Disappointment (money in medicine)

Depending on many different factors in your life, your view of a medical doctor probably varies wildly from your peers. That's even true among medical students. Find one medical student who thinks that doctors should be enriching the lives of their fellow humans and you'll find another who thinks doctors are just workers found in any other banal profession: lawyers, astronomers, sea captains. Which is what makes fourth year so disgusting: there are people who will graduate with me who have terrible ideas on what it means to be human, have no idea what compassion is, and who will probably continue to drive the healthcare machine in this country over a metaphorical cliff into a rift of soul-crushing, human-endangering failure.

Too hyperbolic? Probably. Let me explain:

It really bothers me that there are people who went to medical school because they had a passion for a certain career, and find themselves sending in applications to programs they know they will be denied from because they are terrible applicants. They lack the grades, the board scores, or something as extracurricular as research. They are not.... competitive.

I think dermatology is stupid. I will pick on derm a lot because eyes creep me out and medical imaging was a great advancement, so I optho and radio will be spared my ire in this discussion. The field of dermatology disgusts me because what do dermatologists know that an oncologist (skin cancers) or a well trained primary care physician (rashes) don't? And yet they somehow get paid more for doing less work. It is an artificially competitive field when you compare it to its value in society. And yet some people legitimately like dermatology. The study of skin. I can't fathom why. But they like it--not because they like that there are no emergencies. Not because they will get paid so well and work so little that they will be able to vacation in the fanciest of places atop beautiful yachts. But because they actually like skin and when they see someone with a rash they legitimately want to help them because they see skin as the most important organ of the body. Good hours and ludicrous paychecks are secondary gains--not the prime objective. The prime objective... is people.

And yet this year there will be at least one--from anecdotal evidence--individual who will in all likelihood not match into the field of dermatology despite a strong conviction that that is what they will want to do for the rest of their lives, simply because there are a lot of jackasses out there who see money as the sole solution to all of their ills and who have done so much better on exams that they can and will crowd out the people who would make the best dermatologists.

The best doctors aren't the ones who test best. The best doctors are the ones who are determined to improve the lives of their patients. Studying well and testing well is not the same as staying up late at night worrying how you can implement better care for your patients. Those are two types of hard workers. But only the latter will actually act selflessly whenever possible and improve the lives of others.

Once we start recognizing that--yes--doctors should be smart but they also need to be enthusiastic and deeply invested in their jobs instead of seeing their jobs as a money making venture we can start really making changes to medical machine for the better. For example... why not pay all doctors the same? No matter the field? Remove the pay gaps and see what happens. That would be a fun experiment. It might improve things.

When I was a first year medical student I had an interesting argument with my cousins--who were and continue to be--more conservative than I am. We were discussing healthcare in socialist societies (read: Northern Europe). They were arguing that when you pay doctors not much more than any other profession, you get doctors who really don't want to work hard because there's no point in working harder if you're just going to make the same amount. I actually think this is absolutely wrong. I think if you remove monetary incentives, only the people who actually want to be physicians will become doctors and they will thus work harder because they will love what they do. I think money is great! I love it. And I miss it when I have to spend it on things. But if I knew I would get the same amount of money whether I was an elementary school teacher or a doctor... well I'd still become a doctor because I am really passionate about being a physician. There are things that being a physician provide you that can't be found in other fields to the same degree. There was, and still continues to be although to much lesser a degree, respect for physicians. There is the sense of accomplishment you get from knowing that you know more than most other people. There is the appreciation you receive from patients who will share with you their most intimate of feelings, fears, concerns. My father is a surgeon. He has had the opportunity to be paid a lot of money many times in his life. But he continues to work in inner city Chicago because he enjoys helping people who wouldn't be able to get such surgeries done, even if he knows he will never get paid for operating on them because they have no money, they have no insurance. There were years when my dad made less money from operating than his malpractice insurance cost. That's right--you can make negative money as a physician. But he never considered quitting. Because he has a love for surgery which I don't understand, but which motivates him to work with little consideration to how much money he will make. More physicians should operate (pun intended) in this manner.

