the myoclonic jerk

they stuck me in an institution, said it was the only solution

2006-08-10T12:45:00.000-07:00

every week, we have 90 day conferences with patients on their progress. mostly, their only statements on record are some form of "get me the hell out of here".

ms. x is different. she has been at the psych hospital for a few years, and wants nothing more than to stay there. she is a schizophrenic, paranoid type, but because of her meds is completely lucid and engaging. she is different from most of the other patients: college-educated, articulate, the product of an average middle american family and a "great childhood". she has a work assignment, is an ideal employee and looks forward to being visited by her family.

the problem is, they have little reason to keep her at the hospital because she is doing so well. so the hospital and ms. x have a little game: they see she's doing well and talk about sending her to the step-down board and care, and she starts acting loopy. she's smart enough to know what she needs to do to stay there and does it.

at her last conference, she laid it all out for us on why she wanted to stay. ms. x is about the same age as my parents (mid fifties), and i can really see the 1960s ideals in her. she was always expected to have the same life as her parents: get married, have kids, have the house, etc. but she didn't want that life and acted out. she was homeless for periods and took drugs. she committed crimes, got arrested and sent to the hospital because of her mental illness. now that she's here, she has everything she needs. she gets the structure of having all her needs met, having a job that gives her peace and a sense of accomplishment, and feels that she is in a safe place. the outside world, including the step-down place, doesn't have those guarantees. she cannot imagine going back to it now.

my attending argues that she has such great potential and would have a much better life outside, but i disagree. she dropped out of society for a reason, and by her own admission, there is nothing out there that would be better than where she is now. our rewarding lives out here mean nothing to her, and trying to sell her on it is a waste of time. but the law is the law, so she very well might find herself essentially kicked out. i reckon she'll do something to get back in, maybe for good. i'm hoping that won't be the case, as some of the people in the conference were able to guide her into saying what she needed to say in order to keep her "mentally disordered offender" status and stay there for at least the next 3 months. but will there always be someone willing to help her stay there?

as hard as it is to believe, there are people who are better off in institutions. i don't want to get into a rant about california kicking patients out of state run mental hospitals starting in the 1970s and decreasing funding to both those hospitals or the community-based programs that were supposed to take their place for the ousted patients (maybe next time). the point is, we can't always put our values on our patients. we also can't assume that they will do the same in society as they do in the hospital. some people may fit the state's criteria for being released and self-sufficient, but if they don't feel ready themselves, they are destined to come back. they will do whatever they can to get back in there. and you can imagine what types of crimes would keep you in a state hospital for life.

my DSM-IV code right now is 300.00, generalized anxiety disorder NOS

2006-07-25T20:34:00.000-07:00

it was actually the second day of my psych rotation, but yesterday all we did was get our badges and watch a HIPAA video. i'm on the women's unit, which is both good and bad, being that women scare me in general and i have no experience with violent mentally ill women.

this morning we walked over to the unit, and had to go through a guard's station and about 10,000 locked doors. some of them you look yourself, and some lock automatically, but i can't remember which is which, so tomorrow will be interesting. as soon as we walked into the unit, the patients were lined up to go to breakfast. "oh, we got some white girls!" said one of the patients as we walked in, and everyone laughed, myself included. it was the pseudo clarice starling moment i had been waiting for.

as in all of mental health, everyone smokes, even the staff. i quit smoking in april and if anything, this reaffirms my decision because i realize how nasty smoke smells on people and everything else. even the air is hard to get used to, but the heat might have something to do with that.

the patients are for the most part non-threatening and just about everyone is quite respectful. most of them are trying to get to a step-down unit, so they know they have to behave. we saw about 6 of them today and they all had schizophrenia, which is my reading assignment for the night. since this is a forensic unit, all of them have been deemed NGI (not guilty by reason of insanity), incompetent to stand trial or need to be here for their parole. there's a good mix of crimes, and not all are here for manslaughter, which makes me feel better.

at first i was scared to turn my back to them, thinking that if i did, i'd get shanked. but then i noticed how the staff are not all paranoid, and i got way more relaxed, although i still got nervous when we were out in the yard and they were hovering around us. my classmate was really on edge, having never been exposed to psych patients before. i hope she gets through this month ok.

in reading their charts, i've seen some themes in mental health care within the prison system that i'm going to research a bit and write more about this month. i have to watch what i say very carefully (hence this dry ass post), but i expect to learn tons about how we treat our mentally ill criminals and how they are eventually rehabilitated.

our psych attending is young (um, like 3 years older than me) and is an alumnus of our school. he loves psych mainly because "people do get better". the money and chill lifestyle don't hurt either. will i lose the bet with my dean, who said i was destined for psych? i still feel like i like everything else, that going into psych is a waste of most of my education. i just can't stand the thought of going into the wrong field and things sucking for the next 30 years.

fourthmeal- the crispy, crunchy, cheesy and chewy road to diabetes

2006-07-18T19:21:00.000-07:00

i'm in my last week on the endocrine service, and having seen my fair share of patients about to lose pieces of their lower extremities, i've been thinking a lot about all the little ways we seduce ourselves into insulin resistance and the big DM.

one of the most interesting recent ad campaigns lately is the taco bell fourthmeal concept, which comes complete with a sexy, sims-esque website where one can run amok for hours "rochambelling" other nacho cheese lovers or making special soft drink mixes a la the mr. pibb and orange soda suicides of 7th grade.

i can see why taco bell would want us to eat another meal and wants us to eat it with them. but do you think they did any legal research into corporate responsibility before they started their ad campaign? my best friend the lovely litigator says that even though there aren't any specific laws they could be sued under, it's still really irresponsible to market a new meal when it's obvious we all eat to fucking much already.

some scary data on diabetes, courtesy of the american diabetes association:

Total: 20.8 million children and adults -- 7.0% of the population -- have diabetes.

Diagnosed: 14.6 million people

Undiagnosed: 6.2 million people

Pre-diabetes: 41 million people

1.5 million new cases of diabetes were diagnosed in people aged 20 years or older in 2005.

these numbers don't include those with insulin resistance or impaired glucose tolerance (known as pre-diabetes on the street), conditions which are not considered diabetes themselves, but have a high rate of progression into diabetes.

now i dig taco bell (although i dig del taco even more), but it's such transparent manipulation that it turns my stomach.

the new hummer ads with the slighted soccer mom and the emasculated tofu-lover makes me feel the same way. they aren't online but i'm sure you'll see them soon enough if you haven't- the tofu guy bit played like 2 minutes ago while i was writing this and watching the "spice capades" episode of good food. we all know that ads like these are meant to provoke, and playing on the obvious insecurities of your likely customers is cheeky enough to work like gangbusters. of course i should buy a huge laughingstock of a car because i feel all small and shamed! it's like i never left de mille junior high after all! thanks to my big new fuck-off hummer i'm in my happy place again...

ok, back to fourthmeal. so we're eating all the time thanks to that hideous word snack, plus we're eating crap from places like taco bell (and del taco). but that's not enough! we need another meal, late at night, when we are likely to be drunk and in that state where we don't give a shit who we sleep with, much less how many calories we consume. no longer do we have to feel bad about eating so late, it's legitimized because the taco bell people told us so, right on the drive-thru menu board.

why not a fifthmeal? or eighthmeal? shit, why not just throw an NG tube of taco bell nacho cheese in and have perpetualmeal?

we know that eating too much and too many of the wrong foods can lead to diabetic conditions. so why are we still bombarded with shit like fourthmeal? why are people still eating hotpockets?

there is more media about healthier lifestyles, but so much of it is hollow, like the "Mediterranean diet" brochure i got in the mail from kaiser with my cholesterol results (don't ask, it involves family history and ikea meatballs). the letter said, "read this brochure and get your blood tested again in 6 months". no follow up with the doctor, no call, nothing. it's a start, but any effective lifestyle changes require better monitoring than a letter. kaiser wants to tout their preventative care while still providing the socialist masturbation they call managed care, which precludes any attempt at the necessary communication for said lifestyle changes. if the biggest private health provider can't be bothered to get on the lifestyle changes bandwagon and mean it, we're all potentially on the highway to metformin hell. and for every step forward that we make to educate the public and help stop diabetes before it starts, things like fourthmeal (it's ok! eat another meal, because you're hungry! very hungry!) add up to pushing us back.

