There is a movement called Fat Pride. Marilyn Wann, the author of a book of fat activist essays entitled "Fat?So!" is widely considered to be at the forefront. It supports taking back the word 'fat,' just as the gay rights movement has taken back 'queer,' stripping it of its shameful and painful connotations. As one of my fat activist friends explained to me, "I'm fat. So what? I could say I'm Rubenesque, or generously proportioned, built for comfort and not for speed. But to the rest of the world I'm fat. Why dance around it?"
At a medical school, of course, we are taught that fat (dietary or bodily) is anathema (for those readers who majored in biochemistry and haven't read anything but Cell since sophomore year, anathema means really really bad). Virtually every lecture touches upon it in some way, from last year's biochem lecturer who seemed almost pathologically obsessed with saturated and trans fats (she cut one of her favorite baked goods out of her life entirely when she discovered they contained what I believe was 2 g of trans fat per serving--but then I speak as the person who has a hang up about fiber, which is no less pathological, and has me tallying my 25 grams a day in my daily planner)...to this year's pathology talks on cancer, in which dietary fat intake presents significant increases in malignancy risk. Obesity is a risk factor for cancer, for heart disease, for type II diabetes...yes. This is true. But there are other findings which are not discussed, and furthermore--and more disturbingly, to my mind--there is an atmosphere of...distaste for the obese that permeates our education, and which has no place in the training of future caregivers.
For one (yes, I should cite the study. Go to pubmed, and I have no doubt you'll be able to find it. I know saying 'A study said' without further citation is the gravest sin a scientist can commit. Mea maxima culpa) when overweight but cardiovascularly fit, exercising individuals and 'normal weight' but unfit individuals were tracked for seven years in a longitudinal study...the normal weight couch potatoes were at a higher risk of death. Interesting. Granted, in a social milieu that fosters sedentary life and cheerfully offers to Supersize everything, poor eating habits and inactivity often come together and produce someone who is unhealthy--and who also happens, through the normal workings of thermodynamics, to be overweight. But are all overweight people snarfing deep-fried Oreos and calling Guitar Hero their 'cardio for the day'? Of course not. Look, Grasshopper, and you will see...shades of grey. Yes, I know I spelled it the British way. I like that way better.
As for the distaste for fat people--which we medicalize and sanitize by calling 'overweight or obesity'--that is a much more malignant issue. My medical school class is not a cross-section of society by any means, perhaps most especially (and I find this intriguing) not in terms of body habitus, nor in health habits. Almost a dozen of us--out of 124--ran the St. Louis Marathon last year; many others ran the half-marathon. Today in class, I watched the snacks people were eating: four apples, one bag of carrots/celery, one bag of trail mix, a banana, and numerous diet Cokes. And as for body size, well, we are FAR below the widely cited "1 in 3" obesity statistic. Approaching, in fact, 0%. Perhaps that makes it easy for us to think of the obese as "them": it's something that happens to other people, something from which we (with our daily workouts and carefully planned 1800 calorie, low fat, high-fiber diets) are saved by our superior willpower.
I worry about this.
I worry that this will create physicians who think that nagging, insulting, preaching or condescending will get people to lose weight.
I worry that this will create physicians who think 'fat people' are to blame for all their health problems and are undeserving of sympathy and empathy.
I worry that we haven't found a way to help people who want to lose weight but can't, and that this may be partly because we think fat is a moral failing.
I worry.
Monday, August 31, 2009
Monday, August 24, 2009
Love/Hate
It's that time of the month again...time for things (and people) that piss me off, the Medical Edition! And, because I'm trying to remain positive this year, there will be an equally important Things I Like section.
Things That Piss Me Off
1. When a doctor orders six separate blood tests, and they are tests that need to be done on different Vacutainers of blood, so that I have to give six tubes of blood instead of one. This isn't anyone's fault, per se, it's just one of those things that can't be helped. Also, when the phlebotomist has a hard time finding a vein and rather than WITHDRAWING the needle and trying again, just digs around under the skin...it's an awful feeling. I've drawn blood before, and I've had lots of blood drawn, and it's easier for everyone just to retry.
