Hassling with the "Need" to Medicate Mental Conditions

I think I'd be a great psychiatrist:

1. I like sitting.

2. Physical exams are my worst competency in clinicals.

3. I have several mental conditions (possibly), but I most definitely have one.

4. I treat people with mental conditions like people.

5. I see people with mental conditions as people.

Now let me elaborate:

In clinical neuroscience we end up watching a lot of patient interviews. One day we saw one with a schizophrenic. Later, me and a group of people got into a discussion, and I was the only one on my side of the argument, which was basically, the person seemed fine and functional enough, and why should we deem him “flawed”?

Yes, he had once been an irritable and a frequent assaulter. But on medication, he seemed talkative—enough, he had moods—enough of them, and he seemed normal—enough.

[One small point, shouldn’t normal be set by the patient? For example, when I was depressed, I knew I didn’t want to be depressed, and I considered the feeling abnormal and I wanted it corrected. But if I have occasional hallucinations that I enjoy, why change that? Or if I have synesthesia? That’s enjoyable. Right? And like, all famous actors have dyslexia. And they talk openly about it and it seems normal now, although you could easily argue it’s not.]

No one agreed with me. "Here," they said, "is a deeply troubled man. He assaulted over 100 patients, nurses, and doctors at his first hospital—etcetera etcetera. He was barely lucid. He wasn’t making sense. He wasn’t talkative."

But these things seemed normal to me. The great variance of human personalities also includes medically treated schizophrenics.

And why are we so eager to eliminate imperfections? Even the term imperfections makes it sound like there’s a one true normal (there isn’t) or that there’s only so many ways a person can be functional (there aren’t). I don’t want to sound like the preachy 2^nd grade teacher you were scared of because they loved diversity thiiiiiiiiiiiiiiiiiiis much, but in all honesty, I hate the idea that mental illness has to always be treated and that we all automatically look down on people with mental illness because society has trained us to fear the abnormal, especially the mentally so. I’m not just saying this because I have a mental illness, but as a person who has known, talked to, interacted with, and dated people with mental illnesses, I say we should all work on the way we see others with DSM-logged disorders.

If you’re born with something, you shouldn’t have to awkwardly try to hide it constantly. And while most mental illnesses aren’t entirely genetic, many of them have a strong genetic component. Even more importantly, if you don’t want to hide it, you shouldn’t be forced to.

Schizophrenia an interesting mental illness. While I haven’t yet studied the topic enough to know if most schizophrenics are violent, I do know that public perception of schizophrenics paints them as violent.

[Side note: There was a great episode of Law & Order: SVU that involved a schizophrenic who appeared to have killed the woman who was in charge of his group home. No one trusted him and he was in a panic for the entire episode. Until the person who murdered the woman murdered him. I rarely cry watching law shows. I bawled.]

Most schizophrenics probably don't want schizophrenia. But what if they don't mind it? Similarly, most people with bipolar disorder I don't want it, but what if they don't mind it? Should we medicate people? And when we do, are we actually doing it to protect others? Or are we just doing it to quiet an imperfection, an imperfection we are holding on with us and projecting onto the larger world? I think this is especially a problem for doctors, who control so much power to change a person's life. Wouldn't it be best to understand what quality of life such a person wants first?

Manic Depression

[Warning, explanation: this is the most personal blog post I've written so far, so if being close to people makes you uncomfortable, you can skip this. But it's medically related, technically]:

Psychiatry Class. 9 AM. Dr. S is giving an cursory lecture on various mental conditions. He gets to mania. He starts listing off characteristics. An entire row of students in my lecture hall, turn around to stare at me.

Am I manic? Perchance.

Like many mental conditions, you have to have a certain number of listed signs/symptoms in the DSM to be able to classify yourself as anything. But I do have some symptoms of mania:

Hobbies. I have many.

It’s break! And I’m attempting to catch up on some hobbies that I’ve set off. In the last year I’ve refined my skills in jewelry making and sewing—maybe almost to a commercial level. We’ll see (I’m trying to make a dress for the medical school’s big dance and if it ends up well I’ll put up pictures—thousands of them).

