Thursday, December 16, 2010

Patient's Guide to the Emergency Department

During my last month of working in the Emergency Department, I've come to realize that patients have a lot of misconceptions about the ED. I became inspired to write a sort of "Patient's Guide" to the ED, to air some of them out.

1) Their goal is not, ultimately, to figure out what's wrong with you. Don't get me wrong; a lot of times they will. At the same time, that's not their ultimate goal. There's a lot of patients they need to see, so what they need to do is get you out of the ED as soon as possible. That either means admitting you to the hospital, or ruling out life-threatening conditions and having you "follow up with your primary care physician".

2) Not everything we do is medically "indicated". A lot of times, ED docs (ok...ALL docs) order tests and workups that they don't think are actually necessary. Often, this is either because the hospital requires them, or because the ED physician (EP) is afraid of missing something and getting sued. I see this ALL the time. ALL the time. Patient comes in with symptom X and the doc says to me, "Well, I'm pretty sure this guy has condition Y, but we'd better get such-and-such test to rule out condition Z, just to cover our butts."

3) You're at the mercy of our convenience once you come to the hospital. Sorry. There's a lot of waiting around at the hospital. If you come to the ED on a Friday night with chest pain that sounds heart-related, but isn't exactly a heart attack right now, we'll admit you to the hospital and keep you sitting there over the weekend until someone is around on Monday to do a stress test on your heart. We can't afford to take the risk of sending you home and having something bad happen to you over the weekend. That's how we get sued.

4) Kind of the sum of 2+3...You can say no. You can say, I don't want X test. I don't want to be admitted today. If you want to leave, we'll make you sign an "AMA" form...Against Medical Advice. That's not always a terrible thing...we just need it to cover our butts in case something happens to you. Be VERY, VERY careful about saying no, though. I've heard that if you DO end up having a poor outcome because you did something AMA, insurance companies won't cover it. And, of course, there IS that risk of something happening to you. That's why we want to do XYZ to you...because we're not quite comfortable saying your OK. The best thing to do is talk with your ED doc and try to get his honest opinion. A lot of them will be straight up with you...they'll say, I'm not really worried about X, but just to be careful, I want to keep you overnight. Then take it from there.

5) The ED doc doesn't know you. Anything about you: your medical conditions, how "tough" you are about pain, your family history, your social history, etc...Your PCP does. That makes a world of difference. Think about it.

All of this to say: Don't go to the Emergency Department unless you have to. It's not the place to workup chronic conditions. They can't and won't do need to see a primary care physician about it, unfortunately. Things happen more slowly in the "outpatient" setting...but they're also cheaper and you get to go home in between. If you're not sure about whether or not to go to the ED, consider calling your primary physician. They can often help you over the phone. They (should), after all, know you a LOT better than they do in the ER.

Of course, when in doubt...go to the ED!

Wednesday, December 8, 2010

Helicopter Ambulance

How cool is my job--yesterday, I got to fly around with the local helicopter ambulance team. Unfortunately (for me, at least), weather kept us grounded for most of my shift. I got a lot of much-needed studying done, though!

5 minutes (literally) before I was about to leave for the night, we got a call. It was a perfect run for me, because we were basically transferring the patient from one "community" hospital in town to a higher-acuity it would be a lot of up-and-down, but we wouldn't be sitting around for very long, and since it was all in-town, it wouldn't take long.

The helicopter was in our hanger on a flat-bed trailer. We ran out and pulled it out to the landing field and the pilot fired up the engines. Within a few minutes, we were airborne! I had been hoping that I'd be able to fly during the day, but the view of the city and all the Christmas lights at night was a beautiful sight from the air. Literally a few minutes later, we were coming in for a landing at the community hospital.

We landed and the medic and flight nurse slipped the gurney out of the chopper's rear doors. We hustled inside and discovered that an elderly woman had actually been in the emergency room visiting her sick husband, when she had what appeared to be a stroke, and became unresponsive. We heard the rest of her story and bundled the frail, thin woman up as warmly as we could and headed back out in the the sub-freezing weather. We got her strapped in and the chopper headed back up into the sky.

Moments later, we came in for a landing at the larger hospital. As we neared the ground, I spied a little girl and her mother standing in the parking lot near the landing pad. The little girl was pointing excitedly at our helicopter, clearly fascinated. When you do stuff like this every day, I can see how it can be easy for the glamor to wear off. But looking at it all through the eyes of this little girl, it was pretty neat to think about how much of a privilege it is to get to do what I do.