2. The paper gown. Just when you thought it was impossible for the hospital gown to get any draftier or less comfortable, they've traded in that cloth gown (which, despite being 3 sizes too big, at least provided you with a sense of being somewhat clothed) for one made out of Charmin. No, not even Charmin. Whatever the Aldi brand of toilet paper is, in 1/2 ply.
3. The fact that, despite being gay and despite having been celibate for longer than I care to mention, one of the first several questions any physician will ask me is, "When was your last menstrual period?" Even if I come in for chronic sinusitis. I'm not pregnant, I promise. Or, as I told the X-ray tech the last time I had a chest X-ray, "If I'm pregnant my girlfriend has a lot of explaining to do."
4. That the only medication that has considerably improved my insomnia gives me a hangover effect that keeps me from full consciousness until about noon the next day. During last year's finals, I was 45 minutes late for our Genetics exam because said drug kept me from responding to the alarm. I cycled through 2 anxiety attacks on the way (run!) to class, and got the extreme evil eye from the professor. It's nice to make friends with faculty members who are also in positions of authority within the school at large (ie, if you're going to be late for someone's exam, try not to make it one of the Deans'. Ooops). Thanks, Seroquel!
5. Male gynecologists. I'm sure they're nice people. I know several. I'm probably being sexist. But I don't want a Mormon bartender, I don't want a mechanic who's never driven a car, and I don't want someone without breasts or ovaries examining mine.
Things I like
1. Bandaids with cartoon characters. Call me childish, but Hello Kitty bandages really do make those minor abrasions hurt less.
2. Zyrtec. Can I get a hallelujah from all those with allergies? Zyrtec has made spring and summer enjoyable again. No, I'm not getting paid to say that.
3. Eugenol, or oil of cloves. I had a dry socket (otherwise known as the most painful condition humankind is heir to, outside of childbirth and kidney stones) once, and within seconds of having it packed with eugenol-soaked gauze, the pain was gone. I wanted to kiss the dentist on his big bald head.
4. Ativan. The ultimate anxiolytic, though its usefulness is limited by the fact that it generally leaves me too gorked to perform daily functions. It seems to work as most benzodiazepines do--ie, on the assumption that you can't have a panic attack if you're unconscious.
Things That Piss Me Off
1. When a doctor orders six separate blood tests, and they are tests that need to be done on different Vacutainers of blood, so that I have to give six tubes of blood instead of one. This isn't anyone's fault, per se, it's just one of those things that can't be helped. Also, when the phlebotomist has a hard time finding a vein and rather than WITHDRAWING the needle and trying again, just digs around under the skin...it's an awful feeling. I've drawn blood before, and I've had lots of blood drawn, and it's easier for everyone just to retry.
2. The paper gown. Just when you thought it was impossible for the hospital gown to get any draftier or less comfortable, they've traded in that cloth gown (which, despite being 3 sizes too big, at least provided you with a sense of being somewhat clothed) for one made out of Charmin. No, not even Charmin. Whatever the Aldi brand of toilet paper is, in 1/2 ply.
3. The fact that, despite being gay and despite having been celibate for longer than I care to mention, one of the first several questions any physician will ask me is, "When was your last menstrual period?" Even if I come in for chronic sinusitis. I'm not pregnant, I promise. Or, as I told the X-ray tech the last time I had a chest X-ray, "If I'm pregnant my girlfriend has a lot of explaining to do."
4. That the only medication that has considerably improved my insomnia gives me a hangover effect that keeps me from full consciousness until about noon the next day. During last year's finals, I was 45 minutes late for our Genetics exam because said drug kept me from responding to the alarm. I cycled through 2 anxiety attacks on the way (run!) to class, and got the extreme evil eye from the professor. It's nice to make friends with faculty members who are also in positions of authority within the school at large (ie, if you're going to be late for someone's exam, try not to make it one of the Deans'. Ooops). Thanks, Seroquel!
