Melena Shoes: $24.99
The medical school education that has allowed me to find humor like this hidden in everyday life: $200,000.
Having 'melena' come up in a conversation that doesn't end in, "OK, go do a DRE and get a guaiac.": Priceless.

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!

Finals Week Poetry Breakdown

Reflecting on this block's learning experiences, with a poetic form suited for each.

Pathology (the haiku, a form of infinite subtlety, that nonetheless comes down to just a handful of words--much like a path report).

Bridging necrosis
and Mallory's hyaline:
cirrhosis, but why?

Kill the eponyms?
But won't we hurt Cushing
and Virchow's feelings?

If I never see
One more liver biopsy
It won't make me sad.

Bullous pemphigoid
or mycosis fungoides?
Which one looks grosser?


Dermatology (couplets--short and sweet, and simple to write, just like prescriptions for Retin-A and steroid cream).

Your autoantibodies to desmoglein three
mean pemphigus vulgaris. Better you than me.

I'm sorry to inform you, your mole's cellular division
has crossed the line, and now it's time for a complete excision.

The necklace hubby bought you has given you a rash;
it's called contact dermatitis; next time, tell him, blow more cash.

(Especially for Dr. A. C. L. of dermatopath):
If the lesion is pigmented but the biopsy's a shave
expect at best an angry phone call and at worst an early grave.


Endocrine (Limericks--because everyone knows endocrinology is funny. Right? Um.)

A woman who hailed from Tacoma
had a sizable prolactinoma.
She started lactating,
but more devastating,
Her leg hair required a comb-a.

The doctor she saw told her, "Well,
I can see something wrong in your sell'
turcica--if you're keen,
Try this cabergoline,"
And she did, and it all turned out swell.

GI still to come...

African albinos

Part of a physician's duty, one could argue, is to help protect the vulnerable--whether that means reporting child or elder abuse, ensuring informed consent, or preventing the possible leak of someone's HIV/AIDS status. Currently, health care workers (among other social service personnel) are busy in Tanzania, trying to provide safety and care for albino individuals. See here and here.

There are two main threats to albinos in East Africa: one is skin cancer (what happens when you take a phenotype already prone to cutaneous malignancy and add tropical doses of UV light); the other is 'poaching,' a term usually reserved for animals, but which seems to capture the brutality of the attacks on these people. Local...um...I don't think there's really a PC word for witch-doctor...local animist and Voudoun practitioners claim albino body parts are powerful charms for luck and riches; others use albino blood in their spells. The world is a wide and strange place. But lest we assume that these people are (to quote a commenter on one of the sites) "superstitious, bestial savages," let's remember that--killing aside--a lot of people in the US still wouldn't want to shake hands with an HIV positive person, or someone with psoriasis. Suprisingly, albinism is exponentially more common in Tanzania than in the US.

What got me started on this train of thought? Why, studying vitiligo for my dermatology exam, of course.

Basically, Everyone's Crazy

It's like that song from Avenue Q, "Everyone's a Little Bit Racist."
Today we talked about 'functional somatic syndromes' in our doctorin' class. These are syndromes, ahem, "defined more by suffering and symptomology than by any consistently demonstrable pathophysiology." Which sounds a lot like saying "it's all in your head." Which, to me at least, sounds kind of paternalistic and dismissive--medicine as an entity and doctors in particular putting the burden of 'un-understandability' on the patient rather than admitting that Western medicine doesn't totally have its shit together with the whole mind-body connection. A little like hubris, I feel. In one of the articles we read for today, the authors listed 'side effects from silicone breast implants, irritable bowel syndrome, repetitive stress injury and vaginismus' as among these functional somatic syndromes. The paper was written ten years ago. In 2009, we have official diagnostic criteria for IBS and fibro; everyone and their sister knows that carpal tunnel DOES, in fact, exist; and I'm gonna go out on a limb here, but I doubt that even in 1999 a reasonably intelligent person would say, "Have 500 ccs of potentially allergenic, if not carcinogenic, material pumped into each of my breasts? Don't mind if I do!" As for vaginismus being an issue of mind over body--yeah, possibly, but that doesn't mean the suffering isn't real, and telling women to just relax about it doesn't address the problem. I guess what I'm saying is, we don't know everything there is to know about the world, and it's kind of pompous to say that if we don't, it's the world's fault. After all, just 50 years ago doctors were still telling women that dysmenorrhea was all in their collective heads (and had, apparently, been a form of mass female hysteria since time immemorial).