we have to become resistant to suggestions that we eat more often, eat with our emotions and eat more cheesy bacon with bacon and cheese, and cheesy bacon-blasted ranch dressing. so many people still don't really believe that obesity and diabetes are linked, and that untreated diabetes leads to renal failure, blindness and getting your fucking feet cut off. health professionals need to take a tougher stance, and say something to every patient, every time, even if they don't have any of the signs yet. at first when i saw my attendings talking to patient's families about their own diabetes risks and flat-out saying things like "you're overweight, you need to lose weight and eat better because what is happening to your family member could happen to you", i was floored. but we have to try, make people uncomfortable, make them look at their father's leg stump, make them think. ultimately, it's us or taco bell.

an M3 in 3 days

2006-06-23T15:35:00.000-07:00

i got an extra white coat. some black pens. had all my doctor-y clothes dry cleaned. the car is getting a very expensive tune-up. i read first aid for the wards and how to be a truly excellent junior medical student. i'm taking ACLS this weekend. all of this to be totally prepared for rotations.

but really i'm not prepared at all. i feel woefully inadequate for what i'm about to start. i am about as anxious as i was in the days before i started med school, although i haven't gotten a rash. yet.

it helps to relax at home, doing little but watching tv and catching up on world news. i felt like a loser for not going out all day at first, but after spending the last two years feeling like a different person and wondering when i'll get myself back, i know that part of me is gone forever. that's not just a function of being in med school, it's just being a grown-up.

i know where i will be on monday. i called yesterday and i will be on the endocrine service. i'm technically supposed to be doing general internal medicine, but that's how things go sometimes. the upside is that the attendings for this service consistently get positive comments in evals and everyone emphasizes how much they enjoy teaching students in a non-stressful environment.

i just might survive. wish me luck.

i am alive

2006-06-19T09:45:00.000-07:00

you wouldn't believe the number of times i've said "hmm, need to update the jerk" and didn't. i even had a couple of drafts that i wrote that didn't feel right.

as you can guess, i'm done with 2nd year. i've taken my boards and await to take the USMLE on wednesday. then i start my medicine rotation at...well, i'm not sure really. (ok, this will give away my identity to people who read my other journal, which i have been updating as usual. but, like anyone cares, right?) due to the preceptor's illness, my previous medicine rotation was cancelled. i'm supposed to find out today where i will be next monday. it could be anywhere, even michigan, although that's a stretch.

2nd year went well academically, but personally tested the limits of my sanity and emotional stability. i didn't get divorced or anything, but a death in my husband's family brought confirmation that there is indeed a fatal genetic disease hanging around. i don't want to elaborate, but it's one of those diseases where you think "jesus, i'm glad that's not in my family" when you learn about it, and since it's on every board exam, so i'm bound to get a nice punch in the gut on wednesday when i'm trying to concentrate.

in the last few months, we have learned a lot about insurance policies and terminal illness. patients with the disease have a suicide rate 7 times higher than the normal population, and face the reality of never being insurable again after testing positive. needless to say, i am terrified at the possibility of losing my husband after he suffers from horrible symptoms for years or commits suicide, not being able to have children and the absolute uncertainty of our lives forever.

yes, they could find a cure. the problem is theoretically an easy one to solve, and there is a lot of research money thrown at this disease. but they are still in the easy (like, mouse and drosophila) stages of the most promising research, and i'm afraid by the time they figure out something he will be too sick for it to make a difference. godspeed, researchers- please find the way to help people with this gene.

i wish i could say more, but the fact that this is out there in the internets stops me, as does the pain that comes with thinking (and writing) about it. i just had to put something up here though.

kitty love

2005-09-25T11:07:00.000-07:00

just now, i led our cat, sarin, into the bedroom to greet the husband. she has a little ritual with him on weekdays, where she waits outside of the bathroom door for him to finish showering. when he comes out, she will start chattering incessantly until he starts for the kitchen to feed her. on weekends he sleeps in more often so i end up feeding her. i can tell she's ok with this, but isn't stoked about it as much as she about him feeding her.

when we got into the bedroom, she went over to his side of the bed, where he had left his clothes from yesterday in a pile. he did some yardwork yesterday, and said he forgot to put on deodorant. this = dirty hippie stink all over the shirt. sarin went nuts, treating the shirt like it was sprayed with catnip. she sniffed and chewed the armpits, then flopped down and did the hind legs rabbit routine on it, just in time for him to come in and watch.

this is a recurring theme with sarin. every time there's been a man in the house with her she's taken to them like a giddy schoolgirl. she'll follow them everywhere, hop up on their laps often and sleep on their side of the bed. she makes nests for herself with clothes that smell like them. i will admit i am somewhat jealous because she likes girls ok, but nothing like how she responds to males. i've had her since she was 8 weeks old, and have been the only constant person throughout her whole life. when i come home she might greet me if i happen to go into the room she's in, but when the mister comes home? she runs into the room and starts up with meowing and the face rubbing on his pant legs. it's not me, it's that i'm a girl and she can smell that on me. i have nothing to offer her.

so it makes me wonder how strong is a signal between two species? i always thought they'd at least be different enough so that you wouldn't have tons of useless attempts of interspecies mating going on in the wild.

(as a side note, there are real hybrid animals, but it's between two species that are pretty damn close evolutionarily speaking. still though, a wolphin!?)

wouldn't you know? they've done studies on this type of thing:

"Recent evidence suggests that vomeronasal sensory neurons may be narrowly tuned to specific molecules (Leinders-Zufall et al., 2000), unlike the main olfactory system, so why would one species respond to another's pheromones? Foreign pheromones would be unlikely to carry mutually beneficial information for another species, but they may have common chemical components. Hamsters probably also share a similar repertoire of functional VR genes with other rodents, as is the case for mice and rats (Dulac and Torello, 2003). Common chemicals would activate common receptors but could be components of different blends, each blend a pheromone only for one of the species. It is also possible that the VNO may have receptors (specialist or generalist) for nonpheromone substances. For example, snakes use the VNO to detect predators and prey (Halpern and Martinez-Marcos, 2003)."

now, this study used hamsters, but it gets my point through. if there are common molecular components to the pheromones of cats and humans, sarin's response could be due to some part of the human male sweat that reminds her of boy kitty scent. it's a response i've seen in her reaction to three different men. it's been the strongest in the husband, but when my brother and i lived together with her, she did exhibit the same behavior with him, and still does when he comes to visit.

i don't know if it's purely sexual, or related a deference to males in general. it's hard to swallow that last part if you know sarin, because she's really not the type to play submissive to anyone. at the very least, it highlights how her interactions with our family may not be merely based upon the promise of some more wet food, but as a necessary social interaction. and they say cats prefer to be alone!

since we're talking about kitties-we are in preparations for getting another cat. it's gonna be a boy kitten, and we should receive him as soon as he's weaned, which will probably be another couple of weeks. i think she'll like him. but he's very cute, very laid back and kinda chubb for a 4 week old baby. i'll post pictures when he gets here.

Welcome to MS2: no more fucking around, we've got lives to save!

