There are a lot of interesting, though surely negative ramifications that will arise like some hideous zombie-phoenix from the ashes of our economy. For instance, I shudder to think of what will happen with health care, especially when malpractice caps meet defensive medicine head-on. as another example, the sudden suicidality of financiers is hardly surprising. There's this one story, though, straight out of Beijing (again), that, while probably entirely due to the economic downturn, sounds like the plot to some campy Lifetime made-for-TV movie.
So there's this married businessman with five mistresses. He gives them all cash allowances, and pays for their living arrangements. Sweet deal, right? Well, the economy goes belly-up, and this guy decides he has to cut back to just one mistress (plus the wife, I'm assuming). So, true to our reality show culture, he stages a talent contest to decide which of his lovelies get the boot - ranking them on singing, looks, etc. Anyway, the first one kicked off is the epitome of a woman scorned; she lures the whole polygamous crew into her car under the pretense of a sightseeing trip before returning to her home province - and drives the car off of a mountain. Ironically, she killed only herself; everyone else was just injured. Here's the story.
That's it. I have no medical addendum to that little tidbit. I can, however, say, that if you're a retired show-chimp, you should probably lay off the Xanax (a benzodiazepine sedative). I don't even know where to start on that one, but I'm sure that if I were to look back into my notes somewhere, I'd come across some very rare cases in which new mothers went crazy after taking some sedatives (I'll see if I can find it for you). I'm just sitting here, taking a break from studying all things gastrointestinal (pathology and microbiology, etc), and was so surprised at all of the interesting news today, I just had to share.
Tuesday, February 17, 2009
Monday, February 16, 2009
neuroclutter
The week after a test is always a little light on classwork. I really spoiled myself - I got to work out 5 days in a row - something I've never done down here on the island. I even took a long run along the mountainous roads that loop in and out, giving peek-a-boo glances of the Caribbean sea.
We had our first test of the semester a week ago, and this one was overwhelming. I came out on top, but this was the first time I was really floored by how much we have to know. That was before the actual exam. Afterwards, I was struck by how much stuff I've crammed into my head at this point. After something like 34 official medical school tests, I'm starting to feel like I know stuff. As I've said before, though, we're starting to move to a more practice-oriented learning process, beginning to leave behind our basic sciences years. That being the case, I know lots of stuff, but I know how to do very little.
Nicole and I are fond of watching the Discovery Channel's Mystery Diagnosis. Unless it's some incredibly rare condition that only a handful of doctors even know about, we generally find ourselves struck by the fact that no one figured it out sooner; if we know the answer, why didn't anyone else? It could just be artful editing directed at the diagnosis, but more often than not, I find myself wondering why no one [on the show] is running an MRI on someone with frightening neurological signs. Let me remind you, however, that I may feel like I know a lot, but I know how to do very little.
Perhaps I should clarify that - I can do cardiovascular, respiratory, abdominal, and certain general exams; I can cut into the body and find any organ, vessel, or nerve that has a name; I can do several different kinds of suture. I do not, however, know all of the heart murmurs - I only know a few; I do not know how to do neurological exams - though I will have practiced by the end of this week; I do not know how to administer medication, or dosing - but I can name literally hundreds of drugs and tell you how they work. So far, my learning has been foundational, and while I enjoy looking at pathology slides of gallbladder cancer (bad choice of example...it's not that interesting-looking, but it was on the tip of my tongue), it's the doing; the practice that is the heart of medicine. So I don't really know anything, I guess.
Yet.
We had our first test of the semester a week ago, and this one was overwhelming. I came out on top, but this was the first time I was really floored by how much we have to know. That was before the actual exam. Afterwards, I was struck by how much stuff I've crammed into my head at this point. After something like 34 official medical school tests, I'm starting to feel like I know stuff. As I've said before, though, we're starting to move to a more practice-oriented learning process, beginning to leave behind our basic sciences years. That being the case, I know lots of stuff, but I know how to do very little.
Nicole and I are fond of watching the Discovery Channel's Mystery Diagnosis. Unless it's some incredibly rare condition that only a handful of doctors even know about, we generally find ourselves struck by the fact that no one figured it out sooner; if we know the answer, why didn't anyone else? It could just be artful editing directed at the diagnosis, but more often than not, I find myself wondering why no one [on the show] is running an MRI on someone with frightening neurological signs. Let me remind you, however, that I may feel like I know a lot, but I know how to do very little.
Perhaps I should clarify that - I can do cardiovascular, respiratory, abdominal, and certain general exams; I can cut into the body and find any organ, vessel, or nerve that has a name; I can do several different kinds of suture. I do not, however, know all of the heart murmurs - I only know a few; I do not know how to do neurological exams - though I will have practiced by the end of this week; I do not know how to administer medication, or dosing - but I can name literally hundreds of drugs and tell you how they work. So far, my learning has been foundational, and while I enjoy looking at pathology slides of gallbladder cancer (bad choice of example...it's not that interesting-looking, but it was on the tip of my tongue), it's the doing; the practice that is the heart of medicine. So I don't really know anything, I guess.