I am not an economist. I do not understand the "economy". I simply acknowledge that economic issues must be way more complicated than they appear. Still, just imagine a world where medical school wasn't any more expensive than an undergraduate education. Imagine a world where it was actually free. The person who loves skin diseases--however weird she may be--goes to medical school, falls in love with the study of dermatology, and in her fourth year decides to apply to some dermatology residency programs. Because there are no extrinsic powers enhancing the appeal of dermatology, only those with an intrinsic interest apply. And because skin is such a specific field, much fewer people apply to it. Perhaps the number of applicants correlates with the number of dermatology resident positions available in the field? Dermatology is no more competitive than any other specialty and everyone medical school graduate gets to work in the field they love. They may still not get into their ideal program, but at least they get to be in the OR, or the community, or in the ER, or in a dark room staring at radiographs all day. Which is what they love and want to do well for the rest of their lives. 

So what are doctors supposed to be? Well paid or hard working? Money is a great reward for hard work. But it's also a great incentive for people who should not be physicians to enter the field.

I've struggled with how I feel about how much physicians get paid. Honestly, being a medical student, being a resident, and being an attending are all difficult and they should be paid well. But now that I have started to see my friends struggle to get interviews when people who have developed reputations for "getting drunk and beating up people" or "saying really racist things in class" are getting a plethora of invites, I have to question how well this system was set up.

And I will continue to question it. Because money shouldn't drive the motivation for anything. Especially something as important as taking care of people.

Insulin and Eugenics... I am upset. This is a rant.

As a type 1 diabetic, I am often very angry. Usually this is secondary to hypoglycemia or an ability to eat something because I inadvertently left my insulin at home.

But today I am upset because I am running out of insulin and I only have $600 left in student loans until late February. Why is this a problem? Because as someone with good medical insurance, my doctors have always prescribed me humalog and lantus, which are bloody expensive without a prescription (and are actually still really expensive with a prescription and insurance: $50 each for what I need in a month). But as a medical student I don't have time to go see a doctor to get a prescription to get my bloody f***ing insulin. I am really upset because as I speak I have about enough humalog (lispro, short-acting insulin) to get me through to Monday, after which I guess I'll start employing a poor man's metformin: large amounts of acetaminophen and straight hard liquor. Your liver transaminases skyrocket, but you've effectively bludgeoned your body's best organ so badly that it stops going through with gluconeogenesis. Oh, and a ton of aerobic exercise makes your body more sensitive to the effects of lantus (glargine, long-acting insulin), so I guess I can look forward to dropping a few pant sizes and... cirrhosis. Lots of preventable, freaking cirrhosis.

I don't know what I'm supposed to do. There must be type 1's who are busier than me and have less time to see doctors. And I know there are type 1's who don't have health insurance because this country is absolutely terrible. So how can I get insulin at a reasonable price without having to see a doctor? Because, honestly, I've had diabetes for over ten years and I know my body's personalized ways of dealing with this disease in a way that literally no other health professional could understand. I know the tricks. I know the secrets of my metabolism. My A1c is always under 7.0 and my hypoglycemic events are now well controlled. I know what I'm doing.

SIDENOTE... no wait, MAIN POINT: I think it is absolute bullshit that people need prescriptions for something that their body erroneously stopped producing. Almost everyone else around me is making insulin, but just because my body f***ed up when I was thirteen, I have to spend thousands of dollars on a month's worth of high quality insulin? What kind of justice is that? Answer: it's not. It's wrong. It's condemning people to a constant economical disadvantage on top of the disease they've contracted who's co-morbidities will likely kill them if they don't control the aforementioned disease. In a country where medications aren't regulated to make them fairly priced (hell, I think they should be bloody f***ing free but I realize I'm incredibly biased) and health insurance is severely limited, we are essentially killing off diabetics. I realize that many type 1 diabetics can make it to reproductive age without dying first, but I've seen a 24 year old diabetic with f***ing gastroparesis--that's really severe neuropathy. And now that I've gone through OB-GYN, it becomes apparent that type 1 diabetics with A1c's of 13.6, like this 24 year old, would never be able to carry a healthy child to term. She will likely never produce any children because why? Because our health system is unjust? What sick kind of world is this?

