doc w/ pen

a journalist becomes a doctor before your eyes

Month: March, 2012

Adventures in eDating

For a long time, I’ve been skeptical of online dating. Even though one of my cousins met her husband that way, it just seemed weird to me. If I am a relatively attractive, relatively sane, relatively intelligent person, shouldn’t I be able to meet someone like-minded the old-fashioned way? In person, that is? Well, that doesn’t seem to be working. Especially since I’m at school most of the time, surrounded by undergraduate students who could practically be my children. (Not quite, but you get the idea.) So I’ve decided to give the online dating thing a go. It’s been … well … interesting. Let me explain.

I’ve had two dates so far, both of which were with guys who seemed pretty normal during our messaging and phone conversations. But during the first date, it seemed as though we spent half the time talking about this guy’s two greyhound dogs, and the other half talking about Renaissance literature. Especially Shakespeare. Now, don’t get me wrong. I like Shakespeare, probably more than the average person. Having been a high school literature textbook editor, I even worked on the lesson for Macbeth back when I was at McGraw-Hill. So I’m also probably more knowledgeable about Shakespeare than the average person. But that’s not what I want to talk about — for the majority of the time — on a first date! So that was a “no.”

While that first date was simply dull, the second was simply disastrous. Again, it appeared that this guy and I had quite a few things in common, and our online messages and texts had gone well. So we agreed to meet at a hip taco place for lunch last weekend. He arrived a few mintues before I did (I had trouble finding parking), so he texted me that he’d found us a table. When I got to the restaurant, I looked around for a single guy sitting at a table. I didn’t see any. So I texted him back, asking where he was sitting. Then I saw a guy stand up, and I recognized him from his photos. And I looked at where he is sitting. Seated next to him were a little boy and another guy! (His son and his best friend.) I froze for a second. I don’t know if my mouth literally dropped, but it just might well have. Now, answer me this: Who brings their elementary-school-age son, and their best guy friend, on a FIRST date? Bad form, and seriously bad parenting. Bringing your kid on a date like that is putting him through Internet dating, too, which can be traumatic. I’m not a parent, but if I were, I wouldn’t introduce my child to someone until I had established a stable relationship with him. And another bad sign: this guy was missing one of his canine teeth. I don’t consider myself a superficial person, but c’mon! Modern dentistry has come a loooong way in the last 100 years, so get it fixed, man! That’s simply not attractive, and does not exactly make a good first impression. So again, a “no.”

But I’m not losing hope. There are many fish in the Chicago sea (er, lake?), so anything could happen …

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Shadowing: Open Heart Surgery

Yesterday, I shadowed an anesthesiologist friend of mine. I had shadowed him before, and seen some amazing procedures, both in terms of the anesthesiology and the surgery. But this time was the best by far. I got to see a fascinating cardiac case — open heart surgery. It was a complex case; a double valve replacement (mitral and aortic) and a valve repair to boot (tricuspid).

heart ultrasoundOne interesting thing was that before the surgery, they weren’t entirely sure whether they were going to be repairing the tricuspid valve. So the anesthesiologist did an echo by sliding a probe into the patient, near the patient’s heart, and rotating the probe to look at the different valves on a screen. He could also turn on a blood flow feature, which showed us different colors, each color illustrating a different blood velocity. This allowed us to see whether there was regurgitation, aka “regurg,” which there was, from all three valves in question. (The image of a heart echo here shows mitral regurgitation, or blood flowing in the wrong direction, similar to what this patient had.)

During the surgery, I was on the anesthesiologist’s side, behind the surgical curtain. But they got me a step stool so I could peer into the field. I did this during almost the whole surgery, with the exception of a quick lunch break. I watched the initial incision, the cracking of the rib cage (with a giant chisel!), the separating of the pericardium from the heart, cutting into the heart, the placement of the valves. It was amazing to see a live, beating, human heart just a foot or two away from my face. And then suddenly, it was no longer beating, as they had put the patient on bypass to do the more delicate parts of the surgery (the valve replacements and repair). They cooled the patient’s body to 25 degrees, and literally bypassed blood flow to and from the heart, oxygenating the blood with a perfusion machine and returning it to the body via tubing. They also used a cocktail of compounds (including potassium) to keep the heart from beating during that time.