Also in the last year, I’ve managed to get into prop building, upholstery, and REALLY INTENSE INTERIOR DESIGN. Also glass cutting. Last year there was broken glass everywhere because I was breaking bottles to make sea glass. NOW there’s broken glass everywhere because I’ve been cutting up bottles to make beautiful plant containers. Progress!

Unfortunately, I’ve had so many projects, I’m forgetting about many of the little ones I’ve started, or finishing things late. I said my histology quilt would be done by the end of first semester. It’s still not even half way done.  

But it is still a huge boost to my self-esteem to be able to do things. Even if they’re just silly little things like being able to sew a button or make a good dinner from limited ingredients.  

So below are a series of things I've made or done this break (or in the two weeks proceeding it):

here's my instagram!

garter belt (for garter flasks...?)

making Snake Juice from the television show Parks & Rec

flannel infinity scarf, flannel fabric flower in hair

just the most beautiful colors of thread

jewelry with porcelain beads, sea glass circles, and freshwater pearls

name tag coasters (that can double as wallets!)

a new form of jewelry for me.

beer cap magnets

Seriously though, everything in medicine is really hard to pronounce, which is why there are 1000s of abbreviations.

Compliments of the Charming Cindy Chen

You've got Parrot Fever, Boy! Parrot Fever!

I'm 23 right now so yea.

me

ermergerd

case study micro

24 year old diabetic

fungal infection

dies

that's my M3 year.

Lub-Dub

In medical school, complete restructuring of what you always assumed fact happens quite a lot. You formulate a hypothesis on why something works the way it does when first introduced to a mechanism--only to realize it does not work that way at all when graduate school reintroduces you to it.

For example, our exam two Fridays ago, covered the cardiovascular system. We've already gone over the material cursorily in physiology, anatomy, and embryo last year (I say cursorily only because I don't remember doing particularly well on any of the material covering the heart). But even stretching beyond what I learned in my first year at medical school, I've been learning about the human heart for how long? Since fifth, maybe sixth, grade? That's thirteen years of knowing how the heart works, more or less. A lengthy exposure to the material plus the admission that the sound of a beating heart was the first thing I ever heard, either resounding from my own heart or from my mother's--and you'd think I would know why the heart sounds the way it does. 

But I just realized today that I was completely wrong in my thinking. The lub-dub sound your heart makes about 80,000 times a day is not caused by cardiac muscle rebounding from contractions. It's caused by your valves snapping shut after they're done ejecting blood. You'd think that would sound more like a clap. Nope. Lub-dub, lub-dub. I blame the giant heart at the Museum of Science and Industry downtown for this faulty information. I recall being distinctly unnerved by the sound of a beating heart emanating from an unseen corner of the multi-floored entryway atrium, and upon arriving at the source of such a terrifying sound--a giant modeled heart a child could walk through--there were no flapping heart valves that coincided with the lub-dub. I think there were lights around it stimulating electricity moving from node to node, so I assumed that the electricity, and thus muscle contractions, had to be the source of the heartbeat sound.

So valves make heart sounds. Got it.

Oh wait, Bates (Guide to Physical Exam and History Taking 10th ed.), you have something you want to add?

An extensive literature deals with the exact causes of heart sounds. Possible explanations include actual closure of valve leaflets, tensing of related structures, leaflet positions and pressure gradients at the time of atrial and ventricular systole, and the effects of columns of blood. The explanations given here are oversimplified but retain clinical usefulness.

Wait, so maybe I was right? Hooray! But more importantly: It amuses me to no end that we still don't know the exact causes of things that seem really fundamental. While it is true I am in the process of learning more factual information than what 99% of the global population could ever learn*, what's even more true is that I'm also being given more questions than anyone should have to think about.