We dropped the lady off and headed back off into the night. I don't know what happened to her, but I hope it turned out alright. My wife says that older couples often pass away within hours, days or months of each other. Perhaps this was the time for this couple...if so, I hope they passed with dignity, and I feel privileged to have been able to help with her care.

In sum, yesterday was exciting on so many different levels. It was such a thrill to ride in the helicopter. It was such a privilege to be able to participate in the care of this elderly woman. And it was really cool to see the fascination in a little girl's eyes as she watched us land.

Sunday, November 28, 2010

Drug Companies...The True Motivation?

Imagine this: you walk into your local pharmacy to pick up a bottle of aspirin. You usually grab the store brand--it's cheaper! Now imagine your surprise when you can't find the store fact, there's only one brand of aspirin on the shelf! You pick it up, look at the price, and discover that the bottle that usually costs you about $9 now costs you $485! If you typically use aspirin for things like headaches, you might just turn to another painkiller. But what if you had heart problems and needed to use aspirin every day for that reason?

If that sounds far-fetched, think again. Take the example of colchicine, a drug that has literally been used for centuries, for the treatment of gouty arthritis, among other maladies. Given this drug's age, it was on the market long before the advent of the FDA, and thus had never been officially approved by the same. Ah, but the drug company URL Pharma has come along to dot the i's and cross the t's for the FDA! They went through the motions of running colchicine through the official drug-approving process, and in return, the FDA gave them a 3 year patent on their brand-name "Colcrys".

I found this out during my Family Medicine rotation this month. We had just finished seeing a patient who had an acute attack of gout. After seeing the patient, removing a bunch of the painful uric acid crystals in his knee and adjusting his prescriptions, I talked with my preceptor. He told me about how URL Pharma had been awarded the patent. He told me about how they immediately turned around and sued to have all competitor brands of colchicine removed from the market, a fight which they just won in September. And he told me about how the price for colchicine had basically increased by 50 times now.

Needless to say, I was floored. I came home and did the research myself to confirm. Mostly, insurance companies will bear the up-front cost. But it all comes around to bite all of us in the end. I read it's expected to cost Medicare an extra $50 million, altogether, as if it wasn't strained enough. I understand rewarding a company for finally doing the grunt work to get the data for safety, efficacy, pharmacokinetics, etc. But this is absolutely ridiculous.

And real people are going to suffer.

Friday, November 19, 2010

"So You Know What Hell is Like"

It was the last patient of the day. I grabbed the chart, glancing at the reason for visit. "Med Check" is what was written. I flipped through her last few visits, noting that she had begun an antidepressant 6 months earlier. I make a mental note that her blood pressure was significantly elevated today...a problem she had not had before. Then I knocked on the door and entered with my canned speech, "Hi, I'm a medical student working with Dr. __ today..."

Observation is a huge part of being a doctor, and the first few seconds can be very telling. This woman was standing in front of the examining table, hands held in front, head down. As I walked in, her head raised and her expression went from one of fatigue mixed with grief, to one of clear alarm. "Oh, I'm sorry", she said. "I don't deal well with men. That's the whole reason I see Dr. __." I retreated a little so as not to appear as a threat, and apologized. I said something to the effect that I certainly didn't want her to be uncomfortable, but Dr. __ was with another patient at the moment, and would she mind terribly if we just talked for a little while? She gave me a dubious look but agreed.

I sat down and began inquiring into the purpose of the visit. She had been taking such-and-such medication for 6 months now, correct? How did she feel about that drug? Did she feel it was helping her? Her answers were vague at first, and she said the drug had been helping her "cope" but that she had a lot going on in her life. Not wanting to pry, I inquired if these were things she'd already discussed with my preceptor or not. She said that well, all these things had happened since her last visit. I said, "Would you be comfortable talking with me about what's going on?"

And I guess at that point I won her trust. Her eyes misted and she told me about her son who had been addicted to narcotics and other medications, but had moved in with her while he "quit cold turkey". She told me about her daughter, 9 months pregnant and going through a divorce. She told me about her fiance who was undergoing an ugly court battle with his ex-wife. And there was she, caught in the middle, the one that everyone turns to with no one to turn to herself.

I put the chart down, and rolled my stool closer to her, validating her as a human being and not as "just a patient". I briefly shared with her some of my struggles from a few years ago, when I felt like my own life was falling apart. She summed it all up pretty well when she said, "So you know what hell is like." I said that my hell had certainly not been like what she was going through, but she said, "Everyone has their own hell."

