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.
Friday, October 30, 2009
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."
"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."
Thursday, October 8, 2009
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.
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.
Sunday, October 4, 2009
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.
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.
Subscribe to:
Posts (Atom)
