Morbidity

I hesitate to devote a post to the recent untimely passing of a lovely young actress who was best known to me from the movies ‘Clueless‘ and ‘Love and Other Disasters‘ because in reading about the unfortunate event in the news, I found the random, almost blase tweets of condolence to be almost distasteful in their casualness. It would seem that the loss of a life (any life) would merit more than 140 characters, and that the actress’ true friends would have more to say than a couple of sentences and I don’t want to be just another one of the masses saying something trite and inane. I suppose for acquaintances and fans, simple RIPs and wishes of comfort and support to her family are more appropriate. And fond memories, so here is one: I screened Clueless with subtitles for the girls in the ESS* when I was teaching at 社高校. It seemed like every 5 minutes I had to qualify with a disclaimer that not all (or really, not many at all) high school experiences were like those depicted in the movie but the girls really liked the characters and the comedy (and really, the plot is not so far removed from some 少女漫画) and I and was struck by how even though the movie was 10 years old and even though I’d seen it a million times, I still loved it as much as I had the first time I saw it. I really enjoyed some of Ms. Murphy’s work and am saddened that she is no longer here to continue it.

The budding clinician in me however, was not so sentimental upon hearing the first scant details about the actress’ death. In fact, the first question that came to mind was ‘what could cause cardiac arrest in a 32 year old apparently healthy woman?’. The initial official reports state that she died from “natural causes”, which makes this case even more puzzling. Usually in young people without congenital heart problems, cardiac arrest is seldom caused by a problem with the heart. In fact, I remember going over a Harvey case with Dr. R (Ross’ resident heart guru) this past semester about cardiac problems in young people (in this case, we were exploring hypertrophic cardiomyopathy vs. aortic stenosis as the underlying pathology) and he mentioned that when you see a case of sudden cardiac death in an apparently healthy young person, you have to put drugs on your list of differentials, as it is the most common acute cause. In addition, given the actress’ history of eating disorders and rumors of recent GI distress, one would also have to consider whether a K+ imbalance caused by vomiting resulted in a fatal arrhythmia… So, cardiac arrest in a 32-year-old female with an unconfirmed prior diagnosis of DM Type II, PMHx of eating disorders, current meds unknown. What would be your list of differential diagnoses?

Step Up

I guess when the going gets tough, the tough stop writing…

Apologies to all who’ve been wondering what’s been going on with me since October – I’ve finished up my stint in sunny Miami and have returned to Queens to prepare for Step 1 of the USMLE (dun dun dun!!).

At some point, I’m going to post some advice for those who have chosen (or been assigned) to complete AICM in Miami and other general ‘How to Survive Fifth Semester’ tidbits (as well as the ’secrets’ they don’t tell you until Novemeber, grrr). I’m also going to be posting my Step study plan. Today’s goal is 55 pages of First Aid and at least 48 MCQs. Keep reading for more frequent updates!

And If You Don’t Know, Now You Know

Here’s what the White House has to say about health reform. Here’s info targeted to med students and healthcare providers.

Also, for extra-credit reading, check this out.

What do you think about the public option and health care reform in general?

<<a note for visitors – when people visit my actual house, I usually ask them to take off their shoes. It’s a quirk I picked up in Japan; it helps me keep my floors cleaner longer and really, it’s just how I like things done in my personal space. I don’t mind if people don’t take off their shoes in their own house because that’s really their choice, but in my domain,  shoes are left at the door – that’s how things go. If you’ve happened upon this blog, which is kinda like my virtual house, thanks for stopping by! With that said, I’m going to ask that if you’d like to comment on this particular post, please limit your comments to the parameters set by the question I asked.  I’m not the government and I’ve expressed neither support for nor aversion to the bill in its current incarnation. I’m just presenting a piece of information that I found interesting (to further the マイホーム analogy, think of it as a coffee table piece) and posing some questions about it. If you think the public option is ridiculous crap and can back up that opinion with other pieces of information (links, articles, inside info, etc.), feel free to share it. I’d love to know more about both sides of the argument. But no random rants, please. If your comment suggests you just stumbled in to track dirt all over my floor and not actually have an informed conversation about the public option or healthcare reform, I’m not going to approve it. よろしく!>>