*emphasis on "factual information". While I'll acknowledge that I am smart, I have not dealt with enough of the 7 billion odd humans on this planet to ascertain if I'm worthy of declaring I'm more intelligent than most of them.

That awkward moment when diabetes is kind of cool for once.

[Note: There are some gross photos to follow. If you fall easy to nausea, I suggest not reading this post.]

Alternative title: Microbiology: it's happening on you.

Having diabetes is the absolute worst*. Yesterday, for example, I took to much insulin with my bedtime snack and two hours into sleeping I woke up in a hypoglycemic panic, and before I could grab the glucose tablets by my bed, I began hallucinating: a giant centipede with a human face--a human face without eyes, nose, or mouth--broke into my bedroom!!! Intense!!! And terrifying!!!

Anyway, so usually diabetes sucks. There's the lows and there's the highs (this isn't figuratively, this is literally, as in my hypo- and hyperglycemia). Regardless, thanks to diabetes I've also been given a small arsenal of medical tools to tell me how my body is doing. Usually they're quite mundane. But in certain circumstances I can use them to . It's like having constant access to back-alley, outpatient lab services.

Seven days ago I sustained a large, second-degree abrasion to my left knee. Hilariously, I didn't treat it because we had just learned about skin infections in Micro and I wanted to see if I could catch something hilarious like staphylococcus aureus. As a diabetic I am technically immunosuppressed.

Regardless, my knee ended up scabbing really badly. [gross pictures to follow]

*Diabetes isn't the absolute worst. But in my own life, it is.

Debt

There are 65,000 medical students in America. That's 0.02% of the population. They graduate, on average, $149,000 in debt. That's a total of 9.1 billion dollars of debt. That's 0.05% of our countries national debt.

9.1 billion dollars, however, would be covered by the income of the two largest health insurance companies in America.

Single payer system?

Yea. Maybe we should think about that. Or anything, really. This system is not sustainable and pissing off future doctors isn't really something this country should be doing.

vaccinations! get some

http://www.ct.gov/dph/lib/dph/VPD_US_statistics_2010.pdf
http://www.behance.net/leon_farrant/frame/2878481

We're learning about vaccines in microbiology. It really weirds me out that we have a chickenpox (varicella) vaccine now, because I didn't get one when I was a kid (it was created in 1995, by which time I had already had it). Also amusing: chickenpox affected over four million kids a year? That's crazy. 

Dammit! You're supposed to suck!

The sad part is that I actually am really excited to learn the differences between aneurysms and dissections.

Manic depressive right here.

I think....

I'm also really excited about clinical neuroscience.

Dammit medical school! You're supposed to suck!

3 Hours

Sitting in class and I'm glad I came. The administrator who schedules our exams is also a professor who is currently talking about diuretics. This is surprising. I'm glad I came, kind of like that "The Wanted" song. Nephrons still scare me--proximal, distal, loop of henle--but mnemonics are being thrown my way, like the little stars you pick up in Super Mario Galaxy and use to defeat little alien beasties. Or you save up and trade in for extra lives when you have enough. Or the jewels you picked up in Spyro... spironolactone... use it to clear ascites secondary to liver cirrhosis. God. Liver's are so cool.

What I'm trying to say is I only got three hours of sleep. My mind is wandering. I want my attendance to benefit my learning even though I'd be better served sleeping right now. But I know I wouldn't be able to sleep. I'm an insomniac. I don't know what to do. But with juggling diabetes and insomnia, my body is falling apart from the inside. 

Basic Science Proves Useful! Elora Astonished, Decides to Study Harder in the Future.

Monkey Kidneys & Ethics

Surprisingly, monkey kidney cells are very expensive (I am being sarcastic). What kind of underworld, black market shady dealings do you have to perform to get "monkey kidney"? I presume very unseemly indeed if the acquired monkey kidney tissue is frequently unreliable.

Basically my question is, can you kill monkeys in America?
And if yes,
were these monkeys free range?