We really touched each other, and definitely came back stronger from sharing our experiences. We talked about how all these things had happened at one time in her life, but that many aspects of them were temporary, and she had a lot to look forward to: her son being clean, her new grandbaby, her soon-to-be husband. We talked about making sure SHE had someone to vent to. We talked about her blood pressure, and the possibility of adding some anti-anxiety medication to help her handle everything. And, as I left the room, we talked about prayer.

That's why I do what I do.

Thursday, November 11, 2010

Is Family Medicine for me?

I'm writing this on my lunch break during my Family Medicine rotation. That's right...I get a lunch break. That's just one of the nice things about FM! The "little things" really do add up sometimes.

I've never really considered FM before, for a lot of reasons. But, in the last few weeks, it's gone from not even being on the radar, to what I'm actually probably going to go into. Why?

One thing I really love is the continuity of care. I really like Emergency Medicine, and many of the other specialties are intriguing. The problem I've had with them, though, is that you treat the patient, and then send them to someone else. I always find myself wondering how they ended up. In FM, you see people over months, years, and even decades. You get to see generations of the same the 2 weeks I've worked at this office, I've seen 4 generations of a single family!

That gives you CONTEXT as well. If I have someone who's feeling anxious, but know that the husband is possibly about to lose his job, I can put two and two together. If the parents are stressed and suddnely a child is coming in with abdominal pain...that's something to think about. Etc! I've always been a fan of knowing the "big picture."

You DO get to do some cool stuff in FM. It's not "just" seeing patients in the office. In the last 2 weeks, I've removed moles and skin tags, done Pap smears, used the microscope for various things, injected joints, aspirated joints, given shots...all in the office! You never know what a day is going to bring you. In one day, I saw a 6 day old newborn, and an 88 year old man.

There's lot of little things. Having time for lunch is nice. Not being exhausted when I come home, and being able to play with my son and talk with my wife instead of going straight to bed, is huge. And I'm really enjoying talking with people about managing their diabetes, their blood pressures, the benefits of smoking cessation, and how to really do it, having safe sex, how to manage a cold, how to handle depression and anxiety...I love it!

Which has brought me to the question: can I afford to do primary care? This is part of why I've never considered it. I'm going to graduate with $275,000 of debt, which will explode to over half a million in interest within 10 years. How can I afford to pay that off on the salary of a PCP? To top it off, it looks like the Medicare cuts will be allowed to go into effect in January, cutting (I think I remember correctly) 29% of reimbursement for Medicare patients. We talk about that almost every day in the office here...about where we can add more slots to see more patients in a day, taking on more private insurance patients, etc. We already don't accept new Medicare patients. It's unreal.

I found a REALLY cool program that's JUST for people like me...that are seriously considering primary care, but are worried about paying off the debt. I'll spare you the details, but the gist is that I'd pay between $1000-2000 a month for 10 years of my debt, after which the rest of my debt (approximately $450,000 at that point) would be forgiven by the government. I'd have to work for a government or non-profit agency during that time. But it's sounding like the way I'm going to go.

As to how I'm going to handle the Medicare/Medicaid/health insurance Gordian knot...well, I don't know yet. But I'm excited about figuring it out.

Monday, November 8, 2010

Teen Sex & other news

This morning, there were a lot of interesting articles with respect to teenage sexuality (much of my morning reading comes from "Today's Briefing List" of Albert Mohler). I thought I'd share some of them, and my thoughts about them.

Oh, I also wanted to share this article with you. It's a well-written and fair article about the current state of the Republican party. Key quote: "The Democratic Party may have the wrong answers to these problems. But the Republican Party as an institution often seems to have no answers whatsoever."

OK! I actually found this article from the NY times rather fascinating. It highlights a recent slideshow from about the significant differences between how Europeans handle sex education, and how we handle it in the USA. Overall, it seems as if the American approach is denial and fear, whereas Europeans recognize that teens will eventually have sex, and so they talk about it with their teens and try to help them make informed, "safe" choices as much as possible. The results? Their teens have sex on average the same age as we do (17), but with significantly fewer regrets (girls regret their first time 69% of the time in the US, vs. 12% in Holland), pregnancy and STDs including HIV. I think the results speak for themselves: parents need to TALK with their kids openly and honestly about sex, from an early age. I will definitely encourage my children to hold off on sex, but I'm definitely not going to leave the conversation at that. Your thoughts?

