Friday, May 30, 2008

Two Big FOSEP Events

I haven't posted much about seminars held by Seattle's Forum on Science Ethics and Policy. They have two fantastic events coming up that you should know about. If I weren't posted out here in the Alaskan bush, I'd line up to sit in the front row!

On June 2, PZ Myers of the Pharyngula blog is coming to the Pacific Science Center for a talk titled, "On Science, Blogs, and Intelligent Debates." It's at 7:00 PM and is co-hosted by the Northwest Science Writers' Association.

The very next day, Melanie Roberts, FOSEP founder and two-time AAAS Policy Fellow will speak about "How can YOU influence the federal policy process." She worked in Senator Jeff Bingaman's office and at the NSF. That talk is on the UW campus at 4:00 in the Health Sciences Building's room 747.

If you are in Seattle and are reading this blog, I think you'll find both of them interesting!

Thursday, May 29, 2008

Recycling in Fairbanks

I am very happy right now because I just learned where to recycle aluminum cans in Fairbanks, and it's within walking distance of my apartment!

There are four locations. Two collect and two buy the metal.
  • Collector: Fairbanks North Star Borough 456-1482
  • Collector: Joy Elementary School 456-5469
  • Buyer: C & R Pipe & Steel 479-5174
  • Buyer: K & K Recycling 488-1408
The numbers are (of course) all 907 area codes. Hopefully, if I leave my cans at Joy Elementary School, someone will take them to a buyer to raise supply money for the kiddos.

There aren't many other items that can be recycled. Paper is on hold, glass is not available. Copper, metal scrap and cell phones are accepted at various locations, as is cooking oil. Head over to Green Star for more information.

Wednesday, May 28, 2008

Waste in Medicine

It's time for you to check out another of my articles at The Differential. This one's about how little recycling occurs at hospitals and what could be done to stem the waste-stream. Click it to Read it!


Have I mentioned before that I'm not fond of patient rounds?

Some rotations I've been on consist of half your time in "rounds," a quarter of your time in "sign-out," and the rest split between conferences and patient care. (I know, rounds and sign-out technically are patient care, but they hardly feel personal to me...)

It's no wonder residency programs have to keep their residents over night every fourth night. When else would work get done?

By the way, "rounds" is when a team of students residents and an attending physician walk around on the ward updating each other on patient status. "Sign-out" is when one team tells the next all of the details from the patients' care that day.

Water for $4.00 a Gallon!

This past weekend, as many as 15 motorists in Seattle filled up their tanks with water-contaminated fuel. Evidently 500 gallons of water found a way into the Shell-supplied Safeway gasoline at a few stations around town... No one is sure how this happened. Greedy middleman? Honest mistake? Maniacal anarchist? Each seems a possibility to me in this passive-aggressive, economy-conscious, WTO-rioting city. But my favorite part of the story is a quote from one of the afflicted drivers:
"I didn't think I'd pay $4 a gallon for water," Fitts said. "But I didn't think I'd be paying $4 for gas, either."
Um. Wake up Mr. Fitts!!! That case of bottled water in the back of the SUV you were driving your kids to the hardware store in? I bet that water cost more than $4 a gallon...

By the way, gasoline is so expensive in Alaska that they don't even bother putting the price up on the station marquees. This weekend, I paid between $4.15 and $4.75.

Monday, May 26, 2008


Fortunately for me, I've been busy with work and play this week. Who thought the blog would suffer even with interminable daylight. But fear not! There is plenty of material in the queue. Like pictures of bears and whales and moose. A little too close to each of them. And a new blog project about science and religion. And some thoughts about urgent care and ERs as safety nets. And...

But for now, I need to finish writing up two patients for my OB/GYN clerkship requirement. One who had a basketball-sized ovarian cyst (benign) and another who delivered a breach baby boy by Caesarian section.

Sorry for the delay.

Tuesday, May 20, 2008

Big Day

Three deliveries today.
I 'caught' one.
There was one other regular birth and also a Caesarian section.
But what really gets me is that 9:45 PM, driving home, I needed sunglasses...

Sunday, May 18, 2008

City Moose/Country Moose

If you've been paying attention, you'll know that I'm in the process of moving all over kingdom come for the sake of my medical education. As part of the third year of medical school at the University of Washington, I've lived in Anacortes, Spokane and Fairbanks (in addition to Seattle). There are pros and cons to this lifestyle, some of which I've broken down for you at The Differential this week.

Need more reason to head over there? There's a sweet picture of a moose.

Saturday, May 17, 2008

Students and Sedation

"Your time in the OR can be especially valuable because of the quality of pelvic exams you'll be able to do while patients are sedated."
Caution: squeamish topic ahead...

Last week, I wrote in The Differential about the blurred line in the operating room between humor between physicians and laughs shared with patients. With another week comes for me another state, another clerkship, and another uncomfortable situation in the OR.

