doc w/ pen

a journalist becomes a doctor before your eyes

Month: November, 2016

Caution: sharp objects ahead

When you call it a "butterfly needle," it sounds so innocent and cute ...

When you call it a “butterfly needle,” it sounds so innocent and cute …

One step closer.

That’s what I tell myself with each new medical school milestone. This week, there were two big ones. Both involved sharp objects. But with the exception of some minor bruising, everyone came out just fine in the end.

Monday, I took my first stab at drawing blood (that pun was so intended). I’ve done delicate surgical procedures on mice, including injecting medication into the inferior vena cava. But survival was not a goal of those procedures. Phlebotomy is obviously much different. This first time, we medical students practiced on each other. With some guidance, my classmate stuck me on her first try. I had a little more trouble. Three pokes later, I managed to see the coveted red flash of blood. I patted myself on the back until I saw my friend the next day. When asked, she showed me her arm — a purple bruise where I’d poked.

I’ll get better. It takes practice, just like everything else.

Suture kit

With suturing, you use metal tools to hold the needle and the skin.

Though it was technically my first time with this too, Tuesday’s activity — suturing — actually felt less foreign in some ways. I learned basic sewing when I was in elementary school. I feel comfortable with the general act of guiding a needle and thread. With sewing though, you use your hands to hold the fabric and the needle. With suturing, you use metal tools to hold the skin and the needle. That took a little adjusting.

Another adjustment: it took me a moment (and a comment from a surgery resident on my crazy stitches) to realize that while sewing and suturing share many features and movements, the basic suture technique I was practicing differed from sewing in one very important way. With sewing, you create contiguous stitches to keep the fabric together. You tie a knot and cut the thread only when you’re done, or when you’ve run out of thread. With the basic suturing technique I practiced Tuesday (called the “simple interrupted suture”), you create distinct stitches that are separate from each other. Stitch, knot, cut. Repeat.

This makes sense. Fabric needs that continuity to stay together. With skin, you’re holding things tight temporarily, just until the skin gets its act together and heals itself. Then you don’t need the stitches anymore. The simple interrupted sutures are actually a lot like straight pins in sewing. When you hem a dress, you pin it up first to keep everything straight and tidy. Then you run it through the sewing machine. Once you have that strong hem sewn, you remove the pins. Likewise with the simple interrupted suture I learned: you put temporary, individual sutures in until the skin is healed. Then you pull out the sutures, just like you did with the pins of your dress hem.

It makes sense to me now, but my practice foam block (full of contiguous sutures) must have looked like a complete train wreck to that surgery resident. Well, now I know. And more importantly, I understand.

Knowing, understanding, practicing: this means I’m headed in the right direction. Even if I did leave a little bruise.

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Some little bug is gonna find you …

Bacteria are everywhere.

I’m reminded of this fact as I enter my last class-based unit of medical school, infectious disease. With this in mind, I’m also reminded of a song that my family listened to during my childhood. This was back in the day when people made “mixed tapes” with cassettes, not with an iTunes playlist. A friend of my dad’s made us this particular tape in the mid-1980s. It was a favorite on cross-country road trips to visit my grandparents in Colorado and Kansas. The tape was full of folksy songs about trains, whales, Star Trek, and … gut bugs.

“Some Little Bug” apparently dates back to the early 1900s. This particular version, which I’ve uploaded to YouTube and shared here, was digitized from that old cassette tape. You’ll find the lyrics below the YouTube link.

Enjoy. But not while eating.

“Some Little Bug”

In these days of indigestion it is oftentimes a question
As to what to eat and what to leave alone.
Every microbe and bacillus has a different way to kill us
And in time they all will claim us for their own.
There are germs of every kind in every food that you can find
In the market or upon the bill of fare.
Drinking water’s just as risky as the so-called “deadly” whiskey
And it’s often a mistake to breathe the air.

Some little bug is gonna to find you someday.
Some little bug will creep behind you someday.
Then he’ll send for his bug friends
And all your troubles they will end,
For some little bug is gonna find you someday.

The luscious green cucumber, it’s most everybody’s number
While sweetcorn has a system of its own.
And, that radish seems nutritious, but its behavior is quite vicious
And a doctor will be coming to your home.
Eating lobster, cooked or plain, is only flirting with ptomaine,
While an oyster often has a lot to say.
And those clams we eat in chowder make the angels sing the louder
For they know that they’ll be with us right away.

Some little bug is gonna to find you someday.
Some little bug will creep behind you someday.
Eat that juicy sliced pineapple,
And the sexton dusts the chapel
Oh, yes, some little bug is gonna find you someday.

When cold storage vaults I visit, I can only say, “What is it
Makes poor mortals fill their systems with such stuff?”
Now, at breakfast prunes are dandy if a stomach pump is handy
And a doctor can be called quite soon enough.
Eat a plate of fine pig’s knuckles and the headstone cutter chuckles
While the gravedigger makes a mark upon his cuff.
And eat that lovely red bologna and you’ll wear a wood kimona
As your relatives start packing up your stuff.

Those crazy foods they fix, they’ll float us ‘cross the River Styx
Or start us climbing up the Milky Way.
And those meals they serve in courses mean a hearse and two black horses
So before meals, some people always pray.
Luscious grapes breed appendicitis, while their juice leads to gastritis
So there’s only death to greet us either way.
Fried liver’s nice, but mind you, friends will follow close behind you
And the papers, they will have nice things to say.

Some little bug is gonna to find you someday.
Some little bug will creep behind you someday.
Eat that spicy bowl of chili and on your breast we’ll plant a lily
Oh yes some little bug is gonna find you someday.

Making a difference in dermatology and beyond

Dermatology: another unit in the medical school history books. During the course, more than one dermatologist-lecturer tried to convince us that derm is about more than eczema and acne. That it’s more than pimple-popping. That it’s … interesting. These lecturers tried to woo us with thrilling cases where the dermatologist saves the day. And yes, that must be exciting.

Personally though, what I found most moving about dermatology wasn’t the rare, life-threatening rashes. It was the “boring” bread-butter-cases.

Like psoriasis. Psoriasis never makes the headlines. It’s not at all exciting, from a medical perspective. But it affects people’s lives. According to some researchers, psoriasis can affect a person’s quality of life just as much as heart disease, cancer, diabetes, depression, or arthritis.*

That might be hard to picture. After all, what’s so bad about some scaly skin? But when you hear it from a patient who has lived with this, you understand. The psoriasis patient who talked to our class was a business executive. He talked about how embarrassing it was to see clients when the floor surrounding his desk chair was covered with flakes of dead skin, for example. Thankfully, this patient’s story had a happy ending — he got relief from one of the incredible new treatments now available.

UstekinumabThese treatments are amazing. They don’t work for everyone, but when they do they’re like magic. Here is a before-and-after image, from our psoriasis lecture, showing what one of these new therapies can accomplish in just a few months.

As far as diseases go, psoriasis may not be exciting or exotic. What’s exciting to me, though, is the incredible effect a dermatologist can have on a patient’s life by treating their severe psoriasis. That, to me, is a major appeal of dermatology. And at the heart of it, what I find appealing about medicine in general: making a positive impact on someone’s quality of life.

 

*Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999 Sep;41(3 Pt 1):401-7.

Disbelief and dismay

All lecturers at Weill Cornell are required to show us a slide stating whether they have any financial conflicts of interest related to their presentation topic. One of yesterday’s lecturers, after presenting this customary slide (revealing that he had no financial conflicts), added this commentary:

I will try not to talk about the presidential election, although it’s very difficult. But I suspect that the absence of financial conflicts will be outlawed, and only people with large financial conflicts will be allowed to now do anything.

Many other lecturers, renowned physicians and scientists in their fields, have made similar comments since the election. This is the atmosphere of disbelief and dismay shrouding Cornell.

What we do about this, I don’t know. But for starters, we keep talking about it.

Take your “stage.” Speak up.

The day after our recent presidential election, I wrote here that I don’t “normally” write about politics on my blog. I’ve reexamined that perspective in the last few days. The main intent of this blog does remain the same: to chronicle my journey to, through, and beyond medical school. But given the broad, international implications, these election results are now a part of my journey. Not just because Donald Trump has vowed to decimate the Affordable Care Act, which will affect my future patients. But because his proposed actions, and the cabinet appointments he has recently made, threaten the lives and rights of so many people in this country and the world beyond our borders.

I will continue to write about medical school here. As the cast of “Hamilton” recently reminded us though (see the YouTube video clip above), those of us who are concerned about the direction this country is headed have an obligation to stand up and voice those concerns from whatever platform we happen to have — whether it’s a literal stage, a blog, or a cocktail party.

My goal is not to incite fear or hopelessness. First, there is enough of that already. Second, alone they accomplish nothing. My goal is to provoke awareness and spur cohesion. Maybe that awareness and cohesion can actually foment hope — hope that by speaking our minds, by working together, we can eventually hobble this political malignancy.

With this introduction in mind, I want to share something I read a couple days ago from Humans of New York, which chronicles, through brief interviews and photos, the everyday lives of people in the city I now call home. This woman’s words resonated with me. They saddened me. They also helped me understand why this happened.

A computer lesson on pain control

Our required EMR training includes a 10-minute lesson on how to order PCAs.

Our required EMR training includes a 10-minute lesson on how to order PCAs.

$560 – $635 billion.

That’s the estimated annual cost of pain, according to a 2011 Institute of Medicine study called Relieving Pain in America.

Having spent this past summer immersed in the world of palliative care, I’ve seen how pain carries a heavy personal cost too. I’ve also seen the remarkable difference it makes in a person’s life when that pain is diminished or eliminated.

So as I continued to work on my mandated electronic medical records training last night, I was pleased to see a 10-minute module on how to order patient-controlled analgesia (PCA). PCA involves a computerized pump connected to the patient’s IV line. With PCA, it’s the patient who controls the amount of pain medication they receive (with a limit established by the prescribing physician). PCA is not appropriate in all situations, but it’s one more option in the doctor’s pain management armamentarium.

I don’t imagine PCA ordering is something medical students actually deal with, but I’m glad the module was there — if only to remind us all how important pain management is.

Sunny Sunday in Central Park

On this sunny, Sunday afternoon I headed to Central Park to get some natural vitamin D exposure. (And to revel in the fall foliage.) It was a lovely escape from the concrete streets and skyscrapers. Here are some photos from my excursion.

Note: Click to see larger images.

No regrets

I started college as a biology major, pre-med. I changed my major to journalism after taking an introductory writing class — a course that changed the course of my life. Over the last few years, since coming full circle and deciding to pursue medicine after all, I’ve been asked many times whether I wish I’d stuck with pre-med in college. After all, if I had, I’d be a full-fledged physician by now rather than a lowly medical student.

“No.”

That’s my unwavering answer.

I changed my major back in 2000 in part because I fell in love with writing, and in part because I wasn’t committed to the idea of four years of medical school followed by another three or four of residency. And don’t forget the major debt — a scary prospect for a 19-year-old.

It took me some 15 years to make my way to medical school. But that was the right timeline for me, for me to fully realize that this is what I want in my life, for me to be ready. I wouldn’t change any of it because I wasn’t ready back then. And those 15 years brought all kinds of adventures of their own — all of which provide me with a rich set of life experiences to draw upon as I make my way in my new career. In unexpected moments, those events, and the lessons I learned from them, brighten the path in front of me.

One of those moments occurred during our last unit, where we learned about rheumatology and the musculoskeletal system. Part of the curriculum involved learning various physical exam maneuvers to test for musculoskeletal problems. We had lectures, then brief, proctored practice sessions to learn how to test for rotator cuff tears, for example, or carpal tunnel syndrome. Some maneuvers were easier than others. And while they all made sense while I was sitting in the room surrounded by our orthopaedist-teachers, when I got home, the details of the trickier exams (especially for ACL and meniscus problems in the knee) had faded.

You never know when the past will come back to help you.

You never know when the past will come back to help you.

My past life in publishing, though, offered an answer. The year before I started medical school, I worked for the American Academy of Orthopaedic Surgeons (AAOS). AAOS is the medical society for orthopaedic surgeons, and also publishes orthopaedic books. When I left, I was graciously given a copy of Essentials of Musculoskeletal Care 5, a book on general musculoskeletal problems actually directed at non-surgeons — primary care physicians, nurse practitioners, physical therapists, residents, medical students, and others. Aside from hunderds of pages of expertly written text, the book includes more than 200 video demonstrations of exam maneuvers and procedures. So rather than turn to YouTube for  videos of unknown origin, I had a trustworthy source. And when I practiced the manuevers with my classmates, the videos were something I could share with them, too.

Sure, I could have bought the book. But I’m a broke medical student, and it’s really not in my budget right now. It’s part of the package of my past life, a past life that informs and enhances my current one. And while it might have taken me longer to get here, that time certainly wasn’t wasted.

Parlez-vous français?

Trying to learn about thrombosis in French is pointless for someone (like me) who doesn't speak French. But for the writer and word-nerd in me, the foreign phrases are fun to look at anyway.

Trying to learn about thrombosis in French is pointless for someone who doesn’t speak French (like me). But for the writer and word-nerd (also me), the foreign phrases are fun to look at anyway.

The answer to the question posed in this blog title — whether I speak French — is a resounding “no.” The little I do know about French is that it is a beautiful language, one gentle on the ears, eyes, and tongue. When I hear it spoken or see it written, I have little idea what the words mean. But to me they are lovely words nonetheless.

This love of French words extends, I learned this week, to medical texts. Yesterday our class received an e-mail with this subject line: “Dr. Erkan’s Printed Material – The English Version is Now Posted on Canvas.” (“Canvas” being our online education portal.) I was immediately intrigued. This implied that at some point, a non-English version was available (clearly an accident), but had since been removed. A kind classmate who’d inadvertantly downloaded the foreign language version — in French! — forwarded me the PDF. I had already watched the lecture in English, and had read the English slides. So as I skimmed through the French materials, I had a vague idea of what I was reading. My fluency in Spanish helped a little, as both are Romance languages, with some similarities. This was not at all a productive use of my precious time. I had a test to study for. Looking at the French version obviously would not help. This was pure linguistic voyeurism.

My first childhood crush was on Jaromir Jagr, a Czech hockey player. More than anything, I was enthralled with his last name, which according to English grammar rules was mysteriously missing a vowel between the two terminal consonants.

My first childhood crush was on Jaromir Jagr, a Czech hockey player. More than anything, I was enthralled with his last name, which according to English grammar rules was mysteriously missing a vowel between the two terminal consonants.

I guess I shouldn’t be surprised at this fascination with a foreign tongue. The signs were there at an early age, when I started watching National Hockey League games with my dad. It’s a fast-paced, exciting game, which helped hold my attention. But just as fascinating were the players’ names — especially the Eastern European ones. My first childhood crush was on Jaromir Jagr, a Czech who played then for the Penguins. I didn’t even really know what he looked like, as he was covered in protective padding and a helmet all the time. My true attraction was to his last name, which was seductively missing a vowel between the “g” and the terminal “r.” “How was this possible?!” the young grammarian in me wondered. It was my introduction to foreign languages, to rules so different from the familiar English ones that they took on a magical, mystical quality. I had to learn more.

But life puts time constraints on you. Fluency takes years of dedicated practice — you must choose a language to focus on. So I chose Spanish, and I’m glad I did. It, too, is a lovely language with curious and detailed rules whose application can make me giddy. Spanish is also highly practical in the United States, especially in urban areas like my former home, Chicago, and my current one, New York City. If I could choose another language to learn, disregarding practicality and difficulty, it would be Russian. It hearkens back to the genesis of my linguistic interests, which started with those Eastern European tongues.

I’m in medical school now though, learning a foreign language of another kind: doctor-speak. Fluency here is by fire and immersion. No time for nation-languages. So I must be content, at least in this season of my life, with things like browsing medical texts in French. And dreaming about how someday, I might have time for more.

Foresight is 2020

I don’t normally write about politics here. It’s not the intent of this blog. But today, it’s personally imperative for me to say something about last night’s presidential election results.

Those of you who know me well will attest that I am a nonjudgmental, “live and let live” kind of person. But everyone has a breaking point, and Donald Trump is mine. I cannot watch him climb to the most influential political office in the world and stand by, silent. To simply say “I disagree” with this result, and that I simply “disagree” with half of the electorate in this nation, is also insufficient. No. I am terrified and sickened as I contemplate the next four years under the thumb of a man who seems more likely to rule with the principles of tyranny than with those of democracy.

More specifically, here are a few things I want to say publicly, and in print.

As a woman, I refute the misogyny Donald Trump has spewed during this campaign. As someone with friends of many racial, ethnic, religious, and geographic backgrounds, I refute the racism and intolerance Donald Trump clearly espouses. As a future physician, I refute Donald Trump’s positions on health care availability and funding. As a decent human being, I refute Donald Trump’s stance on the provision of social services. As an American citizen, I refute Donald Trump’s capacity to serve as our president.

I could go on, but you get the idea.

I voted. I’m glad I did. But I wish I had done more. Would it have made a difference? Just me, no. Though maybe if a lot of people had decided to do more, it would have.

In four years, in the 2020 presidential election, I’ll be deep in the harried, sleep-deprived life that is medical residency. I’ll have even less time than I do now. I’m not sure what I’ll be able to contribute. But we can’t let this happen again. All I can come up with in this dark moment is that we need to start thinking ahead now.

Who’s ready to start campaigning for Elizabeth Warren with me?