And you know what's worse? The type 1 diabetic population that is under insured and hurting the most is minorities, specifically blacks. And you know what's f***ing insane about that? DIABETES IN AFRICAN POPULATIONS HAS NO DISCERNABLE GENETIC COMPONENT. Whereas caucasian type 1 diabetics usually have some weird HLA inherited predisposition sh*t. And yet, at least in Chicago, those people will be preferentially allowed to live with a disease that could be greatly reduced within the human population if only they were put to the slow and painful death that awaits most uninsured type 1 diabetics.



[edit]: Okay. So I calmed down a little bit. Let me just say that I recognize that a lot of white people don't have health insurance either. But at least in Chicago, economics and race are obnoxiously linked in a way that has already started to upset my psyche. So I'm sorry about that. The truth is, all type 1 diabetics are in an equally unfortunate place in a society where close health maintenance is ludicrously expensive.

And also, I don't think I do a good job of separating my emotion's from the job. Especially other type 1 diabetics so far along. Seeing another black, 24-year-old, type 1 diabetic, laying on a bed in the emergency department, clutching at her stomach and moaning for morphine, secondary to gastroparesis and then her resultant addiction to painkillers, really upset me I guess. I want to help them but I know that it's literally too late because you don't recover from severe autonomic neuropathy. You just suffer until you die. From something completely preventable.

I guess this whole thing bothers me, not just because on the whole diabetics are treated very poorly, but because I'm now a healthcare professional, and I am surrounded by physicians every day, but I don't think I can just ask them to write me a prescription for insulin because I'd rather go to work than call the doctor's office to set up an appointment, then call the dean of student affairs (another physician), and then the clerkship director (also a physician), and then drive to god knows where for a fifteen minute conversation with the doctor to write me a prescription so I can save $350 for something that almost everyone in the world doesn't think about.

It's upsetting. If I had my way, everyone with a type of medical/biochemical deficiency would be able to get whatever they need for next to nothing because that's what equality is. Hypothyroid? You get thyroxine, no problem. Chronically depressed? We'll get you an SSRI or maybe even some SNRI's if you're lucky and need more norepinephrine. Diabetic? We'll get you all the insulin you want. Because giving you anything less than that is a crime.




So this is where I read that Diabetes in blacks and asians is often idiopathic: http://www.aafp.org/afp/1998/1015/p1355.html
Although since I am both caucasian and african, I won't know if I have the idiopathic form until either A) my entire genome gets sequenced (I hear it's only $1000 now!) or B) they look for islet cell antibodies in my serum.

BRBPR... & hipsters

Today I realized two things:

1) BRBPR does not stand for "be right back, personal relations". It stands for bright red blood per rectum.

2) You can't spell PBR without BRBPR!

What's Death Got to Do With It?

I realized something today while I was hypoglycemic at 63 mg/dL and more susceptible to fear: I am absolutely terrified of death. Not that that is something new. When I was nine I watched a movie about time travel while vacationing around Mesa Verde, and I realized, at nine, that one day I would die and all my accomplishments would account for naught. More than that, I realized that an eternity of total, unyielding unconsciousness was something I never wanted to experience but something I one day would. I, personally, do not want to die. Besides the fact that I engage in a lot of moderate risk behaviors, I do not want to die. I have been suicidal twice in my life, and those events were partially fueled by untreated depression, but they were mostly fueled by my previous realization that one day I will die and everything about me will mean nothing. 

Besides the soul-crushing nihilism surrounding my personal future death, I am also reaching the age where the people I know and love are starting to die. Yet still these deaths are mostly accidental… I feel a great amount of guilt for the deaths of people close to me… those that have stolen people who are related to me by blood in particular… but I cannot change what I did, and ultimately, even though I failed to do things that may have prevented their deaths, their lives were not my responsibility*. 

