MEDICINE IS THE BEST MEDICINE.

When I was little and I thought my parents were being unfair, I would make lists of things I would...

Sat, 13 Nov 2010 06:17:38 -0500

When I was little and I thought my parents were being unfair, I would make lists of things I would never do to my kids. Now, in med school, I make lists of things I won’t do or say to my patients and staff, and ways I won’t treat them.

I have been doing this for 5 months, with surgeons and doctors who were arrogant as hell. The guy I’m working with tonight takes the jackass cake ten times over.

"Do not resuscitate if… Resuscitation would be futile because the patient shows clear signs of..."

Wed, 03 Nov 2010 16:49:17 -0400

“

Do not resuscitate if…

Resuscitation would be futile because the patient shows clear signs of irreversible death (decapitation, rigor).

”

- Emergency Medicine Roadmap

"Patient takes an herbal iron supplement… She, thus, also requires the herbal stool softener."

Fri, 24 Sep 2010 14:18:00 -0400

“Patient takes an herbal iron supplement… She, thus, also requires the herbal stool softener.”

- Pharm.D

Greetings, friends, from the exciting world of Internal Medicine! That’s right - to the best...

Fri, 03 Sep 2010 21:32:16 -0400

Greetings, friends, from the exciting world of Internal Medicine! That’s right - to the best of my knowledge, I have survived my surgery rotation, and all of its responsibilities, privileges, and awesomeness.

I have to admit that I liked surgery a lot more than I thought I would. The hours are intense, to be certain, but I got to do some truly amazing things, things I never thought I would be comfortable doing. For example:

I scrubbed in to or observed around 40 procedures over the course of the month.
I took five overnight calls.
I participated in a trauma surgery involving a ruptured bladder - I got to put my finger inside a human bladder.
I learned how to steer a laparoscopic camera, and got pretty competent at it - I only got yelled at (on average) twice during each gallbladder surgery!
I scrubbed into a surgery that started after midnight.
I worked with very friendly patients, who were very patient with me as I learned.
I found some residents and attendings that were excellent teachers, and really enjoyed working with almost everyone I met.

It really is as intense as two months could be outside of, say, Kabul. I took call on my first day in the hospital - feet to the fire, never mind that nobody told me that I was going to need a change of underwear and a toothbrush on my first day of work. And yeah, I did get socked in the face by a sundowning old lady that night… which kind of sucked. But for the most part, surgery was REALLY, REALLY fun, and I find myself missing it, now that I’ve arrived at the slower pace that internal medicine seems to take.

I wouldn’t trade the hours on IM for anything right now, though!

I keep a list. It’s a list of people I’ve cared about, people I’ve taken care of,...

Tue, 03 Aug 2010 23:52:07 -0400

I keep a list.

It’s a list of people I’ve cared about, people I’ve taken care of, people I’ve loved. Some of the people on the list are people I’ve watched grow up. Some of them are people who watched me grow up.

Besides being on my list, the only thing that they all have in common is that they’ve passed on from this world. They’re taking their next great journey.

I keep a list because I need to remember. I need to honor their memories. I also need to remember that they are the reason why I’m going through this, the 30-hour shifts, the blistered feet and aching mind, the endless textbooks and journal articles. They are the reason. When I am mindful of their contributions to my life, I remember that my journey to becoming a physician is because of them. Their influence on my life, I can only hope, will make me a better doctor someday.

I added another name to the list tonight. A 20-year old boy that I’ve had the honor and blessing of knowing for the past nine years, who fought cancer and survived, who always had a winning attitude and a great sense of humor. He will be missed by all who knew him, but not forgotten.

Dear AMA, Please do not try to sell things to me by telling me how expensive they are in terms of...

Sat, 17 Jul 2010 15:20:50 -0400

Dear AMA,

Please do not try to sell things to me by telling me how expensive they are in terms of lattes. I don’t drink coffee. I drink water and chew wintermint gum. I wouldn’t need any of these things if I hadn’t been getting up at 4AM. I don’t mind being there early, really. I just don’t want you trying to sell me things that others consume so that they can manage the work hours.

Love,

A bedraggled third year medical student

Your best weapon on surgery- a big smile and a plate of cookies for your nurses. Yeah, that’s...

Fri, 09 Jul 2010 10:51:20 -0400

Your best weapon on surgery- a big smile and a plate of cookies for your nurses. Yeah, that’s right - I went there!

In the hospital, remember this one thing: in almost every situation, no matter how bad your day has...

Thu, 08 Jul 2010 19:57:24 -0400

In the hospital, remember this one thing: in almost every situation, no matter how bad your day has been, the patient in the bed is having a far worse day than you.

Your attending might yell at you, you might not do well when being pumped, you might resent being up at work at 5 am.

But you woke your patient up at 5 am too, in a strange bed in a strange place so that you could poke and listen and ask if they have passed gas. At the end of the day, your attending will have forgotten that they yelled, you will have learned something new, and you’ll get to go home to sleep in your own bed. So never forget to put your own feelings aside and remember - this experience is not just about you, and that getting to do this at all makes you very, very lucky.

"Congratulations on your tapeworm."

Tue, 22 Jun 2010 14:47:59 -0400

“Congratulations on your tapeworm.”

- V.B.

Jumping Frenchmen of Maine Disorder

Thu, 03 Jun 2010 10:47:13 -0400

Jumping Frenchman of Maine Disorder is a condition of abnormal, exaggerated startle reflex in response to a sudden sensory input. The example provided by George Miller Beard, the first physician to study and characterize the disorder, as that if one was “abruptly asked to strike another, he would do so without hesitation, even if it was his mother and he had an ax in his hand.” (1) It is an uncommon condition, with most observed cases occurring in the Moosehead Lake region of Maine and the Beauce region of Quebec (where many of the lumberjacks came from). There has been some evidence of family history, but most patients did not become symptomatic until beginning work as a lumberjack, suggesting that it is a psychologic, rather than neurologic, disorder.