Yet.
Thursday, February 5, 2009
Tragic Irony
In Beijing, China, a 13-year old girl attempted suicide, in order to donate her liver to her father, who apparently had cancer. To help shuffle her off this mortal coil, she chose the decidedly nonviolent method or downing 200 sleeping pills (women tend to kill themselves in a manner that preserves their faces). However, there are two levels of irony here that make this incident much more tragic than other accidents involving adolescents. First, even though you can't live without your liver, if you want to help someone who needs one (and you happen to match on all levels of the HLA), you can donate part of your liver. Some organs grow back, and some don't - the liver is one of them that does (Keep in mind, though, that severe damage - alcoholic cirrhosis, some types of hepatitis - can damage a liver beyond repair; only a healthy, not-too-badly-damaged liver can regenerate itself).
That would be enough irony for one day, but it gets worse - the fact that she tried to kill herself with sleeping pills probably caused irreversible hepatic damage. The enzymes and chemicals in the body that break down all of the harmful, poisonous products we take in (alcohol, medications, etc), are broken down by cells of the liver. With a high enough load of toxic chemicals, those detoxifying cells (more specifically, the hepatocyte smooth endoplasmic reticulum) simply die. The girl is in intensive care right now, I suppose. Surprisingly, the Chinese Daily News refers only to the burns she received from an electrical blanket while unconscious, and mentions nothing of the fact that, now, both father and daughter may need a liver transplant.
Poor kid - she was just trying to help, I guess.
That would be enough irony for one day, but it gets worse - the fact that she tried to kill herself with sleeping pills probably caused irreversible hepatic damage. The enzymes and chemicals in the body that break down all of the harmful, poisonous products we take in (alcohol, medications, etc), are broken down by cells of the liver. With a high enough load of toxic chemicals, those detoxifying cells (more specifically, the hepatocyte smooth endoplasmic reticulum) simply die. The girl is in intensive care right now, I suppose. Surprisingly, the Chinese Daily News refers only to the burns she received from an electrical blanket while unconscious, and mentions nothing of the fact that, now, both father and daughter may need a liver transplant.
Poor kid - she was just trying to help, I guess.
Tuesday, February 3, 2009
That's....that's IT?
I was actually rather looking forward to today - now that I'm a fourth semester, we're moving out of the academic and into the practical, in this endless medical pilgrimage. Today was the first day I was scheduled to go to the hospital, and I made very sure to have all my i's dotted and t's crossed - I'd read and re-read the syllabus, gotten all of my instrument together, and even went so far as to buy an iron so I could finally melt on my Ross patch. I'd heard stories from other students - one sat in on an autopsy in their pathology rotation, and another watched a third-world hospital gunshot-wound debridement. How was I to know that my day would be wasted?
We stood around for about 10 minutes in front of the library before being crammed onto one of the nicer Dominica buses. These aren't like American charter buses - or even like American school buses. They're like really big vans, and this was one of the nicer ones. Each row of chairs has these little folding seats and, since my name was the last called, I got stuck with one. There was no way to sleep - the top of the seat hit somewhere around my 12th thoracic vertebrae. Luckily, I'd brought a pathology review book, and managed to read through blood vessel disorders. I generally have no problems reading in moving vehicles - that's partly how I kept my sanity on cross-country bus trips between Georgia and Michigan, and then again from Connecticut, to Georgia, to Texas. Those were American roads, though - quite unlike the Dominican....paved trails, I'm going to call them. Somehow, they're all winding and curvy, and they all feel like cobblestones. The mountainous terrain forces them up and down, up and down... I'm not only lucky that I actually managed to get some reading done, but that I'd scored some Dramamine from Nicole over a pancake and egg breakfast this morning.
After a hour's drive to the capital city Roseau (ROW-zoh), we got to Princess Margaret Hospital, affectionately called PMH (because it's not medicine if there aren't abbreviations. CXR, D&C and a DNR, anyone?) We were broken up into groups - everyone was supposed to bring scrubs, just in case they started out with surgery or path, but some folks forgot theirs, and so there was some switching going on. I wanted to switch -especially when I found out that I'd been assigned to OB-GYN (that's Karma), but I figured it'd be unprofessional to try to switch out of something just because I wasn't interested in it. Another guy did, though - and looking back, I think I should have also. Two other students and I were quickly lead to where we'd meet our doctor.