Learning the pelvic exam is an important part of medicine. As a doc in a busy ER, I bet I'd average one a shift. But who wants a student doing their exam? Any manipulation downstairs is one that needs to be done with respect and professionalism. There are gender issues, privacy issues, and the question of whether the exam is medically indicated. (Many docs subscribe to a policy of giving a rectal exam to every patient with gastrointestinal problems or anal pain - a colorectal surgeon I recently worked with thought otherwise.) In the context of these issues is the fact that students don't have a clue what they're doing when they start doing exams!

Med students learn these important exams first with paid healthy volunteers (NOT each other!), and graduate to willing patients. With rare exception, a student's exam will need to be followed by a resident's or attending's exam. Two for the price of one. Would I volunteer? Many patients do not.

Which brings me back to the quote above. When a woman has a hysterectomy or other gynecological procedure under general anesthesia, it is very important to know where the uterus and cervix are. The patient has agreed to having a student in the OR, so implicitly agrees to an exam. The pain from the procedure far outweighs any discomfort caused by a pelvic exam, and the anesthesia leaves the patient without a trace of memory from the exam.

So why am I still uneasy about performing a pelvic exam on a sleeping patient? Strangely, I'm more comfortable with someone conscious. But I bet I need the practice.

Ella Ella Eh Eh Eh

This week has been busy, if a little disorienting. I do not think I'll get used to the daylight round the clock. It will make it easier to stay up all night if I am so called. For the next few days, I'll probably be humming Rihanna's Umbrella tune. Not because it was raining yesterday, but because of this. (Warning: if you're not familiar with this pop song, watching this video could be really painful.)

Didn't know the words to this song in the first place? Now you can sing along about the microbes you don't want to get...

Monday, May 12, 2008

Ready, Set, Count!!!

Man is it going to be tough to sleep.
Sunrise, 4:30 AM. Sunset, 11:00 PM.
And gaining 7 minutes of light every day.

Sunday, May 11, 2008

Welcome to Fairbanks

9:30 PM

As in, I took this photograph of my rental car at 9:30 PM.

I'm in Fairbanks for my obstetrics and gynecology rotation. My wife will be doing surgery. Today consisted of finding the hospital, the outpatient clinic, and a delicious Korean restaurant in a bowling alley's basement. We also paid visits to the Safeway for groceries. This evening, it's 63 degrees and party sunny. Notice in the photo above the power cord hanging out of the Subaru's grille. This isn't some alternative energy scheme, when temperatures drop, a preheated engine increases the chances of successful start and also reduces emissions. We don't expect to use the plug. After all, we noticed college co-eds from the University of Alaska walking down the street in shorts and bikinis this afternoon!

In Spokane, our apartment was adjacent to Lincoln Park, which offered a nice place for evening strolls. Here in Fairbanks, we're just next to a bird sanctuary called Creamer's Field. On our exploratory walk this evening, we saw sandhill cranes! Some were engaged in their silly mating dance.

The Ethics of Laughter

Have you ever been uncomfortable with humor in medicine? Or experienced uplifting laughter with a patient or your doc?

My recent entry over at The Differential explores this idea in the context of some of my recent patient experiences.
Check it out. If you have a chance, let me know what you think about humor as therapy.

Thursday, May 08, 2008

And The Sky Went Wild

The Wild Sky Wilderness is a reality!

Just northeast of Seattle is an area of amazing beauty and spectacular scenery that until today was just a patch of government land. Today, after many years of politcal wrangling, it has been Federally designated as wilderness, thereby protecting it for generations to come. This wouldn't be possible if Richard Pombo (R-Ca) had not been defeated in 2006 and if George W. Bush wasn't trying to salvage his 2000 campaign promises of expanding national parks and preservation areas.

The photo above shows an area just up the ridge from the Skykomish River, nearly at the point where I wrapped my canoe around a boulder two summers ago. I'd like to blame the scenery on my faulty steering, but really, I just read the river wrong... What's nice is that the 'Sky' river is just on the border of this soon-to-be pristene area. It will now be difficult to develop the river, thereby preserving the land, the sport and the fishery in that basin.

Put the Wild Sky Wilderness on your list of must-hike outdoors destinations. But not too many of you...

Photo credit to Joshua Trujillo and the Seattle P-I.

Wednesday, May 07, 2008

Bacertial Rasmosis

In the coming age of the electronic medical record, all of your health information will be stored as pixels and megabytes. The consequences of this are far-reaching. Hopefully, your record will be able to move seamlessly between doctors and accessible no matter which ER you find yourself in after one of your drunken tree-climbing escapades. Of course, EMRs are not yet standardized, what with 5 or 6 competing software companies hawking their services. And there is the Health Insurance Portability and Accountability Act (HIPAA) to deal with... (What we really need is a Health Information Portability and Accessibility Act!) But this is all to set the stage for a unique problem faced in health care.

How does all the information get into the computer?

Doctors from my generation (and especially my 5 year younger classmates) grew up typing. They'll be able to type their notes and orders real time. In the outpatient setting, many resident physicians carry a laptop into the office to enter patients' data. But what about the folks who can't type very fast?


