Your Children Will Thank You

for giving them names that are at least passably familiar, or that are spelled in accordance with the rules of English phonetics. This isn't a cheap shot at foreign names--rock on, little Ashwin from India and Toan from Vietnam--but as I have learned after 2 weeks in a certain pediatric emergency room, there are a lot of parents giving their children...creative names. This isn't a race or class thing either, so don't think I'm going after the LaKieshas and Dantaes (fact: the majority of the kids at my high school were African American, and in part because of that I know not one, not two, but three women named LaKiesha. Aaaaand so we see how novelty becomes the new conformity). So here are some tips/warnings/desperate pleas to assist you in naming your bundle of joy, so that when I walk into the room to see your child I don't have to a)mispronounce their name horrifically or b) say, "And who is this?" to slyly get you to pronounce your kid's name.

1. Spelling a name backwards is something fun to do in your 'special, secret diary'--you know, the one with the cheap lock you could break with 30 seconds and a hairpin--when you're twelve. But you're not twelve, and you're not writing about the bitchy girls at school who made fun of your troll earrings; you're naming a child. When I saw 'Samej'' on the screen in the ER it took me a second to realize the level of atrocity that had been committed. A few days later I saw not one but two Nevaehs (yes, it's 'Heaven' backwards; it's also juvenile forwards).

2. If there are more silent letters than there are letters that are pronounced...it's time to take a look at what you're doing. And though I realize that you're a good-hearted yuppie who wholeheartedly supports social welfare spending,this is not a depression-era public works project where the goal is to get as many letters involved as possible. This is a name. Kimberleigh, Carleaux, and Peaulleigh thank you in advance for sticking with Kimberly, Carlo and Polly.

3. Picking a random noun for a name is not acceptable. I know celebrities are doing it, but celebrities are also doing high colonics and that doesn't make those OK. Apple, Blanket, Sky...this is supposed to be a nursery, not a picnic. Even more egregious faux pas--naming a child after a consumer good, especially one that is...comment se dit? A trifle tacky. Pity poor Chablis and Chardonnay; pity Lexus and Alize even more.

4. Finally, the ones that have fifty potential pronunciations, and bear little relationship to any name you have previously encountered: Sajquanna, Jayreon, Mekhi, Keajah, Jniqua. This is obviously my problem, not theirs, but...I. don't. understand.

All of these are names I have seen in the past 2 weeks. I can only imagine what I might have gathered with more time on my hands.

If you're unsure about the name, try this test. Imagine the name substituted into the following three phrases:
"And now I present to you our CEO, (name) Smith."
"In other news, twenty-two year old (name) Smith was arrested this morning during a police raid on his/her meth lab."
"And now, on the center pole here at Jackson's Gentleman's club, (name)!"

If it works in the first, you're golden. If it sounds better in one of the other two, you might want to give it a little more thought.

And today...we learned the pelvic exam.

First, there was the pelvic exam, which was largely demonstrated via a video (with the sound turned off) which an Ob/Gyn attending walked us through. It was odd sitting in a room with all these other people looking at a projected vagina larger than the lecturer's head.
Things learned, and fun quotes:
"So a few weeks ago my eighteen year old son, who is very dear and who's just begun dating, came to me and wanted to know about women's menstrual cycles...specifically how regular they are and what the implications are. And so, after I had a coronary and grabbed him and shook him until his fillings came loose..."

The 'inspection' portion of the exam, during which you inspect and palpate the external genitalia, went on FOREVER in the video. Quoth both Dr. W and Dr. S, "Don't ever stare at a woman's vulva for this long. I have no idea what's going on with this video...also, when doing the pelvic or breast exam, DO NOT make any comments on the patient's appearance. Not even compliments. ESPECIALLY not compliments. Especially if you don't want to get sued."

Put lube on your fingers, lube on the speculum...lube it all up. It won't interfere with Pap smear results, and it will make everyone more comfortable.

"Don't open the speculum until it's all the way in. Because if you get it halfway in, tentatively, and then open it up...(Every woman in the room winces and gasps). Yep, that's right. Every woman in here knows it. And guys, just imagine having something rammed up your urethra."

Be careful if you insert your finger before you insert the speculum...don't try to have too much stuff in there at once. Quoth Dr S, "There is a finite amount of space in most women's vaginas."
This is true--it's not like Santa's sack in there. It's not a clown car.

