I'd someday like to be a Caleb Burhans of science, medicine and society. Don't know who that is? I didn't either until I read today's New York Times feature of him. Or, if you're oriented more to screen than print, watch this clip:
I found it an inspiring example of following one's interests and passions.
Sunday, October 05, 2008
Saturday, October 04, 2008
Carnivals!!!
My fellow bloggers,
Are you looking for some carnivals to showcase your best writing? Listen up!
Like so many of my extra-curricular interests, blogging has fallen a bit behind in the face of licensing board exams, finals, and long hospital work hours. It doesn't help that my current bus lines do not have wireless... But you've seen an increase here and at The Differential of late. I am really excited about what is going down over at Clashing Culture in the next two weeks. Thanks to the strong work one of my co-bloggers there (Mike, also known as Tangled Up In Blue Guy), Clashing Culture will be hosting not one, not two, but three carnivals in the next two weeks.
On deck over there is:
Are you looking for some carnivals to showcase your best writing? Listen up!
Like so many of my extra-curricular interests, blogging has fallen a bit behind in the face of licensing board exams, finals, and long hospital work hours. It doesn't help that my current bus lines do not have wireless... But you've seen an increase here and at The Differential of late. I am really excited about what is going down over at Clashing Culture in the next two weeks. Thanks to the strong work one of my co-bloggers there (Mike, also known as Tangled Up In Blue Guy), Clashing Culture will be hosting not one, not two, but three carnivals in the next two weeks.
On deck over there is:
- October 8: Carnival of the Liberals ... Liberal politics hosted by Mike
- October 8: Four Stone Hearth ... Anthropology hosted by me
- October 15: Carnival of Evolution ... Evolution hosted by Mike
Wednesday, October 01, 2008
it is finished
Step 2 Clinical Skills is in the rear view mirror, and I'm driving the speed limit. Which is only 55 on the freeway passing though my municipality.
Why only the speed limit? It's all those gruesome traumas I've seen in the ED were for folks driving ABOVE the limit...
Anyway.
I'm pretty sure I won't have to take the exam again.
Why only the speed limit? It's all those gruesome traumas I've seen in the ED were for folks driving ABOVE the limit...
Anyway.
I'm pretty sure I won't have to take the exam again.
Monday, September 29, 2008
Blame it on Congress
Before we all scream about how congress didn't pass a bill to give $7x10^11 to a bunch of fat cat bankers...
...don't forget about:
The bankers who lied to themselves.
And the loan applicants who lied to the lenders.
Oh! and the lenders who didn't care they were being lied to.
Boy, am I glad to be liquid!
...don't forget about:The bankers who lied to themselves.
And the loan applicants who lied to the lenders.
Oh! and the lenders who didn't care they were being lied to.
Boy, am I glad to be liquid!
Practice Question
A 30 year old colleague approaches you for a curbside consult. A friend of his who is 4 days status post a recent comprehensive psychiatry exam is now complaining of malaise, headache and frequent urination. He has rhinorrhea, and is complaining of frequent sneezing and a "throat tickle" that requires frequent clearing of his throat. He denies throat pain, ear pain, nausea or vomiting. Your colleague humored his friend with a brief physical exam. On exam, there were engorged nasal turbinates with profuse clear discharge, there was a mild white discoloration of pretonisilar pillars; tonsils were absent. His breath smelled faintly sweet. Bilateral mobile, tender, 3 cm sub-mandibular nodes were appreciated. Chest exam was clear. Further history revealed nocturnal urinary retention and dry mouth that awakens him several times at night. A thorough social history indicated the 'friend' felt a sense of impending doom, especially when presented with web-based tutorials. Your differential diagnosis includes:
A) Antihistamine use
B) Panic Disorder
C) Viral upper respiratory infection
D) USMLE Step 2 CK
E) Sleep disorder NOS
F) Caffeine dependence, sustained
G) Specific Phobia
A) Antihistamine use
B) Panic Disorder
C) Viral upper respiratory infection
D) USMLE Step 2 CK
E) Sleep disorder NOS
F) Caffeine dependence, sustained
G) Specific Phobia
Saturday, September 27, 2008
Eloped
My latest article at The Differential is about the medical use of the word, "elope." It probably won't get as much interest and commenting as my last article about firing patients and abortion.
Some of the critical comments responding to my entry suggested it was inappropriate for me to draw similarities between firing psych patients because you cannot help them any more and referring patients to another provider if you are uncomfortable not performing a procedure (namely, abortion). At the core of my argument is my concern that patients get the best care available, and that they should seek said care from the best individual able to provide it. Most of the rest took the opportunity to voice their own opinions about abortion in medicine. Some of my critics argue that all doctors should be willing to provide abortions (that's not going to happen). One reader questioned my disclosure that I was 'uneasy' with providing abortions myself. I'm not sure how to respond to that... Finally, one reader has argued that we must get over the fact that the country is divided about abortion. I would argue that adopting this perspective would effectively invalidate half of your patients' beliefs.