Obscure Medical Condition (1/2)

Several weeks ago I woke up in the middle of the night. I wake up in the middle of the night a lot--I've never been a good sleeper. Usually when I wake up in the middle of the night, I resign myself to the fact that I'll either be awake for the next two hours or I'll take another benadryl and I'll be asleep within the next two hours. But this night I notice something unusual when I swing my feet over the side of my bed to get some benadryl: I can't feel my right foot.

At first I assume this is just a thing, like how your appendages--arms, feet, hands--lose sensation in a variety of situations. But once I've taken my benadryl and am sitting on the side of my bed, I begin rubbing my foot and I still can't feel my middle toe. After about two minutes I begin freaking out, or as much as one can freak out in the middle of the night: rocking back and forth, mumbling prayer-esque incantations, crying.

The symptom, the chief complaint if you will, is Peripheral Neuropathy.

I pull up a differential diagnosis in my mind. Top of the list, do-not-miss: Diabetic Neuropathy. This is terrifying because I am twenty-three years old. Statistically, I have a lot more life to live. I don't want to live it without my legs. But there are more diagnoses--less depressing than diabetic neuropathy, but still depressing.

Chronic Alcohol Abuse. I drink a lot. I assumed I was safely staying within my Federally Mandated limit of two drinks a night. But maybe I was drinking much, much more than that. Although alcohol abuse and pancreatic cancer aren't directly tied to one another, I am still pretty terrified that I will get cancer, and over drinking to the point of developing peripheral neuropathy seems like over drinking enough to give me some type of cancer. Even worse: Alcoholics can develop Korsakoff-Wernicke's syndrome. Now Wernicke's aphasia would be awesome! But the Korsakoff part of Korsakoff-Wernicke's leads to being delusional and "confabulation." I don't need to be any more delusional than I already am.

[Question: Why does chronic alcohol abuse lead to peripheral neuropathy? Answer: A) Alcohol dehydrogenase requires oxidizing agents and can quickly use up important molecules like thiamine (Vitamin B1) or B) Drinking distracts your liver from doing other important things, so that it can't send out as much cycling lipids as it should. Neuron helper cells can't keep producing myelin, and you lose nerve conductance. At least I think this is how it works... If you have a better way of explaining it, please share!]

Malnutrition. I had been on a diet the entire summer. It was great: lost 15 pounds, and now my BMI is 22--super normal. However, there were days when I went "overboard." I tell myself it takes a lot of willpower to only eat 565 calories a day, but it's still probably not a good idea. Being able to lose a pound in a day feels awesome! But really, you should be losing that much in a week, if not even over longer time periods. I tried to eat well, the little I did eat was healthy, but it's possible my body needed more and began shirking its biosynthesis responsibilities, resulting in me losing sensation in one of my feet.

So what do you think I have?

Patient History

Patient is a reliable, 23-year-old diabetic (DM type 1).

CC: Patient's chief complaint is an inability to feel her feet.

Past Medical History

Patient has been diagnosed with:

sickle cell trait (congenital)

exercised-induced asthma (age 8)

seasonal allergies (age 8)

Diabetes Mellitus Type 1 (age 13)

anemia (age 15)

hypertension (age 18)

hyperlipidemia (age 18)

depression (age 19)

Medication

Patient is currently on:

Humalog (short acting insulin)

Lantus (long acting insulin)

Nasonex (seasonal allergies/allergic rhinitis)

Fexofenadine (seasonal allergies)

Atorvastatin (hyperlipidemia)

Vitamin B12 (2000 mcg/day)

Social History

Patient denies recreational drug use. Patient admits to smoking cigarettes, about 8/year and having 1-3 drinks/day, occasionally drinking more (6-8 drinks/night) on weekends. 

Patient exercises about 30 minutes everyday.

Family History

Patient's father is alive, has hypertension that has been controlled by diet, and glaucoma.

Patient's mother is alive, has dyslipidemia, and had breast cancer in 2007. Currently in remission.

Both patient's sisters are alive and healthy.

So what do you think I have?