2005-09-18T11:20:00.000-07:00

this year started off with a bang, namely the party the boy threw for me when i got back. it was great to see all the people i'd missed while being braised in my own sweat over in bethesda. our research finished nicely, having seen something like 26 patients. with every patient taking half a day, that's pretty damn productive. if all goes well and the gods are happy with the immolation, we'll get a couple papers published.

it's become very clear from the start of MS2 that there will be no more of what one of our professors calls "academic bulimia". it's not like we didn't realize before that we needed to know this stuff for a reason other than to pass an exam, but it seemed so far away then. now it's less than a year away. the exam questions have become more clinical in nature and the lecturers now assume we remember the anatomy behind the stuff they're teaching. needless to say, i've been breaking out the old shit a lot.

currently we're in the cardiovascular system. i've never been the heart's biggest fan, given that it's a lame-ass pump (with 14% efficiency i might add), but nonetheless, it's pretty important since so many people have bad ones. here's some numbers for the US, from some guy named Ben Best, who seems to like death + statistics as much as i do:

in the US:

(1) Diseases of the heart heart attack (mainly) 28.5%
(2) Malignant neoplasms cancer 22.8%
(3) Cerebrovascular disease stroke 6.7%

In other places:

(1) Ischemic Heart Disease 12.4%
(2) Cerebrovascular Disease 9.2%
(3) Lower Respiratory Infections 6.9%

and it's only gonna get worse for my generation of physicians:

-From 1979 to 2002 the number of Americans discharged
from short-stay hospitals with CHD as the first listed
diagnosis increased 22 percent. (CDC/NCHS)
-From 1990-1999, the median duration of hospital stay
related to acute myocardial infarction dropped from 8.3 days
to 4.3 days, according to an analysis of the NRMI. Findings
were similar for both patients receiving primary PTCA and
those receiving thrombolytic therapy. (J Am Coll Cardiol
2000;2056:63)
-Based on the NHLBI's Framingham Heart Study (FHS) in
its 44-year follow-up of participants and the 20-year followup
of their offspring (Hurst W. The Heart, Arteries and
Veins. 10th ed. New York, NY: McGraw-Hill; 2002)
-The average annual rates of first major cardiovascular
events rise from 7 per 1,000 men at ages 35-44 to 68 per
1,000 at ages 85-94. For women, comparable rates occur
10 years later in life. The gap narrows with advancing age.
Under age 75, a higher proportion of CVD events due to
coronary heart disease (CHD) occur in men than in women,
and a higher proportion of events due to congestive heart
failure (CHF) occur in women than in men.
-The aging of the population will undoubtedly result in an
increased incidence of chronic diseases, including coronary
artery disease, heart failure and stroke. (Circulation
2002;106:1602:5)
-The U.S. Census estimates that there will be 40 million
Americans age 65 and older in 2010.

Source: American Heart Association Website

so yeah, this heart stuff is pretty important no matter how damn boring it is.

as i was looking all this stuff up, i found out that september is not only National Cholesterol Education Month, but also National Osteopathic Medicine Month.

spread the word, get your cholesterol checked. mine is total: 176, LDL: 115, HDL: 51 and triglycerides: 48.

yes, thank you, i will have another steak.

and get some osteopathic manipulative medicine done, because frankly, your back is killing you, isn't it?

as an aside, if you want to be thuroughly informed and entertained, the rest of Ben Best's website is completely awesome. beware of driving in Portugal or South Korea, and of being poisoned in Russia. he also write stuff on nutrition, calorie restriction and how it makes you live longer, and cryonics for when you've fucked it all up and want another spin on this mortal coil.

neurology is sucka free

2005-08-03T19:48:00.000-07:00

yeah yeah yeah. it's not that i have nothing to say, it's just that i have trouble wanting to spend time saying it. getting used to this government science-y thing, being lazy as hell.

so here is a quick but not-so-succinct update:

-research going well, last patient done today! with all luck, i'll have the abstract done this week, just in time to jet the hell home to long beach. i leave saturday morning at 6am. that means i gotta be at dulles at like 4 in the morning. no fun at all.

-husband fainted during transcranial magnetic stimulation. was it a deep subconscious fear of medicine? a seizure? lack of a proper breakfast coupled with a very warm room? we will never know. at first i was like, "oh no! my poor syncoped boy!" but then i was all "damn, we could have scheduled a real patient during this time!"

-met other med students, finally. they are all smart and cute and party like crazy. i would too if i had a year off of med school to do basic science research slack and get paid for it all. with free housing! as one said "it's great! you sneeze on a piece of paper and they publish it, plus i don't have to wake up until 10!" i met students from Texas A&M, Northwestern and Hopkins (yes, i was surprised that real live people actually go there too). They thought i went to Case Western Reserve when i said the name of my school, and i had to correct them with the ubiquitous "it's a DO school" when they didn't recognize the name.

-the fellows in our institute arranged a neuro jeopardy game the other day for all the summer students. to paraphrase my mentor before it started: no pressure- but if you win they'll say it's because your team had the only med student on it, and if you lose, they'll shudder at the thought of you ever getting to treat patients. our team's name? the myoclonic jerks. no, i didn't think of the name. but it is pure neuro gold i tell ya. we won, but not before i embarrassed myself by not knowing woodie guthrie died of huntington disease. i totally thought it was ALS! that's close, right? fuck, the other team didn't even know who woodie guthrie was. i did answer a couple of big ones right (circle of willis, cold caloric, biceps reflex) so i was feeling pretty good. i even got some prizes: burt's bees lip balm and a washington DC fridge magnet.

-i am vacillating between feeling like i've done something huge and important and great this summer which will help me land that residency spot without having to blow anyone and feeling like i've just wasted my last summer ever on being depressed and alone in a crappy town with too much weather for my liking. now just as i'm leaving i feel all sorts of nervous about starting school again. after hearing some really cool people in my class will be repeating, it's hard to be completely ecstatic about moving on to M2.

that's enough for now. i'll write more from the non-humid confines of my backyard hammock in a couple days.

big place, lots of smart people

2005-06-14T21:28:00.000-07:00

two weeks into this NIH thing. it's still a bit odd to be in a clinical place where everyone is wearing sandals, but the relaxed atmosphere is really cool compared to the dictatorial arena of medicine california-style. who would have thought i'd have to fly to the stodgy ol' east coast to see pedicured toes in the ICU? i'll keep my danskos on, thank you.

the one thing that does get me is the complete separation in medical research between the patient as subject vs. the patient as person. last week, we had a patient come in for a diagnostic procedure. all patients at NIH are here because of a study, which is why it's only a hospital-ish environment. i'm working in neurology, and our procedures always seem to have such creative torture elements, especially the minimally invasive ones. like the EEG: hold completely still for an hour after i stick 30 electrodes to your head and intermittently put a strobe light 3 inches in front of your eyes and make you hyperventilate until you're *this close* to passing out.

it's well-known that when you're giving someone a painful procedure, they're likely to have an emotional response to it. sometimes it's anger and they scream at you to stop this fucking test right now and sometimes they just start crying. since most neurological and musculoskeletal diseases are of the chronic, completely shitty variety, i'm not surprised anymore when my patients have a response like this. i always feel terrible for contributing to their emotional landfill with yet anoher test.

this procedure was a painful one. both my PI and i talked to the patient about mundane things to distract her, but she started crying softly. she mentioned recent stress and depression three times within a short period of time. the bells went off and my medically infantile mind sprang to action with the proper way to handle this situation. for once, i know exactly what to do!, i thought.

so because of my past experience in the mindfuck that is neurology, the year of essentials of clinical medicine in which we were taught to smile warmly, nod at the right points and reassure when needed, and my obsessional need to make everyone feel better, i asked this patient if she was seeing anyone about her sadness and stress. when she said no, i asked her if she would like to see anyone for this. she again said no, thanking me for asking but saying she'd be ok.

these same questions that got me a commendation from my standardized patient on my "sincere empathy", got me a friendly redirection later by my PI.

she was very nice about it, and placed it within the frame of "i know they teach you guys to do this in med school and residency", but clearly she wanted me to know that one does not delve into these questions in medical research unless they pertain to the particular study at hand. then, just like our running class joke about behavioral science goes, i felt shame.

i've had it hammered into my touchy-feely, dirty hippie osteopathic brain that we've got to treat the whole patient, emotions and physical maladies alike. but in clinical research, we measure a variable that becomes a figure in a paper for Experimental Brain Research. we're not there to treat, diagnose or prescribe, only to collect data.

and it bothers me. i saw my research fellowship to be an opportunity to blend together the things i love most about medicine- sometimes you get to see patients, and sometimes you get to figure out what makes them sick in the first place. i wrote in my cover letter that i was interested in a career that had elements of clinical and scientific medicine. in short, i wanted to gorge myself in the doctor's buffet.

