So after the heady delight of yesterday's clear liquid diet and colonoscopy prep (read the details here, if you're inclined--it included 1) a grand total of 17 trips to the bathroom, 2) the drinking of 2 liters of a substance whose foulness could probably be approximated by mixing together 2 liters unsweetened lemonade, a cup of salt, and a few tablespoons of rancid butter, 3) my internal organs producing rumblings and gurgles more commonly associated with active volcanoes and hot springs)--came the event itself. The things I remember, after the glorious sedative/miracle that is Versed:
1) The anesthesiologist was kind of a jerk. Not mean; just not real heavy on the people skills. Example: "Did you eat or drink anything today?" "Yes, some diet coke. A few ounces." "When?" "To take my Synthroid this morning..." (interruption) "I said when, not why." Maybe I'm hypersensitive, but slow your roll there, Dr. Feelgood. I flushed a little bit at this--because hey, I'm here in a 2-ply paper gown about to have someone spelunking in my colon; I'm worried about my own asshole, so I don't want to worry about what you've got wedged up yours right now. "You've got a sort of rash on your chest. Have you noticed that?" Poking my chest, checking to see if it blanches...poke, poke, poke. Hey, why not ask before you start prodding? Just a thought. And I'm flushed because I'm pissed off but I'm not good at verbalizing anger.
2) The nurses were awesome, as nurses usually are. Warm blankets, and this hose that essentially blew warm air through the blankets I had on to keep me toasty while I waited. Someday I'm going to make friends with a medical supply rep and get one of those for my house. Or, you know, an electric blanket. Probably cheaper.
There was one bit of an awkward moment--the nurse was explaining things to me in that reassuring way that nurses have, while I was looking at the pulse oximetry reading and trying to consciously lower my heart rate to sub-tachycardic levels (have I mentioned I'm kind of tightly wound? And that I've been obsessed with controlling my heart rate and blood pressure since I read an article on biofeedback in sixth grade?). "And you can just relax--we'll have machines to keep track of your heart and your breathing, and the doctor will give you some medicine to make you nice and sleepy...now what grade did you say you were in?" (I'd mentioned being a student.) "I'm a second year medical student."
3)Apparently the doctor came into the recovery room and explained everything, but damned if I remember anything. Thanks again, Versed!
Monday, November 30, 2009
Tuesday, November 17, 2009
Nazi doctors: read with caution
A lot of what I write is relatively...light in nature. I've been told I'm funny, at least (which is better than just being funny-looking--what I'd be left with otherwise). Recently, though, the question of just what the ethical standards of physicianship are has come up at WUSM. There was a presentation on the atrocities perpetrated by the Nazi 'doctors' (I put doctors in quotes because those who so demonstrate so clear and complete an absence of conscience, so utter a disregard for humanity and decency, no longer deserve the title), and--understandably--there has been some upset, mostly related to some not-so-sensitive questions that were asked afterwards. Namely, whether the Nazi doctors were subjected to peer pressure, and whether this in part explained their actions. I will add that I was not at this talk, and so am at best dealing with secondhand information about said upset...realistically more like third or fourth-hand, with the attendant reliability issues that entails. Nevertheless, this seemed like fertile ground for exploration, and something about which I must make my opinion known.
As most people (I hope?) know, the Nazis' crimes against humanity included 'medical experimentation' conducted chiefly by 'Drs.' Josef Mengele [Auschwitz, all manner of horrors], Carl Clauberg [Auschwitz, both forced sterilization and forced impregnation, ie rape], Sigmund Rascher [Dachau, especially high-altitude and hypothermia experiments], and--killing any naive belief one might have that women are always nurturing and incapable of such vile inhumanity--Herta Oberheuser [Ravensbrueck, creating 'battle wounds' and infecting them with gangrene and staph]. To call their undertakings 'research' is to defile both that word and the memories of those who were tortured. Mengele is perhaps the most infamous of these doctors; his experiments, particularly on twins, are the stuff of nightmares. He injected solvents into twins' eyes in attempts to alter their color, performed surgeries--like intestinal resections--without anesthesia, and allegedly attempted to 'create' conjoined twins by sewing a pair of Romani twins together. These are not the acts of a scientist, however depraved, and they are most certainly not the actions of a physician. They are what happens when an already sick individual is given such power that his perversion becomes florid, all-consuming, utter. They are what happens when a psychopath is not subject to the slightest judicial or societal restraint.
I've known about these things since middle school, when the Holocaust was first mentioned in our history classes and I found myself appalled that such things could have happened; not so much that Germans 'allowed' it to happen (there is something to be said for what someone does under duress, the ways in which a totalitarian state twists the mind and the soul--read Alice Miller for an in-depth exploration of this from a psychoanalytic perspective). Reading and hearing about them has an effect on everyone merely by virtue of their humanity: it is impossible not to be repulsed. As a medical student I find that my response, while essentially the same, is still more profound.
