to figure that at least half of all physicians will specialize and then America's left with a dearth of primary care again so... Yea, America's screwed.
I don't know who decided to limit the number of medical students--yes, there's a cap on the number of students allowed into medical school each year. And I don't know who decided to make medical school so expensive--I put down $601 for text books this term, wait no... that only covered half of my course expenses. And I don't know why no one seems to be subsidizing primary care physicians even though American legislature has no problem subsidizing corn crops, a process that has negatively impacted the global food market, the obesity rates of Americans (who, as a result, will require even more physicians), and Iowa. But if I could meet the people who decided these arbitrary things, I'd punch them in the face.
I attempted to forget my bitter thoughts on this issue. The dean finished his talk; the entire auditorium erupted in curt applause that ended quickly. Then the dean of the podiatry college was introduced. She was funnier than our dean. But near the end of her time standing in front of anxious first years, she too echoed the first dean. Did you know? There's also a shortage of podiatrists in America.
So at least there's that.
Further Reading:
During orientation last week, the dean for CMS stood in front of all the first years in all five programs and told us that this was an exciting time to be getting into medicine. Why? There's a shortage of doctors in America. I disagreed with his use of the word "exciting" when "important" seemed more accurate. But no matter how anyone chooses to describe the situation, it's still a problem. I've read about the issue extensively, and the number of doctors America will be missing in the next decade is startling. Even the most modest estimates claim that the American health system will be missing 91,000 doctors by 2025. As I sat in the middle of Rosalind Franklin University's largest auditorium, surrounded by one of the larger medical school classes in America--boasting almost two hundred students--it occurred to me: this country is screwed.
I tried to run the numbers through my head. There aren't thousands of medical schools in America. There are 159. If the average class size is fifty... that's about 3,000 new medical students per year. If they all practice for about forty years before retiring, then that's about 120,000... but then the population of America will probably keep increasing... and you have to figure that at least half of all physicians will specialize and then America's left with a dearth of primary care again so... Yea, America's screwed.
I don't know who decided to limit the number of medical students--yes, there's a cap on the number of students allowed into medical school each year. And I don't know who decided to make medical school so expensive--I put down $601 for text books this term, wait no... that only covered half of my course expenses. And I don't know why no one seems to be subsidizing primary care physicians even though American legislature has no problem subsidizing corn crops, a process that has negatively impacted the global food market, the obesity rates of Americans (who, as a result, will require even more physicians), and Iowa. But if I could meet the people who decided these arbitrary things, I'd punch them in the face.
I attempted to forget my bitter thoughts on this issue. The dean finished his talk; the entire auditorium erupted in curt applause that ended quickly. Then the dean of the podiatry college was introduced. She was funnier than our dean. But near the end of her time standing in front of anxious first years, she too echoed the first dean. Did you know? There's also a shortage of podiatrists in America.
So at least there's that.
Further Reading:
Aug 7, 2011
How Doctors Think
In anticipation for orientation, I've been reading How Doctors Think by Jerome Groopman, MD. It was interesting, and I was immediately compelled to finish the 200+ page book after he references and quotes Judith Hall and Debra Roter in the introduction. Hall and Roter are two researchers who have looked extensively at doctor-patient interaction and communication styles, and I referenced them a lot in my Rhetoric thesis that examined communication in health care. The book was eye opening in that it did a great job of informing the reader about which types of cognitive errors bias the way doctors treat their patients. Absolutely fascinating. I've always found that understanding logical fallacies allows you to deal with people and to make sense of complicated situations. To know that there are several logical fallacies that even well intentioned doctors make frequently is reason enough to write an entire book.
I have two concerns with Dr. Groopman, however. First, he seems to be praising all the doctors he talks about (with a few exceptions). I wonder if it would be more useful for people to know how bad doctors think more so than to understand how competent doctors deal with diagnoses, because sometimes you aren't given the liberty, although you should have it, to choose your clinician for yourself.