Some of the critical comments responding to my entry suggested it was inappropriate for me to draw similarities between firing psych patients because you cannot help them any more and referring patients to another provider if you are uncomfortable not performing a procedure (namely, abortion). At the core of my argument is my concern that patients get the best care available, and that they should seek said care from the best individual able to provide it. Most of the rest took the opportunity to voice their own opinions about abortion in medicine. Some of my critics argue that all doctors should be willing to provide abortions (that's not going to happen). One reader questioned my disclosure that I was 'uneasy' with providing abortions myself. I'm not sure how to respond to that... Finally, one reader has argued that we must get over the fact that the country is divided about abortion. I would argue that adopting this perspective would effectively invalidate half of your patients' beliefs.
Saturday, September 20, 2008
500 Coyotes
Earlier this week around 6 AM, we caught a glimpse of a bushy black-tipped tail. And this evening, there was the familiar refrain of yip yaweeee. What a great way to celebrate my 500th post! The introspective coyote, searching for his reflection in pavement puddles is not a bad representation of the recent self examination I've been doing in the residency application process.
I'm guessing this season will have more rain and introspection. Hopefully, more coyotes too!
Happy 500 to me!
I'm guessing this season will have more rain and introspection. Hopefully, more coyotes too! Happy 500 to me!
Thursday, September 18, 2008
More than Meets the Eye.
I love living in a world where this is news.
When the transformer malfunctioned, operating temperatures rose from below 2 Kelvin to 4.5 Kelvin -- extraordinarily cold by most standards, but warmer than the normal operating temperature.Isn't this so much better than what's her name's what's it called?
Wednesday, September 17, 2008
Controversy!
Abortion, psychiatry, firing patients: three issues that elicit strong emotions. So if you suffer from a panic disorder, you may not want to...
Read my latest entry at The Differential to get my take.
Otherwise, carry on!
Read my latest entry at The Differential to get my take.
Otherwise, carry on!
Monday, September 08, 2008
ERAS
I just finished uploading my personal statement, applied to 30 emergency medicine programs and shelled out $365 to the Electronic Residency Application Service (ERAS). That's just one dollar a day to feed an orphaned... wait, that must be something else. I'm just glad I have the opportunity to continue my training to be a physician. Since my wife and I are both applying, we have selected ten cities that have programs that appeal to both of us. They include (from west to east):The Bay Area
St. Louis
Chicago
Atlanta
Pittsburgh
DC/Baltimore
Philadelphia
New York
New Haven
Boston
St. Louis
Chicago
Atlanta
Pittsburgh
DC/Baltimore
Philadelphia
New York
New Haven
Boston
This is the end of one stressful task (applying), and the beginning of another (hopefully, interviewing!). Read my personal statement here.
Saturday, September 06, 2008
Palin, The Alaskan
My favorite local editorial cartoonist points out that just because you're from Alaska, doesn't mean you have the interests of wilderness in mind. And by one perspective, it's likely that your idea of custodianship is more akin to pillaging. 
We Washingtonians have an interesting relationship with Alaska politics: we're big trading partners, AK is a frequent vacation destination, most of the fishing fleet docks in Seattle's Ballard neighborhood, we share a medical school - okay that last one's not SO big a deal... This is the third or fourth consecutive shot at Go. Palin that Horsey has taken this week. I guess it's one way we look out for or meddle in the business of our neighbor to the north.
We Washingtonians have an interesting relationship with Alaska politics: we're big trading partners, AK is a frequent vacation destination, most of the fishing fleet docks in Seattle's Ballard neighborhood, we share a medical school - okay that last one's not SO big a deal... This is the third or fourth consecutive shot at Go. Palin that Horsey has taken this week. I guess it's one way we look out for or meddle in the business of our neighbor to the north.
Thursday, September 04, 2008
Me, In A Page
Lately, I've been diverting most of my wordsmithing to a one page document that may be the single determinant of where I spend the next four years of my life. Putting these ideas about science, medicine and society into a page has me really excited about a career in emergency medicine.
*****
One late summer night in Harborview Medical Center's emergency department, an exasperated medicine resident turned to me with a rhetorical question: “Who would want to treat homeless, drug-using prostitutes?” When I immediately thought, “I do,” I knew I was home. This epiphany at the end of a month in Seattle’s level one trauma center cemented my commitment to a career in emergency medicine. Contributing to the trauma team, working with a diversity of cases, the rapid progression from presentation to diagnosis to treatment, and the societal issues I pondered after each shift all conspired to entrench my connection to the ED.