This article from USA Today kind of fits with that theme. Teen girls have a LOT of misinformation about their changing-pubescent bodies, and about sex. Remember that article from last week? Teens actually PREFER to get their education about sex from their parents, and especially missing is input from Dad. They're not going to ask for it, though. Parents, we have to step up to the plate!

Finally, an article about "shacking up", and how it's becoming much more prevalent these days. Your thoughts? I moved in with my fiancee a month before our wedding. My advice would definitely be against it, in case you were wondering. Still, what are your thoughts?

Discuss! :D

Wednesday, October 27, 2010

News I Think is Interesting

So, I've done this before, and I'm doing it again. Mostly, I'm doing it because the "link" feature on Facebook seems to be malfunctioning, and I found a bunch of interesting news stories today that I want to share! If anyone likes this, let me know, and I'll probably keep doing it.

Here's an interesting article on psychological "disorders" and their beginnings in youth. Not particularly NEW news, but a good overall insight into how complicated it can be to discern what is normal fluctuation of mood/handling of the world in a child, versus what is abnormal, and potential ways to push young minds in the right direction.

Caffeine + the same bottle? Yeah, THAT'S a good idea. Especially with it's energy-drink-style can and fruity flavors, it's a recipe for disaster with teens and young adults. The FDA has been asked to review them. Caffeine blunts your body's natural response to alcohol, and makes you feel as if you aren't as intoxicated as you are. Energy drinks alone are bad, but throw alcohol into the mix, and it's really bad.

Girl's Want to Talk About Sex- With Dad?" is the title of this article. And yep, Dads, we need to get with the program! Daughters want the "guy's" perspective on sex. Studies show that teen girls who talk with their dads openly about it have sex later, with fewer partners, and safer. I like that this article stresses that this needs to not be just a one-time conversation, but an ongoing openness. The same can be said of a lot of things!

This amount of sleep is too much, this amount of sleep is too little, this amount of sleep is just right. This article references a study on sleep that researched age of death of over a million Americans, and looked into how that correlated with reported hours of sleep a night. It appears the magic number is 6.5-7.5 hours a night. I wish!

Yuck. We already knew this was happening, but the official reports are that from 2007 to 2009, Insurance claim denials rose by 50%. Disgusting! Sure, that'll be against the law come 2014, but insurance companies will (and already are) finding ways around it. I've only been in direct patient care for 4 months and I'm already fed up with insurance companies, and the limbo we have to go through to satisfy their requirements. If I go into a specialty where I can do so, I'll probably avoid insurance companies altogether and engage in direct contracts with my patients.

That's all I've got for now. I'm taking the surgery shelf exam on Friday, and then I'll write a post about my surgery rotation experience! Have a wonderful week.

Thursday, October 21, 2010

On Call During a Full Moon

My alarm jolts me into consciousness at 4am. I hit the power button on the coffee maker (Dad always said I'd pick up the coffee habit once med school started), take a quick shower, throw on my scrubs, grab the bag of pumpkin muffins I made last night, whisper a goodbye to my sleeping family and head off to the hospital. Hmm, it's starting to get chilly. I think I'll grab a jacket.

I toss my backpack in the callroom with everyone else's and trade my black jacket for the white coat with my name on it and my patients' information in the pockets. I head up to the floor and spend the next hour or so seeing patients and writing down vitals, lab values and reports from the night shift. I head over to a conference room to hear sign-out from the night team, and the next 2 hours is spent seeing patients with the entire team.

When rounds are over, I find a free computer and get to work updating orders and notes. I gobble a couple muffins down and head to the OR where we open up a man's abdomen to drain a pocket of pus. We decide to hold off on repairing his hernia until his wound heals up, so it won't get infected. It's now 5pm, and the day team heads home. I'm on call tonight, though, so I grab a bite to eat from the cafeteria and focus on studying for the surgery exam I'm taking in a week. I try not to drink too much, because you never know when you'll have to go the operating room, and you never want to have a full bladder in the OR.

It's 10pm...BEDTIME! I turn off the lights, kick off my shoes and close my eyes. Immediately, I hear the BUZZZZZ!!!! of my pager vibrating on the desk! "Med student needed in OR 15, STAT!" I throw my shoes back on and race upstairs, throwing on a scrub cap and mask. I hear the story: Man who had abdominal surgery 3 weeks ago was found by his son with altered mental status, distended and very painful abdomen. Apparently it's been bothering him for a week now, but he didn't want to come in and have it looked at. A CT scan shows what we never want to see: free air in his abdomen, meaning he has a bowel perforation. I quickly remove the staples from his old belly incision while anesthesia puts him under. We "scrub in" and open up his belly quickly but carefully. The surgeon tells me, "Have suction ready." Understatement. Of. The. Century. The last layer of tissue was cut, and approximately 3 liters of...fluid, let's say...erupted from his abdominal cavity. Everywhere. As Han Solo famously said, "What an incredible smell you've discovered!" His abdominal organs had been sitting in feces and digestive juices for a week, and he had actually eaten away much of them. His liver looked like cottage cheese. We patched him up and took him to the Surgical Intensive Care Unit (SICU).