While this condition is rare, it’s impact became far-reaching. Beard’s initial studies on the Jumping Frenchmen sparked an investigation by Georges Giles de la Tourette to study what is today known as Tourette’s syndrome.

(1) http://www.ncbi.nlm.nih.gov/omim/244100

Hypophyseal relationships?

Sun, 09 May 2010 11:37:45 -0400

V.B.: How come there's no auto-fill in for when I google "the pituitary is whose bitch"
V.B.: I expected to see "hypothalamus."

Medical Students' Disease

Fri, 07 May 2010 00:19:37 -0400

Much of medical education is an art, but just as frequently, it is an exercise in pattern recognition. A woman of child-bearing age who presents with abdominal pain must be given a pregnancy test - while the team might suspect an appendectomy, ectopic pregnancy must be ruled out. Hypoparathyroidism presents with “bones, stones, groans, and psychological overtones.” Ask any medical student who has gotten through a year or more, and they will tell you that medicine is just as much about being a super-memorizer as it is being able to tease out a history that allows for proper diagnosis of a patient.

One of the problems with studying medicine, though, is that we know the symptoms. What we don’t know, we can access resources to find it out. We spend hours hunched over our pathology texts. Over time, it’s inevitable that we recognize patterns in our own systems that may be consistent with diseases - the rarer, the better. This phenomena is so common that it has a name - hypochondriasis of medical students, or medical students’ disease.

The condition was first referenced in the 1960s. Frequently, preoccupation with a specific disease has more to do with recent study, and once the student moves on to something else, the concern usually passes. It is widely prevalent in medical students, though currently viewed more as a manifestation of normal perception and learning than as a psychiatric illness. When learning about a new condition, the medical student examines the constellation of symptoms that make up the disease. The student may then subconsciously apply the relevant symptoms, while ignoring those that he does not have.

After awhile, these concerns usually go away. We move on to the next lesson, the next disease. I no longer worry about a sinus infection that goes rogue, becoming a meningitis. Even though I have recurrent pain in my great toe, I’ve stopped worrying that I have gout - I’m far too young and I don’t honestly consume enough protein to make it a realistic diagnosis. Over time, one might even gain the skill of actually talking themselves out of such ridiculous possibilities. And yet, that too is as much a curse as it is blessing - just ask my friend with an 18-hour history of right lower quadrant pain… no fever, or nausea or vomiting… it was appendicitis after all… and that’s a story for another time.

"The clinical definition of fibromyalgia is how you feel when you’re post-call."

Wed, 05 May 2010 22:40:52 -0400

“The clinical definition of fibromyalgia is how you feel when you’re post-call.”

- Attending

Exploding Heads: When Truth and Fiction are Equally Bizarre

Tue, 04 May 2010 23:48:00 -0400

In 1994, Weekly World News - a tabloid - published a story about a chess master whose head exploded in the middle of the game. Naturally, the explosion was fatal - “experts” diagnosed him with a condition named Hyper-Cerebral Electrosis, in which the body’s electrical system becomes overloaded. The article references a physician, who states that highly intelligent people are at risk and that if one knows that they have the condition, they have better odds of surviving it. Three of the following “symptoms” establishes a diagnosis:

Aching head when thinking too hard
Ringing or humming in ears
Unable to get a thought out of your head
Spending more than five hours a day engaged in thoughtful activity
Pressure in temples when feeling angry or frustrated
Overeating ice cream, doughnuts, or other sweets
Too much self-analysis

By my count, this fictional condition certainly afflicts everyone. Who doesn’t have trouble putting away the pint of Haagen-Daaz? Who hasn’t been afflicted with a bad case of earworm? Or get a headache when they spend too much time thinking, or being angry?At any rate, HCE is a fictional condition. However, Exploding Head Syndrome is an actual, valid diagnosis.

Exploding Head Syndrome is a sleep disorder, in which a sleeping subject hears a loud noise in their head. The noise originates from inside their head, but there is no pain, swelling, or other physical manifestation. It occurs just before or after deep sleep. Patients sometimes feel a “rush,” or experience a sense of fear or panic, but this appears to diminish as the patients become more familiar with the noise. It’s not dangerous in its own right, and doesn’t have much of an effect on sleep. Incidence increases with age, and more women than men are affected.

What causes Exploding Head Syndrome? It seems to be connected to stress and fatigue. It may be an aural seizure in the temporal lobe, or by movement of the middle ear or eustachain tube. It may be connected to some drug withdrawals. Treatment with clomipramine, a tricyclic antidepressant, has been effective in some patients.

A short list of things never to Google right after eating...

Tue, 04 May 2010 12:50:00 -0400

Ascariasis: a parasitic roundworm that infects as much as a quarter of the world’s population. The eggs are eaten, they hatch, and the larvae burrow through the intestine, into the blood supply and migrate to the lungs and respiratory tract, where they are then swallowed back into the intestine. They can cause all kinds of problems, most notably, a fatal bowel obstruction. Awesome.

Teratomas: tumors made up of tissue from all three germ cell layers, caused by a failure of normal tissue migration. They can contain hair, teeth, and bone… and sometimes more complex organs. A tumor with an EYE? Gross. They are usually benign and are present at birth.

Caseating granuloma: a hallmark of pulmonary tuberculosis infection. Why are we seeking to give cheese a bad name?