My path to a career caring for the acutely ill started with dreams of building life support machines. As a clinical technician for the University of Pittsburgh's artificial heart program, I learned that invention and patient care have a tendency to interdigitate. The image of science and medicine clasping hands framed my motivation for earning a bioengineering PhD. I developed innovative new surgical, molecular and tissue engineering techniques as part of my thesis project to improve the viability of embryonic stem cell-derived cardiac tissue replacements for use after myocardial infarction. Long hours in the lab doing thoracotomies on mice and measuring with echocardiography the extent to which we were repairing infarctions introduced me to the importance of intellectual and manual dexterity in medicine. Experience suturing hundreds of rodents enabled me to consider each human laceration repair a new artistic challenge. My first successful ultrasound-guided basilic vein cannulation opened wide my appreciation for sonography in the ED. Emergency medicine requires mastery of numerous techniques and knowledge from many disciplines; this environment of collaborative innovation makes EM a perfect career for someone like me who wants to combine multiple skills and interests to provide the best care for patients.
The notion that today’s scholars have to focus narrowly on subdivided fields in order to make contributions to society contrasts with my perspective that the actors of social change must think deeply in multiple fields. As a graduate student working with human embryonic stem cells, I learned firsthand not only how scientific research occurs in the context of social and political concerns, but also that scientists and physicians are obligated to contribute to public dialogue. I am as proud of defining 'blastocyst' and 'in vitro fertilization' for stem cell research legislation in Washington State as I am of my labwork to further the potential of cardiac regeneration. Through a science policy group I co-founded, I planned campus-wide conversations about genetically modified food that spurred constructive conversations that continue more than three years later. Hosting President Clinton's science advisor to engage the University of Washington about the future of research funding in America offered a glimpse into the importance of sound science policy.
However, one needs look no further than county hospitals' waiting rooms to see that innovation in patient care is not merely a scientific enterprise – it needs to be a social one. Our current policy morass of underserved health care in America establishes emergency medicine as the front line for individuals seeking to heal people and the system. Solutions are not easy to find, especially from within the academic ivory tower; some of my understanding of the complexities of urban health care is grounded in relationships I've built over four years as an STD counselor for homeless teens. I aspire to be the emergency physician who draws on experience treating the neediest of patients to facilitate difficult conversations about health policy.
The ED is not merely a safety net. Challenging ethical dilemmas that emerge from a diversity of diseases, the urgent presentation of humanity in crisis, and the varied manner in which people respond to acute illness demand that emergency providers have ethical reasoning skills at the ready. The emergency room is a laboratory for teaching medical ethics; I hope to translate an “Ethics in the ER” course I developed for medical students at the University of Washington into a training tool for tomorrow's doctors. My experience designing this course has helped me understand better that educating others is a critical element of the practice of medicine. Teaching forces me to shore up topical understanding and requires communication accessible to a range of individuals: patients, students and colleagues. I look forward to an EM residency that provides both teaching role models and opportunities to refine my own skills.
Scientist, activist, writer, ethicist, engineer, doctor: for me, each of these roles supports the others. Rather than a collection of titles in separate contexts, I prefer the simple title of citizen-physician. There is deep meaning in the patient-physician interaction, both in the literal space of a sick person seeking care and as a metaphor for how physicians can improve society. My diverse and well-developed interests are ingredients for a career in emergency medicine that steps beyond discrete disciplines to address patients’ immediate health needs and improve the practice of medicine.
*****
One late summer night in Harborview Medical Center's emergency department, an exasperated medicine resident turned to me with a rhetorical question: “Who would want to treat homeless, drug-using prostitutes?” When I immediately thought, “I do,” I knew I was home. This epiphany at the end of a month in Seattle’s level one trauma center cemented my commitment to a career in emergency medicine. Contributing to the trauma team, working with a diversity of cases, the rapid progression from presentation to diagnosis to treatment, and the societal issues I pondered after each shift all conspired to entrench my connection to the ED.
My path to a career caring for the acutely ill started with dreams of building life support machines. As a clinical technician for the University of Pittsburgh's artificial heart program, I learned that invention and patient care have a tendency to interdigitate. The image of science and medicine clasping hands framed my motivation for earning a bioengineering PhD. I developed innovative new surgical, molecular and tissue engineering techniques as part of my thesis project to improve the viability of embryonic stem cell-derived cardiac tissue replacements for use after myocardial infarction. Long hours in the lab doing thoracotomies on mice and measuring with echocardiography the extent to which we were repairing infarctions introduced me to the importance of intellectual and manual dexterity in medicine. Experience suturing hundreds of rodents enabled me to consider each human laceration repair a new artistic challenge. My first successful ultrasound-guided basilic vein cannulation opened wide my appreciation for sonography in the ED. Emergency medicine requires mastery of numerous techniques and knowledge from many disciplines; this environment of collaborative innovation makes EM a perfect career for someone like me who wants to combine multiple skills and interests to provide the best care for patients.