There was a lot of waiting around today - it was sort of life class, only without the sitting. We stood in the postnatal unit (ahem....hallway) while two interns chatted away, finally recognizing us at a break in their conversation. The doctor was busy doing something at her office, so one of them would show us some stuff. She led us to the prenatal area, and performed a physical exam on this woman who was something like 34 weeks pregnant. That was it - just a little strategic "laying on of the hands", and that was that. We retired to the little desk/nurse's station in the post-natal hallway to chat about pregnancy and such.
Finally the doctor came, and continued asking us questions about more pregnancy. She gave us something to think about (rather, asked us a questions and told us to think of the answer) while she went to do something, and then came back for more talking. Boring as hell. The girl in our group, who's actually interested in this stuff, politely asked the intern (prior to the arrival of the doctor) what she'd be doing on a normal day. Unfortunately, this was the day before surgery day, and there just wasn't a whole lot going on. I will say, though, that this one intern had a peculiar talent, which I've only seen in one other person (an incredibly intelligent college roommate of mine) - the ability to, when asked any question, vault into a lengthy, meandering digression full of truly impressive tangentiality, only to not forget the question, and somehow answer it in such a way that the rambling makes sense. Very Dickensian, I suppose.
The doctor led us down to the gynecological ward (room, I mean), and we were actually allowed to palpate and percuss the belly of a women in possession of massive uterine firbroids. They treat those with surgery. That was that.
After that, we hopped in a cab and drove to some restaurant (whose name escapes me) that had a sign like a Starbucks, and seating like a Starbucks, but faced a massive cruise ship, moored like a dingy in the massive Caribbean sea. I had a nice chicken panini something or other and a coffee-flavored slushy-thing . Because of the timing, we actually ended up having about an hour and a half. Nice not to be rushed.
We returned to PMH and were broken up into new groups - I was placed into surgery. I was looking forward to this part too - I know that it was going to be post-op, but I'd at least hoped it'd be cool. Firstly, unless any of you have ever spent time in a third-world country, you cannot know what I mean when I say that this hospital was downright spartan. There were no individual patient rooms, merely neat rows of beds partitioned off by brightly colored curtains. Everything looked like it was from the 70's, or 60's, perhaps. We were given an hour to do as much of we could of the H&P (history and physical).
The gentleman we'd been assigned to had been smashed in the back of his head with a rock by a 16 year-old kid two Sundays ago, was knocked unconscious, and brought to the hospital via ambulance. They sewed in 10 stitches, took some x-rays, drew blood, and discharged him on Tuesday. That Friday, he came back, complaining of terrible headaches. When we saw him, he was still waiting for his CT scan. The thing we're worried about when it comes to head trauma is neurological injury, but this guy was fine - with one exception. He followed motor commands, had no problems with his memory, was oriented to time and place, and, otherwise, was found to be healthy as a horse -but, since the accident, he'd lost his sense of smell. That's called anosmia, and is generally due to a fracture of the cribiform plate of the ethmoid bone; trauma is just about the only way it can happen. I said he was healthy otherwise, and he was - his cardiovascular, respiratory, and abdominal exams (most of which I performed) were perfectly normal.
After presenting the case to the attending and listening to other cases, we hopped on the bus back to campus, and I regretted not bringing any more Dramamine with me. It was lightly drizzling when we got back, but I was dropped off close to where I live, so I didn't have to trudge through it. I then went and poked around in the prevertebral region of one of the cadavers for half an hour, because no one showed up for my TA session.
We stood around for about 10 minutes in front of the library before being crammed onto one of the nicer Dominica buses. These aren't like American charter buses - or even like American school buses. They're like really big vans, and this was one of the nicer ones. Each row of chairs has these little folding seats and, since my name was the last called, I got stuck with one. There was no way to sleep - the top of the seat hit somewhere around my 12th thoracic vertebrae. Luckily, I'd brought a pathology review book, and managed to read through blood vessel disorders. I generally have no problems reading in moving vehicles - that's partly how I kept my sanity on cross-country bus trips between Georgia and Michigan, and then again from Connecticut, to Georgia, to Texas. Those were American roads, though - quite unlike the Dominican....paved trails, I'm going to call them. Somehow, they're all winding and curvy, and they all feel like cobblestones. The mountainous terrain forces them up and down, up and down... I'm not only lucky that I actually managed to get some reading done, but that I'd scored some Dramamine from Nicole over a pancake and egg breakfast this morning.
After a hour's drive to the capital city Roseau (ROW-zoh), we got to Princess Margaret Hospital, affectionately called PMH (because it's not medicine if there aren't abbreviations. CXR, D&C and a DNR, anyone?) We were broken up into groups - everyone was supposed to bring scrubs, just in case they started out with surgery or path, but some folks forgot theirs, and so there was some switching going on. I wanted to switch -especially when I found out that I'd been assigned to OB-GYN (that's Karma), but I figured it'd be unprofessional to try to switch out of something just because I wasn't interested in it. Another guy did, though - and looking back, I think I should have also. Two other students and I were quickly lead to where we'd meet our doctor.