I head back to my call room and take a fast shower. I'm covered in abdominal fluids. Ah, much better. The other students on call are covering the 2 emergent appendix removal surgeries. My hip is buzzing again. Trauma, Level II, 2 minutes. Please, people, if you must ride a motorcycle, where a helmet! This guy got lucky and should be able to leave in a day or two. Ok, maybe I can actually get a wink or two of sleep?

I close my eyes again. BUZZZZ!!!! "Trauma, Level II, 3 minutes." We have a skeleton team since one of the appendectomies is still going on. The patient rolls in and the paramedics give their report. "20-something year old male found unconscious in a restroom at McDonald's." We don't know much else about him, except that he REEKS; he's wet his pants, he hasn't bathed in...a long time, and he is covered in what looks like mold. The emergency room doctor recognizes him as a "frequent flyer" who abuses a few different drugs, and we realize that he has overdosed on one of them. He's coming in and out of consciousness. "Don't worry, you're at the hospital," we tell him. With his left hand, he flips us off, and he makes a fist with his right hand and starts flailing at the staff. I have to hold him down to keep everyone safe, and I think I may gag from the smell that is now inches from my nostrils. I wonder about what we can do to really help people like this, from doing this to themselves.

As I hold down this guy, I hear "Ah-OOGA!" I glance at the clock. It's 4am. Time to "wake up". When he's stable, I wash my hands and grab a big cup of coffee from the "Cafe Oasis" and head back upstairs to do my morning routine of checking up on my patients. This morning is much like the last. Sign-out, see patients, updates notes and orders. I ask the intern how else I can help him. He must recognize that look of exhaustion in my half-closed eyes. "Are you post-call?" he asks. "I am!" "Ok, thanks for everything, why don't you go home?" I hesitate a moment before asking him if he's sure. It's 10am. I've been awake for 30 hours.

I stagger down to my truck. I turn the key in the ignition. Nothing happens. My "Service Engine Soon" light has been on for 9 months...has it finally caught up with me? I pop the hood, and thank God, I'm able to coax the engine into starting.

I get home, and my 2 year old screams "DADA!! You're home!!" My dear wife asks "Are you hungry?" and I realize I haven't eaten since last night. She makes me steak, mashed potatoes and spinach. Oh, YEAH. It's good to be home. I take a shower and read a book to my son. My wife whispers those sweet words, "Now go to bed." I trudge upstairs and am asleep before my head hits the pillow.

It's 12:30pm.

Saturday, September 4, 2010

My Internal Medicine Rotation

I wanted to make sure that I wrote this out before my vacation ends, and my surgery rotation starts, and I forget it all. So, here goes!

In July, I started my first rotation as a 3rd year medical student. I began a 2 month rotation on "Internal Medicine", which for all you non-medical peeps, is basically adult medicine (versus surgery). There are many subspecialties within internal medicine, including cardiology, nephrology, oncology, gastroenterology, and so on. During the month of July, I was on cardiology.

I could not have asked for a better first team. The resident of the team was amazing, in that he was very approachable and helpful, always answered questions, gave the students enough responsibility but not too much. It was so awesome to be able to see real patients! For the first two weeks, I was on the "Acute Coronary Service", which is basically where all the patients with heart attacks go. It was very straightforward (cuz basically everyone had the same problem!) and thus a great environment to get my feet wet. I learned SO MUCH from that rotation.

I definitely learned that the nurses know EVERYTHING. And even if one nurse doesn't know, they have a secret phone system to all the other nurses and they'll just call the nurse who DOES know, and find out for you. DO NOT MAKE THE NURSES MAD.

At the end of my first week, I learned a lot of lessons from a 39 year old woman who had a heart attack in bed with her husband. He immediately started CPR, but it was a massive heart attack, they flew her to our hospital and we opened up her arteries right away, but she coded twice. I was really touched by all her family members that showed up, crying, saying "She's a fighter", praying on their knees in the conference room we set up for them. That night, I went home and I made sure to spend time with my family, because that's what's so important: if I had a heart attack, would my family care that much? Anyway, I was sure she was dead, but just over a week later she walked out of the hospital! I talked with them as they were leaving, and the husband remembered that I had put my hand on his shoulder in the elevator on Day 1, she herself said she was quitting smoking, and they were all so incredibly grateful for everyone's help.