who says you can't pour some syrup on your bacon?

it's been reported for years that the population of physician-scientists is declining so precipitously that soon it'll all be PhDs answering our burning questions about diabetes and heart disease. this is lamented and the reasons behind it are pondered- this article says it's because medical school admissions committees aren't taking the more scientific applicants anymore. they want to make more humanistic physicians, so those who have tons of research experience but little clinical exposure are not favored as much as those who have the converse.

when i was talking to my best friend sarah about how crappy it felt to have to disconnect from patients all suddenly, she said "well, you might not have been able to help that one person feel better, but you're potentially helping thousands of other patients by learning more about their diseases". it's an argument given by many physician-scientists as the precise reason why the more humanistic people should consider careers in research medicine. while i agree that it is vital to the future of medicine to figure out how to lure more people into research, it doesn't make it any easier when there is no mention of it in our day-to-day studies. i can only speak of my own school, but there is a complete absence of talk in regards to academic or research based career tracts there. of course the administration is very happy i received such a prestigious (god, i hate that word) fellowship, and we do have a small but thriving biomedical research club. but with so few research labs on campus, and constant quips from professors and clinicians on how we'll all become primary care doctors (by far my favorite DO-specific fallacy), i don't see how any of us can really foster our interest in this part of medicine. how are we supposed to want to do something that is currently at odds with our own conceptions about our profession and moreso, something that we aren't even told about?

and then when we do get the odd exposure to research, we don't get to hone that part of ourselves that wanted to become a doctor in the first place. i'm caught between the two things i like a lot, and neither one seems able to encompass the other.

so why not give more exposure to medical research within medical school (especially osteopathic institutions), and within that, find a way to create a bridged atmosphere for both patient and doctor during medical research. one that manages to let the patient get their actual immediate issues addressed and still fulfills the requirements for adequate, accurate data collection.

now that would be as rad as syrup on bacon.

don't go back to rockville

2005-06-08T19:08:00.000-07:00

ok ya'll, i know it's been awhile. but i've been busy for once! first new york with the mister to celebrate our anniversary early, and then DC alone for some serious NIH nerdiness.

the people there are great. it's like a hospital, but everyone wears open-toed shoes. the patients are all zebras! they don't care what time i come or go, but like a dutiful med student i come early and stay late. money flows like water, yo. in short- it's all those little things that make the rest of medicine bearable, all together in one place. i'll write more on this later.

but living in the DC metro area blows. i am in rockville, or north bethesda if you prefer. it's very white here, with big houses and volvos and "caution! children playing!" statuettes in the streets. thankfully rockvillans like their food tasty and organic, so i'm not too far from trader joe's and balducci's, which is what is known as either "bristol farms" or "highway fucking robbery" in LA. good for some things, but i want whatever awesome drug they were on when they decided to charge 8 bucks for honey. the song in this post's title was playing in there last night whilst i bought myself a dman good steak. i had a good laugh realizing no one else seemed to notice.

the DC metro is pretty and fast and has blinking light telling you when a train is coming, but those trains speed only towards to places 5 miles away from where i want to be. my house is a straight 3 mile shot down old georgetown road to NIH, yet it required either 1) a 20 minute walk, a bus ride, then a 10 minute walk, or 2) a 10 minute walk, a bus ride going the wrong way, getting on the metro for one stop, and a 10 mintue walk. this could take up to an hour and a half to complete. for a week i had no method of transport except my tender unused LA feet, and they had blisters on top of blisters after a week in new york. i felt like i was 13 again- so many places to go, no way of getting there without relying on a woefully inadequate transit system. thankfully, REI was close to a metro stop. so, i bought a bike with a comfy seat and some panniers. this transportation method is a bit better, but fuck, i've gotten used to getting out of bed with only enough time to get somewhere going 90mph, and this requires serious planning. i will have one hell of a body by august though.

the other summer kids i've seen are lame, and i haven't spoken to any of them. it doesn't help that most of them are pre-meds, and from the tony east coast schools. i'd like to say that i hope the medical school admissions process shaves a bit of arrogance off of their pretty, shiny haired little heads, but who am i fooling? those are the kids that get into hopkins and yale. that haughtiness has been finely tuned.

since this post has already gone to shit, i might as well change directions one last time: for some reason, my blog's name is mentioned in the june 6th LA times, although only to illustrate how some medical blogs have clever names. some other cleverly named blogs are mentioned quite extensively (what, no link?), but i am stoked nonetheless that one person has read my shit. thank you, random LA times writer. now would you tell your subscription department to stop fucking calling me?

all over the place

2005-05-19T16:52:00.000-07:00

wow, just like that, i'm an MS2. pretty fuckin' sweet.

at least i think i am now. that all depends on whether i passed the musculoskeletal exam. now i know exactly how it feels to wish i had studied more. i've been a good little gunner for almost a year, but i flamed out as i am wont to do, just like old times!

i have a clinical skills exam tomorrow morning, but it's just a timed H&P on a standardized patient. easy peasy lemon squeezy! then off to`new york. all day i've been repeating a line i remember from wayne's world, back when it was just on SNL. "i'm from new york. i've got a gun. let's go to a broadway show!".

enough with the silliness. cut to cure had a post a couple weeks back about the future of trauma surgery. there's a deep part of my brain that says "trauma surgery! i'm fucking so on that shit!", but it gets beaten down by the more realistic part of me that says "nah, it's the expressway to a divorce.." since i had to bribe and cajole the husband to stay with me while i'm in school (not really, but he did get some nice dinners right before i started), i'm interested in doing anything i can to make sure i don't turn out to be just another divorced surgeon.

but that's not really what i wanted to write about. he mentioned generation X, generation Y and (of all things) generation Z, which is such a stupid fucking name. so i'm wondering, what is X vs. Y in terms of years included?

i've always thought i there had been some global conference on this, and the consensus was determined a long time ago. as luck would have it, my birth year (1977) is right in the middle and is mentioned in different sources as being part of both. i know my friends and i always talked about being gen X, but it seemed like there were always people playing the part way better than we could.

in high school, i worked in a coffee house largely staffed by zine-reading, whippets-inhaling, psychology-degree-having 25-year-olds. they had dreads and listened to seven year bitch, drove banged up late 1960s comets and dusters and were the coolest people i could imagine. they were letter perfect to how the media portrays generation X. i was crushed because i figured i was in this other, shittier generation, who was known mainly for being spoiled, bipolar and liking limp bizkit. i just wanted to be like christian and kelly and a girl named toast, who was a drummer and was in three bands at once!

when i got to be around 25, the memory of these terminally hip people was replaced by the reality that they must be in their mid-thirties now, and how uncool it really was to have so little to show for your age. i thought maybe it was better to be in gen Y- at least i had more time to have fun and popular culture hadn't quite whittled us down into a 2 minute alternative rock montage of hairstyles. now i'm not sure where i want to be. it seems both generations are considered together when it comes to discourse on the current direction of medical specialties, and i'll get the same result no matter what label i stick on my white coat.

it's kind of a letdown that generations X and Y as discrete entities is a myth, and that one really has to determine which generation they fit into better. being born on the cusp of two astrological signs, i guess i can sorta understand. just like i'm totally more gemini than taurus, i think i'm more X then Y. and just like astrological signs, it's nothing more than entertainment in the end.

just alterations

2005-05-18T22:21:00.000-07:00

today i got some pants back that i had gotten altered. i'm annoyed that i even had to do this, because it is a new thing for me. maybe it's that i'm suddenly buying "slacks" for clinical wear, or Maybe it's that the american fashion industry is on some terribly entertaining drug. all the sudden all the fucking pants i buy are so long i can't even wear them.

i'm not short by any means- in fact, i'm an 1 1/2" taller than the average american woman. so how come all nice pants these days have 35" inseams? my dad, who is 6'2", doesn't even have a 35" inseam. wtf?