5. Male gynecologists. I'm sure they're nice people. I know several. I'm probably being sexist. But I don't want a Mormon bartender, I don't want a mechanic who's never driven a car, and I don't want someone without breasts or ovaries examining mine.
Things I like
1. Bandaids with cartoon characters. Call me childish, but Hello Kitty bandages really do make those minor abrasions hurt less.
2. Zyrtec. Can I get a hallelujah from all those with allergies? Zyrtec has made spring and summer enjoyable again. No, I'm not getting paid to say that.
3. Eugenol, or oil of cloves. I had a dry socket (otherwise known as the most painful condition humankind is heir to, outside of childbirth and kidney stones) once, and within seconds of having it packed with eugenol-soaked gauze, the pain was gone. I wanted to kiss the dentist on his big bald head.
4. Ativan. The ultimate anxiolytic, though its usefulness is limited by the fact that it generally leaves me too gorked to perform daily functions. It seems to work as most benzodiazepines do--ie, on the assumption that you can't have a panic attack if you're unconscious.
Friday, August 21, 2009
Fun stuff: Wegener's granulomatosis.
When someone has had what seems like allergic rhinitis for fifty thousand years, despite pouring on the Flonase and all but mainlining cetirizine, one begins (if one is as obsessed with rare diseases as I am) to think about Wegener's granulomatosis. It's an inflammatory condition--not a cancer, not an allergy--that eventually leads to extensive vasculitis (ie, inflammation of the blood vessels). It can cause problems especially in highly vascular organs--kidneys and lungs particularly. On microscopic examination, clumps of white blood cells are visible: granulomas. Hence the name.
However, there's now pressure to rename the disorder, in part because eponyms don't actually tell you very much about the condition itself (though I have to say the alternative proposed in this case--ANCA-related granulomatous vasculitis--doesn't tell me much more) and also because of Dr. Wegener's past. Apparently he was wanted by Polish officials after the end of WWII. Apparently he was, for at least a short period of time, associated with the operation of the eugenically-minded killfest that was Lodz in the late 30s.
How do I know this? Because the aforementionedly awesome Dr. W. brought it up in class.
"Haven't you heard Dr. L's tirade about this?" she asked one of the co-instructors. "I remember hearing him go on and on about this Nazi granulomatosis." Which made me imagine clumps of white blood cells wearing little olive drab uniforms and goose-stepping all over the body.
When someone has had what seems like allergic rhinitis for fifty thousand years, despite pouring on the Flonase and all but mainlining cetirizine, one begins (if one is as obsessed with rare diseases as I am) to think about Wegener's granulomatosis. It's an inflammatory condition--not a cancer, not an allergy--that eventually leads to extensive vasculitis (ie, inflammation of the blood vessels). It can cause problems especially in highly vascular organs--kidneys and lungs particularly. On microscopic examination, clumps of white blood cells are visible: granulomas. Hence the name.
However, there's now pressure to rename the disorder, in part because eponyms don't actually tell you very much about the condition itself (though I have to say the alternative proposed in this case--ANCA-related granulomatous vasculitis--doesn't tell me much more) and also because of Dr. Wegener's past. Apparently he was wanted by Polish officials after the end of WWII. Apparently he was, for at least a short period of time, associated with the operation of the eugenically-minded killfest that was Lodz in the late 30s.
How do I know this? Because the aforementionedly awesome Dr. W. brought it up in class.
"Haven't you heard Dr. L's tirade about this?" she asked one of the co-instructors. "I remember hearing him go on and on about this Nazi granulomatosis." Which made me imagine clumps of white blood cells wearing little olive drab uniforms and goose-stepping all over the body.
