Thalassic

Thalassic is defined as "of or relating to the sea." Thalassemias are hematological conditions in which you don't produce adequate amounts of certain proteins that compose your hemoglobin (the stuff that carries oxygen around on your RBCs).

The name for this condition comes from the prevalence of this condition around the Mediterranean Sea, essentially: you live around a sea and your blood is messed up. However, another translation of Thalassemia would be something like.... "Blood full of the sea" or "Sea Blood" which sounds to me like the exact opposite of Land Lubber. I love it.

Unfortunately, there is a wide spectrum of how severe a thalassemia can be: from clinically silent to death in utero. 

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. 

Aphemia

I love medical words. I can't pronounce many of them, but I still love them. Like aphemia. It's a form of mutism seen in catatonic patients. But if you separate it into its parts, (aph)asic and -emia, you get:

Lack of language within your blood.

or

Loss of words from your vasculature.

Really, just poetic.

No Duh Aristotle

Sometimes bioethics can be really dumb, and yet so disturbingly profound.

No, that last half is profoundly sarcastic.

Here is a fun quote from our Bioethics text:

"Common to all theories of justice is a minimal requirement traditionally attributed to Aristotle: Equals must be treated equally, and unequals must be treated unequally."

NO. WAY.
I think my brain just exploded from the complexity of that statement.


But to be serious for perhaps a paragraph, I really enjoy bioethics. I miss writing things out. Also, it's fun to posit ridiculous arguments. However, I don't know if I'll ever write anything more ridiculous than the following sentence I wrote for a discussion on vaccinations:

"I think we can safely assume that this family is inherently evil."
So get your kids vaccinated! 

The Human Model

You can learn a lot from patients.

Sometime last week I went over to the Hospital of Veteran's Affairs to volunteer at a clinic. The clinic is submerged into the homeless shelter at the VA. We were instructed to take patient's histories, a skill we all learned as part of our Essentials of Clinical Reasoning course. I was uncomfortable at first, but it's always surprising how human-like human patients can be.

Regardless, one of the people I saw was a fellow diabetic. While the people running the show scrambled around looking for an appropriate test meter (because I do not know how to use the really fancy ones; OneTouch meter's are always full of extraneous options that I can't work), I got to talk to the patient.

Somehow we got onto the topic of significant others, and the diabetic had some wise words to say about the ills of domestic violence. He said two really touching things. The first was a rather hilarious anecdote about the only time he had hit a girl. It was in high school, and he had slapped his girlfriend, thinking to himself that she was acting like a b*#$!. Well, he had not been counting on being held accountable. Coming home, he was greeted by his seven sisters and his affronted girlfriend. They did more than "explain" why his behavior was out of line.

Second thing: he expounded on why women are ultimately the more important gender. I was fairly impressed, and I keep thinking about what a character that diabetic was. I want to write more about him, or at the very least, write down what he said so I can tell my own kids how to avoid domestic violence in relationships. Honestly, I don't think he learned anything from me. But I ended up learning a lot from him.

Another strike against paternalism. Perhaps the doctor-patient relationship is more like a symbiotic relationship, where both groups are made better through their interaction. Regardless, I feel like I could write a chapter on the character that this patient presented, even if briefly--even if less than twenty-minutes.

This is why I went into medicine.

I want to learn more about the human condition. I can't write about people if I do not understand them, first. Certainly that's not only the reason I am in medical school. But for the part of me that is a writer, that's all the motivation I need.