<<p.s. grammar is a plus – English teachers (even former ESL ones) always notice.>>

Half Crazy

from http://hubpages.com/hub/Crazy-Doctor-Joke

A note to my Ross 後輩*: Miami might occasionally be breezy but don’t let anyone tell you that 5th Semester is a breeze. It’s week 7; we are officially in the latter half of the semester, and things have started to get crazy. After being brutalized by the midterm yesterday, I’ve been at my wit’s end trying to prepare for the slew of assignments due in the next week: a SOAP note (with a to-be-determined presentation date), a literature review (for which I am still scouring JAMA and NEJM to find research articles) and a 15-20 minute presentation on preeclampsia and eclampsia. Ahead lies the 45 minute full physical exam, the final and the Step. It’s enough to drive a person insane, or drive a person to doubt. Can I handle this? Am I smart enough for this? Can I make it through this?

All Night Long – ER、その2

Last night’s ER shift was about a thousand times more awesome than my first. Over the course of the 9 hours we spent there (we were set free at 6 AM), we dealt with 2 car accidents, 4 sick infants, a volcanic abscess, a hernia, saw three pelvic exams, two ultrasounds and my rotation partner got to remove a catheter! The doctor in charge (Dr. F) was ridiculously cool and he showed us so many awesome things. He allowed us to watch him perform a lumbar puncture on a tiny, mysteriously febrile 3 month old (the poor thing!). I even got the chance to brush up on my fundoscopy (I finally saw a vessel! Hallelujah!). Our next shift is on Thursday and I think the same doctor will also be in charge, so I’m really looking forward to an excellent learning experience.

Even though I was exhausted, that wonderful, giddy ‘I’m going to be a doctor!’ feeling was with me all night. Dr. F would instruct us to go see a patient and I’d practically skip to their bed, grinning with excitement. I know the grins would start to fade if I were working every night, having to stick babies with sharp needles and push herniated bowels back through fascia and all of the other things that come with helping the ill and injured but at least for now, that wonderful glow of certainty that this is exactly what I’m supposed to be doing with my life is there and it makes me so happy. I can’t wait for Thursday.

Just for fun, here are some lumbar puncture videos. Our poor little baby didn’t even get lidocaine.

The volcanic abscess patient actually asked us to tape the lancing on his Blackberry. I wish I had that video to post too…

The Real World – ER、その1

On Tuesday, I began my ER rotation at North Shore Medical Center (not to be confused with North Shore LIJ). Although my rotation partner and I are assigned to this rotation for 2 weeks, we’ll really only be spending about 36 hours in the ER. We started with a 7 to 7 twelve hour shift which we spent taking patient histories, performing basic physical exams and trying to get our assigned doctor’s attention. Only a few doctors and a handful of nurses and techs run the ER; patients are triaged according to how life-threatening their injuries/complaints are and tended to accordingly. Mostly, we were left to our own devices so we periodically visited the patients, listening to their stories, assuring them that the doctor would be coming around soon and trying to make them feel less neglected.

Although it was a daytime shift early in the week, we did see some interesting cases: a mangled finger, a pelvic exam, a case of lupus, and a code blue, as well as a thrillingly belligerent patient brought in by police handcuffed hand and foot and yelling curses non-stop! (They didn’t let us get near that one). Quite a few patients were in the ER due to cardiovascular complaints, which shouldn’t have been surprising, since heart disease is actually the leading cause of death in the US. We also saw a few with respiratory complaints and got to hear some crackles and a real live murmur.

Even though I hear my classmates in Michigan are going to be giving out flu shots (so! jealous!), being in the ER was still pretty cool. Every now and then, I have these random, giddy ‘I’m going to be a doctor!’ moments and I can’t help but grin. Even though I was exhausted after my shift (which I better get used to, stat, ’cause twelve hours is nothing!), I felt that way the whole ride home, and fell asleep reflecting on my awesome experience. I’m really looking forward to our next shift, a Saturday overnight. I suppose it’s kinda wrong to hope for excitement in the emergency room but if we’re going to be there all night, I hope we at least get to see something educational. People get up to some crazy stuff on Saturday nights. But who knows, maybe my excited smile might help a patient feel a little less miserable to be there.