Campus Security

Prompted by a reader, I now publish the entirety of a warning sent to our school through e-mail from the Director of Campus Security:

Today at 1215 Campus Security received a call from a lab that a suspicous person was looking into labs and offices on the 3rd floor of the BSB.

The individual was tracked by camera and eventually approached by security after he walked through the 2nd floor and part of the Lower Level.

He stated he was looking for two individuals he met at a club. Neither person was in our database.

We have his name and Driver's License number.

He was advised that he was trespassing and warned not to return.

Please make sure you keep your office or lab secured when not occupied,personal belongings secured and call Security immediately at X3288 if you notice anyone or anything suspicous.

We have a serious problem. Lab assistants have enough time to go to clubs.

some of my friends are talented...

Yes. I have friends. 

I don't know what the general public thinks medical students are like. But some of us are pretty cool. Including my friend Colin, who for some reason really likes turning designs into t-shirts. I don't think I've ever seen any design or artwork from him that wasn't already on a t-shirt when presented to me. 

Quite. Fascinating.

Now we just need to sell these beauts. 

Powerpoint Presentations

I really miss jazzy powerpoint presentations. It's not that this material is boring, per se. Most of it is actually fascinating. I know our professors work hard, but I want physical proof that they are working as hard if not harder than me. Selfish, I know, but medical school is pretty lonely and isolating. I want to think that our professors' lives are also spent toiling away reading and re-writing notes.

But in all actuality, I just want a beautiful powerpoint presentation.

Last year, in Biochemistry, for the protein section, our professor put in actual sound effects to explain various ways proteins could be manufactured through transaminases. It was corny--(the sound effect was usually one of a chime)--but it was also awesome.

AND THEN! One of our physiology professors actually explained the molecular basis of muscle contractions by using, and illustrating, actual pictures of famous people (and one professor) through a powerpoint presentation. Amazing.

Today in Micro we got the above. It was great.

....I'm worried Medical School has lowered my standards of what certifies as "exciting."

Gotta Catch 'Em All

I only have to collect heart, kidney, liver, and lung disease before I win something!

Got my flu shot today. It was actually awesome for two reasons: 1) it was the first time I ever got to check yes to the question: "Are you a healthcare worker?" and 2) needles just keep getting smaller! It was literally painless.

It was also, somehow, free. So thanks America, for always having my back (it's the least you could do after you presumably gave me asthma.... we need cleaner air damn it!!!) But still, Walgreens' Pharmacy, specifically at my Walgreens, is always a pleasure and has re-instilled my faith in  health care.

Now I just need to find a family physician... to deal with my multitude of health problems (see above).

Smiling Segs

I just want that polychromatophilic erythrocyte to know that there is nothing funny about three hours of anemia-centric lecturing.

And that it should stop smiling because it's making everyone else feel bad.


[8:47 am, Sep 24 UPDATE]: That's actually not a polychromatophilic erythrocyte: It's a polymorphonuclear leukocyte, a neutrophil if you will (hehehe, half-rhymes). Regardless, it's a good thing I know that now, because I have an exam in less than five hours. Hurrah.

Retinoblastoma (gross)

Pathology, you have a penchant for understatement. 

A Cholesterol Guide for Beginners

To explain: My sister asked me about her cholesterol levels. In response, I spent an hour making a presentation.

As you all know, I want to be a medical/health writer. There's something so alluring about communicating health to the greater public. Even the simple, often corny health pamphlets in hospital waiting rooms are so fascinating.

My mom was on the evening news once, talking about breast cancer, and I thought it was the coolest thing ever. I aspire to do something similar someday. 

There's no black or white answer to the question: "Are you studying?"

existentialism 'n stuff

Ah! I am pretty excited right now. We are talking about mycotic diseases. Translation=fungi! And funguses are pretty cool because A) they're not an animal, a vegetable, or a mineral and B) they're an important part of ecology and my love of that study will never die. 