There was a lot of waiting around today - it was sort of life class, only without the sitting. We stood in the postnatal unit (ahem....hallway) while two interns chatted away, finally recognizing us at a break in their conversation. The doctor was busy doing something at her office, so one of them would show us some stuff. She led us to the prenatal area, and performed a physical exam on this woman who was something like 34 weeks pregnant. That was it - just a little strategic "laying on of the hands", and that was that. We retired to the little desk/nurse's station in the post-natal hallway to chat about pregnancy and such.
Finally the doctor came, and continued asking us questions about more pregnancy. She gave us something to think about (rather, asked us a questions and told us to think of the answer) while she went to do something, and then came back for more talking. Boring as hell. The girl in our group, who's actually interested in this stuff, politely asked the intern (prior to the arrival of the doctor) what she'd be doing on a normal day. Unfortunately, this was the day before surgery day, and there just wasn't a whole lot going on. I will say, though, that this one intern had a peculiar talent, which I've only seen in one other person (an incredibly intelligent college roommate of mine) - the ability to, when asked any question, vault into a lengthy, meandering digression full of truly impressive tangentiality, only to not forget the question, and somehow answer it in such a way that the rambling makes sense. Very Dickensian, I suppose.
The doctor led us down to the gynecological ward (room, I mean), and we were actually allowed to palpate and percuss the belly of a women in possession of massive uterine firbroids. They treat those with surgery. That was that.
After that, we hopped in a cab and drove to some restaurant (whose name escapes me) that had a sign like a Starbucks, and seating like a Starbucks, but faced a massive cruise ship, moored like a dingy in the massive Caribbean sea. I had a nice chicken panini something or other and a coffee-flavored slushy-thing . Because of the timing, we actually ended up having about an hour and a half. Nice not to be rushed.
We returned to PMH and were broken up into new groups - I was placed into surgery. I was looking forward to this part too - I know that it was going to be post-op, but I'd at least hoped it'd be cool. Firstly, unless any of you have ever spent time in a third-world country, you cannot know what I mean when I say that this hospital was downright spartan. There were no individual patient rooms, merely neat rows of beds partitioned off by brightly colored curtains. Everything looked like it was from the 70's, or 60's, perhaps. We were given an hour to do as much of we could of the H&P (history and physical).
The gentleman we'd been assigned to had been smashed in the back of his head with a rock by a 16 year-old kid two Sundays ago, was knocked unconscious, and brought to the hospital via ambulance. They sewed in 10 stitches, took some x-rays, drew blood, and discharged him on Tuesday. That Friday, he came back, complaining of terrible headaches. When we saw him, he was still waiting for his CT scan. The thing we're worried about when it comes to head trauma is neurological injury, but this guy was fine - with one exception. He followed motor commands, had no problems with his memory, was oriented to time and place, and, otherwise, was found to be healthy as a horse -but, since the accident, he'd lost his sense of smell. That's called anosmia, and is generally due to a fracture of the cribiform plate of the ethmoid bone; trauma is just about the only way it can happen. I said he was healthy otherwise, and he was - his cardiovascular, respiratory, and abdominal exams (most of which I performed) were perfectly normal.
After presenting the case to the attending and listening to other cases, we hopped on the bus back to campus, and I regretted not bringing any more Dramamine with me. It was lightly drizzling when we got back, but I was dropped off close to where I live, so I didn't have to trudge through it. I then went and poked around in the prevertebral region of one of the cadavers for half an hour, because no one showed up for my TA session.
Monday, February 2, 2009
You know...whatever...
I have been immersed in the pathology of hearts and lungs. Pharmacology has grown more esoteric, and isn't nearly as pleasant as it was - more esoteric and somehow more pertinent; these are the drugs people actually use. EKGs actually are really interesting. Microbiology is in full swing - I love the names: Bordetella sounds like "bordello". I have decided that Seven Pounds is one of my favorite movies of all times, and that, in order to become a film critic, you have to have failed miserably at something very meaningful in life (because they're all stupid and wrong). I have rediscovered the music of Yasunori Mitsuda, and am eagerly awaiting amazon's or iTunes' uploading of Roberto Cacciapaglia's Mp3s. This is all just as well, because I also have not only my first big test of the semester in a week, but I'm also going to the hospital tomorrow to practice some of what I've learned I'll have to do a serious write-up, while studying for the test. I've decided not to be a head-TA - I don't want to do all of the administrative work. I am, however, already elbow-deep in showing new kids the wonders of the branches of the external carotid artery. And the band played on.
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