It was a long surgery; around five hours. (And this does not count the time the anesthesiologists spent prepping and anesthetising the patient.) I felt privileged to be able to see how modern medicine has made such a procedure possible. And so incredibly ready to start medical school …

Finances and Fashion

As a full-time student, I have grown used to living on less, since I am living on loans. Soon, though, that loan money will run out. Which means I will need to re-enter the workforce. That’s not the problem – I have no aversion to working hard (if I did, I would certainly be going into the wrong field!). The problem is the economy. There are fewer jobs out there and more people applying for them. But I have a couple of strategies, which I hope will help me survive the next year and a half.

1. Apply Early, Often, and Broadly
I am looking to work in a research lab for the next year (my so-called “glide” year). School ends in early May, and I’m looking to start working in June (giving me some dedicated MCAT study time), but I’m starting to apply for jobs now. Given that I was laid off several years ago, I am pretty handy with the whole job search thing. So I believe that if a job gets posted online, I will find it. And thus far, I have found around 30 jobs to apply for in the Chicago area, all research lab positions, most at higher education institutions (one at a private hospital lab). I am applying so early because I know how long it can take these institutions to sift through resumes, give interviews, and make decisions. I want to give myself the best shot possible at landing a job before that loan money runs out. I am also applying to a broad range of positions. Sure, a genetics department position would be great, but I’ll take what I can get. As long as it’s a lab job and it pays the bills, I’m willing to do it.

One of the vintage pins I've recently sold from my new Etsy store, FashionRelics.

One of the vintage pins I’ve recently sold from my new Etsy store, FashionRelics.

2. Sell My Stuff
I’m not much of a salesperson, but Internet selling – that I can do. And I actually have quite a few things to sell. I was an avid collector of vintage hats, clothing, and jewelry for many years, and have built up quite a stash of items. None of them are super valuable, but all put together, they’re worth a pretty penny. So I have opened a new shop on Etsy.com called FashionRelics (fashionrelics.etsy.com). I have had fun sifting through my vintage goods, photographing them (thanks to my dear friend Lisa for the dressmaker’s mannequin!), and posting them on Etsy. I just started listing things this last week, and have already sold three items. It’s not much, but it’s a start. And since I’ll likely be moving at some point, no matter where I end up going to medical school, paring down my possessions isn’t such a bad idea, either.

3. Consider Alternative Living Situations
I love my one-bedroom apartment. I hope to be able to stay here during my glide year. But if I don’t get a job by June, I won’t be able to afford it. Thankfully, my wonderful and generous mother has offered to let me move in with her. Granted, it’s not my first choice – I like my space and privacy. Don’t get me wrong – I love my mom, and we get along fantastically. But I’m 30 years old, and moving back in with mom just isn’t the most appealing prospect. But it would save me tons of money, so if that’s the sacrifice I have to make, I’ll make it.

Following a dream as big as this one does require sacrifices – I knew that, and am constantly reminded of it. I am willing to part with some material things, move out of my apartment, and possibly take a job I’m less than thrilled about to make it happen. Because in the long run, it will all be worth it.

Single … Again

As the title of this post says, I’m single again – officially. As in, officially divorced, as of Tuesday morning around 9:45 a.m. It was crazy how quickly it all happened. It literally took 10 minutes in front of a judge to undo 10 years of a relationship. My attorney asked me a few “yes / no” questions, I answered them, the judge said his bit, and then he wished us (both Geoff and myself) luck. Geoff and I were back in the car by 9:55 a.m.; the whole thing had started shortly after 9:30 a.m. 

I got a little teary-eyed as we left the courtroom. Those 10 minutes went by in a blur, but it was an emotional blur, to be sure. I entered my former marriage thinking it would last forever. It didn’t. That is painful to contemplate.

So instead of looking back, I try to look forward. I look toward applying for my MD/PhD in June. I look toward hopefully working in a lab for the next year. I look toward a new chapter of my life, and someday, a new relationship. 

Until then, I’m single again. And I’m OK with that.

Drosophila Conference: Part II

Things are coming together, thanks to the Drosophila genetics conference I have been attending this week. What exactly do I mean? What I mean is that I think I have discovered what I want to study for my PhD. And it represents a beautiful dovetailing of my research passion, and clinical compassion.