I was astounded the male GU and genital exams were actually demonstrated to us live. More on that after the jump.

Just a note

I would just like to say a few things.
To the prof who put a picture of a puking pumpkin in the power point presentation on eating disorders: Real sensitive. You're on the list.

To my body in general: stop producing prostaglandins. To my uterus specifically: stop trying to claw your way out of my abdomen. It really, really hurts and makes it difficult for me to study.

To Amina, who taught me that the best treatment, if not cure, for dysmenorrhea is a combo of red wine, David Sedaris essays and Sade (Sha-DAY, the singer of 'Smooth Operator,' which I thought of every time someone mentioned the obturator nerve last year in anatomy...actually, I think of lots of inappropriate songs at inappropriate moments...for instance:
-Talking to one of my high school friends about how she finally stopped self-mutilating: 'The First Cut is the Deepest,' by Sheryl Crow
-When one of my acquaintances (who I didn't particularly like) got evicted in college: 'There's No Home for You Here' by the White Stripes
-Watching Ann Coulter on FoxNews: 'Evil and a Heathen' by...shit, what was that band that came to play at Cornell my junior year?
-Listening to an attractive member of the faculty discuss drug abuse and dependence: 'Addicted to Love'
-At the 'Get to Know your Administrators' lunch: 'Dean's Dream' by the Dead Milkmen
-Sitting in the lecture on treating sexual dysfunction: 'Limp' by Fiona Apple)

Damn that was a long parenthetical.

Oh, and to Fiona Apple, since I'm thinking of it: Thank you for your body of work. Please put out another album.

Psychiatric DDx

During our psych small group discussion today, everyone kept forgetting that mental disorder due to substance abuse is part of EVERY differential diagnosis in psych.

I am hoping the following two words will burn into people's brains that drugs alone can make you completely, utterly, mother-freaking insane:

Amy. Winehouse.

You're welcome.

Great Quotes from Lectures Today...and a TV Show

"I am not giving up. I never give up...I'm...transcending the situation." -Sheldon, from 'Big Bang Theory' (How I've felt about the past...approximately...week.)

"We finished that lecture a little early, so should we take an extra long break before the next one? There might be other people coming...What? Ok then, screw 'em." -Dr Z

"No, you don't want to give lorazepam to someone who's already intoxicated. They have a tendency to stop breathing." -another lecturer

"The appearance of oligodendrocytes on section is mostly due to artifact...but we're just neuropathologists, so a reproducible artifact is good enough for us." -yet another lecturer

Psych is not crap.

Why is it that people...even other physicians...treat psychiatry like the Special Olympics of the medical specialties? "Oh, I have a cousin who's a psychologist!" (Psychiatrists are physicians. Psychologists--even those with PhDs--are not. Doctors, sometimes, but not physicians. Psychiatrists can prescribe drugs. Psychiatrists are required to complete medical school, residency, and generally fellowship. Psychologists go to graduate school, and are fantastic, gifted, and frequently delightful people, but they aren't doctors).
In the words of one of my instructors, when they heard I was interested in psych, "Oh, you guys have come a long way from the days of id, ego, superego...you're getting really...scientific now." He's an ID (infectious disease) guy, and I wanted to reply, "Yeah, and you guys don't believe in miasmas and evil humors anymore. Good job." So instead I said, "Yeah, I did research this summer using co-registered structural MRIs to perform volumetric analysis of paralimbic brain regions associated with early-onset major depressive disorder. It was pretty...scientific."
And we're doing psych now, and a lot of my classmates are talkin' smack. Not all of them, but a lot, and a number of folks have been pretty effing insensitive. So, for the record, I've had some psych issues myself--early onset, partially genetic, partially environmentally induced. Anxiety and severe depression. Life-shattering, oh-crap-it's-hospital-time depression. An eating disorder thrown in. And I'm not particularly ashamed of it. Know why? Because if more people were willing to admit these things, it might be normalized, and people would calm the hell down with the guilt trips--"Oh, I NEVER let myself get depressed. I just don't have time."
"Maybe if you stopped thinking of yourself and started thinking of other people you'd feel better."
"It's all in your head."
"Snap out of it."
"Pray harder and Jesus will heal you."
"Just eat something."