ALF and PE guinea pigs

Yesterday, on my first visit to the assisted living facility (ALF), I managed to incur the wrath of the doctor in charge before we were even assigned patients! After we met Dr. L, one of the on-site physicians, he led us down the halls of the facility, peeking in to patients’ rooms and asking if they’d mind having a bunch of medical students mess with them. When he emerged from one, he shouted, “Anyone speak Spanish?” Even though I was, at one point, quite good at Spanish and had visualized myself conducting an interview so fluid and fluent Telemundo could’ve televised it as I lay in bed the night before, my anxiety got the better of me and I blurted, “…not well enough.”

“Don’t be a smart@ss!” Dr. L yelled, and tears sprang to my eyes. He came out of the room and fixed me with a frightening glare, his voice dripping with disdain as he told our faculty doctor, “I asked if they could speak Spanish and this one,” he pointed, “says, ‘Oh, not well enough!’” He inflected it with a girly additudinal lilt*, shaking his head. “Sounds like she should be a lawyer.”

I was mortified! “No, I didn’t mean…I’m sorry, I wasn’t talking about everyone, I didn’t mean them, I meant me, I don’t speak Spanish well enough to feel comfortable and do a good job, and I…” As I stammered out apologies, he chuckled.

“Well, here’s a patient for you.” Dr. L directed me and my partner to another bed in the room. “These two young ladies are medical students and they’d like to talk to you. Is that all right?” The patient agreed and Dr. L left us to introduce ourselves. When I made my introduction, the patient gave me a knowing smirk and said, “Oh, so you’re the lawyer.”

Blushing**, I shook my head. “Not really.”

Whale $#%! – AICM in Miami

Welcome to a new chapter of the chronicle! When I began 医者の卵, I was getting ready not only to embark on a career in medicine, but also on an adventure in another country. For 16 months, I studied the basic medical sciences at the Ross University campus in the Commonwealth of Dominica (again, not to be confused with the Dominican Republic). It was certainly an experience – at times, exciting, at times, frustrating, at times, lonely, and yet, at other times, wonderful. I learned a lot during my time on Dominica and made a lot of friends. Luckily, most of us survived the basic sciences (even if it was by the skin of our teeth!) and, despite enduring some crazy trials and tribulations, we managed to get to 5th semester. The most satisfying part of making it through was knowing that we’d accomplished something. Even though we were technically only halfway through our medical education, we’d survived the worst Dominica had to throw at us and emerged stronger, wiser and better than we were when we arrived. However, at the end of the basic sciences, we knew we were destined to part ways. There are three sites at which Advanced Introduction to Clinical Medicine (AICM)–the transition module designed to bridge the basic and clinical medical sciences–is offered: one site is the Princess Margaret Hospital, the Ross teaching hospital in the capital city of Dominica. One is Synergy Health in Sagniaw, Michigan. The other is where I am now, sunny Miami, in the sizzling south of the sunshine state.

On Faith and Pharmacology

(Or, How I Survived Fourth Semester)

For most intents and purposes, to me, religion is a private topic. It has a place in my life but it’s not a banner that I wave everywhere I go. It’s something personal, something I’ll share if asked but otherwise, keep to myself. I’m not big on evangelism; I don’t like clubbing people over the head with my beliefs and I especially don’t like the stereotypes with which the people who practice my religion get painted, in broad, bigoted swaths. So it is with a measure of reluctance that I talk about the role my religion played in my triumph over the big bad final. When I began this chronicle, I made a promise to myself to make it primarily about my experience of med school and less about my personal life. Self (and readers), forgive me for my departure from that vow.

The Saddest Review Question Ever

Courtesy of LWW’s BRS Pathology:

7. A 78-year-old man is found in his closed room unresponsive in bed after the first cold day of winter. There is a kerosene heater still on from the previous night. On attempts to rouse him, officers note the cherry hue of his lips, cheeks and mucous membranes. The likely mechanism of his death was:*

a) accidental ingestion of ethylene glycol

b) binding of carbon moxoide to hemoglobin

c) hepatic necrosis with fatty change

d) inhibition of hemoglobin production

e) inhibition of incorporation of iron into hemoglobin