The notion that today’s scholars have to focus narrowly on subdivided fields in order to make contributions to society contrasts with my perspective that the actors of social change must think deeply in multiple fields. As a graduate student working with human embryonic stem cells, I learned firsthand not only how scientific research occurs in the context of social and political concerns, but also that scientists and physicians are obligated to contribute to public dialogue. I am as proud of defining 'blastocyst' and 'in vitro fertilization' for stem cell research legislation in Washington State as I am of my labwork to further the potential of cardiac regeneration. Through a science policy group I co-founded, I planned campus-wide conversations about genetically modified food that spurred constructive conversations that continue more than three years later. Hosting President Clinton's science advisor to engage the University of Washington about the future of research funding in America offered a glimpse into the importance of sound science policy.
However, one needs look no further than county hospitals' waiting rooms to see that innovation in patient care is not merely a scientific enterprise – it needs to be a social one. Our current policy morass of underserved health care in America establishes emergency medicine as the front line for individuals seeking to heal people and the system. Solutions are not easy to find, especially from within the academic ivory tower; some of my understanding of the complexities of urban health care is grounded in relationships I've built over four years as an STD counselor for homeless teens. I aspire to be the emergency physician who draws on experience treating the neediest of patients to facilitate difficult conversations about health policy.
The ED is not merely a safety net. Challenging ethical dilemmas that emerge from a diversity of diseases, the urgent presentation of humanity in crisis, and the varied manner in which people respond to acute illness demand that emergency providers have ethical reasoning skills at the ready. The emergency room is a laboratory for teaching medical ethics; I hope to translate an “Ethics in the ER” course I developed for medical students at the University of Washington into a training tool for tomorrow's doctors. My experience designing this course has helped me understand better that educating others is a critical element of the practice of medicine. Teaching forces me to shore up topical understanding and requires communication accessible to a range of individuals: patients, students and colleagues. I look forward to an EM residency that provides both teaching role models and opportunities to refine my own skills.
Scientist, activist, writer, ethicist, engineer, doctor: for me, each of these roles supports the others. Rather than a collection of titles in separate contexts, I prefer the simple title of citizen-physician. There is deep meaning in the patient-physician interaction, both in the literal space of a sick person seeking care and as a metaphor for how physicians can improve society. My diverse and well-developed interests are ingredients for a career in emergency medicine that steps beyond discrete disciplines to address patients’ immediate health needs and improve the practice of medicine.
Sunday, August 31, 2008
Where'd I go?
Long Story Short:
My computer crashed and I've been busy studying for Step 2 of the medical board exam in the midst of a rather busy psychiatry service.
I'm still working on recovering everything from my old (Windows) lappy. Once that is done, I'll be more happy. Yes - that rhyme was sappy.
But at least I'm back.
My computer crashed and I've been busy studying for Step 2 of the medical board exam in the midst of a rather busy psychiatry service.
I'm still working on recovering everything from my old (Windows) lappy. Once that is done, I'll be more happy. Yes - that rhyme was sappy.
But at least I'm back.
Wednesday, August 20, 2008
Psyche Me In!
Just a brief update:
I finished the third day of my psychiatry clerkship this evening. The patients my team cares for are on the lowest acuity section of the floor, but that means there are a lot of interesting - and sad - personality disorders (versus the floridly psychotic). The learning curve is steep, but I think I'll get a basic hang of the topics in a few weeks. What I am really excited about is honing my interview skills. This is the perfect place for that.
I finished the third day of my psychiatry clerkship this evening. The patients my team cares for are on the lowest acuity section of the floor, but that means there are a lot of interesting - and sad - personality disorders (versus the floridly psychotic). The learning curve is steep, but I think I'll get a basic hang of the topics in a few weeks. What I am really excited about is honing my interview skills. This is the perfect place for that.
Tuesday, August 19, 2008
Big News!
One of the things that has been keeping me from posting new entries here is a little project I've been working on for the past 4 or 5 months. Today, I received an email from the chair of UW's Medical History and Ethics department that opened with,
I mean, "My, what a fine outcome. I cannot wait to see this effort come to full fruition." Or something.
The bottom line is that back in March, I was in the emergency department admitting a patient to the medicine floor when I ran into an emergency attending who I knew as a sophomore medical student back in what they call the day. We knew each other to be writers, so we caught up about each others' activities. She told me about a cool medical humanities 'zine she was writing a proposal for (since funded!). I told her about my gig at The Differential. And she mentioned an idea for teaching an ethics class based on cases from the ER.