Our group leader described his thought processes well--when prescribing a tricyclic antidepressant for a woman with irritable bowel, it's common to be met with the dismayed cry, "Doctor, you think I'm crazy! I'm not crazy!" At which point he then points out, "Your gut is very special--it's the only organ system that has a complex 'brain' of its own...(explain about the enteric nervous system, neurotransmitters, la ti da ti da) and I think that these drugs, even though they were originally prescribed for depression, might have some usefulness here." Meanwhile, he says, 'I'm thinking, yeah, I do think you're a little bit crazy, but so's everyone.' So that's a nice message to keep in mind next time someone's acting like a whack job and being really frustrating--everyone has their own particular flavor of crazy. It's like the world is a huge Baskin-Robins, but with neurosis instead of ice cream.

Healthcare professionals make the worst patients

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!

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.

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.*

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.

Quotes from Urology Lectures

First, I wonder what urologists tell people they do at parties. It seems like one of those areas of employment where, despite the fact that it took over twenty years of schooling to attain, you might be tempted to...well, not embellish the truth. Not embroider it, certainly...but, perhaps, omit. "I'm a doctor," you'd say, or a surgeon. I'm in men's health, maybe. Because otherwise there will be jokes, almost certainly of questionable quality, and the teller will probably think he's the first one ever to think of something so hilarious, and you'll get thrown out of the party when you finally succumb to temptation and punch him in his damn mouth. That said, some quotes from our urology lectures.

"It's very important to find out what kind of sexual dysfunction a man's experiencing before you just send him home with Viagra. Because if the problem is anorgasmia, and he's been taking 30 minutes to get things done, and you give him a vasodilator-- well, not only will you not solve his problem, but when he's now going 60 or 70 minutes, his wife is going to come looking for you. Probably with a gun."

"The commonest problem in young men is actually not ED--it's...(pause for answers, all of which--interestingly enough--were provided by the women of the class) premature ejaculation, that's right. And you're going to have to ask about it, because I can guarantee you, no one ever comes into the office and says, 'Can you help me, doc? I'm a premature ejaculator.'"

"Men will tell you that they use recreational drugs to treat their ED. Listen, guys: Pot and coke don't make it easier to maintain an erection or anything like that. You just don't remember the erections you aren't having."

Things I learned this week, and some quotes

1. "In a differential diagnosis, include the 'mosts.' The most common, the most dangerous, and the most interesting. Though in the case of acute chest pain, skip the most interesting. Because if someone has ST elevation on their EKG and you're talking to the resident about parasitic pericarditis, they're going to hit you with the clipboard. And so they should."

2. "Speaking as an internist, every last one of you in this room has a pulmonary embolism until proven otherwise. That is something you never ever want to miss."

3. Apparently there is an outlet for my hypochondria and tendency to catastrophize: unleash it on my patients! "Put in the differential the absolute worst things it could be...the really bad shit. Because you'd feel really bad if the patient died and you had to say, 'Oh, a pneumothorax...I never thought of that!'"

4. 'If a little is good, a lot is better' does not apply to high-fiber cereal bars, no matter how tasty they may be. Remember that SNL spoof about 'Colon Blow' cereal? Back when SNL was funny? Yeah.

5. Physicians, especially ER docs, really seem to relish catching malingerers. Their eyes always light up when they talk about it, and they start grinning like feral chipmunks. For instance, someone complaining of chest pain angling for MI-type attention who says it hurts when you press *right there* is probably faking it. That's musculoskeletal. "I always tell them, oh, good, I think you're out of the woods. Peace."