Doctors have notoriously bad handwriting. As patient encounters became more important for the legal record and later were stored digitally, there needed a way for scribbles to be translated into typeface. Docs started using services that would transcribe speech into text. Sometimes 'in house' stenographers collect tapes at the end of the day and type them up the next day. In more urgent situations, docs can call an 800 number and connect with a service that contracts out the conversion from spoken to written word.

These days, voice recognition software is phasing out the transcriptionist. Voice recognition is good enough that docs can list the illness history, physical exam findings and treatment plans realtime between patients.

But whether it's human transcription or computer, there will be typos. Take for example my recent discovery of a patient who presented with a significant history of bacertial rasmosis. 'Bacertial' looks enough like 'bacterial' that my mind barely noticed it. But rasmosis? A new class of infection? I immediately consulted Dr. Google. About the closest I could find was the species name for the herbal called black cohosh. Cimicifuga racemosa. Black cohosh is bad enough for you - especially in women of child-bearing age. I hadn't heard of infection exacerbation. That's the funny thing about medicine - there's always something new to learn.

The other funny thing about medicine is that some of what you learn is wrong.

Enter the punchline. This woman had recurrent bacterial vaginosis. The record was an error of transcription. Welcome to the EMR.

This Morning

I went in to the hospital extra early this morning to get some studying in, but decided to visit the ER to see if anything was going on. The first person who rolled in at 5:30 or so had broken her arm last night. It was clear she would need IV access for a probable surgery. I jumped up and put in an anticubital IV like it was nothing. I know doing these simple tasks will get old after a while, but seeing her immediate relief after giving nausea and pain medicine (through the IV, of course) was quite gratifying.

Shown above is a schematic of a self-retracting IV catheter needle like we use to place peripheral lines.

I'm in the hospital's library studying right now and just heard the helicopter land. You might be an aspiring ER doc if the sound of chopper blades makes you think "Airway Breathing Circulation" and inspires you to flip in your trauma surgery notes to the section on the four main types of shock...

Must... Keep... Focus... On... Studying...

Tuesday, May 06, 2008

Rotten Politics

The time has come for two more states to weigh in on who will be the presidential candidates in November. My state has already caucused, so my opinion was heard. Technically it hasn't been counted yet. In such a state of limbo, I am forced to rely on my prognosticator of elections past present and future. This tool is also known as:

"These Colors Don't Run (they grow mold, ferment, degrade, are infested with insects, turn to slime and just plain smell bad):
A Long Term Study Of The Forces Of Nature On Assorted Fruits From The Western United States"
Wood, Glass, Found Berries
Thomas Robey
January 8, 2008 - May 6, 2008
Refresh your memory of what these candidates... I mean samples... looked like on Day 1. Of note is that the berries on the far right were collected in Hawaii, one of the places Barack Obama calls home. Also note how the other blue sample is molding from the bottom up. The red berries are white with mold, and the white berries are either a slimy mess or a tinge red... In past installments, I have ruminated extensively over the meanings of the relative degradation of the various red, white and blue berries, resulting in predictions that have ranged in accuracy. Obama appears aged, hardened and perhaps stale. Clinton is increasingly foul. More than that, all I have to offer is:

They're all rotten.

Let's get it over with, already. We need to start from scratch! It's beginning to be berry season in the Northwest and I'm anxious to move on with this piece of art...

Monday, May 05, 2008

Thinking Back On The Lab

My wife tells me I'm a hypocrite because I like reading PhysioProf's posts at his blog and at DrugMonkey. Those familiar with both PhysioProf and me immediately will know why. For everyone else: foul language usually makes me cringe.

One of the reasons I like reading his blog is that his insight reveals a connection with science, teaching and mentorship that I resepect. Exhibit A:
[One] thing to keep in mind ... is that by the time you reach the end-game of grad school, are finishing up the last few experiments, and are beginning to write the thesis, it is highly likely that you will be pretty much completely disgusted with the science underlying your project, life in the laboratory, and science as a career. This state of mind is a natural consequence of the grueling process of earning your PhD, and does not reveal anything particularly salient about how you really feel about a life in science.

It is similar to how Army recruits feel at the end of basic training: drained, exhausted, miserable, and wanting to quit. But this is no time to make life-altering decisions, such as leaving science for some other profession. As soon as the thesis is accepted, a huge weight lifts, and over the course of a few months, you begin to remember the joys of a life in science.

He sure hit the nail squarely, here. Except for one thing.

I'll let you know when the weight lifts.

Saturday, May 03, 2008


If I didn't have sensitive hands...
If I were 5 years younger...
If I wasn't married...
If I could be content doing one thing at a time...
If I could put up with the hierarchy just a little longer...

I would totally pursue a career in cardiac or vascular surgery. In its favor is:

The 'get in there and fix it' mentality,
The meticulous microsurgery,
The dependence on bioengineered technologies,
The adrenaline of cutting open the aorta (on purpose), and
Working on a team.

I suppose I can find those things and a lot more elsewhere. Well except for the cutting open the aorta part...

Friday, May 02, 2008

Patients As Healers

This week at The Differential, I take stock of some of my favorite patients, and discover how much my memories of them are good medicine for the times I feel down. Long-time readers may recognize some of these stories. Read the article here.