Schreech!!! My mind and body did a double take.
I don't exactly recall what condition the patient I was admitting had, so will take some narrative privilege (and play the statistics) to report that I thought: "the guy with hepatic encephalopathy can wait a few more minutes." In truth, it was 3AM, we had already examined him and written orders and I was checking lab results in the fishbowl (which we call the central command center of the ER) before getting a couple hours of sleep. As usual, sleep takes the back seat.
The bottom line is that sleep was sacrificed for this project more than once. The opportunity to apply what has always been an extra-curricular (or at best co-curricular) interest in ethics to my chosen profession was amazing. As the chips lie today, this winter I'll be co-teaching (with the emergency medicine attending) a class to first through fourth year medical students called "Ethics in the ER." The curriculum is discussion oriented, is based on numerous actual cases, will employ a blog/discussion board and require a small amount of reading from medical humanities and ethics sources.
I think the curriculum we're developing is a unique approach in medical ethics education, and are excited about testing it and reporting our experiences for others to learn from and improve. I am also looking forward to a few more energized late nights turning theory into practice.
We are happy to endorse the plan for an ER Ethics course as you outline it, and look forward to providing it as an MHE offering.Whoop Whoop!
I mean, "My, what a fine outcome. I cannot wait to see this effort come to full fruition." Or something.
The bottom line is that back in March, I was in the emergency department admitting a patient to the medicine floor when I ran into an emergency attending who I knew as a sophomore medical student back in what they call the day. We knew each other to be writers, so we caught up about each others' activities. She told me about a cool medical humanities 'zine she was writing a proposal for (since funded!). I told her about my gig at The Differential. And she mentioned an idea for teaching an ethics class based on cases from the ER.
Schreech!!! My mind and body did a double take.
I don't exactly recall what condition the patient I was admitting had, so will take some narrative privilege (and play the statistics) to report that I thought: "the guy with hepatic encephalopathy can wait a few more minutes." In truth, it was 3AM, we had already examined him and written orders and I was checking lab results in the fishbowl (which we call the central command center of the ER) before getting a couple hours of sleep. As usual, sleep takes the back seat.
The bottom line is that sleep was sacrificed for this project more than once. The opportunity to apply what has always been an extra-curricular (or at best co-curricular) interest in ethics to my chosen profession was amazing. As the chips lie today, this winter I'll be co-teaching (with the emergency medicine attending) a class to first through fourth year medical students called "Ethics in the ER." The curriculum is discussion oriented, is based on numerous actual cases, will employ a blog/discussion board and require a small amount of reading from medical humanities and ethics sources.
I think the curriculum we're developing is a unique approach in medical ethics education, and are excited about testing it and reporting our experiences for others to learn from and improve. I am also looking forward to a few more energized late nights turning theory into practice.
Monday, August 18, 2008
Getting By On Metaphor
I take my metaphor extended, not mixed. Need proof? Read my latest post at The Differential. It's about the residency application and interview process. I'm only at the opening round of the process, and I've already had to lean on allegory. If John Bunyan were a senior medical student, I think he'd approve.
I am only slightly comforted by the fact that my understanding metaphor rules out certain psychiatric diseases. Today was day one of my psychiatry clerkship, and I've already determined that I'm one major depressive episode away from a Bipolar Type II. (Anyone who knows me can appreciate the hypomania I've experienced over the years. I guess I'll just have to settle for cyclothymia. And as my psych attending pointed out today, people don't get admitted for cyclothymia - it's just to close to normal!
By the way, look for additional self diagnoses in the next 6-10 weeks. I hear it's pretty common on the psychiatry clerkship!
I am only slightly comforted by the fact that my understanding metaphor rules out certain psychiatric diseases. Today was day one of my psychiatry clerkship, and I've already determined that I'm one major depressive episode away from a Bipolar Type II. (Anyone who knows me can appreciate the hypomania I've experienced over the years. I guess I'll just have to settle for cyclothymia. And as my psych attending pointed out today, people don't get admitted for cyclothymia - it's just to close to normal!
By the way, look for additional self diagnoses in the next 6-10 weeks. I hear it's pretty common on the psychiatry clerkship!
Thursday, August 14, 2008
The HIPAA in the Room
I've been a little gun-shy of my posts on Hope for Pandora recently. It seems as though a Seattle medical version of big brother may be watching... watching blogs. One of my friends - a blogging friend and real-life friend - was asked to remove material or shut his blog down because a compliance officer at a hospital where we train was concerned that certain of his posts violated patient confidentiality. Check out Noel's blog, aptly named, Constructive Procrastination.