Now that I am in medicine, lives are very much my responsibility. I have a feeling that this is the source of my fear. I have always been a very good liar. I sometimes attribute this to the fact that I am a natural fiction writer, and therefore I am more readily capable of producing fictional realities in my mind. But the reason why I lied when I was little, and the reason why I occasionally lie now at the age of 24 is because I do not want to let someone down… I do not want to fail.

As a result, when I encounter a patient-doctor situation where the patient might be dead, I run back to my resident and make up reasons for not seeing the patient. I have two examples of this behavior:

The first example occurred when I was asked by my team to inform a suicidal patient that he wouldn't be able to leave the hospital until he was admitted by psych and evaluated for several days. I went to the patient's room and found it empty… But all suicidal ideationists have to have a 1 to 1 sitter, someone with them at all times…. yet here was a hospital room completely devoid of people…. although the bathroom light was on… and it occurred to me that this patient of ours may have hung himself on the water line that connects to the shower head… or cut open his veins, letting the blood pool out from around his wrists, only to let is fall on the brown tiles that constitute our hospitals bathroom floors. WHAT I WISH I COULD HAVE DONE would have involved knocking on the door, and upon not hearing a response from its occupant, opening the bathroom door to see if any dead bodies were mucking around. If a dead person had been found, I surmise I would have run out into the hallway and yelled "HELP", forgetting how to present patients to healthcare professionals.

The second occasion involved a patient with chronic hypotension. My intern instructed that I run to check the patient out--ask about dizziness, measure blood pressure, assess any changes in mental status--but when I got to the room the patient was fairly unarousable… he was asleep. I knocked several times on the door to this room and on the walls containing him. I even yelled out his name. Yet he did not even twitch underneath his sheets. The next step in arousing a patient would be to apply a sternal rub--basically pounding on somebody's chest with your fingertips. But I couldn't bring myself to touch this patient… what if he was really dead? He wouldn't respond to my tapping. He wouldn't be saved no matter what medical interventions were applied to him.

In both of these situations, the patient was found to be very much alive. I was acting inefficiently when I decided to enter the patient's room only to promptly leave it when I didn't get the response I wanted. 

The death of a patient seems like the greatest insult to a physician, even scoring above having your medical license removed. It tells you that you missed something. Hell, we have M&M's specifically designed to analyzed where you as a physician failed the patient.

I don't want to tell someone a patient died because we didn't check their blood pressures often enough. I would rather lie than experience that shame and guilt.

Internal Medicine Clerkship (Entry 1: First Impression)

So now I'm starting the third week of my internal medicine rotation, and I am loving it. These residents are significantly nicer than the surgery ones (although most of the surgery residents were definitely good human beings), and because of that, I feel like I'm getting more out of the rotation. Basically, I feel forced to learn and study on my own because not looking something up would make my residents disappointed in me and that would break my heart.
Speaking of hearts, and as an example of the previous statement made above, I finally understand EKGs. It's still very difficult for me to determine what the exact diagnosis is, but considering before I could only get rate, I think it's a step in the right direction. Maybe by the end of this rotation I'll feel and sound intelligent! The only drawback--but it's not that bad--is there's a lot of scut work. A lot of using pagers and calling people and talking to nurses, or social workers, or consultation services.
Speaking of scut work, today I was trying to decipher a note, but it was using an abbreviation I didn't know so I sent an e-mail to my surgeon dad to see if he knew what it was (I could of more easily used dr. google, but I like to keep my dad informed of my learning).

ELORA: "Hey dad! Does PCI stand for percutaneous catheter intervention? Thanks!"
FATHER: "I am not sure. That is why acronyms are not welcome in medical practice. It does make sense that PCI stands for percutaneous catheter insertion. It could also stand for pulmonary catheter insertion or pulsatile cardiac imaging. The message is TRY NOT TO USE ACRONYMS unless you are with friends, who cannot judge you. Dad."