Later in the month, I had a guy who was pretty sick. His arteries were so clogged that he needed open heart surgery, but his blood counts were pretty low, and we kept working him up to assess his lung function, the source of his bleeding, etc. Every time I went to check in on him, though, he was smiling, and said he was doing "Alright!"

I had a patient who kept passing out, and she'd been told before what the cause of it all was, but it had clearly not been explained to her very well, because she kept coming to the ER for it. I took the time to look up patient information sheets on it for her, and explained the process of how it happens, and I (like to) think that it actually sank in.

I noticed a patient one morning, as I was getting vitals on my patients (at 6am), who was sitting in her wheelchair in her doorway, seeming to glare at the nurses' station. I tried to smile at her, but she just glared back at me. Later, I saw a handwritten note taped on her door, "I can't shut my door, so PLEASE PLEASE keep it down so I can sleep!" I inquired, and apparently she was on a medication that required her door to be kept open, in case her IV alarm went off, and that also made it so she had to be right by the nurses' station, so they could hear if it went off. I heard so many times during my rotations, "This isn't a hotel, and the patient's will just have to learn to live with all the noise." Well, yes, some of that is true, but we (doctors, nurses, other staff) can also learn to try to provide an environment that is conducive to healing.

I had a very negative experience during my 2 week oncology rotation, in the beginning of August. It was a big change from cardiology: the patients were a LOT sicker, and we had more patients per doctor, so everyone was busier. The new resident in charge ran things differently than in cardiology, and I found that I had a LOT more "busy work" to do, and a lot less time to spend with patients. To my shame, I acted very resentfully during this rotation, and didn't make the most of the situation. I did learn a lot of things,though (even though many of them were what NOT to do in the future!!)

We did have one patient that came in because his nursing home had not been treating him well (he had throat cancer and couldn't speak, eat or drink through his mouth). They had not been giving him enough liquids at his nursing home, and his electrolytes were all out of balance. Tragically, somehow it got mixed up that we did not actually order fluids for him for over 8 hours after admission...thankfully when we realized this, we were able to get it under control. But, TWO DAYS LATER, we discovered that no one had ever ordered FOOD for him, either! (He needed food to drip through a tube through his skin into his stomach). We got that under control as well, and he did end up stabilizing enough to be discharged. I faced an ethical dilemma here, though, because the doctors in the team said we didn't need to report that as an "incident". I wasn't so sure, and talked with some of the medical school leadership, who advised me to fill out an Event Report, myself. I felt kind of like I was tattling on my team, but I did end up filling out an event report, because it was absolutely unacceptable to have a patient on our service not eat for 3 days because of our negligence. If we can study this occurrences when they happen, we can hopefully learn how to prevent them from happening again.

The 2 weeks I spent on the infectious disease consult service was a lot of fun. Whenever someone in the hospital had a patient with a difficult infection, they would "consult" us, and we would go see them, and give our recommendations on antibiotic choice, duration, etc. So, every day I was assigned one or two of these consults, and I got to spend a few hours learning everything about their case, talking with them, doing a thorough physical exam, and then reporting back to the team. It was here that I really got to develop my exam skills, because I had the time to do so! I did get to see a lot of interesting patients, too. A lot of nasty, nasty infections!!

Well, this is already hugely long, so I'll cut it short here. I saw many patients and families who touched me, and I've kept a little journal about their stories, so I can always remember them. I think it's very important to learn not just the science, but also the art, the human side, of medicine.

(I also confirmed that I DON'T want to go into internal medicine...I had a lot of good experiences, but adults are terrible patients!)

Tuesday, June 8, 2010

Judgment Day is Here

Greetings, my dear friends! Tomorrow morning, at 8:00am EST, I will be beginning the 8 hour ordeal of the USMLE Step 1 exam. I have been preparing for this exam, 15 hours a day, for the last 6 weeks (bless my dear wife for all she did to allow me to study that much). I look forward to rejoining the "real world" (including Facebook!) tomorrow evening.