i took them to a place called "just alterations". the girl there irks me. she's not even remotely friendly, but not outright rude either. she's just there. no inflections in her voice, no "hi! how are you?", no smile, nothing. it's not like she's old or freaky or anything. she's my age, and a cute girl! why is she bitter? maybe she hates everything in life except viscose. i tried smiling at her, making small talk. nothing worked. she was even a bit snarky in asking me exactly how i wanted them when she was measuring the hems. i guess i didn't give her the right answer, but shit, i'm not a tailor- so how am i supposed to know the ins and outs of of pant shortening? i wouldn't get pissed at you for not knowing exactly what i do in my job (actually, i think i'll prefer it thanks). i thought maybe she was having a bad day or two last week, and today she might be different, right? wrong, still the personality of the wire hanger my pants were on. i guess that's why the place is called "just alterations" and not "alterations with a smile".

and while i'm bitching about stupid shit, why doesn't the washington DC area have a well fargo? it's really my fault for picking a bank based on their extensive use of stagecoach logos. and what do you say when people ask you what state washington DC is? i always say "it's a district. of columbia". i don't even think it has a state. it's stateless, just like how the 5 boroughs in new york city are like counties within a city, but also in another county. this east coast shit is whack, yo.

the unrelated-to-this-post word of the day: cuckold

2005-05-17T18:57:00.000-07:00

today was our last proper school day as MS1s. after thursday we will be able to call ourselves MS2s.

i'm a little sad. for some reason, change irks me sometimes. oh, to contemplate this mortal coil....

on the other hand, new york city!! and washington dc!

(scratch that last one. damn swamps, i'm gonna sweat my tits off this summer)

info on the unrelated-to-this-post word of the day, from www.askfactmaster.com:

A cuckold is, quite simply, a man with an unfaithful wife. There are connotations of helplessness and humiliation attributed to the word, implications that the husband is helpless to stop her infidelity, and too cowardly to leave the wife. "Cuckold" appears in older texts as a highly insulting and pejorative term.

Cuckolds are sometimes written of as "wearing the horns of a cuckold" or just "wearing the horns". This goes back to an unsubstantiated reference to a tradition in villages of unknown European location where the community gathers to collectively humiliate a man whose wife gives birth to a child recognizably not his own. This is said to have been a parade where the hapless husband is forced to wear antlers on his head as a symbol of his wifes infidelity. Whether this actually happened or not is irrelevant to the phrase, which survived.

The history of the word is thought to be related to the Cuckoo bird, who is known to put its eggs in another bird's nest. Some think that this points to another hallmark of the cuckold the raising of a child that is not his own.

Today the term is making a resurgence amongst non-monogamous couples with a dominant female allowed to take on additional partners, and submissive male who is not.

my carpool buddy and i were discussing this word today. its etymology is especially interesting- those no-good whoring birds!

a quandary: hang out with surgeons or your former high school classmates?

2005-05-15T13:21:00.000-07:00

so i just found out this week that my 10 year high school reunion is coming up. there isn't a concrete date set yet, and as luck would have it, the first choice date is october 22. this is the same day as the start of the osteopathic surgical conference, which is in orlando. the reunion will be in LA.

as the national liaison for the SOSA chapter at our school, my only duty is to go to these conferences and schmooze. the surgical club at our school has sucked for the last couple of years, so we really need to get back into the national scene. i'm really hoping they pick another date for the reunion, so i can go.

i didn't think i'd care about my reunion, but it's like watching a car chase on live tv- i just gotta see if there's a crash (read: formerly cuter-than-shit girls with big fat asses and possibly alcoholic husbands).

i'm going to be overly dramatic right now and state that this is a conscious effort on behalf of the gods to fuck with my serenity. the extracurricular stuff i'm doing for the upcoming year was meticulously chosen for the fact that it wouldn't take up too much of my time. now my lone opportunity to help our school get it's surgical mojo back will deprive me of the immature pleasure i take in seeing how badly my classmates have aged. what are the fucking odds that the only two big things i should attend this year on are the same date?

dammit!

i was watching romy and michelle's high school reunion yesterday on the ABC family channel (shut up), and it struck me how much anxiety people tend to have about reunions. yesterday i went to indian buffet with some high school friends who i still hang out with, and we all made pacts to lie about what we really do. the thing is, i actually don't want people to know what i do because part of me is embarrassed to be where i am. it's partially because of my age- if i'd found my self-confidence earlier i'd be in my third year of residency by now. but mostly it's because i was sort of a fuck-up in high school. i got ok grades- some good, some bad. i dabbled in tons of clubs but wasn't serious about any of them. mostly i was the "kooky" girl, owing to my fashion sense, a big mouth and being in the drama troupe. my yearbooks are filled with "stay unique!" or "you're so crazy!". people seemed surprised that i was going to college at all, and always thought i would study art or theatre.

10 years later, i feel like it'll be anti-climactic to come as a happily married medical student. so, i'm gonna be a pirate.

i haven't decided yet whether i'm going to go through with the plan and have the "sea police" come into the reunion and handcuff me and take me away, but i do have some nice police issue handcuffs that should be put to use. shit, saying i run a savage band of murderers around the south china sea is highly preferable to saying i study the kidneys and lungs.

xanax me, bitch!

2005-05-14T16:48:00.000-07:00

i've been more than a little anxious lately:

-musculoskeletal final is next thursday. although i've done well in all my previous classes and definitely will not be forced to repeat next year, i still worry i'll tank the last class. and since it's a relatively easy subject, it would be fantastically embarrassing to fail it. it's been nearly a whole year in school (cuz i started anatomy early), and studying is really not happening at this point.

-my 28th birthday is in exactly one week. 30 is coming down the pipe, the floating deadline for not being a fuck-up in my mind. birthdays as days are either very good or really really bad. i'm hoping it's the former this year cuz i could use some good times right about now.

-flying to new york on friday. flying to DC on the 28th. i don't like flying. at all. it's not so much a "flaming sonic winged death" issue, more that i don't like being squeezed into a tiny seat for five hours with nowhere to go. that and the possibility of living long enough to know i'll die soon, smashing headfirst into the ground at 300 miles an hour. this is complicated by the fact that the people who sit next to me on planes are always 1) fat as fuck and 2) talkative as fuck. especially if they find out i have anything to do with the field of medicine. but i am hopeful! the mr. is coming with me, so between him, my favorite book and the ipod, i should be able to ward off any annoying rays.

-starting NIH fellowship. will i be smart enough? will i work hard enough? will i get published? will the cool kids snicker and shun me when i tell them i'm from a DO school? gotta learn that dance from can't buy me love stat.

that's dr. cannon-fodder to you

2005-05-10T18:19:00.000-07:00

i had a classmate take the above with his cell. they're little squishy dolls from the air force, part of the constant recruiting efforts to get more indentured servants- i mean, medical service members into the military. those dolls did their job well- if their job was to distract us from lecture for hours on end as we "modified" them. some students built a scary clone army which valiantly defended the center right back row from the seat-stealing insurgents. it is our god-given right to sit in the seats we have become accustomed to, and to rain down like fire on any person that tries to take that liberty away from us.

so no doubt if anyone is reading this, i'll get some hate mail of some sort. as you might be able to tell, i'm not a fan of the military. they called me relentlessly after high school, offering me all sorts of booby prizes like "money for college" or "structure". i told them i had a real issue with waking up early and was described by my parents as "congenitally insubordinate", and told them to kindly fuck off. thankfully they did, until i started med school. now i get lovely letters from the navy all the time telling me how awesome it will be on a big fat fucking boat stuck somewhere in the persian gulf.

according to the bureau of labor statistics, there were 25,563 officers in the category of "health professions" in all branches of the armed forces in 2003. i really, really wonder how many of them wish they were somewhere else.