Wednesday, August 19, 2009
Excessive Awesomeness
I thought our first day back in the saddle with 'Practice of Medicine' would be the same old routine. Nope. The coursemaster (actually, coursemistress...is it more or less PC to call her that?) contributed greatly to the overall awesomeness. So sharp she might cut somebody--and she also appears to have an exquisitely low bullshit tolerance, so she might cut somebody for being inane, too. Which, I will be frank, I like. There was a brief discussion of how to comport ourselves out on the floors, including the admonition to take out the facial piercings and cover the tattoos. Also--and you'd think this wouldn't be an issue at our institution, but alas, it apparently comes up--to be well-groomed and hygienic. To quote Dr. W (all my Ithaca pals are laughing because that's the name of the Wegmans store-brand diet Dr. Pepper I drank by the liter all through college):
"Every year a resident gets the dubious honor of talking to one of the house officers about grooming issues. My favorite ever was, 'J, please wear underwear.' You do not want to be that person."
Mother of God. I can't even imagine the situation in which that talk became necessary. I can see "please don't wear any more leather miniskirts," I can see "please wear an appropriately-sized belt to prevent us seeing your 'Sizzling Scarlet' lace g-string," I can even see "If you're going to wear short skirts, cross your legs when you sit down." But...no underwear? In a hospital? Definitely not hygienic.
"Every year a resident gets the dubious honor of talking to one of the house officers about grooming issues. My favorite ever was, 'J, please wear underwear.' You do not want to be that person."
Mother of God. I can't even imagine the situation in which that talk became necessary. I can see "please don't wear any more leather miniskirts," I can see "please wear an appropriately-sized belt to prevent us seeing your 'Sizzling Scarlet' lace g-string," I can even see "If you're going to wear short skirts, cross your legs when you sit down." But...no underwear? In a hospital? Definitely not hygienic.
Sunday, August 16, 2009
and so it begins.
As it turned out, today's orientation chat was in fact a mere 30 minutes in duration, due in part to the absence of one of the deans (who was settling her daughter in at college...which, actually, is pretty sweet and indicative of good priorities). Additionally, it was very un-fire and brimstone: the admonition that yes, there are grades this year, was followed by an assurance that it is indeed possible for everyone to receive an 'Honors' grade in every class, as there's no curve. The acknowledgment that Boards will be upon us in less than a year's time was alloyed with the assurance that if we take them in June we'll have more than ample time to study, and a gentle chiding that it really is in our best interest to take them then (although our school, strangely, does not require us to take the USMLE; you'd think they'd want everyone to go get liscensed, but whatever) because you're REALLY not going to remember that stuff about the pentose phosphate pathway three years out from biochem. We have to register, or more accurately register TO register, in September. Getting your test date set is apparently a multipartite and esoteric ordeal, which may or may not involve setting up a bank account in the Canary Islands and/or painting the last four digits of your SSN in blood on the carpet of the registrar's office at midnight (bonus: Since this IS a medical school, the blood doesn't have to be your own, as long as you use universal precautions while handling it. As a vegetarian I'm allowed to use beet juice).
The laid-backness of the talk (which did not meet my expectations--but in a good way) was primarily due to the fact that it was Dean K giving it. All our deans are pretty chill, and indeed in all cases nice people that I wouldn't mind having drinks with, but I'll just come out and admit that I think Dean K is the bee's knees. When I've had occasion to deal with her, she's been fantastic. She's unbelievably helpful and grounded; one of those rare people that exudes NICE while also giving the impression that she is exhaustively competent and would not hesistate, if it became necessary, to kick serious ass (which here comes in the guise of the 'professionalism concern form'): in fact, not a bad role model.
The real deal starts tomorrow. Pharmacodynamics. Frankly, I'm a little scared by the sheer quantity of material it looks like we'll be covering in lecture tomorrow. We're in the army now!
Parenthetical remark count: 5
The laid-backness of the talk (which did not meet my expectations--but in a good way) was primarily due to the fact that it was Dean K giving it. All our deans are pretty chill, and indeed in all cases nice people that I wouldn't mind having drinks with, but I'll just come out and admit that I think Dean K is the bee's knees. When I've had occasion to deal with her, she's been fantastic. She's unbelievably helpful and grounded; one of those rare people that exudes NICE while also giving the impression that she is exhaustively competent and would not hesistate, if it became necessary, to kick serious ass (which here comes in the guise of the 'professionalism concern form'): in fact, not a bad role model.