Clerkship

I hate my life.

But first, let's focus on the positives:

• During my last entry, I had decided (although not revealed) that I was going to push my step one test date back 10 days to June 11th. Good news, I passed. 
• I am now almost entirely moved into my downtown apartment. My room is still full of random stuff and I still don't have a well stocked fridge, but I know the area pretty well now and every weekend I go to the beach (within walking distance) with my friends. 

Okay, now on to clerkships.

I started with Surgery. At Lutheran. Widely rumored to be the toughest place to do a surgery rotation. Results are in: I hate it even though I love how much I'm learning and how much I'm doing everyday. In the last two-and-a-half weeks I have cried six times, every single time because of surgery. I am a mess. And I finally know exactly why so I'll tell you:

Being a third year medical student on rotations is like being a middle child: no one likes you and no one pays attention to you so you might as well die. 

If we were to compare the classical hierarchy of teaching hospitals to a nuclear American family circa 1950, the Attendings would be your parents, your older sibling is the residents, medical students are the middle child, and depending on group dynamics, the role of younger sibling is played by either medical students who are great at sucking up and being professional or interns. 

Attendings are the people you want to be like. They are your role models. Sometimes you hate them, but most of the time you love/respect them. They may make you upset because they yell at you and occasionally call you dumb, but eventually you realize they are right about almost everything. 

Residents are your older sibling. But there are a lot of different ways older siblings can act:

-We're in this together: Life is hard. But with any luck, your older sibling likes you and wants you to succeed. This sibling gets extra points if they know how to succeed. Residents can be good role models, just like attendings, but they can also be terrible influences. And as a young med student, you can't really know what's right or what's wrong yet. So you just pray these people are good influences.

-Too cool for you: Okay, you can't really blame someone for this, and to be honest, medical students are dorks. So...

-Constantly antagonistic: For some unknown reason, most likely being they are still bitter about that you took attention away from them (i.e., your birth), they hate you. They would never say that. But if they can, they will make you look bad. For fun. Because, to sum it all up, the world is cruel and if seeing someone else suffers helps you get through your shift, then someone's going to suffer. 

Essentially, residents will determine how you feel about yourself day after day. Your parents may be important to you, but sometimes, they just don't understand. If a resident physician tells you that you did something well, then you feel pretty cool and competent. Otherwise you're just a useless person who know one pays any attention to.

Finally, there are the suck-up med students, the little sibling who really just makes you feel worthless. Everyone is so much nicer to them for reasons you cannot completely elucidate. They are even nice to you--but only some times. At other times they are totally working the angle so they get more assignments. Everyone wants to be around them... nobody wants to be around you. 

Anyway, I'll probably post up something less... emotional, more analytical later. But right now, an hour past my bedtime, I'm genuinely shocked that I haven't quit yet. 

More good news I guess.

13 days, 23 hours

I pushed back my test 10 days. I wasn't hitting what I wanted to get on my practice exams, and it didn't seem realistic that I'd get to that target in five days, no matter how much I studied. Also, I've probably spent over $1000 on books and reviews for this exam and all the courses it supposedly covers. I'd like to at least skim all the materials I have.

Oddly, my stress headache has returned. Which is impairing my ability to study. You can't overdose on Ibuprofen right? Damn it. I should know this.

HOLY .... ! IT'S ACTUALLY A TUESDAY! This update on my progressive is appropriately timed, then. And I'm taking the exam on a Tuesday. That bodes well, doesn't it? 

6 days, 20 hours

Continuing on with how poorly my body handles stress:

I've developed BPPV (benign paroxysmal positional vertigo) and the skin on my outer ear (my auricle) is peeling off and scabbing over and it is thoroughly gross.

I was going to claim that I have trichotillomania (compulsive pulling of hair) or dermatillomania (compulsive picking at skin), but apparently these are serious conditions. And even though I can't sit still and not pull my hair or pick scabs while I study, I feel absolutely fine when I get up to do something else (that's a lie. I never feel fine anymore).