As a physician-in-training (not even yet a doctor) I took an oath on the day I got my white coat; more importantly, I made a promise to myself and to the world when I chose healing as a profession. I swore that above all, I would do no harm; that I would always put the needs of my patients foremost. I promised that I would act with humanity, compassion, and humility, and that I would work for the preservation of human life and dignity. There are circumstances in which this is not easy--when, indeed, it might even seem unfair. As a specialist in Jewish medical ethics said at a talk I once attended, if a terrorist and three of his victims come into your ER, and the terrorist is triaged at a higher level than the victims, he gets care first (ideally, of course, everyone's getting it at the same time). Or, to paraphrase a little-heard B-side of Alanis Morissette's, if a man's in the emergency room with a bleeding head because he was beating his kid and she hit him back...you still stitch up Dad's head. WITH adequate anesthetic (not, of course, that I would think of doing it any other way).
L'olam lo suv. Never again.
As most people (I hope?) know, the Nazis' crimes against humanity included 'medical experimentation' conducted chiefly by 'Drs.' Josef Mengele [Auschwitz, all manner of horrors], Carl Clauberg [Auschwitz, both forced sterilization and forced impregnation, ie rape], Sigmund Rascher [Dachau, especially high-altitude and hypothermia experiments], and--killing any naive belief one might have that women are always nurturing and incapable of such vile inhumanity--Herta Oberheuser [Ravensbrueck, creating 'battle wounds' and infecting them with gangrene and staph]. To call their undertakings 'research' is to defile both that word and the memories of those who were tortured. Mengele is perhaps the most infamous of these doctors; his experiments, particularly on twins, are the stuff of nightmares. He injected solvents into twins' eyes in attempts to alter their color, performed surgeries--like intestinal resections--without anesthesia, and allegedly attempted to 'create' conjoined twins by sewing a pair of Romani twins together. These are not the acts of a scientist, however depraved, and they are most certainly not the actions of a physician. They are what happens when an already sick individual is given such power that his perversion becomes florid, all-consuming, utter. They are what happens when a psychopath is not subject to the slightest judicial or societal restraint.
I've known about these things since middle school, when the Holocaust was first mentioned in our history classes and I found myself appalled that such things could have happened; not so much that Germans 'allowed' it to happen (there is something to be said for what someone does under duress, the ways in which a totalitarian state twists the mind and the soul--read Alice Miller for an in-depth exploration of this from a psychoanalytic perspective). Reading and hearing about them has an effect on everyone merely by virtue of their humanity: it is impossible not to be repulsed. As a medical student I find that my response, while essentially the same, is still more profound.
As a physician-in-training (not even yet a doctor) I took an oath on the day I got my white coat; more importantly, I made a promise to myself and to the world when I chose healing as a profession. I swore that above all, I would do no harm; that I would always put the needs of my patients foremost. I promised that I would act with humanity, compassion, and humility, and that I would work for the preservation of human life and dignity. There are circumstances in which this is not easy--when, indeed, it might even seem unfair. As a specialist in Jewish medical ethics said at a talk I once attended, if a terrorist and three of his victims come into your ER, and the terrorist is triaged at a higher level than the victims, he gets care first (ideally, of course, everyone's getting it at the same time). Or, to paraphrase a little-heard B-side of Alanis Morissette's, if a man's in the emergency room with a bleeding head because he was beating his kid and she hit him back...you still stitch up Dad's head. WITH adequate anesthetic (not, of course, that I would think of doing it any other way).
L'olam lo suv. Never again.
Wednesday, November 11, 2009
Day of Diarrhea
Laugh, if you must. After 6 hours of lecture and small groups devoted to the intricacies of the human bowels, I certainly did. Maybe I was a little slap-happy, getting back in the swing of things after an entire (gasp!) 48 hours sans studying--but by the last hour of lecture yesterday, I was seeing double-entendres everywhere.