My second concern is more insidious and/or uppity. Paternalism. It's clear that Dr. Groopman is against it. He is quick to praise a few doctors who unbiasedly talk to their patients in order to make sure that their patients choose their treatment for themselves and aren't subjected to being helpless to control their own medical destiny. But Dr. Groopman has a severe pronoun problem. Even though he talks about two or three excellent female physicians, he always refers to doctors as hes. And I guess that wouldn't be unforgivable, because grammatically he can be used as a gender neutral pronoun, even though it no longer carries that meaning for most readers. No, what makes it unforgivable is that he often refers to hypothetical patients as shes. He even ends his book talking about this hypothetical patient, and how she is adding vigor to the clearly sexist clinic by being an expert communicator and able to understand her male physician's every thought.
Gross. When the movement began to minimize paternalism in the clinic beginning in the 1970s, paternalism was symbolized by the interactions women had with men in that time. Women don't make decisions. They let their husbands decide for them. Because men and doctors generally have an elevated standing in society compared to women and patients respectively, this visualization makes sense and should strengthen a progressive individual's will to end clinical paternalism at all costs.
Though the insight that Groopman has into clinical practice makes it easy to forgive him. Also, the fact that he's in his sixties or seventies and trained during a much more... sexist time, makes it a burden, but an acceptable one, to not get overly upset and just take value where there is some and ignore the rest.
Debra Roter and Judith Hall are two excellent female researchers. They have looked into the differences in communication styles between male and female physicians and are aware of the challenges facing women in health care. I wonder if they, after reading Groopman's book, noticed this slight rhetorical misdeed, or just conceded that there are some minor injustices you just have to accept.
I have two concerns with Dr. Groopman, however. First, he seems to be praising all the doctors he talks about (with a few exceptions). I wonder if it would be more useful for people to know how bad doctors think more so than to understand how competent doctors deal with diagnoses, because sometimes you aren't given the liberty, although you should have it, to choose your clinician for yourself.
My second concern is more insidious and/or uppity. Paternalism. It's clear that Dr. Groopman is against it. He is quick to praise a few doctors who unbiasedly talk to their patients in order to make sure that their patients choose their treatment for themselves and aren't subjected to being helpless to control their own medical destiny. But Dr. Groopman has a severe pronoun problem. Even though he talks about two or three excellent female physicians, he always refers to doctors as hes. And I guess that wouldn't be unforgivable, because grammatically he can be used as a gender neutral pronoun, even though it no longer carries that meaning for most readers. No, what makes it unforgivable is that he often refers to hypothetical patients as shes. He even ends his book talking about this hypothetical patient, and how she is adding vigor to the clearly sexist clinic by being an expert communicator and able to understand her male physician's every thought.
Gross. When the movement began to minimize paternalism in the clinic beginning in the 1970s, paternalism was symbolized by the interactions women had with men in that time. Women don't make decisions. They let their husbands decide for them. Because men and doctors generally have an elevated standing in society compared to women and patients respectively, this visualization makes sense and should strengthen a progressive individual's will to end clinical paternalism at all costs.
Though the insight that Groopman has into clinical practice makes it easy to forgive him. Also, the fact that he's in his sixties or seventies and trained during a much more... sexist time, makes it a burden, but an acceptable one, to not get overly upset and just take value where there is some and ignore the rest.
Debra Roter and Judith Hall are two excellent female researchers. They have looked into the differences in communication styles between male and female physicians and are aware of the challenges facing women in health care. I wonder if they, after reading Groopman's book, noticed this slight rhetorical misdeed, or just conceded that there are some minor injustices you just have to accept.
Aug 6, 2011
The First Post
Orientation week begins in a few days, so it seems appropriate that I had my first clinical nightmare last night. This is not a metaphor. I actually had a nightmare that took place as I was making "rounds." Tellingly, one of the main characters in this dream was JD from Scrubs. So... that happened.
I begin as an M1 (somehow this translates to first year, but I have yet to know what it actually stands for) at Chicago Medical School (CMS) in less than two weeks. I'm fairly anxious. And I don't think watching Scrubs will help.
I begin as an M1 (somehow this translates to first year, but I have yet to know what it actually stands for) at Chicago Medical School (CMS) in less than two weeks. I'm fairly anxious. And I don't think watching Scrubs will help.
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