Regardless, my exam is in 6 days and 20 hours. I have a box of Pop-Tarts, a box of Teddy Grahams, Hansen's natural cane soda, Fruity pebbles, and a box of Quaker Chewy bars. I also have about 65 more hours of lectures to watch. So.......

Rifampin blocks RNA Polymerase.

Okay, so I think I was being a tad melodramatic. True, this level of stress and constant cramming is incredibly dangerous to my health: I have lesions on the mucous membrane of my mouth, I bruise much more readily than ever before, I see so few people that I talk to myself and drag my teddy bear everywhere I go for companionship.
So I lied to myself. I'm going to pass step 1. Now I'm just studying. Not for a good score. Not to pass. But simply to learn. And it is fun. I'll tell you why:
There are fundamental concepts I just don't understand--never understood them--but now I have a chance to solidify the simplest things, and hopefully memorizing from this point will get easier as I develop a stronger framework.
I should have anticipated this earlier--I barely passed all my classes last year. UWorld tells me my worst subject is Physiology. Uh... what?That's not good! Physio is pretty much everything in medicine without a proper name (because pathology is actually everything in medicine, but it's just so obnoxious with all of it's diseases named after now dead jerks). So now I'm just focusing on physiology for a few more days than I originally planned. And I feel like that'll be alright.
Honestly, I just want to sound like I know what I'm taking about--even if it's just vaguely--when I step into surgery July 1st.
Speaking of....!!! I finally know the difference between prothrombim time, partial prothrombin time, and bleeding time! It was so simple I don't understand how biochemistry AND pathology overexplained it to a point where it didn't make sense. But it's probably also my fault, considering I thought plasma cells were platelets until recently. I AM DUMB.
For know...

UWorld Blues & A Murderous Rage

Studying for boards is driving me into a murderous rage. It is a combination of self-hatred for not studying more earlier and the incredible disbelief that they want us to know so much.

Also I keep getting diabetic questions wrong on UWORLD, which is probably the most depressing thing. You think you understand the process of something fully only to find there are perverted ways of asking questions that make you question what you once knew as true.

This is hell. I also have normal human being things to worry about, but I'm not paying attention to them anymore. I need to cash checks. I need to move. I need to get a new phone. I haven't checked my blood sugar in three days because I lost my glucometer while trying to pack up my apartment. So that should freak me out. But it doesn't. What makes me chuck the First Aid review book across the room as hard as possible is not the fact that my life has deteriorated to this point where I don't care about my own health and safety. No, it is the realization that I don't know how Rifampin works. I haven't been this angry since I studied carbohydrate metabolism in Biochemistry--a class I was desperately failing. I actually flipped a table when I realized memorizing all the intermediates and enzymes that metamorphose glucose was not going to be enough to do well on the exam.

That's how I feel right now. That I know a lot, but that come test day, everything I know either A) won't be tested or B) won't be enough to answer enough questions correctly.

But I have come way too far to fall apart in the next 12 days and fail Step 1 on June 1st.

12 days.

Occupational Diseases (Hypersensitivity Type III Reactions)

"There are many...pulmonary type III reactions that bear names related to the occupation...such as pigeon breeder's disease, cheese washer's disease, bagassosis (bagasse refers to sugarcane fiber), mapke bark stripper's disease, paprika worker's disease, and the increasingly rare thatched roof worker's lung." -Immunology: A Short Course, 4th ed. Benjamini, Coico, and Sunshine. 2000.

Advice from the Downeaster

Last week was our spring break (conveniently located in winter), and I spent some time in New York City before heading up to Maine to visit my older, lawyer sister. The Amtrak Downeaster travels between Boston and Brunswick, the largest town (not city, which would be Portland) in Maine with a population of over 20,000.

Regardless, I sat down next to a window, minding my own business, when an incredibly chatty older woman, her friend, and her friend's daughter, sat down in my row. I tried to quietly play Triple Town on my tablet, but I could not escape the questions and story tellings of the woman, and we eventually fell into an on-again, off-again conversation that eventually ended in me getting a free Shipyard Export Ale.