plenty of my classmates are on the flag-draped coffin scholarship, and will be spending this summer in officer basic, which they describe as "kinda like basic training, but way easier!". um, somehow i doubt that. but nonetheless, i don't hold anything against them for wanting to go military- on the surface, it promises job security, a good residency and it's free! the ones that have already served and are coming back for more (thinking of med school as an extended leave if anything) will be happy to be back in, and will make fantastic military docs. the others i worry about, many because they are doing it for the money. money is THE big issue, because most of us will come out into residency 200 grand in debt, and we make like 40 grand starting. so it makes sense that some people want to get a free ride.

it's a free ride alright. for uncle sam. he ponies up some cash and buys your well-educated ass. there's a year for year commitment required, which doesn't include school, internship, or residency. with all the stop-loss orders and creative data fudging going on, i wouldn't be surprised if some people end up career military docs because they just can't seem to get discharged. cuz remember: they own you.

they will tell you all sorts of lovely things to get you to join up. between repeating "we pay for medical school! we'll even give you some money!" over and over, they tell you you'll get the cush residency of your choice, then a nice appointment at a VA somewhere, where you can sit back and rake in the dough, knowing that those patients you treat can't sue you if something happens. it's the same old bullshit as what is being told to high school seniors everywhere. the world is promised to the potential recruit, a world of endless choices.

when you sign up, you discover these choices are all theirs.

you specialize in what they tell you to specialize in. wanna do derm? sorry, they have enough derms, but they need more IM docs. so, you get to do IM. want to live close to your family? sorry, you get to live where they tell you to live, be it north carolina or baghdad. don't want to die? sorry, if you are told to go mend severed limbs in an active combat zone, you go knowing you might be another blurb on the evening news, described as "name will not be released until family members have been notified". i wish i could find data on how many military physicians are ever in active combat areas. if anyone can provide this data, i'd be curious to see how often docs are put in direct danger. is your life worth 200 grand and a $1200 a month stipend?

i found a short article from a military doc detailing his views of the current problems with the system. he makes a good point, in that sometimes the free tuition doesn't add up when you factor getting to practice a specialty you want, the ever-present autonomy factor and a system of insulting pay and little ability to advance. it sounds like a shitty job, not a calling.

just so you know, i do see the irony in my above statements. medicine (surgery especially) is the same beast as military service when it comes to the structure. i know i will get my ass handed to me many times in the near future and for the most part i welcome it. but the difference i see in my future civilian career is that i can go into the specialty i want to go into, as long as i have the stats. i can leave it anytime i like, with crushing debt but my medical license intact. that's not what i'd get if i told the armed forces "sorry, you know this kinda sucks. i'm giving my two weeks as of today, cuz i think i'd be better off somewhere else".

there are other ways to get a free ride through med school than wearing camo. NHSC sounds like a fantastic deal, but they only want primary care docs. i guess poor people don't really need surgery that much. but there are other loan repayment programs sponsored by state agencies, which allow for a greater amount of autonomy, less threat of a horrible painful death at the hands of some asshole with a rocket launcher, and the ability to actually get out when you're supposed to. that to me seems much more inviting than signing away your life to someone who won't even acknowledge those two little wars going on "over there".

since i have always wanted to work at a county hospital serving the poor and indigent, i know i won't make piles of money once i graduate. money isn't a huge thing for me, but the freedom to choose how to practice medicine is. it's scary thinking of how many of my classmates will hold up their end of the bargain, sacrificing what they worked so hard to procure, only to be kicked in the nuts when they realize the military is only looking out for itself. it's their choice though, and i hope they thought long and hard before they signed those papers.

time til end of MSI: about three weeks.

2005-04-25T08:40:00.000-07:00

it's been a couple of weeks, so i should definitely update my lame-ass medical blog life:

-this weekend i will be working the medical tent at coachella. i'm doing saturday only, then coming back sunday to just hang out and see some good acts. i figure the big patient complaints will be dehydration and drug ODs, maybe some allergies and asthma attacks. i just hope no one gets really sick, because no one should have to leave coachella for the hospital, mmkay?

-found a place to stay in DC! i can't believe it, but i found it through craigslist. i was a bit weary of putting an ad on there, since i figured i'd get responses from frat boys, pimps and serial killers. but no shit, the person sounds downright normal, and the house looks fantastic. she's a retired doc, and has other lodgers there. i will get a nice big room, and a bathroom to myself, which suits my love of pooping in private.

-we're going to new york for our anniversary! the mr. and i have never been to the east coast, and decided we are both old enough to be fucking losers for not having been to a whole section of our native country. we've been all over europe, yet have never been new york or boston- what the hell is that about? this year, thanks to a gigantic tax refund (single zero and 33 grand in tuition is the only way to fly baby) and one week between my last final and starting at NIH. and here, a word of advice: hire a tax preparer. spend the money! if you think you could possibly get more than $500 back, they are worth their weight in gold. we have friends and family hopefully to put us up, but we're also looking for a cool hotel that isn't 400 a night. although part of me is like "fuck the money! let's stay at hotel gansevoort!" that's the same part that was screaming "woo hoo! his and hers vespas!" when we walked out of the tax preparer's office. but no, we are responsible adults now, and we must pay off debts and be frugal. so, i'm waiting until hotwire gets a little cheaper for that boutique four star in midtown east, which is the W.

anything more i can say? i gotta get dressed for school. we have a group report to do on aromatherapy. i figure we'll just turn in some apple cinnamon candles and nag champa and call it a fucking day.

looks good to me!

2005-04-11T18:57:00.000-07:00

neuro is done! what the hell am i supposed to do with my time now?

oh, right. OMM

it's funny how OMM tends to be my least favorite part of school. 2 days a week we have to dress in shorts and sports bras (or no bras for those with penises) and check for somatic dysfunction, aka you done fucked your back/ribs/pelvis. then we try to fix it, using various methods ranging from shit that is basically massage to hardcore neck crackin'. it's the only class we've done straight since last august.

just so you know : i believe i run halfway between "i'm only doing this shit cuz i couldn't get into an MD school" and "oh my god who gives a fuck about biochem? let's find your cranial rhythm!" on the osteopathic student spectrum. some of it is complete bunk, and some of it works really well.

that being said, something that bothers me is how subjective our diagnoses are. although you can't deny that some of us are running around with dysfunctions (i happen to have a massive rib/scapula thing going on right now), it's pretty fucking obvious that there is some fudging going on by the students when we diagnose and then retest after treating. simply put- we move our hands when our hands are suposed to move- "hey look! a positive standing flexion test!" and we don't move our hands when they aren't supposed to move -"hey look! the patient's tranverse processes are equal at T6 after i treated them!"

i see it happening, and feel it when i'm the patient. i have had scoliosis, an anatomical short leg, my entire ribcage stuck down on the left, and too much paravertebral fullness to quantify. i can tell you all of those are bullshit diagnoses, although the short leg somewhat satisfied my desire to be more pirate-like. some things do come up over and over, like a flattened thoracic kyphosis and my left shoulder being higher than the right in comparision to my head. these things i'm sure really are there. when a classmate (very much an OMM master) found my bad shoulder/rib thing today, i was ecstatic not merely because it hurt and i wanted it fixed, but because i hadn't told him where the problem was.

and i know i must fudge shit all the time, especially when i'm finding a diagnosis hard to ascertain. it's totally unconscious for the most part for all of us, but it's disconcerting to say the least. it's just like back in my neurodiagnostic days when we had a borderline EMG, and depending on the doc, it would either be a positive finding or a negative finding. the thing that always bugged me was that the result affected the patient's outcome, sometimes being one of the factors that helped the orthopaedist decide on whether to do surgery or not.

this early on in my career, thinking that a diagnosis i give can have such a serious effect on the patient's clinical course it frightening. when i was volunteering at one of our clinics a couple of weeks ago, i checked a new patient's BP. lo and behold, it was high. we presented to the doctor, and she went in, talked to the patient, and was writing up a scrip for an anti-hypertensive when i asked her sheepishly to re-do the BP reading, just in case. she did, and the reading was almost exactly the reading i'd gotten. i felt stupid for being such a pussy and doubting my skillz, but i also didn't want any patient to walk out the door with a prescription they didn't really need for a malady they didn't really have.

since OMM was our first clinical exposure and continues to be most concentrated doctor thing we do, i think it's natural at first to let what you should find influence what you do find. i just hope we can find the real shit in a couple of years, when it's important and not a matter of getting it done so we can the fuck out of our sports bras.

whiny self-serving post with pointless links!

