Lub dub

Lub-dub. Lub-dub. S1/S2. Systole-diastole. Blood to the body, blood to the ventricles. Lub-dub. Keep it beating. That’s our job. That’s my job. This mechanical organ, this pump made of flesh, keep it going.

Spindle shaped extravasated red blood cells is pathognomonic of Karposi’s Sarcoma.  Will that factoid help me treat patients any better? I can recognize KS without knowing that. Sure, it’s interesting. But how will it benefit my patient? I need to know how to treat my patient in body and mind.  Focus on the drugs. What do they do? What are their side effects? What will be the barriers to having patients take them? What is the best one to give? Tell me that. Test me on that. Tables, tables, more tables. A picture of one person’s dead heart. How will this help me? Tables help me memorize important information. CHF, HTN, AE, d/o, LVH, LBBB, AMI, I’m learning the language. That doesn’t help me help patients. Not yet. It’s like being able to read Hebrew and follow along in the prayer books, but not knowing what I’m reading save for a few words. 

What kind of doctor will I be? Is it at all reflected in the test scores I achieve my first 2 years? I have to learn something. I have to learn a lot. Does doing average on these exams mean I won’t know enough? Does above average mean being a better doctor? What about below average? What if I fail one? Or two? Will I put patients in danger? Or will I, in reality, have a chance to learn it better, in clinic, in a setting where I can see the people I’m helping? I know I will be a good doctor in terms of talking to people, caring about them, and that matters a lot… like alotalot. I just hope I can get enough knowledge into my head so I don’t kill anyone. 

3rd year

So I went to a real hospital for the first time, as a med student. I saw a real patient. I think I’m going to love 3^rd year.  That endorphin release you get when answering a question right is pretty nice. It made me think of the clients I used to work with – the recovering addicts. No wonder they found outdoor movies and spa night so uninteresting; they obliterated their reward pathway (nucleus accumbens!) by overloading it with drug-induced endorphin release.  It made me grateful for the simple endorphin rushes in life. 

So getting questions right feels good. I totally can answer questions confidently, whether or not I have any idea, which the attending seem to appreciate. I can organize data into a coherent presentation. I learn quickly, so the individual variation on what attending prefer will not be much issue.  I actually think I’ve learned something in the past year and a half, so all those things combined will make me a good 3^rd student (I hope).  I really loved the interaction with our preceptor. I forgot how much personalities play into the experience of the healthcare provider. Working at that top-notch hospital before medical school gave me a little window into that. I observed mostly, but I also noticed that the politics and play of personalities.  So much of 3^rd year, it seems, is how personalities fit together. Some students will think their resident is a jerk, and some will like the same person.  It’s not necessarily a good thing, but it’s something I can be good at.

It’s nice to have some decreased anxiety about going to the floors next year. There’s just that pesky step 1 between now and then.  

We Hate Fat People

What more do I love to do at 9am than make fun of fat people? Make fun of fat people in front of an entire medical school class, that’s what! Oh wait, no, that’s not me, that would be my professor. 

Obesity is an important topic, especially as it relates to diabetes, and the medical complications it causes are necessary for us to know – no argument there. There is a clear link between obesity and diabetes – again, no argument.

Now, I have a sense of humor and have been known to say and do completely inappropriate things in the company of friends, but he showed a satirical video clip essentially making fun of the number of fat people in America. Seeing this in a professional setting and hearing the class erupt in laughter was disturbing to me.

The prof augmented it with a few other comments poking fun of fat folk. It was subtle enough, but definitely there.  This is certainly not the first time I’ve heard distain about obesity from physicians and professors.  My upper year friend told me her resident once said of a patient who had lost 40lbs, “wow, she must have been really fat before!” 

Personally, I’m very torn between the sentiments that people should love their bodies no matter their size and the knowledge that obesity takes a toll on one’s body.  I’ve also struggled with weight myself and have been able to lose about 40lbs*.  I recognize the systematic problems that lead to obesity: so-called “food deserts,” poverty, parents working multiple jobs, lack of education, lack of time, living in a time-pressured culture that doesn’t value savoring food, and so on. I also recognize the choices one makes and the need for personal responsibility. But even if we view obesity just like smoking (which I don’t), we don’t make fun of smokers as much as we make fun of fat people.  We counsel them to stop smoking, we have to use motivational interviewing and meet people where they are.  Repeating, “eat well and exercise” and “stop smoking” is like beating our head against a wall – it’s condescending and unhelpful. We need to take it a step further.