I have sought to maintain the integrity of my writing by anonymizing my stories or asking permission of my patients to write about them or folding several patients into one pseudo-fictional account in the interest of telling a good story. Each of these techniques fall within the guidelines of the Healthcare Blogger Code of Ethics. What bothers me is that my friend had also observed these behaviors in his writing.
What bothers him is the manner in which he was approached. I'll let him tell the story in his own words, which started a couple of weeks ago. It seems as though our hospital wants to have more control over what gets into the public domain from experiences inside the hospital. Since I have vague aspiration to publish some of my own expereinces in a format more commercial than a blog, this got my ears up. After all, I already write for lunch money over at The Differential. I contacted folks in the community relations department before starting that gig - I wonder if someone else is trying to enforce some element of control or oversight on writers like me.
I think that my hospital administration is a little out of its league right now. One in ten Americans have tried their hand at blogging or something like it. I'm betting that health professionals are no exemption to that. I'm a little worried about an Orwellian move here. Why isn't the Health Care Blogger Code of Ethics or something like it good enough?
The compliance office may be full of friendly faces and good intentions, but do they really know what they are trying to do? Fortunately, my friend has volunteered to provide a voice for us bloggers.
I have sought to maintain the integrity of my writing by anonymizing my stories or asking permission of my patients to write about them or folding several patients into one pseudo-fictional account in the interest of telling a good story. Each of these techniques fall within the guidelines of the Healthcare Blogger Code of Ethics. What bothers me is that my friend had also observed these behaviors in his writing.
What bothers him is the manner in which he was approached. I'll let him tell the story in his own words, which started a couple of weeks ago. It seems as though our hospital wants to have more control over what gets into the public domain from experiences inside the hospital. Since I have vague aspiration to publish some of my own expereinces in a format more commercial than a blog, this got my ears up. After all, I already write for lunch money over at The Differential. I contacted folks in the community relations department before starting that gig - I wonder if someone else is trying to enforce some element of control or oversight on writers like me.
I think that my hospital administration is a little out of its league right now. One in ten Americans have tried their hand at blogging or something like it. I'm betting that health professionals are no exemption to that. I'm a little worried about an Orwellian move here. Why isn't the Health Care Blogger Code of Ethics or something like it good enough?
The compliance office may be full of friendly faces and good intentions, but do they really know what they are trying to do? Fortunately, my friend has volunteered to provide a voice for us bloggers.
Facebook Pages
Here's a little entry to bring the blogosphere and the facebookosphere (?) a little closer together.
I've recently joined some Facebook groups that some of my readers may be interested in:
I've recently joined some Facebook groups that some of my readers may be interested in:
- The American College of Emergency Physicians (ACEP), where I've started a little thread about ethics in emergency medicine.
- The American Scientific Affiliation - a group of Scientists who are Christians... all perspectives are welcome - even extreme ones - but most of us seek paths that makes the two fully compatible.
- The Student and Early Career Network of the ASA... there isn't a lot of support for younger Christians who are scientists. Perhaps this group could help with that.
- Science Bloggers. Yeah, I think I am one of those.
Saturday, August 09, 2008
Seven Years
August 9, 2001: A day that will live in infamy. (Among stem cell researchers, at least.)
That's when President Bush announced his policy regarding human embryonic stem cell research.
In remembrance of this day, I wrote up my thoughts at the seven year point over at Clashing Culture. In a way, I am glad Bush made that speech. I probably would not have gotten so invested in science policy and the public communication of science, may not have involved myself with FOSEP, and would not have developed a self-conception of myself as a citizen-scholar.
Whoa...
That's when President Bush announced his policy regarding human embryonic stem cell research.
In remembrance of this day, I wrote up my thoughts at the seven year point over at Clashing Culture. In a way, I am glad Bush made that speech. I probably would not have gotten so invested in science policy and the public communication of science, may not have involved myself with FOSEP, and would not have developed a self-conception of myself as a citizen-scholar.
Whoa...
Sovereign
Hopefully you've noticed that some battles between countries are not merely figurative (as in Beijing right now). As war breaks out between the small republic of Georgia and its enormous neighbor, one cannot help to recall parallels with previous conflicts between a superpower and a thorn in the side. And if you've any confusion about what I'm referring to, consider this snippet (made in Beijing, where the speaker had just eaten lunch with Russia's president):
“Georgia is a sovereign nation, and its territorial integrity must be respected,” Mr. Bush said in a hastily arranged appearance at his hotel. “We have urged an immediate halt to the violence and a stand down by all troops. We call for the end of the Russian bombings.”It seems to me (in my simple mind) that Russia's just taking a lesson from the good ole U S of A. I would like to see the above quotation replace 'Russia' with 'America' and 'Georgia' with 'Iraq.' but that's just me.