"There are two etiologic categories for diarrhea. Number one isn't that important, but number two..." *Snicker*
"There is a wide range of frequencies for bowel movements." (Display of an actual GRAPH of the number of bowel movements per day--in case you were wondering, 'normal' runs from three times a day to three times a week, and the median is once a day.) "As you can see, the graph peaks at once a day, and sort of tapers at either end." *Hee hee*
"Diarrhea is frustrating to diagnose, but it usually comes out all right at the end." *Further laughter, and the recognition that I have the maturity of a fifth-grader.*
"There are two etiologic categories for diarrhea. Number one isn't that important, but number two..." *Snicker*
"There is a wide range of frequencies for bowel movements." (Display of an actual GRAPH of the number of bowel movements per day--in case you were wondering, 'normal' runs from three times a day to three times a week, and the median is once a day.) "As you can see, the graph peaks at once a day, and sort of tapers at either end." *Hee hee*
"Diarrhea is frustrating to diagnose, but it usually comes out all right at the end." *Further laughter, and the recognition that I have the maturity of a fifth-grader.*
Monday, November 2, 2009
Awards
Today we had the 'Distinguished Service Teaching Awards' at school. Which mostly translated into 'free reception snackies and diet Coke...and alcohol, but no alcohol for you, because you're trying to cram another hundred renal facts into your cranial vault in the next twelve hours, and champagne will not help you do that.' So, in the spirit of such awards, let's hear it for The Body Systems, Organs, Diseases, and General Medical Stuff Awards! Yay! (Sponsored by Valtrex).
Most alarming symptom that's usually fine: Rectal bleeding. Notice I'm NOT a doctor, but rectal bleeding, especially when accompanied by pain, is usually hemorrhoids--and you'll usually be fine in a couple days if you get your hands (well, not your hands exactly...) on some hydrocortisone suppositories. Yes, suddenly being confronted with unexpected blood--particularly from this region--is distressing (as I *almost* said to my physician when she asked 'how much' bleeding I was having, "I don't think there's an acceptable lower limit for ass blood"), but it's nowhere near as bad as, say, vomiting blood.
Most innocuous condition that makes me wish I were dead: It's a tie between menstrual cramps and migraines, both of which feel like I have tiny angry elves inside my body trying to hack their way out with pickaxes. Sometimes I get both at once (oh joy! It's fairly common, apparently, and has to do with all those shifting lady hormones), and all I can do is stay perfectly still in my dark, dark, bedroom with earplugs in and a heating pad on. Oh, and take Ultram. I don't think it's a narcotic...
Grossest-looking infection that is in no way dangerous: Onychomycosis, or for those playing the home game, fungal infections of the nail bed. The thing is, it's not limited to people with poor hygeine, either...sometimes you'll be at the pool and some cute little twentysomething will walk by and only when you look down do you notice that she has, not to put too fine a point on it, toenails like corn chips. Fritos.
Prettiest-sounding infection that's actually quite gross: Chlamydia.
Most recent disease to be stripped of eponym status: Wegener's Granulomatosis, now ANCA+ vasculitis or granulomatosis (because it turns out Dr. Wegener was a Nazi, which is actually really not cool).
Laziest 'organ'- The appendix. Yeah, that's right, I put organ in scare quotes.
Overachieving organ: The liver. It does everything. If you've been reading this blog for any length of time you know my love of the liver is vast.
Organ so large and in charge you don't even think of it as an organ: The brain. More than a traditional dish in the zombie-American community; it's what keeps everything running smoothly.
Most alarming symptom that's usually fine: Rectal bleeding. Notice I'm NOT a doctor, but rectal bleeding, especially when accompanied by pain, is usually hemorrhoids--and you'll usually be fine in a couple days if you get your hands (well, not your hands exactly...) on some hydrocortisone suppositories. Yes, suddenly being confronted with unexpected blood--particularly from this region--is distressing (as I *almost* said to my physician when she asked 'how much' bleeding I was having, "I don't think there's an acceptable lower limit for ass blood"), but it's nowhere near as bad as, say, vomiting blood.
Most innocuous condition that makes me wish I were dead: It's a tie between menstrual cramps and migraines, both of which feel like I have tiny angry elves inside my body trying to hack their way out with pickaxes. Sometimes I get both at once (oh joy! It's fairly common, apparently, and has to do with all those shifting lady hormones), and all I can do is stay perfectly still in my dark, dark, bedroom with earplugs in and a heating pad on. Oh, and take Ultram. I don't think it's a narcotic...
Grossest-looking infection that is in no way dangerous: Onychomycosis, or for those playing the home game, fungal infections of the nail bed. The thing is, it's not limited to people with poor hygeine, either...sometimes you'll be at the pool and some cute little twentysomething will walk by and only when you look down do you notice that she has, not to put too fine a point on it, toenails like corn chips. Fritos.
Prettiest-sounding infection that's actually quite gross: Chlamydia.
Most recent disease to be stripped of eponym status: Wegener's Granulomatosis, now ANCA+ vasculitis or granulomatosis (because it turns out Dr. Wegener was a Nazi, which is actually really not cool).
Laziest 'organ'- The appendix. Yeah, that's right, I put organ in scare quotes.
Overachieving organ: The liver. It does everything. If you've been reading this blog for any length of time you know my love of the liver is vast.
Organ so large and in charge you don't even think of it as an organ: The brain. More than a traditional dish in the zombie-American community; it's what keeps everything running smoothly.
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