My views on psych meds are...complicated, and more suited for an extended essay than for this venue. But hey, just for fun, let's talk about how difficult it is to get yourself euthymic (ie, OK) on meds. It's hard. I've been sampling various medications since I was eleven, trying to 'get right,' and in that time, guess what I've taken? Oh, you don't have to ask, I'll tell you. *This is why I haven't had to go to many of the psychopharmacology lectures.*

Sertraline, venlafaxine, fluvoxamine, trazodone, lorazepam, alprazolam, clonazepam, valproic acid, gabapentin, mirtazapine, quetiapine, lamotrigine, lithium, topiramate, zolpidem, aripiprazole.
How many? 16, ladies and gentlemen. The majority of diabetics have an easier time managing their condition than I've had keeping this under control. And I don't even get any MedicAlert bling for my trouble.

Do It Now.

I think I've made my views on this clear in the past, but you need to go get emergency contraception. Right now. Plan B is now available as a single pill. In the past, it was necessary to take two pills, twelve hours apart. This is a great step forward (anyone who thinks having to wait 12 hours to take a second pill is no big deal has never been, or had to deal with, someone who actually needed to use EC...the condom broke, or there was an assault, or there was a night of drunken irresponsibility, or whatever; waiting 12 hours to take the second pill and 'be done with it' can seem like torture).

It's available over the counter if you're over 17; with a prescription if you're younger. Buy some for yourself, and encourage your friends to do the same. If you have a teenaged daughter, take her to the doctor for a prescription and get it filled (assuming, of course, that if she's sexually active you've already been a responsible parent and taken her to an OB/Gyn to get on the Pill, had a long talk with her about the importance of taking charge of her own sexuality, only being sexual with someone when she's ready, not when some sixteen-year-old Lancelot starts panting about 'If you really loved me...' and, for the love of all that is holy, USING PROTECTION).

Oh, and obligatory myth-busting--EC doesn't cause an 'abortion.' In fact, it won't work if you're already pregnant. So, on this particular point, right-to-lifers--chill. Also, EC is safe--safer than aspirin (though the more I learn about NSAIDs in med school, the more terrified I am by the prospect of using ibuprofen, or aspirin, or any of those ilk anyway).

When/if the need arises, you'll be glad you have it in your medicine cabinet.

Exploding Stomachs

...or, as a professional would say, 'gastric rupture.'
I was cleaning out our fridge and idly picked up the box of baking soda that's been in there for, oh, six months, and which is no longer absorbing odors (and which I rather suspect of harboring rogue odors of its own--the Yemen of my refrigerator). And as I looked at the box, you know how you do, I saw a paragraph on the back describing how one might use it as an antacid. Why, in the era of proton pump inhibitors, one would do this...well, it's cheap, I guess. But it also contains a buttload of sodium (yes, that's the SI unit of measure), and there was a severely worded, bold warning on the side of the box: TO AVOID SERIOUS INJURY, DO NOT TAKE UNTIL POWDER IS COMPLETELY DISSOLVED. IT IS VERY IMPORTANT NOT TO TAKE THIS PRODUCT WHEN OVERLY FULL FROM FOOD OR DRINK.

Being of the science-y persuasion, and remembering the vinegar and baking soda demonstration from fourth grade, I conjectured: Baking soda + stomach acid = internal volcano? But could a slug of baking soda after a big meal (and really, isn't that when you have indigestion anyway?) truly cause your stomach to explode? After a few minutes Googling around, I found my answer:

NM Downs, PA Stonebridge, Department of Surgery, Royal Infirmary,
Edinburgh. "Gastric rupture due to excessive sodium bicarbonate ingestion"
Scott. Med. J. 34(5) 534-5 (1989)

Around the same time, apparently (the late 1980s were evidently as bad for stomachs as they were for fashion), a young man in Denmark had a large meal of sausages and soda pop, took some sodium bicarb to help settle his tummy, and caused HIS. STOMACH. TO. EXPLODE. So be careful out there, kids. Even the most innocuous things, used in a--comment se dit?--stupid manner, can kill you. Pay the extra money for Prevacid--or (and here's a concept) don't eat so many sausages that you are literally at risk of rupturing your internal organs. Cheers!