Thursday, August 07, 2008
With a Little Help From Your Friends
My latest article for Medscape's The Differential includes some tips about how to make the most of the teaching you'll encounter on your clinical rotations. If you listen closely, you'll encounter help from people all around you. 
Even from the gruffest nurses and most militaristic scrub techs. Check it out.
Even from the gruffest nurses and most militaristic scrub techs. Check it out.
Wednesday, August 06, 2008
Podcast From the ASA Meeting
The talk I gave last weekend at the annual meeting of the American Scientific Affiliation about blogging as a useful tool for talking about ethics, science and religion in the classroom and in the public sphere is online. Listen to it here. It features my motivations for blogging, my experience here and at Clashing Culture, and some ideas about how blogs could play a larger role in dialogue about science and society in the public and within the mission of the ASA.
Man, is it painful to listen to yourself. Follow the link to the audio file at your own risk. I'll figure out how to post my slides, too.
I did talk a little about PZ Myers and Pharyngula as an example of discussions about religion that are more one-sided than I like. What did not come across until late in the discussion was how PZ linking my page once was a great boost to my activities on the web. For his notice and the associated traffic it brought I am thankful.
I did meet some other bloggers at the conference. One of whom lives about two miles from me.
Don't worry! There will be plenty of responses to the meeting coming up, mostly at Clashing Culture. See you there!
Man, is it painful to listen to yourself. Follow the link to the audio file at your own risk. I'll figure out how to post my slides, too.
I did talk a little about PZ Myers and Pharyngula as an example of discussions about religion that are more one-sided than I like. What did not come across until late in the discussion was how PZ linking my page once was a great boost to my activities on the web. For his notice and the associated traffic it brought I am thankful.
I did meet some other bloggers at the conference. One of whom lives about two miles from me.
Don't worry! There will be plenty of responses to the meeting coming up, mostly at Clashing Culture. See you there!
Monday, August 04, 2008
In LA for an Exam
I'm typing this entry from a hotel in Los Angeles. A few days ago I was in Portland for a conference about issues in science and Christianity - more on that later.
Tomorrow I take an 8 hour clinical skills exam in which I interview (and am evaluated by) standardized patients who act as though they have diseases. For this opportunity to demonstrate my bedside manner and English proficiency, I get to pay about $1500. I'm sure I'll have more to say about that. My wife and I are taking the test at the same time, so at least we can split the hotel room!
We went for a walk around the neighborhood tonight - the test center is just across the street from a Raytheon plant. Yes, the same Raytheon that makes bombs and missiles. And there's a huge oil refinery in the other direction. Awesome...
Tomorrow I take an 8 hour clinical skills exam in which I interview (and am evaluated by) standardized patients who act as though they have diseases. For this opportunity to demonstrate my bedside manner and English proficiency, I get to pay about $1500. I'm sure I'll have more to say about that. My wife and I are taking the test at the same time, so at least we can split the hotel room!
We went for a walk around the neighborhood tonight - the test center is just across the street from a Raytheon plant. Yes, the same Raytheon that makes bombs and missiles. And there's a huge oil refinery in the other direction. Awesome...
Friday, August 01, 2008
Carnivals!
Hey You!
Go check out two recent blog carnivals that I happen to have entries featured in. There's a moving collection of "Why I'm in medicine" posts at the Grand Rounds hosted by Edwin Leap, and my Differential colleague, Ben Ferguson assembled and reviewed a great collection of cancer articles at nosugrefneb.
Go check out two recent blog carnivals that I happen to have entries featured in. There's a moving collection of "Why I'm in medicine" posts at the Grand Rounds hosted by Edwin Leap, and my Differential colleague, Ben Ferguson assembled and reviewed a great collection of cancer articles at nosugrefneb.
Thursday, July 31, 2008
Code-I-fied
I am now certified by the American Heart Association to run a code.
Should someone stop breathing, drop her heart rate below 50, pass out, develop hypothermia, have a stroke, elevate his heart rate to more than 150 at rest, have a heart attack, not have a pulse, or otherwise become unresponsive, I have the requisite knowledge, practice and peace of mind to direct complete life saving measures. In other words, I am ACLS certified.
This does not apply to kids or to individuals who arrive at a compromised state because of trauma. Even so, it's pretty amazing.
And to think four weeks ago I was arguing my case about an unfair grade.
One more night shift for me, then a weekend conference in Portland, than an oral clinical examination in Los Angeles, then...
...back to regular blogging!
Should someone stop breathing, drop her heart rate below 50, pass out, develop hypothermia, have a stroke, elevate his heart rate to more than 150 at rest, have a heart attack, not have a pulse, or otherwise become unresponsive, I have the requisite knowledge, practice and peace of mind to direct complete life saving measures. In other words, I am ACLS certified.