Let me explain. On Thursday afternoon, I attended a session at the conference entitled “Drosophila Models of Human Disease.” This was the session I was most excited about, because disease is what I am interested in. Although until Thursday, I wasn’t sure which disease. That became more clear to me after a presentation by Dr. Susumu Hirabayashi from Mount Sinai School of Medicine. He presented his work on “A Drosophila Model Linking Diet-induced Metabolic Disease and Cancer.” In other words, a compelling example of how diabetes and cancer are connected. (Which is something I was not aware of previously.) I found myself riveted throughout the presentation – it was an elegant, and eloquent, demonstration of the use of Drosophila melanogaster genetics to explore a disease that has devastating implications for the people who suffer from it. To be more precise, some 25.8 million people in this country alone, according to the American Diabetes

Association (http://www.diabetes.org/diabetes-basics/diabetes-statistics/). That is, approximately, a whopping 8.3% of the U.S. population. And that proportion is only going to get higher as baby boomers age, and as more and more people become overweight and obese.

Diabetes is not unfamiliar to me. In fact, only a few days ago, I wrote a blog post about a diabetic patient at the free clinic where I work as a Spanish medical translator who refused to start taking insulin, and the lessons I learned from that encounter. Probably the majority of the patients for whom I translate have diabetes, in part due to the fact that Latinos are at a higher-than-average risk for this disease (as are African-Americans). From those translating sessions, and from conversations with doctors at the clinic, I have learned a great deal about the various complications associated with diabetes, as well as the treatments for it.

As I sat listening to Dr. Hirabayashi’s presentation on Thursday, it clicked: studying diabetes would represent for me a confluence of my passion for genetics research, my compassion for the Latino community, and also my clinical experiences and knowledge thus far. I found myself nearly bouncing with excitement (although I contained myself, for the sake of the conference attendees sitting behind me).

The next day, I rewrote my “significant research experiences” essay (which is for my MD/PhD application) to reflect what I had learned at the career luncheon, as well as to reflect my discovery of this new research – and clinical – interest. Which really isn’t so new; it’s more a matter of me only now putting the pieces together. I also began investigating laboratory research opportunities to study diabetes and other metabolic disorders at various graduate schools. I found many such opportunities, both at schools that were already on my “to-apply-to” list, as well as schools that were not. (I will likely be adjusting that list accordingly.) I also discovered that my dual experience with two of the most popular model organisms in science – mice and fruit flies – will serve me well, as most researchers studying diabetes use one of those animals in their work.

If I do indeed decide to study diabetes (for the PhD side), that would lend itself very nicely to becoming an endocrinologist (for the MD side). That would involve doing a residency in internal medicine, and then a fellowship in endocrinology. I have been wanting to find a research subject that coordinated with a medical specialty, and this does exactly that.

Do I have it all figured out? No. Could I change my mind on this? Sure. But it is nice to have a jumping-off point, and a potential goal, as I embark on this MD/PhD journey.

Drosophila Conference: Part I

Drosophila melanogaster (fruit fly)

Drosophila melanogaster (fruit fly)

Wednesday evening was the start of the Drosophila genetics conference. Over the last couple of days, I have learned so much, both about this amazing model organism, and about the research community that studies it. The first evening, there was an incredible presentation by a recent PhD graduate who had studied olfaction in both Drosophila melanogaster and in the mosquito. As I learned through her presentation, fruit flies have a natural aversion to carbon dioxide. However, they are attracted to decaying fruit (they eat the microorganisms inhabiting the fruit). And fruit emits carbon dioxide. This presents a paradox: why are the fruit flies attracted to the fruit, if they are naturally avoidant when it comes to carbon dioxide? She discovered that there are various compounds (also emitted by the fruit) which inhibit the flies’ carbon dioxide odor reception mechanism. She then extended this work to mosquitoes, which have significant gene homology (similarity) to fruit flies when it comes to their carbon dioxide receptors.