Anyway – back to this professor. I tend to give people the benefit of the doubt and assumed he just didn’t give much thought to that part of the presentation (still unprofessional though).  But then, in another lecture, he poked fun at women with hirsutism, and said, “if you have a mustache ladies, please shave them.” Now I just think he’s an ass.

*mostly because I’m a privileged white kid: I was able to love my body at a bigger size, I’m surrounded by healthy people in med school, and I have time and money

You're doing it wrong

Most common cause of hypoparathyroidism: iatrogenic


pseudopseudohypothyroidism*: naming fail. (I swear I'm not making this up). 
*(similar phenotype to pseudohypothyroidism without the same genotype)

Best Quotes from Repro

This was the best unit so far. The teaching was excellent, explicit, and done with a great sense of humor:

"I'm not saying that in order to be a physician, you have to have a dirty mind...but it helps."

“This one is yellow, and the other is extra large” –passing condoms around

“What, you might ask is a fomite? A fomite is anything a patient might put in her vagina.  Like if she douches. Or… what am I thinking of… yes, a vibrator”

Using a story about a trans woman who was the baker at our professor's grocery store, he made the point that everyone seemed to know and not care at all, which is the way it should be. He said, “it made me incredibly happy to eat her rolls, which were quite delicious”

“I loved Barbies when I was growing up – no surprise to anyone” (openly gay professor making the point that his straight male cousin also played Barbies)

Cultural Competency

I am totally on board with the importance of cultural competency in medicine. I used to get very excited about seeing it on the syllabus.  I was an anthropology major, I want to work with underserved populations.  Trust me, I get it – it’s IMPORTANT.  But I know it’s going to be awful. 

Example: this week we had a large group session on cultural competency.  We had to read an article about 1) the importance of spirituality in health, 2) a prospective study on the effectiveness of phone vs. in-person translation and 3) unequal treatment of black Americans in the healthcare system.  These articles were valuable and thought provoking and worth reading and discussing. Except that we didn’t discuss them. We watched a movie about an Afghan man getting lost in translation and not receiving chemotherapy as a result. Also worth discussing. Except that they squashed any meaningful discussion by forcing each group to answer a very specific, often repetitive question.   

In contrast, our small groups are run very well this year. They give us articles like the ones described above, or about the importance of hand washing, minors and gardasil, or cardiovascular risk factors and we have constructive discussion and get to learn from our very amazing, knowledgeable small group leaders.

Anything they do in large groups – “discussions” or lectures are useless and leave me banging my head against the wall, along with the rest of my classmates.  It’s a shame because these are extremely important issues. We need to face our own biases and prejudices and understand the effect of time pressure on obtaining a translator.  These issues will affect our patients’ outcomes. So why do they bollocks it up so badly?  I know these are relatively recent additions to medical education, and they (obviously) haven’t figured out how to teach it yet.  But really? Telling us translation is important and respecting our patients’ culture is important is like telling us that HPV causes cervical cancer.  Most of us know that much at this point, so don’t waste 2 hours telling me that (It leads to days like this).  I can handle something slightly more advanced. 

Pop culture knowledge gaps

This weekend, I was hanging out with some friends and pop culture came up. Something like this happened:


Friend 1: "...it was like that Antoine Dodson video."


Me: "Who's Antoine Dodson?"


All three friends look at me in disbelief, "Where have YOU been?"


Me: "Uhh... in med school."


Friend 3: "Yeah and [SR] doesn't know who David Sedaris is either."

Expiration

“A 65 year old man experienced crushing substernal chest pain, was found to have suffered a myocardial infarction and expired.  The most likely pathogenesis for this…”

Excuse me? He expired? Like milk? Like that slab of steak in the back of the fridge? I guess we all are hunks of meat.  We have a shelf life that maxes out at about 100 years.  A baby born today – “best used by 2110.”

He expired.  I remember that time when the patient I enrolled in our observational study died.  Her lab values were out of wack and I totally missed that little word at the top left of the screen, “expired.” I wouldn’t have known what it meant.  Maybe, “oh, the records expired, no wonder the labs don’t make sense.”  The patient expired.  No, this child died.  She had parents, maybe siblings, friends, people who loved her. 

He expired.  They’re asking me to identify the pathogenesis… what about his family? Did he have children, a spouse, a dog?  How many more questions will I have to read like this in order to learn? How many more expired persons will I need to brush past*?  

*Apparently lots more. I wrote this in August and I've already become desensitized to this kind of language.  Oh, look, there goes that empathy med students loose between 1st and 3rd year.