6. Having whacked out hormone levels (though not, as of yet, any confirmed $%&# diagnosis) has made me a little...hairier than usual. Supposedly acne is also part of the sideshow. "At least I don't have that," I consoled myself. Wrong. Long workouts + androgens + ubiquitous bacteria = not just acne but, cruelly, ass-ne. *Is there no end to the ignominy?!?!*

7. My first hospital session (with an actual patient) is next week. I'm a little (ok, a lot) nervous. Hopefully I will not blind the patient with the ophthalmoscope or forget part of the physical or lose my train of thought during the history and just sit there staring blankly. No. All will be well.

Does she or doesn't she?

Only her reproductive endocrinologist knows for sure.

The 'so, do I have PCOS?' circus continues. Altered hormone levels, especially high androgens (male hormones)? Check. Irregular periods? Check. Increased (ahem) body hair? Yeah, fine, check. Obesity? Well...no, but the comorbid eating disorder could have something to do with that. So what's the most distressing? Honestly, the hair (this from someone who hasn't shaved since middle school). I feel like I'm either going through puberty again or turning into a wolf. Or possibly both. Wasn't there a book during the eighties called 'I was a teenage werewolf?' I think there was.

Americans have really...effed up responses to female body hair. When I wear shorts, I catch people staring. A lot. I wish, if they were really that curious, that they'd have the testicular fortitude (ie balls) to come up to me and say, "Hey, I think your particular style of bodily presentation is really different and kind of cool. Would you tell me a little bit about why you do things this way?" Then I might not want to disembowel them with a spoon for tee-heeing with their friends behind my back at the Metro stop. Y'know, the way I do now.

In a 1998 study, 125 undergrads of both sexes were shown 2 videos of a woman drying off after a swim. In one she was clean shaven, and in the other she had hairy armpits and legs. The unshaven woman was rated as less: moral (?!?), relaxed and fun; she was rated as more assertive, aggressive, serious and 'in better physical condition.' This was the same woman, mind you. The only difference was the presence vs. absence of hair.

A few days ago, on what I generally consider to be a feminist blog, one of the commenters (in discussing her feelings about fat acceptance vs. fatphobia) brought up the subject of choosing with whom one associates, and said, "For instance, I think women have the right not to shave if they don't want to, but I still think it's abnormal and weird and I probably wouldn't want to spend a lot of time with them." REALLY? AYFKM? (Think it out...Are You F*cking Kidding Me?) Just having looked at me, without so much as a hello, you know you don't want to chill with me based on the state of my hair follicles? Not to mention that it's NORMAL for women to have body hair--IT GROWS THERE AND WILL BE THERE UNLESS YOU ACTIVELY REMOVE IT--and so the whole "It's abnormal/weird" argument is proof positive that you've bought into the consumerist/patriarchal/western beauty complex.

The excess hair associated with PCOS is called 'hirsutism,' and it really isn't so much an excess of hair (though it can be) as it is a male-pattern hair growth--ie, on the chest, the lower stomach, the shoulders, upper lip and chin, lower back. Most people bleach it/electrolyze it/shave it. Some people, like Circus Amok performance artist Jennifer Miller (google it...you'll like it) don't. It's all part of the pulchritudinous plethora of personalities we call life. So for now, I'm going to discreetly pluck a few places...and leave the rest.

Fun quotes from the past week

Pulmonary lecturer: "If there's blood in the pleural space, obviously the lung can't expand there. Two bodies cannot occupy the same space at the same time...though, of course, it's fun to try."

Renal lecturer: "So if this woman has 6 liters of extra fluid on board but she doesn't have pitting edema, where did she put it?"
Student: "I don't know, in her hump?" (full disclosure, it was me.)
Professor: "What?"
Other student: "She's a camel!"

Other renal lecturer: "And if you had to guess which diuretic Peter Griffin from Family Guy is on, you would guess spironolactone. Because of the gynecomastia." (For those playing the home game, gynecomastia is when men develop hypertrophic breast tissue; in layman's terms, man-boobs).