In the meanwhile, I would ask for your prayers, for (at least one of) the most important exam of my career. God has been truly blessing my studies, and I will be MOST pleased if I do as well on the real thing as my diagnostic exams have predicted. Still, nothing is set in stone yet, so please pray for my mental sanity and stability, that I be able to discern with the precision of a scalpel what the questions are really asking, and that I be able to piece together each step of the solution for the correct answer. If you're not the praying type, I'd still appreciate any good vibes/energy and well-wishes you'd like to send my way!

Thank you so much!

Tuesday, June 1, 2010

I think I have the FLU

Ok, not really. But SHEESH...I have to rant a bit about drug names, cuz that's what I've been studying all day. Here are all the drugs (that I can think of) that start with "Flu", and I have to know them all for the USMLE:

Fluticasone & flunisolide (inhaled anti-inflammatory agents for asthma).

Fluconazole (antifungal).

Fludarabine (anticancer).

Fluorouracil (anticancer).

Fluoxetine (Prozac).

Fluphenazine (Antipsychotic).

Flutamide (Treats enlarged prostate).

Flumazenil (Treats overdose of benzodiazepines like diazepam).

Ok, as my mom would always say, "I've grumbled, now it's time to get to work". Cheers!

Wednesday, May 19, 2010

USMLE Stereotypes

"How to discriminate your way to the top"

It's very true, as I'm studying for the USMLE. Every African-American has sickle cell anemia, and every "sexually active female" has gonorrhea AND chlamydia AND syphilis. Every child living in an "old house" has lead poisoning, and every caring adult child who goes back to Pakistan to help with the family wool-sorting factoring will have anthrax. Enjoy the stereotypes!

Sunday, May 9, 2010


Do you ever consider writing an autobiography, but then don't because you know too many people would get hurt if the truth got out there? Maybe I'll have something published post-humously. Grandma always said my life would make a great novel.

Wednesday, May 5, 2010


Just sharing with you what my life is consisting of at the moment. Yahahaha!!

Friday, April 30, 2010

Easter Pictures!

It's become a tradition in my family to take themed pictures around Easter. Here are some of this year's pictures :)

Saturday, March 20, 2010

Immigration Reform

I've been hearing a lot about Immigration Reform lately. Of course, I've heard a lot about it over the last few years, as well, but the pot is definitely coming to a boil. This article came into my inbox this morning, and I thought I'd share it with you. The article reports on the march in Washington, D.C. scheduled for this Sunday, of people stating that it is a religious imperative to legalize "illegal immigrants." They quote Scriptures such as Leviticus 19:33-34, Deuteronomy 27:19 and Matthew 25:35 to support their claims.

Now, legitimate counter-arguments can be made. Those passages were written to a specific people in a specific time, and America is not the Israelite nation and those words were given millenia ago. SO many errors are made in taking Biblical passages out of context. Also, can mandates given to individual people be extrapolated to apply to a nation? Not always, and we must discern whether we can do that in these cases.

My dad has often compared the illegal immigrant situation to people breaking into your house. He argues that illegals have broken into "House" America, stolen our food, our healthcare, our jobs, etc etc. He argues emphatically against legalizing them, and makes a logical point that doing so would encourage more of the same.

I'm not sure exactly how I feel about all that. My sympathy is with these people, who often driven to the U.S. by unbearable conditions in their native lands. But, America does have limited resources, and it makes sense that the benefits of living here should go to the people who have made a commitment to that society by learning the language, valuing the history and paying taxes.

Being NO economist, I wonder what the economic impact of legalizing vs deporting all the illegals currently in the U.S. would be. I know that many of these people are willing to work for far lower compensation than we Americans are, with our great sense of entitlement. Would deporting them provide more jobs for the many jobless Americans? Or, would it crash the economy. I don't know!

I'd love to hear your thoughts :)

Wednesday, March 3, 2010

Cleaning My Carotids

A super awesome parody of Eminem's "Cleaning Out My Closet." It's the Transient Ischemic Attack (TIA) song! Hope you enjoy the awful rapping, and maybe, just maybe, it will help you study.

Ethics Poll

I'm going to try to start posing an ethical question on here on a fairly regular basis. I want to know YOUR thoughts (even if this posting is super old by the time you read it!). A lot of these will be medical ethics situations (I am a medical student, after all!) If you could tell me your opinions as to both 1) What you think the doctor should do, and 2) What you would want your doctor to do, if you were the patient in the situation. The two won't always be the same!

Here's the first situation. After awhile, I'll give you my opinion.


You are the attending (senior) cancer doctor in charge of a patient, Mr. Jones. You've been seeing Mr. Jones for awhile and treating his cancer. The cancer is going away, all seems well, but all of a sudden it's back. It's a type of cancer (acute leukemia) that almost never goes away again once it comes back out of remission. All of a sudden Mr. Jones is going to die within an hour if you don't put him on life support.