The real deal starts tomorrow. Pharmacodynamics. Frankly, I'm a little scared by the sheer quantity of material it looks like we'll be covering in lecture tomorrow. We're in the army now!
Parenthetical remark count: 5
Saturday, August 15, 2009
Things'll be different, baby. Promise.
So the new school year starts on Monday, and tomorrow we have our one and a half-hour 'second year orientation,' which the class ahead of us has said is basically 90 minutes of having the fear of God put into us...ie, this year we have real grades, this year even more is expected of us, no more messing around, no more procrastinating and trying to cram everything in two days before the exams, etc. A sort of preemptive strike against laziness; a preventive spanking.
Problem is: this is what I have going through my head 24/7, in stereo and at a volume setting of 11 (out of 10). Do I really need to have the shit scared out of me to do a good job? Especially when I'm already, so to speak, flowing in that direction? Now we have Honors, High Pass, Pass and...*Not a Pass* as grading options, rather than the previous Pass/Fail. Of course, I'm going to shoot for all Honors, but do I need to go to Gunner Attitude Boot Camp tomorrow to get ready for the coming year? Maybe I'll have a little Xanax before I go... Am I high strung? Pas de tout.
And this year it'll be different. Not so much with the studying (I studied a fair amount last year, and didn't generally put things off...just tried to stay on track, rather than trying to learn a semester's worth of material in three days like some people I know...who shall of course remain nameless), but with life. A balance. Social activities, studying, exercising, and perhaps most pertinent for those reading this: blogging. I'm going to update this site, if not daily, then at least 4x a week. Hopefully there will be hilarious hijinks to recount, poignant moments to share, and my strange mix of hippy-dippy idealism and cynical misanthropy to vent. Join the fun!
This first 'block' of courses includes
Pathology, ie: 'When stuff goes wrong,' or 'Looking at the process of disease' or 'The Microscope's Revenge: The Return of Histology--this time it's nasty.'
Pharmacology, or 'Yes, we can make even DRUGS monumentally un-fun. Who remembers what gets processed using Phytochrome 450? Or perhaps more trickily, what doesn't? Hands? Tell me the difference between adrenergics and cholinergics and be smart about it!'
and Otolaryngology, or "The only lecture you're really going to remember is the one about things kids have stuffed up their noses."
Problem is: this is what I have going through my head 24/7, in stereo and at a volume setting of 11 (out of 10). Do I really need to have the shit scared out of me to do a good job? Especially when I'm already, so to speak, flowing in that direction? Now we have Honors, High Pass, Pass and...*Not a Pass* as grading options, rather than the previous Pass/Fail. Of course, I'm going to shoot for all Honors, but do I need to go to Gunner Attitude Boot Camp tomorrow to get ready for the coming year? Maybe I'll have a little Xanax before I go... Am I high strung? Pas de tout.
And this year it'll be different. Not so much with the studying (I studied a fair amount last year, and didn't generally put things off...just tried to stay on track, rather than trying to learn a semester's worth of material in three days like some people I know...who shall of course remain nameless), but with life. A balance. Social activities, studying, exercising, and perhaps most pertinent for those reading this: blogging. I'm going to update this site, if not daily, then at least 4x a week. Hopefully there will be hilarious hijinks to recount, poignant moments to share, and my strange mix of hippy-dippy idealism and cynical misanthropy to vent. Join the fun!
This first 'block' of courses includes
Pathology, ie: 'When stuff goes wrong,' or 'Looking at the process of disease' or 'The Microscope's Revenge: The Return of Histology--this time it's nasty.'
Pharmacology, or 'Yes, we can make even DRUGS monumentally un-fun. Who remembers what gets processed using Phytochrome 450? Or perhaps more trickily, what doesn't? Hands? Tell me the difference between adrenergics and cholinergics and be smart about it!'
and Otolaryngology, or "The only lecture you're really going to remember is the one about things kids have stuffed up their noses."
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