2005-04-08T22:33:00.000-07:00

it's friday night, and i haven't studied one bit for the final exam i have on monday. although the house of god and scrubs have done a good job of describing the intern year (i'll know this for sure in about 3 years), i haven't seen a really good account of med school itself, especially the pre-clinical years. there are some intangibles like the scary i-know-i-have-to-study-but-i-just-can't phase i'm going through right now. pointless self-destructiveness! my reasoning resembles the makings for a bad hangover: a good score on the last exam, the NIH coup and most of this exam being path (which is my fucking subject dawg) and i just can't be bothered. it's a bad, bad attitude to have.

knowing this doesn't mean just yet that i can fix it just yet. i thought i was being all pious and gunnerous when i begged out of the last night ever for a good 60s soul club, but i am sitting here writing a blog post and not studying the reticular formation.

and my inertia is making my writing suck. have you read this shit? i'm saving this post to remind me that medicine is much more of an option than being one of those blog darlings. no go fug yourself for me.

site feed

2005-04-06T20:29:00.000-07:00

ok, i'm still getting used to all this shit so i hope the site feed works. i had put in a request to be included in medlogs and was wondering why it never showed up. it seems that it's just because i'm a dummy with all this internets stuff.

sometimes i totally wonder about my computer abilities. although i think i'm fairly savvy with technical stuff i know i totally got shafted when it came to the all important computer basics when i was wee. stupid LA public schools! i mean, we had those crappy apple IIs that with the amber screens and scary buzzing sound effects, but all i seem to remember doing on them was some fraction bullshit and playing the oregon trail. i will admit that shit was dope, although i got to oregon for the first time a only couple of years ago using an emulator. in third grade i just couldn't maintain my concentration long enough to kill animals for food or plan ahead for inclement weather. so i usually ended up leaving missouri in the late summer, drowning my team of oxen while trying to ford the river (cheapskate i am i wouldn't dare pay an indian guide to help me), getting all my clothing and wagon wheels stolen in the middle of the night, or losing all my travellin' companions to snakebites, dysentery and broken legs. i had never even seen the last part where you ride down the columbia river dodging rocks before! i was perfectly content killing myself and four other people over and over for hours on end, little obsessive monkey that i am. same thing happened when i tried to play everquest. i didn't care to go on quests with other players-i just spent hours killing bats in front of the castle and sexually harassing any player who was dumb enough to come up to me until i got bored.

i'm not sure how i this post lapsed into musing about nerdy video games. must. study. now.

and now to bring the scary DO agenda to a medical journal near you!

2005-04-06T19:57:00.000-07:00

i have been accepted for a summer research fellowship at the NIH!

this is a very very big thing for me as a DO student, since we historically don't get a tremendous amount of research experience in school. we had one student from our school get a NIH fellowship last year, and this year myself and one other person have had offers. my classmate decided not to accept his offer, but i jumped at the chance to do it. the NIH summer fellows tend to be of the harvard and johns hopkins variety, which makes me a bit nervous to be honest. but it's a chance to see how much (if any) we differ, and hopefully i'll be able to put the whole "MD vs. DO" argument to bed for the benefit of all those nervous pre-meds on SDN. i will be working at the National Institute of Neurological Disorders and Stroke, which is very cool because i heart the brain.

it pays well, it is the kind of work that i wanted to do, i get fantastic experience at one of the best research institutions in the country, and i get to spend the summer on the east coast. since i've never been further east than atlanta, georgia (not that i haven't traipsed around europe quite a bit), i honestly don't know what to expect. i have some friends to see in DC and new york and will be hitting the mutter museum in philidelphia, plus spending random time with the hubby when he flies over for a couple of weeks mid-summer.

if it were easy....

2005-03-30T16:51:00.000-08:00

i haven't written in a few days, and it hasn't been because i didn't have anything to write. i guess i've been trying to figure out what topic i'd like to blather on about, without having to resort to writing about the same ol' shit that everyone else is on. thus, there will be no long rant on terri schiavo.

so instead i want to talk about mental health, substance abuse and physicians. i go to a psychiatrist and at our appointment the other day, she gave me a copy of the action report for the california medical board. this was because last time i'd seen her, i'd mentioned i was interested in maybe applying for a student position with the CMA. the one i wanted to do the most had to do with physicians that are addicted to drugs or those with mental illness. i didn't end up applying cuz i ain't got no time, but i was happy that she remembered something i have an interest in.

substance abuse and mental health are a very touchy issue for me, given that i'm going into a field that is ok with these diseases in anyone but the people in the field. i have a strong family history of drug and alcohol abuse on both sides, and have been very afraid for a long time that i'll somehow find myself an addict. thus far, that fear coupled with a very low amount of alcohol dehydrogenase has kept me clean, but i still worry about it plenty. and while i'm seeing a psychiatrist for ADHD, which could reasonably be considered more of a neurological disorder, i still feel weird about admitting i go to the crazy doc and take mind altering drugs every day. i don't keep this info secret, but i do worry that one day that frankness will bite me in the ass.

seeing the action report scared the shit out of me. physicians lose their licenses for DUIs, petty theft, depression-all sorts of stuff that for anyone else would be just a little misstep in life. lots of drug addicts in there, injecting themselves and writing illegal scrips. the list was long.

so how did those poor docs find themselves losing their licenses? my carpool partner wondered how many of them were just bad people, and how many were good people that found themselves in a bad situation? i said i figured most were the latter. i say this because i can totally see how it could happen, especially in the last month or so.

it's apparent that our class isn't doing too well right now. i'm willing to bet 2/3 of us fit the clinical description of depression. i've been pretty sad myself, for a myriad of reasons, but mostly just because of all the stuff i have to do every day. i'm constantly tired, waking up early after staying up late, not studying effectively enough to satisfy my perfectionist psyche. after going to lecture and lab for 8 hours a day, i come home and try to shovel in more material, in hopes that i'll actually get higher than a 71 on this next exam.

it's not that i can't hack stressful situations- i once worked 21 hours without even noticing it and spent 3 years on call 24-7 (EEG techs aren't too plentiful, even in LA). most of the people in my class that i've talked to feel the same way. the problem is that we do all this with so little instant gratification, which our generation has gotten used to. we won't see the results of all our sacrifices for another 3 1/2 years, when we match. until then, we study our asses off to barely pass, doing all sorts of community service and club stuff in our spare time to look better on paper.

this last part is especially true for DO students. as a 4th year recently told us: "why should residency directors pick you when they can pick an MD?" she was trying to tell us that we have to go head first into what we love, and start early. but some took that as proof that we're all destined to settle into primary care, because that's what everyone expects of us. that is, unless we find some way to walk on water before match day.

so now we mope. we cry. we tense our shoulders and walk with them hunched over, staring at the ground. we're depressed, and what is to stop us from self-medicating?

nothing, really. we were told in a recent lecture on opiates that medical personnel abuse oxycontin and fentanyl like it's going out of style. the stigma attached to getting help for mental health issues when you're supposed to be a paragon of health causes a lot of us to look to a way of forgetting it all for a little while. we have counseling at school, and they tell us to get help if we feel out of control. they even say that they'll get us into treatment for addiction if we tell them we have a problem, but how many are comfortable risking their education to ask for it?

we're supposed to just suck it up, right?

it all comes back to that stupid cliche we've seen over and over on ER: we are expected to be perfect, but we can't live up to it. being at the pinnacle of society, more hardcore than the regular people is why we want to do this job in the first place, but we still hate to find ourselves the victims of our own hubris. i could get into a whole rant on that, but for now i'll just leave it.

in other news, i'm getting braces! the invisalign ones! straight teeth is something to be happy about.