On a more spiritual note, I thought of this during our first hour of microbiology, the hour we were introduced to virology, which has a complexity I'd never really thought of:

Clicker Farm

 Some people don't live in North Chicago. But to get extra credit you have to use your clicker in 70% of the classes. Consequently, a lot of clickers end up mysteriously in class, on the desk of someone who doesn't own them.

I hope PETA doesn't get upset about this, because the clickers are treated with the upmost respect.

This is what makes studying bearable:

Our second exam of the year is this monday. I have now been in the library, at the same wooden cubicle, for over five hours. My back hurts, I haven't eaten anything in eight hours, my carpal tunnel is flaring up, and I am literally itchy all over (study-induced pruritus, probably).

That being said, the soon-to-be-tested-upon material is, by my estimates, twice as cool as anything we learned last year and an infinite amount of times more useful because last year we didn't learn anything clinical. Last year was just cram, cram, memorize these dumb facts about obscure biochemical pathways.

How helpful has this year already been for me? I'll tell you:

Just a little biased....

GUESS WHICH GENETIC MUTATION I HAVE!

Time "Well" Spent

Today was a relatively difficult day, with me waking up--unwillingly, seriously, my alarm was set for 9:30 and I woke up two hours earlier--in time for my first class. My first class of six. Of course, most of that miscellaneous time was spent making a pie chart for my blog. What is more depressing? The fact that I spent more time in our lecture hall than I spent sleeping? Or the fact that I spent 52% of my day "studying"?

Well regardless I'm proud of myself. I'm not a type A person, so the fact that an entire seven days before my exam I'm already pounding the books... is either a great sign or a desperate call for help. Did no one see me in the library?! Because I was totally there. Totally studying. Totally not an Elora thing to do.

Watches

Since early last year I've been dying to get a watch. I do not know why I associate professionalism with watches, but let me speculate:

1. Pulling out a phone to check the time is "disrespectful" (your older professors will assume you're getting a quick round of "words-with-friends" in).
2. Being successful but also professional means having functional bling. If I get a doctor's bag, it's going to be the most abstract Vera Bradley pattern I can find. If I have an excuse to have a watch, it will be like a crazy beautiful watch. It won't be like I'm "dressing" up (which would be unprofessional) because I actually need a timepiece (... well I mean technically. I think I can make the argument that I need a time piece).
3. It just feels like a doctorly thing to have. I want to be standing over a patient, taking their blood pressure, their heart and respiration rates, and instead of staring at a wall, I want to be looking somewhat at the patient so I don't seem distant. I also feel like there are a lot of portraits of doctors looking at their watches while assessing a patient's vitals.
4. Also, most obvious: being late is unprofessional. You can lose "professionalism points" from our clinical reasoning course by being late to lab. So yea, punctuality is professional.

Consequently, I've been obsessed with finding a watch. Stylistically, I'm pretty "out there," so the challenge is to try and find something that expresses my personality but doesn't force my personality onto others (or worse, offends people). I also don't want to drop much more than $100, so I went to overstock.com because it's really difficult to find cool watches for women. I guess time is more of like a "dude thing." I don't know and I didn't really care, until, after scrolling through about 500 watches I see this atrocity:

Not only is this thing disgusting, it also asks a very important question: why isn't there a "whimsical women's doctor theme white leather watch"? I do not think I want to put on an air of "whimsicality" when I begin rotations next year, but dammit, I want a doctor's watch made for my womenly wrists!

Well, I have since searched overstock.com for a doctor's watch, and they don't have any. I tried searching for "professional" watches, and of the 40 results I got, 39 of them were men's watches. The one female watch was for "professional divers." Which I guess is cool and stuff because hey! I would've never thought women could descend to the same depths as men due to their whimsical womenly constitution's and other almost-trivial-but-still-obnoxious sexist b***s***. 

Anyway, rant over. If you're curious, I bought the above two watches. The one on the right is transparent, which means I've finally gotten something that's actually my skin tone.... which is another thing I could complain about. But I won't. Since like, I'm in medical school and am like, totally busy and schizz.