Mr. Jones has expressed to you that he absolutely does not want to go onto life support. His wife, however, is 200 miles away and driving as fast as possible to get there, but unless you do something, he will be dead before she arrives. Mr. Jones' parents are present, and urge you to put him on life support to keep him alive until Mrs. Jones can get there.

While you decide what to do, Mr. Jones loses consciousness. There's virtually no hope that he will regain consciousness whether you intubate him (put him on life support) or not. His last expressed wish was just to die naturally. you intubate him, or not? Remember, he's unconscious and won't know what you do either way.

Note: This was an actual patient. The name has been changed to protect patient privacy. I'll update later with both MY personal opinion as well as what actually happened in this case.

Tuesday, March 2, 2010

They're People, Too!

I haven't blogged in forever, blah blah blah, sorry sorry, excuse know

I read an article a few weeks ago...I wish I could find it and link to it, but I deleted the source and can't seem to locate it. Anyway, I've been thinking a lot about that article, and trying to apply it to my own life. I think there was a great truth presented therein.

The main thesis of this article was that a reason for much of the rude, inconsiderate, cruel and even downright monstrous behaviour that we humans have toward each other is that we don't think of other people as being real. I believe the author termed this concept "abstraction".

By not being "real", I mean that we put other people into a box, so that we can safely treat them however we want to, and it doesn't matter, because they're not real, whole people. We put labels on them, whether consciously or not, and then we're free to mistreat them.

An example of this concept in its most extreme form is the Nazi treatment of people of Jewish descent (I believe the author specifically mentioned this example). The Nazi government did a wonderful job of painting them as less than complete humans: they were just "those Jews".

This behaviour often creeps into our lives in a very insidious manner, though. It's seldom that extreme. You are showing this behaviour every time you yell at someone who cuts you off...the person who just cut you off is not a real person, he's just "a jerk." How often do we wonder, honestly, in a charitable manner WHY he's driving so aggressively? Perhaps if he is late one more time to work, he's going to get laid off...whether you agree with his reasoning or not, it's a good thing to try to be compassionate like this.

What about the nice man or woman who brings your mail every day? Do you ever smile and wave at him as he drives by? Do you thank him for bringing your mail? Or is he "just the mailman". Or, what about the cashier? Do you even say hello to her as she rings you up, or do you continue talking on your cell phone without even acknowledging her existence. Do you stop to think about how she's a single mom, trying to take care of her kids with this job and the one she has to go to right after her shift there is done? I suspect that most of the time, she's "just the cashier."

Telemarketers are real people, too. Don't yell at them, don't hang up on them. They're just trying to make a living. For once, be polite and say, "I'm really not interested in your product, but I hope you have a pleasant day." Really think about how often you label other people and then just write them off because of it.

"Those liberals!" "Those conservatives!" "Darn those pro-choicers (or pro-lifers)!" Are you guilty of this one, as I am? -"Why can't this or that stupid professor just explain the material clearly?!" ...without thinking, hey, this is that professor's first time ever teaching this class. Give him/her a break! S/he's probably super nervous and just trying to pull through, and will learn from these experiences and become a better teacher later on.

People are people, people! Try to think of each person in all aspects of his or her life. What about your spouse? Do you think about the parts of his/her life that don't involve you? His/her hopes/dreams/aspirations?

I challenge you to do this: for an entire day (or longer!) think about EVERY person you encounter as a whole person. Try to envision every aspect of his/her life. See if that changes how you interact with him.

Saturday, February 6, 2010

Plug for a Friend

Hello there! I know I've been AWOL for a long time, but you know this is just a sporadic blog :-P Christmas was wonderful, we did a 6200 mile road trip from Columbus, all the way to California, dipped into the Southwest then came back. Saw lots of family and friends! It was a lot of fun, but it's also been fun to get back into the swing of things here. We decided to renew the lease on our home in Southern Columbus, and I will be starting third year of medical school in July, after taking Step 1 of the licensing exam in June!

I'm working on a post or two in my mind, but I was reading the latest post of a good friend of mine, and I wanted to plug his blog to anyone who might happen to read mine. Two plusses: He posts a lot more regularly than I do, and he's a VERY thoughtful and VERY smart author. I always find his work interesting, and I hope that it will at least make you ask some questions of yourself. His name is Robert and he blogs at TheCuriousChristian

Check him out!