Thankfully for me, the woman was a retired nurse anesthetist, and therefore our conversation was a lot more interesting than the conversations I've had with other people I know nothing about. Pathologies and other medically related topics that came up in our conversation included the following:

• Neurofibromatosis Type I & Type II
• Renal Cell Carcinoma (RCC)
• Abdominal Aortic Aneurysm (AAA)
• Celiac's Disease
• Out of Sync Child
• Dyslipidemia
• Migraines
• Alcoholism
• Disseminated Intravascular Coagulopathy (DIC)
• Metastic Breast Cancer
• Bone Spurs
• Vaginal Birth after Cesarean (VBAC)

Incredibly fascinating! As it turned out, the group of three women had travelled down to Boston to get a better opinion on an AAA found in the friend. Originally, the AAA had been sized as a 4.7, but in Boston--with better equipment--it was sized at 4.2. And oddly! I knew exactly what that meant! 4.2 is in a lower risk group than 4.7. And so to celebrate, they had all gotten drinks and were still in a pretty joyous mood. Which is why, an hour away from Brunswick, this woman got herself a gin and tonic while also getting me a Shipyard (which is a delicious microbrew). 

Anyway, before leaving the train, she made sure that she had given me the following two pieces of advice, several times:

• You need disability insurance more than you need life insurance--start paying into it early.
• Keep a journal and write down the quirky/fascinating little stories that are part of your day to day life.

The first piece of advice was given to me because of the woman's personal experience: she had been a nurse anesthetist for a long time when she was injured on the job (broke her hand due to faulty hospital equipment), and found it impossible to keep going to work. Without disability insurance, her family would have struggled. A stark reminder of how important working mothers can be to their families.

And it was obvious why the latter one was pertinent--this woman had decades of really interesting stories to tell, ranging from the depressing and upsetting, to the hilariously unbelievable. I hope that this blog will function as a repository for the brief encounters in my day to day life as a healthcare professional, holding onto stories until one day I too can expound upon them with a much younger person I've capriciously decided to mentor on a three hour train trip.

Meanwhile! I love Portland, Maine. It is beautiful. It is cool. It has nice restaurants. It has nice beers. It has a lot of gay pride. It is nerdy. It is liberal. It is walkable. And it has a hospital in it! I kind of want to try and spend a part of my fourth year rotating through Maine Medical. 

Baby Sunglasses

So today in pathology we learned about my favorite organ, the liver. But sometimes baby livers don't work as well as they should, and so babies are born with jaundice of the newborn (which sounds a lot better than hemolytic disease of the newborn but what do I know about newborns as a barren 23 year old?). Regardless, our professor was explaining that one of her children had this condition fresh out the womb, and they had to keep it overnight at the hospital in a light box*, and it was apparently incredibly traumatic for her. I suppose I can understand her emotional trauma. You're technically supposed to bond with your baby like, as soon as it's born, so to have it in a plastic box would kind of put me on edge. What if the baby ends up liking UV rays more than mommy? And as a young adult in college it gets more oxytocin visiting tanning salons than calling its own mother? Then it probably gets skin cancer (because it's probably white) because it can't stay away from L.A. Tan. #whitepeopleproblems

MY experience with jaundice of the newborn is much more amusing. I was beyond excited/curious during the gestation of my little sister, Erisa. One of my earliest memories is tapping on my mom's stomach to assess whether or not it actually contained a human or if my mom was just being lazy and taking weeks off of work to lie in bed. Regardless, when my baby sister Erisa was born she had a little jaundice. But we got to take her home, and so in the yellow walls of our home's nursery, I got to observe my little sister converting unconjugated bilirubin to photobilirubin while wearing super cool little baby sunglasses that I was hella jealous of. And so began my love/annoyance with my little sister. And my appreciation of cool shades.