why we need to turn down the howard stern and start talking in the OR

2005-03-15T17:59:00.000-08:00

i was reading an interesting article on when anesthesia fails

he mentions briefly about how in certain spinal procedures the neuro monitoring requires anesthesia levels be adjusted. when i read that my heart sang, because in my former life i was a board-registered neurodiagnostic technologist, and this little-known issue was my whole life.

i worked for five years around southern california doing intraoperative monitoring during various brain and spinal cord surgeries. there was so much time spent arguing with surgeons and anesthesiologists over gas levels during surgery, which often ended up being just a masturbatory gesture because they couldn't see how their levels of inhalational gases left my signals weak or non-existent. in the end, when we failed to communicate or agree on how to proceed, the patient suffered because they weren't getting the best standard of care during a sometimes very risky procedure. i was always frustrated because the anesthesiologists just needed to shut up and do what i told them to do, and for some reason they didn't like being told that.

which is why i knew i needed to get the fuck out of my dusty corner of the OR and get over to the sterile side of the room. they'll listen to me then, those bastards.

but i digress.

somatosensory evoked potential (SSEP) , motor evoked potential (MEP) , EEG and EMG monitoring used during surgical procedures can be very useful when done properly (here's an article on intraoperative monitoring 101 for those interested). the problem is, to be maximally effective there must be complete cooperation between patient, surgeon, tech and of course, anesthesiologist. it's not just a matter of keeping inhalational anesthetics within a range that will lend itself to accurate assessment of signals. because the techniques are varied for different types of procedures, the surgeons also need to be aware of which modality will be used and what their role is in assisting the tech.

for instance, during procedures in which pedicle screws are placed, EMG can be used to verify that the screw is not in contact with any nerve roots. it's simple enough in theory: place recording electrodes on muscles that correspond to the dermatomal levels in question, then take a monopolar stimulator (or a nasopharyngeal EEG electrode for the creative), contact the screw hole or screw itself, and send a small current through. if there is a muscle response below a certain threshold, the tech can tell the surgeon that they might want to re-place that screw. the surgeon must know how to place the stimulator and be in constant communication with the tech about what level is being stimmed, and whether they have dropped the stimulator on the ground, again. pedicle screw stim also requires that there be no muscle relaxants on board. since this is often done concurrently with SSEPs, the anesthesiologist must now make sure that both inhalationals and muscle relaxants are within the range to ensure a true positive or true negative result. being anesthesiologists, they don't like that. so they yell, make snide comments, ignore my requests, or lie to me, which is kinda dumb since 1) i can read the gas levels on the machine and 2) it's not hard to tell when someone is paralyzed when you are testing their neuromuscular junction.

i understand their position- it makes their job much harder and increases the chances of the patient having some bad memories of the surgery. but it's important if the surgeon wants to make sure their patient won't have post-op nerve pain or worse from a mis-placed screw. everyone benefits from a good outcome, and everyone gets the shaft from a bad one. which is why you'd think the surgeon, who has a vested interest in their patient not waking up with pain or neurological deficits, would help us out here and maybe advocate for the tech to the gas man in the evnt of any trouble. but you'd be wayyyy wrong there. even though they often are annoyed by their drug-pushing colleagues, a little tech buzzing around them having the gall to ask for a little fucking help here is much more annoying.

circulating nurses, scrub techs and slimy instrument reps weren't much help either, preferring to ignore me unless my shit was in their way.

thus, although pedicle screw EMG is ideally a five minute test, i never had as many problems with any other modality than with this one. and on top of all the screaming going on, something technical always went wrong: a cord was too short, or not plugged in; 60Hz interference in the room completely obliterated the EMG signal, so everything was sequentially unplugged until the offender was found; the stimulating or recording electrodes didn't work; or as mentioned before, the fucking surgeon dropped the stimulator.

communication during surgery is critical. i know that seems like an obvious statement- but with the cavalier, military-style attitudes inherent in the OR, it was frowned upon for a lowly tech to direct anything, even if it was required for us to do our jobs properly.

in an effort to change this and increase communication between neurodiagnostic tech and the physicians that loathe them, a wonderful colleague of mine (a complete hardass if there ever was one) developed this: The Los Angeles Anesthesia Friendliness Scale.

LAFS was a great way to kill two birds with one stone: get the anesthesiologist to do what you need them to do, and use it to feign interest in their specialty and all its crazy sleepytime drugs. they like that because it makes them feel important and special after being yelled at by surgeons all day. when you make them feel special, they will become your best friend and then everyone is happy.

i must end this by saying that even though anesthesiologists made my life a daily hell for five long years, i can forgive them now that i'll never be stuck behind their stinking machines ever again. you can go back to your wall street journal guys, cuz i ain't mad at ya!

insert "MTV's the real world" style intro: "this is the true story, of 200 strangers, picked to live in a lecture hall..."

2005-03-10T23:29:00.000-08:00

our class is going crazy. a combination of long hours in lecture, a low average on the last exam and spring break not.coming.soon.enough has driven us to become lame parodies of the students seen in movies like gross anatomy. we don't yet know who is the token drug addict or gunner-student-who-has-a-nervous-breakdown.

shit-talking is an art right now- there's not even a clear pattern to who is this week's slut or asshole. our ethics classes turn into pissing matches on who can be the most paternalistic and judgemental. i really didn't expect this. i thought we were above such asinine behavior.

and yet, here i sit venting to a blog. that no one reads. so what's the point?

the point is, as a classmate said today, we'll all be hugging again when MS2 starts. at least for a couple of weeks.

intros and assholes

2005-03-08T15:55:00.000-08:00

i feel like my first post needs to be all witty and make me sound super creative and literate, but it just isn't happening right now, so i might as well give a bio thingy:

- i am a first year med student at an osteopathic institution somehwere in the US. yes, yes, i know, i'll talk about it later.
- i am a girl.
- married, no kids.
- i like the brain and hello kitty.
- i also like tomatoes.

so i must start by asking a question: how much is too much information to tell a medical student? i am halfway through my second semester of med school, and i have had three people already ask me about their asses. i know a little about the booty, but not nearly as much as any doctor that actually is a doctor. why can't they ask one of them?

now i admit one was a family member, but that means two weren't. they were complete strangers, and after five minutes of knowing them, i also knew about their buttholes. the worst thing of all wasn't that they asked me about that area, it was that they didn't even buffer it with some questions about chest pain or swollen ankles. it was "hello, nice to meet you, i've got a question..."

random person #1: "i have a question, since you're gonna be a doc. i've got this thing on my ass.."
me, horrified: "um, on the butt cheek or by the anus?"
random person #1: "on the cheek. it's big and red and hurts like hell, and i have trouble sitting."
me: "sounds like it might be a boil or something. you'd better get it checked out"
random person #1: "i'm just embarrassed about going to the doctor about that kind of stuff."
me, in my head: "yet asking a med student you don't know at all is perfectly comfortable for you?!"

random person #2: "maybe you can help me- i've had some trouble...down there...with leaking"
me, wondering if i have "asshole expert" written on me somewhere: "urinary or bowel?"
person #2: "the last kind. and, it bleeds a lot."
me: "um, wow, like a lot of blood? is it dark or bright red?
random person#2: "bright red"
me: "ok, rectal bleeding is really never a good thing, especially with bowel incontinence, so why don't you get it checked out by your doctor?"
random person #2: "yeah, i should do that."

family member: "i need some medical advice"
me: "only if you promise to actually take it"
family member: "________ (her husband) has this hole in his ass."
me: "what? like an accessory hole?"
family member: "yeah. it occasionally drains and he says the stuff that comes out burns really bad"
me: "how long has he had this?"
family member: "well, since i met him, so 20 years.. it gets bigger all the time, and now he can stick his finger in it"
me: "what the fuck?! dude, he needs to ge that taken care of"
family member: "i have him soak in the bath, and it cleans it all out nicely."
me: "no, it doesn't. he has a fistula, and needs to have it sewn up. like, now."
family member: "sewn up surgically or something? oh, he's way too squeamish to have that done"

as an aside, i was surprised that fistulas aren't mentioned but casually in Robbins.