Mosquito

Mosquito

Mosquitoes, though, have the opposite behavior when it comes to carbon dioxide: they are intensely attracted to it. In fact, that’s how they discover humans – by sensing the carbon dioxide plumes that we inhale. (Which I found fascinating; I had no idea that was how they found us!) She tested the same compounds that had inhibited the fruit flies’ carbon dioxide odor receptors, and found that they also inhibited the mosquitoes’ receptors. In essence, she may have found the next generation of mosquito repellents, which could be released into the air rather than applied directly to the skin. In related experiments, she also discovered compounds that mimic carbon dioxide’s appeal to mosquitoes. Her goal in doing this was to try to develop a more effective trapping mechanism for mosquitoes. Apparently, current mosquito traps involve producing carbon dioxide via burning propane or evaporating dry ice, two methods which are both expensive and cumbersome. She did indeed find several compounds that mimic carbon dioxide’s effect on these flying pests, which could be used to trap and kill them. These mosquito solutions may not be as relevant in this country, where mosquitoes are mainly annoying. But mosquito-borne illnesses such as malaria are devastating in many third world countries, and coming up with more effective ways to combat the spread of these diseases (via trapping mosquitoes, or repelling them) would be a significant accomplishment. Several wonderful, real-life applications of Drosophila genetics!

Thursday afternoon, I went to a career luncheon sponsored by the Genetics Society of America (GSA). I sat at a table with several undergraduate students, as well as a professor from Tufts and another professor from Albert Einstein College of Medicine. We students were there to learn about choosing the right graduate school (that was the topic at our table – other table topics included science writing, starting a lab, finding a post-doc position, etc.). The professors were very candid and helpful, in terms of helping us learn about the selection, application, and interview processes. I definitely feel I have a better sense of what PhD committees want to see in my research essay after the conversation I had with those professors. This led me to rewrite my “significant research experiences” essay, which is part of the MD/PhD application, yesterday. (And I think the essay is much improved!) One of my own questions related to how to discern the “environment” of a school, or a specific lab. For example, is it super competitive? Is the PI (principal investigator) a true mentor, or is he/she hands off? I told the professors that of course I would love to go visit a dozen schools, but I simply can’t afford to do that. As a student living solely on loans, I’m pretty much flat broke. The professor from Tufts suggested e-mailing graduate students from the PhD programs I am interested in and just asking them what it is like to work and live in that particular school environment. I’m not one to be afraid to ask questions, but I had honestly not thought about this. So that’s something I’m looking forward to doing. It’s tough, because I essentially have two sets of curriculum to evaluate – a medical school’s and a graduate school’s. And because I will (hopefully!) be spending seven to eight years wherever I go, I want it to be a positive experience, as much as possible. I also asked both professors about my own unique background – which is strong in journalism, and perhaps less strong in science than the PhD typical applicant – and how that would be perceived by PhD admissions committees. The Tufts professor said that I could turn what might be seen as a weakness by some into a significant strength. For example, with my writing background, I am in a much better position to successfully write scientific papers and grant proposals than other graduate students, who likely have weaker writing skills. That was very encouraging to me.

I realized this morning that this conference has, overall, been a fantastic opportunity for me to learn more about the research process, community, and experience. I have felt pretty confident in my knowledge about the medical aspect of my application experience and process, but until this week, I have simply had less exposure to the PhD community. What I have absorbed in the last few days will, I believe, help me achieve and succeed in the other half of what I want to do with my life. And that’s a good feeling.

When it comes to conferences – especially ones where you have to shell out some money – you never know what you’re going to get. Will it be worth your while, and worth the expense? In other words, will it deliver? This one definitely has.

Pay For Performance: A Medicare Failure

medicare mazeI’ll be honest. When it comes to Medicare rules and regulations, I, like so many Americans, am a little lost. The whole system is incredibly complicated. But I learned something rather disturbing about this complex system this week at the clinic where I volunteer.

I was talking with an attending physician about a patient who had various comorbidities (multiple conditions that interact with each other). This patient was not doing well. The physician told me that under Medicare, the doctor caring for that patient would be in trouble. Why? Because the government has, over the last several years, been instituting what is called P4P – Pay For Performance – measures. These measures reward doctors, hospitals, and other facilities for patients who meet certain “quality metrics” – i.e., do well – and penalize them for patients who do poorly.

On the surface, this might seem like a good idea. Because the goal is indeed a good one: improve quality of care for Medicare patients, while reducing costs and preventing unnecessary expenses. But, it seems, these measures are coming at a cost to some patients who have complicated health issues or a poor prognosis.