*Why would you ever put a newborn in a light box?: You put babies with too much bilirubin/jaundice in light boxes because it converts the insoluble bilirubin into photobilirubin which is soluble and can be excreted in the urine. A lot of bad things can happen if you let bilirubin build up in a newborn, but by far the worst is kernicterus, which is a condition that damages the brain.

another discovery!

I've begun studying for the boards, and at no other point in my life have I felt like I know so much and yet have so much more to learn. I believe this is well illustrated in a recent discovery: emboli and thrombi are not the same thing. Surprise! For most of last year, the distinction was never pertinent to doing well on exams (I presume). But now I know that they are different and I feel like a genius (which is sad because, well, I'm probably an idiot).

Emboli are traveling coagulopathic bundles of debris. Coagulopaths!

Thrombi stay put embedded in arterial walls. Lipitor!

I'm probably an idiot. 

Propofol? More like propolol...

I really am not enjoying the humor employed by First Aid. Also, since most of medical literature uses the term "African-americans", this publication's use of the word "blacks" seems a smidge too racist. Oh well. At least they call whites whites. I'll wait to see what they call asians....

More Good News Everyone!

Alcohol is good for you! But only in moderation. This fact is best illustrated by the J-curve, which suggests that not drinking at all and heavy daily intoxication are equally dangerous for you and your health. Suck it teetotalers (read: Utah)! Regardless, it appears that the range of 1-50 g/d is the healthiest for you, which is equal to 1-4 drinks per day. Even at my most debaucherous  I usually don't go 4+ drinks more than once or twice a month.

However, the most successful drinking plan involves lower levels of intoxication for a longer period of time. Which means you shouldn't drink more than 1 drink/hour. Which means! I get to drink for four hours! Every day! Good thing I start with dinner. 

C ut-Back

A nnoyed

G uilty

E ye-Opener

Questionnaire.

Going Over

This is awesome.

This is also terrible.

But still kinda awesome.

Child psychopathology is actually super fascinating. Unfortunately, lecture has gone over by 24 minutes. This might be a record.

Regardless, usually I wouldn't care. I love it when classes go long--if they're interesting. But today something else is amiss. My blood sugar is low (it's 55 mg/dL). And I need to go get a Coca-Cola.

OH! Class just broke. Great!

On the problems of the DSM-IV-TR

Seems about right...

Cheap Medicine

"Don't be the ones who order labs because by the time you practice we won't be able to afford the labs."

-Psychiatrist Professor

Empowered

So thanks to my involvement in Step Up (a tutoring/mentoring program at NCCHS) and AMWA, I feel like I can do anything. Or at least, I can try to do anything. I have the resources and the know how. I feel as though I can affect change in my surroundings--and what could make anyone feel more powerful? Regardless:

The American Medical Women’s Association (AMWA) at my school is really awesome. I’m not just saying that because I’m on the board, but that fact helps a lot.

Regardless, last year was the first time we put together an event called the “High Heel-Athon” which was designed to raise money for a domestic abuse shelter in Chicago. It was a good event in that we raised a lot of money—over $500. It was not good in the turnout. We got about 14 people, including board members, which was depressing, at least to me, a lowly M1 who had yet to realize that medical students are flooded with apathy.

So this year, the president, the ambitious and awe-inspiring Alice Lee , and I, decided to tone it back a little bit, and have a High Heel Gala instead. We were going to get a speaker to give a speech, pertaining to domestic violence and what we as medical students should know, and how we should aspire to deal with the situation when we became practicing physicians. We wanted to not only raise awareness, but we also wanted to help our peers become better physicians.

Unfortunately, we couldn’t find a speaker, so instead my mother (a professor at the school) suggested we give the presentation ourselves. So we did! And not only was it really nerve-wracking, it turned out totally amazing. Alice Lee and I are both creative types, so the presentation looked pretty. Alice Lee talked loudly and authoritatively, and I rambled somewhat less than usual (I suck at preparing speeches; “I’ll do it live!”)

Even better, more than twenty people, not including board members, showed up and many of them said they enjoyed the presentation. So below, for your benefit dear reader, I’ve posted some of the more informative slides: