doc w/ Pen

February 27, 2013

The MCAT: My Ticket

Exactly three months from tomorrow, on May 23, I take the MCAT. It’s the equivalent of D-Day, a potential turning point in my long pre-med journey. Hopefully a positive turning point, with a “victory” (a good score). Given that I want to do an MD/PhD, a victory for me means scoring at least a 35, out of a possible 45. That might not sound difficult, but the national average in 2011 was about a 28. Most people are happy if they get a 30. So naturally, I’ve been a bit nervous about the whole thing.

But about two weeks ago, I had an epiphany. I realized that I could look at the MCAT in one of two ways: either as standing in the way of my getting into medical school, or as my ticket to getting into medical school. Regardless of which way I view this exam, I need to study my butt off. But having a more positive outlook, I think, will help me be more confident. And confidence, when it comes to standardized test taking (or to anything for that matter), can make a huge difference. Self-doubt, on the other hand, is most certainly not a recipe for success.

Being a musical person, as I pondered the word “ticket,” a song popped into my head: The Beatles’ “Ticket To Ride.” Granted, the majority of the song’s lyrics have nothing to do with my situation (thank goodness). But one memorable chorus line definitely does:

She’s got a ticket to ride

But she don’t care

The MCAT is my ticket. And I don’t care what else is going on, what distractions may come my way. I will focus on my ticket. Because one way or another, I am going to ride.

February 16, 2013

Health Care: A Risky Business

A classic scabies rash.

There are, clearly, risks associated with becoming any health care practitioner, including a physician. One potential risk that comes to mind is an accidental needle stick. This can transmit bloodborne pathogens such as HIV or hepatitis. Obviously not good. Thankfully, I have never experienced that. However, this weekend I did experience the dangers of the health care profession firsthand.

I likely have scabies.

My mom is a hospice nurse, and one of her patients was recently diagnosed with this skin condition, which causes extreme itching and skin lesions. I have been itchy the last couple of days but attributed it to the cold Chicago winters and dry skin. But this morning, I was literally scratching head to toe – not normal. My mom put two and two together (and she has a couple of the classic scabies lesions on her arm) so we both went to urgent care. The physician there said she couldn’t make a definitive diagnosis, but she said we needed to be treated regardless. This involves literally putting a cream on your entire body, leaving it for 8 to 14 hours, and then washing it off. Like with a lice infestation, you also have to wash all your sheets, clothing, etc. A big hassle.

An image of the mite the burrows into your skin (and lays eggs there), causing scabies.

My mom was at first so embarrassed and upset. But I just laughed. What else could we do? It happened, there was nothing to do about it now. It was nobody’s fault. It’s an adventure, a learning experience. And I will definitely now know the signs of scabies should I ever treat someone with it!

When you go into health care, you have to be prepared for such risks. It’s easy to say you are. But less easy to deal with the consequences if it actually happens. I’m very glad this wasn’t a serious issue, and it’s one that is relatively easy to treat. At the same time, my reaction to it makes me aware that I seem prepared for health care-associated risks, not daunted by them. That is a good sign, I think.

February 16, 2013

New [Mouse] Surgeon on the Block

Until a couple of weeks ago, I had mainly been doing genotyping at my lab job. I’ve got it down to a “science” (pun intended). I’ve been getting great results, which is wonderful. But I was itching to learn some new techniques. Well, I’ve gotten my wish.

My supervisor is teaching me animal surgeries. She has dozens of these to perform in the coming weeks and months, and wants someone to help reduce her load. And of course, I’m thrilled to learn something so practical for my future career as a physician-scientist, especially given that the mouse is the most frequently used animal model for diabetes research, which is what I want to do.

The first technique I learned (and am now pretty good at) is called an ELW (Excess Lung Water) procedure. It involves nebulizing mice with LPS, which basically gives the mice a septic lung infection, and then measuring various aspects of their lungs and blood. The most difficult part is taking a blood sample from the inferior vena cava, which you can imagine is pretty tiny in a mouse. And given that I’ve never really handled a syringe before, getting that needle in and then pulling the plunger back (with the same hand) was at first a challenge. But Thursday I performed my first ELWs on experimental, as opposed to practice, mice, and all went relatively well. (Except for one thing, which I will talk about in another post.)

The other procedure I’m learning is much tricker, and I’ve only mastered the first half. The purpose of it is to clear the mouse’s lungs of blood so they can be used for other experiments, such as histology, sectioning, etc. Cutting out the lungs is the easy part. The more difficult parts are putting the mouse on a ventilator (yep) and catheterizing the heart. Getting the mouse ventilated involves cutting part way through the trachea (again, quite small in a mouse), inserting a trach tube, and then hooking that up to a ventilator machine. The hard part is all the manipulations you have to do with your forceps prior to getting the trach tube in – for example, getting the 90-degree forceps under the trachea without causing the mouse to go into tracheal spasms (so you can pull through silk thread to eventually secure the trach tube). At first, I really struggled with getting that trach tube in. But I am quite good at it now, which is very exciting progress for me.

After getting the mouse on the ventilator, I heparinize the mouse to prevent blood clots, again through the IVC. Not that bad, considering I now am pretty decent with the ELWs. Another challenge after heparinization is catheterizing the heart. A mouse’s heart is literally the size of my pinky fingernail (and I have small hands). You have to get silk thread under the pulmonary artery, cut off half of the atrium, cut the aorta/IVC, and then slice slightly into the left ventricle to insert a small catheter. You then feed the catheter up the heart, into the pulmonary artery, so the fluid (PBS) going through the catheter will clear the lungs. This part of the procedure I am not so good with yet, but I am making progress. “Paso a paso,” one step at a time.

It’s slightly amusing to me that I am doing these procedures, and really enjoying learning them, given my past history with animal dissections. When I was a kid in homeschool, my mom would go to the butcher and get meat remnants (eyeballs, a pig head, various organs) for us to dissect. My sister would totally go to town with them, using a surgical kit that my dad, a physician, lent us. I wasn’t afraid of the dissections, but neither was I interested in them, so I hung back, watching. Now I’m totally into it, and thrilled to be expanding my skill set, as well as becoming more useful in the lab.

2 Comments

January 5, 2013

Anatomically Correct HEELS?!

Google search terms:
“inferior vena cava.”

One result:
See these photos of high-heeled shoes.

Flickr caption:
“Can you spot the inferior vena cava?”

My reaction:
“Can I wear these when I take the MCAT?”

December 21, 2012

Patient Education: It Can Make All The Difference

I volunteered this week at the free clinic where I am a Spanish medical interpreter. I was reminded of a very important lesson: the need for patient education.

As I have mentioned previously, I am very interested in endocrinology and diabetes (both the research and clinical aspects). The Latino population in general is at a higher-than-average risk for diabetes, so a large proportion of the patients with whom I work have this disease.

A diabetic patient came in with high daily blood sugars as well as a high HbA1c (the test that monitors blood glucose over a 3-month period). The physician who patient saw was somewhat frustrated at the fact that his diabetes was uncontrolled, because the patient was on a high dose of NPH insulin.

So the doctor probed the patient. Did he ever skip doses of his meds (including the insulin)? Was he taking his insulin twice a day as prescribed, X units in the morning and Y units in the evening?

Turns out that the answer to the second question was “no.” And not because the patient was trying to be noncompliant. He was taking all (X +Y) units of insulin once a day, because he had previously been on Lantus. He didn’t understand that Lantus is a long-acting insulin, which means you can take it only once a day, while NPH is intermediate acting, which means you have to take it twice a day to appropriately control your sugar. (The reason he had been switched from Lantus to NPH was that the clinic pharmacy had run out of Lantus, an unfortunate occurrence which sometimes happens given that all the medications at this free clinic are donated.)

When the doctor explained this clearly, it was like a light bulb went off for the patient. He said he just didn’t know, and thought that it was OK to keep taking the insulin the same way he had been taking it before. He agreed to make the change right away.

It is true that sometimes patients are just noncompliant, and that leads to uncontrolled conditions. But other times, they simply don’t understand the (often very complicated) instructions they receive. Language and education barriers make this all the more difficult. And so it is the responsibility of the physician to make sure the patient does understand, so that he/she has the tools to control the disease, whatever it might be. A good lesson to remember as I make my way toward a career in medicine.

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December 16, 2012

Death In The Line of Duty: The Ultimate Sacrifice

The Friday, Dec. 14 shooting at Sandy Hook Elementary School has citizens across the United States, and the globe, mourning. And thinking. In part, about ways (such as more stringent gun control) to try and prevent such tragedies. It has the Newtown, Conn. town thinking about how to move forward amid the grief and shock. According to a Chicago Tribune article I read this morning, people across the town are taking down Christmas decorations, saying that celebrating a festive holiday during a time like this is unthinkable.

This tragedy, a massacre of 20 young students and 6 school staff members, got one of my friends, who is an education major, thinking about something else. Something more personal. I spoke with her yesterday on the phone, and the shooting came up (as I know it has among so many conversations in the last couple of days). She just finished a semester of class observation at a local middle school. Over the course of the past semester, she has told me multiple times how much the students meant to her, how much – even though they were not her own students – she cared for them and appreciated them. And yesterday, she told me all she wanted to do was go to the school and give each and every one of them a big hug, even though they would likely not understand why. She had thought long and hard about what it would mean to lose a student, and how that would affect her. And she could not even imagine what those community members, including those teachers, are going through right now.

But she also got to thinking about the school staff who literally gave their lives for their students. In that same Chicago Tribune article, I read about principal Dawn Hochsprung, in an attempt to overtake the gunman, paid with her life. And about 27-year-old teacher Victoria Soto, who tried to use her body as a human shield to protect her first-grade students, was also killed. One of Soto’s friends, Andrea Crowell, was quoted in that Chicago Tribune story as saying: “She put those children first. That’s all she ever talked about. She wanted to do her best for them, to teach them something new every day.” That day, Soto taught her students about the ultimate sacrifice: death in the line of duty.

Which got my friend thinking: Would she, as a teacher, be willing to die for her students in the same way Hochspring and Soto did? Would she feel OK about giving her life in exchange for her students’ lives? “And I decided that yes, I would,” she told me. I felt shivers go down my back, and tears well up in my eyes. I told her that this was a profound moment for her. Then she told me that she had begun thinking of herself more as a teacher than as a college student. This realization, I told her, was evidence of that newfound association.

And in the course of that conversation, my dear friend got me thinking (as good friends do). Would I, as a physician, be willing to give my life for my patients’ lives?

Granted, there are very few instances where teachers, or doctors, are called to do that. But I believe that it is something that people who enter service professions such as medicine and education need to consider. As a teacher, you put your students first. As a physician, you put your patients first. Above yourself. Always.

People don’t normally think of medicine as a “risky” or “dangerous” profession. They often think of it as a posh one, at least financially. But there are risks involved. When a you makes a treatment decision, for example, you risk angering a patient (or a relative) and having them come after you. While I didn’t find a lot of examples of this on the Internet, I did find a few:
– 2007: a Chicago dermatologist was allegedly killed by a patient who (according the Daily Mail article I read) thought the acne medication he was given made him impotent
– 2009: a Las Vegas internal medicine physician was allegedly killed by a patient, possibly because he was in intense pain from prostate cancer and might have blamed the doctor (according to the Asian Journal article I read)
– 2009: a Kentucky physician was allegedly killed by a man whose motive may have been that the doctor denied him narcotics after the patient refused to give a urine sample (according to the Associated Press article I read)

Another risk to physicians is that of contracting a contagious disease during the course of treatment. In an American College of Physicians article posted on the AMA Web site, called “The Physician and the Patient,” there is a section on the “Medical risk to physician and patient.” The article clearly states that doctors must put their own health second to that of their patients’, and that refusing treatment to patients with potentially dangerous conditions is out of the question, ethically. Here is what the article had to say on the subject:

“Traditionally, the ethical imperative for physicians to provide care has overridden the risk to the treating physician, even during epidemics. In recent decades, with better control of such risks, physicians have practiced medicine in the absence of risk as a prominent concern. However, potential occupational exposures such as HIV, multidrug-resistant tuberculosis, and viral hepatitis necessitate reaffirmation of the ethical imperative … Because the diseases mentioned above may be transmitted from patient to physician and because they pose significant risks to physicians’ health and are difficult to treat or cure, some physicians may be tempted to avoid the care of infected patients. Physicians and health care organizations are obligated to provide competent and humane care to all patients, regardless of their disease state. Physicians can and should expect their workplace to provide appropriate means to limit occupational exposure through rigorous application of infection control methods. The denial of appropriate care to a class of patients for any reason is unethical.”

Whether a teacher, physician, police officer, firefighter, or other service professional will, indeed, give up their life in an emergency situation may be difficult to predict until the situation presents itself. But it is definitely something to consider.

For myself, and for those of my readers wanting to practice medicine someday, let us ask ourselves: What would we risk for our patients?

November 27, 2012

Getting a Patient’s Perspective

Note: I suggest not reading this post if you are eating, or have recently done so. Not that I’m trying to gross anyone out, but this is a medical blog after all, and some medical stuff is, well … you know.

Self-diagnosis: It’s a common phenomenon, one in which a little knowledge is a dangerous thing. When you take Psych 101 in college, for example, suddenly having a bad day or two makes you think you are schizophrenic or bipolar. And when you are a pre-med, every cough, sneeze, or tickle sends you to Google, which inevitably yields the most rare and horrible diseases as its search results.

Then again, sometimes The Google Doc is right.

It was in my case last week, when, ironically, I wound up with one of the very bacterial infections I wrote about in my recent post “The Kinky World of Bacterial Sex.”

It all started with some vertigo and nausea. When that didn’t go away after a few days, I headed for a local urgent care center, where the doctor there diagnosed me with a sinus infection and gave me a prescription for amoxicillan. I’m still not clear on whether that diagnosis was correct, because I didn’t really have any sinus symptoms … but then again, I’m not a doctor. I started taking the antibiotic. Almost immediately, I started having diarrhea. But I was out of town visiting a friend, so I shrugged it off as related to a temporary change in my diet. After a couple of days, though, when my body was wracked with horrible abdominal pain, I admitted something was not right and called the urgent care center. The doc there (a different one than I had seen before) told me to stop taking the amoxicillan. But the pain and diarrhea only got worse, so I went back to urgent care when I got home from my trip. Blood work and abdominal CT (to rule out appendicitis) were normal. But a stool culture revealed exactly what Google had suggested when I first looked up the keywords “amoxicillan” and “diarrhea”: Clostridium difficile, or C. diff.

When that showed up as a possible diagnosis during a Google search on my iPhone, I attempted to be rational and dismissed it as the worst-case scenario. My symptoms could also have been side effects from the amoxicillan itself, and in my attempt to not self-diagnose, I believed that’s what they were. But it appears that my worst-case scenario came true.

Well, not exactly. My association with C. diff from writing my recent blog post was that it’s a nasty superbug, one that is resistant to antibiotics and very difficult to treat. That is true, in some cases. But certainly not always. Usually, you can treat it with the antibiotic Flagyl, or if that doesn’t work, Vancomycin. In some cases, C. diff infections require hospitalization and IV antibiotics. But that’s unlikely in my case, especially since I have not recently been in an environment (such as a long-term care facility or a hospital) where the superbug strains of C. diff tend to thrive.

The irony of contracting a C. diff infection after writing about it on this blog certainly does not escape me. Neither does the irony of switching roles from confident pre-medical student to sick, scared patient.

Before I received a definitive diagnosis yesterday, I was frustrated and scared. I didn’t know what was wrong with me. I was in a lot of pain. I couldn’t keep food down. My normally active and productive lifestyle had been reduced to a cycle of sleep – drink Gatorade – go to the bathroom – repeat. A friend suggested I change my perspective and try to look at the experience as a learning one, one in which I could gain a better understanding of what it is like to be a patient. Because one day, I will be treating patients, and if I have a good understanding of what it is like to be one, hopefully I will be a better and more compassionate physician. So I started paying attention to how the practitioners were treating me, trying to figure out, from my own reactions to their behaviors, what kind of doctor I wanted as my own doctor. And hence, what kind of doctor I wanted to be to others. I learned a great deal from both doctors and their support staff.

I remember the first physician I saw at the urgent care center. While she was nice enough (I guess), her demeanor and body language suggested that she was in a hurry and that she was just trying to get through our visit. She didn’t explain anything about my diagnosis, or the medication I was to take. I understand that physicians these days have a huge patient load and are very busy. But I think there are ways to take just a minute or two to help assure a patient that he or she isn’t an inconvenience, which is how I felt. The second doctor I saw at the urgent care center was much better. She was more thorough in terms of her interview with me, and she acted like she cared about my well-being. She had concern and compassion that I could see, hear, and feel. I could tell she was busy, too, but she made sure to tell my why she was ordering an abdominal CT, why she wasn’t giving me any medications right then and there, and what might help me feel better until I had a diagnosis and course of treatment. She also made a point of asking me multiple times if I had any questions.

But obviously, it’s not just the physicians who comprise a treatment team. There are nurses, techs, receptionists, and other support staff. I tried to learn from them as well. The tech who took my vitals and drew my blood on my second visit to urgent care was amazing. I’m not always good with names, but I remember hers – Melissa. She made me feel at ease, in part by being calm herself, in part through humor. I was somewhat dehydrated (from the diarrhea), so my veins were difficult to find when she was trying to draw blood for a CBC. Melissa was very patient, and rather than hurry and stick me multiple times, kept palpating my arm until one popped out. I was very grateful for that.

And then there was the radiology support services lady at the hospital where I went for my abdominal CT scan. She was amazing. I had never had an abdominal CT before, so had not had the pleasure of the lovely barium contrast drink they give you (and they give you a LOT of it). I was already feeling sick, and the bitter-off taste of the clear liquid wasn’t helping. The woman at the front desk walked through the waiting area and asked how the drink was going down. I told her not so well, and she asked whether it would help if I had some juice to help wash it down. When I said “yes,” she replied, “Well, I’ll go see if I can scrounge some up for you.” Her kindness – and the apple juice she found – made all the difference in the world.

Sometimes you can’t cure someone, but you can bring them a little bit of comfort. That’s the kind of doctor I want to be.

November 4, 2012

Elemental, My Dear Watson

As I was studying for the MCAT yesterday (General Chemistry), doing the Examkrackers practice problems, I kept having to refer back to the periodic table at the beginning of the book. Now, I know quite a bit of the periodic table information – the molar masses of oxygen (~16), carbon (~12), and nitrogen (~14), for example. But if a problem comes up about nickel, I’m gonna be in a pickle.

Thankfully, I discovered today, we DO get a periodic table on the MCAT, which includes atomic numbers and atomic weights (whew!). Otherwise, I thought I was going to have to memorize this song …

November 4, 2012

It’s All Coming Back To Me Now

Finally, after some hemming and hawing, I have begun studying for the MCAT. “M”-Day for me is March 23, 2013. So I’ve got a bit of time. But given that I took Physics, General Biology, and General Chemistry two years ago (2010-2011), and Organic Chem one year ago (2011-2012), I feel the need to do some hard-core review. That, and the fact that the average MD/PhD matriculant’s MCAT score is a 35 puts a bit of pressure on.

To put that score in perspective, the mean MCAT score for 2011, according to the American Association of Medical Colleges, was a 25.1. That’s out of a best-possible 45. Not a single person got a 45 in 2011. The highest score was a 42. To get a 35, I would have to be in the 94th percentile. Yikes. (See the full score report from the AAMC here.)

My strategy is to use the Examkrackers review books series, both the subject matter review books and the “1,001” questions books. I have started Gen Chem, Orgo, and Gen Bio. Today I will venture into the world of Physics. I am making flashcards on Quizlet, which I can study anywhere using their iPhone app. With all of these resources, along with taking (and re-taking) the available AAMC practice tests, I believe I will be as prepared as I can be.

That said, I was a bit worried, when I first opened the review books, that I would have forgotten … EVERYTHING. Not so. And thus, the song “It’s All Coming Back To Me Now” has been cycling through my head. And of course, like most songs that play in my head over and over again, I had forgotten most of the lyrics. Solution: YouTube. So here, I present Glee performing this song, in celebration of the fact that my science knowledge is … all coming back to me now.

2 Comments

November 3, 2012

Stupid Google! (and some HTML resources)

Dear Google:

Your Dynamic layout series is wonderful, in many respects. It is interactive, reader-friendly, and attractive. However, there is one major problem: The inability to change the HTML coding stifles creativity, and seems to go against the philosophy of Google itself. I hope you will fix this problem. In the meantime, I am sadly restricted to one of your lesser templates, simply because it affords me the ability to customize my pages. Were it not for my followers (however few they may be), I would consider changing blogging platforms. For now, though, I will hold out hope for your listening to the many complaints online about this omission in your template design.

Sincerely,

Lorien Menhennett
mybedsidemanner.blogspot.com

For those of you who may have visited my blog in the last few days, you may have noticed that it has been a revolving door of layouts and templates. For this, I apologize. I realize this can be disorienting and confusing to readers … I know it is to the author.

The reason for this is as follows: I found a very wonderful template, called the Dynamic series. However, I wanted to customize it by changing the HTML coding. After about an hour of frustration on both my blog and other blogs dedicated to helping bloggers blog, I discovered that this template series does not allow you to edit the HTML code. It is fixed, so to speak. I find this very frustrating. Hence my faux open letter to Google in my faux version of The New York Times (at right).

I find it humorous that this was a problem for me (at 5 a.m. on a Saturday, especially). I never would have dreamed that I would be editing HTML code. But I have learned bits and pieces of it, through different Web sites and others’ blogs. This post is a shout-out to those of you who are experts at this foreign language, which I am slowly learning. This post is also a complaint to Google for not making it possible to speak this language in the Dynamic template series, which aside from this issue is pretty darn cool.

With that said, here are two sites I have found helpful in learning HTML code. Just in case, ya know, you want to try it out too …

http://www.quackit.com/html/
This site is great. It offers tons of code HTML code resources. One of my favorite things about this site is that it has “code generators.” I know, I know … the purists will call me lazy, but I really like that I can just specify the number of columns, rows, background color, etc. in a table and have the site churn out the whole table’s code for me, which I can then copy and paste into my blog. (Here is the specific table generator link: http://www.quackit.com/html/html_table_generator.cfm.)

http://blogger-hints-and-tips.blogspot.com
There are blogs about everything. Including blogs about blogging. This is a great one if you need tips on technical things (I have found it quite useful).