In a 2009 opinion piece published in the Wall Street Journal (“Why ‘Quality’ Care is Dangerous”), the authors referenced a study from California in which “doctors dropped noncompliant patients, or refused to treat people with complicated illnesses involving many organs, since their outcomes would make their statistics look bad.” Another study these same authors talked about “indicates that report cards may be pushing Massachusetts cardiologists to deny lifesaving procedures on very sick heart patients out of fear of receiving a low grade if the outcome is poor.”

Clearly, this cherry-picking of patients is not what the Medicare rules are intended to encourage, but this is what is happening, in some situations. As I said, these regulations have a good intent. But for complicated cases, they seem to be worsening patient care, not improving it.

Do I have a solution? Unfortunately, no. But I don’t think this is the solution, at least in a broad application. One option, perhaps, is to make exceptions for those more complicated cases. But that seems like a logistical nightmare – where would you draw the line?

When I have talked with doctors about my own desire to enter the field of medicine, many have referenced increasing regulations – both from the private and public sectors – as complicating their ability to properly care for patients. Do we need to control costs? Yes. Do we need to improve care? Yes. But not by faulting practitioners for cases in which patients don’t adequately improve. And not by encouraging practitioners to drop patients who aren’t likely to see that improvement in the near future. While the goal of P4P may be a good one, the outcome seems to be lose-lose, for both patients and doctors. And if both parties are big losers, then a set of regulations that aim to improve care by issuing report cards receives, in my book, a big fat “F” itself.

The Ups and Downs of Doctoring

Being a doctor can be incredibly rewarding. At the free clinic where I work as a Spanish medical translator, I have seen some of those rewards – hypertensive patients whose once-elevated blood pressure comes down to a normal range, or diabetic patients whose blood glucose levels are finally controlled after months of trying to find the right combination of medications.

But being a doctor can be incredibly frustrating, too. I was a witness to that this week during one of my translating sessions.

syringeA patient came in with very uncontrolled diabetes, and a hemoglobin A1C (a test that measures blood sugar levels across three months’ time) of above 12. For diabetic patients, you try to get that level to somewhere around 7, so this level was not good. Not good at all. The patient had been taking a combination of pills to treat the diabetes, but clearly that was not enough. So the doctor said it was time to start insulin. The patient balked, and asked whether there were any other pills, any other methods, they could try. The patient promised to eat better, to exercise more. But there was no way to come down from that high of a hemoglobin A1C level without insulin, the doctor explained. Insulin was necessary at this point.

But the patient would have none of it, even when the doctor explained all of the possible effects of maintaining a high blood sugar level for a long period of time – eye problems that can lead to blindness, kidney dysfunction that can lead to dialysis, persistent infections, higher stroke risk, heart issues, extremity amputations.

As I was translating, I tried to think of the situation from the patient’s perspective. Having to inject yourself with medication every day, probably for the rest of your life, is a scary prospect. No one wants to have to do that. On the other hand, all those diabetic complications are terrifying. I found it difficult to understand why someone wouldn’t want to do everything possible to prevent them, even if it meant a daily injection. But as a translator, I am an intermediary, a conduit, so I kept my own thoughts out of things.

Clearly, the physician was frustrated too. She was doing her best to provide the best care she could, and the patient was refusing to do what was necessary to maintain a healthy body. Although the doctor tried her hardest to persuade the patient, the patient continued to refuse the insulin. And the patient had the right to make that choice.

I hope the patient has a change of heart and decides to take the insulin, I really do. I know the doctor I was working with does, too. But in the end, I think that as a physician, you have to realize that you can’t fix everything. You can’t force anyone to do something they don’t want to do, no matter how beneficial it might be for them. So at some point, you have to let it go. That’s not to say you don’t revisit the issue on a future visit. No, I think doing that is entirely appropriate. Maybe eventually, the patient will change their mind. What I mean is that people will make their own choices, and sometimes there is nothing you as a physician can do, regardless of all your knowledge and education and degrees, about those choices. Do you stop caring? No, certainly not. But I think you have to guard against internalizing such situations and taking them personally. And while you do that, try to maintain a glimmer of hope that maybe, next time, they will come around.