This does not apply to kids or to individuals who arrive at a compromised state because of trauma. Even so, it's pretty amazing.
And to think four weeks ago I was arguing my case about an unfair grade.
One more night shift for me, then a weekend conference in Portland, than an oral clinical examination in Los Angeles, then...
...back to regular blogging!
Friday, July 25, 2008
Typing My Way Through
I've been typing my way through the dark hours in an effort to maintain the night schedule I'm currently assigned to on my emergency medicine clerkship. Only six shifts remain in this 4 week marathon sprint through emergency medicine. My lists from the ER have grown long with procedures learned, diseases treated, and stories both of pain and resilience. This evening I've bounced between editing my residency application's personal statement, that left-over of a paper from grad school that just can't seem to make its way into print, blog posts here and elsewhere, a presentation about blogging in the public sphere for a meeting of the American Scientific Affiliation, and a few case studies for an ethics class I hope to help teach in the Winter quarter. Typing my way through the night, indeed!
As the morning dusk transitions into the early hues of dawn, I realize that there's more than just productive work going on here. Sunrise has always inspired reflection in me. Context is an important historical factor here: 2 AM weariness has been reliably rewarded with 5 AM ebullience secondary to completing a project or assignment; early rising is often associated with an exciting day's activity; waking up with the sun reminds me of fond camping memories.
Today seems different to me, however. The sun is rising on my day in the context of deliberate introspection. Whether it be blogging recent experiences in the emergency room or dissecting (massacring?) the one-page personal statement, tonight prepped me to reflect on more than just why I do medicine. Why do I write? Why do I love? Why teach? Why make art? Why work so hard?
Maybe it's that built-in ecstasy of the morning, but today the answers to each of these for me is all so clear. And I think it's the same for many people, and especially health care workers.
In family life. In students' learning. In patients' health. In my own health. In my community. In...
Sure, there are other subtle or specific reasons for doing the things I do, and other large parallel motivations exist for how I carry on and prioritize my activities. My personal faith, for example is a dominating motivator and inspiration for me.
My "a-ha" this morning was due to my realization that each of the major pillars of my sense of self is linked to the other. I write to help myself through the trials of medicine or love. I teach to build understanding - in myself and others - of the interrelation of the human condition through art, science and medicine. Medicine helps inform my writing, teaching, and how I love friends, family and fellow man. I work to fill in gaps that will always persist - in my own understanding, between rich and poor, and between sickness and health.
All of this is too vague and flowery for a personal statement, but nothing's off limits for blogs, right? When it comes down to it, I'm training to be a doctor because I love. Walking along side people for a little while in times when they need help doesn't sound so bad to me as a profession. But balancing self-care and care for others is a trick for anyone invested in others' personal lives. For me, it's a lot easier when the facets of life are tied to central principles.
Interconnectivity of personal purpose has worked for me. Is there a reason I do this or that? For me, the answer is yes even though I'm be able to put my finger on it at the time. For example, I started blogging in the dark days (they usually hit around the third year) of graduate school; writing generated in me a greater comprehension of calling. If only because it was so helpful then, you can expect to find me typing my way through future joys and struggles as well.
And now, I must go wake my wife. My goodnight kiss is her good morning. Today, I'm an alarm clock, too.
As the morning dusk transitions into the early hues of dawn, I realize that there's more than just productive work going on here. Sunrise has always inspired reflection in me. Context is an important historical factor here: 2 AM weariness has been reliably rewarded with 5 AM ebullience secondary to completing a project or assignment; early rising is often associated with an exciting day's activity; waking up with the sun reminds me of fond camping memories.
Today seems different to me, however. The sun is rising on my day in the context of deliberate introspection. Whether it be blogging recent experiences in the emergency room or dissecting (massacring?) the one-page personal statement, tonight prepped me to reflect on more than just why I do medicine. Why do I write? Why do I love? Why teach? Why make art? Why work so hard?
Maybe it's that built-in ecstasy of the morning, but today the answers to each of these for me is all so clear. And I think it's the same for many people, and especially health care workers.
I seek to make a difference.
In family life. In students' learning. In patients' health. In my own health. In my community. In...
Sure, there are other subtle or specific reasons for doing the things I do, and other large parallel motivations exist for how I carry on and prioritize my activities. My personal faith, for example is a dominating motivator and inspiration for me.
My "a-ha" this morning was due to my realization that each of the major pillars of my sense of self is linked to the other. I write to help myself through the trials of medicine or love. I teach to build understanding - in myself and others - of the interrelation of the human condition through art, science and medicine. Medicine helps inform my writing, teaching, and how I love friends, family and fellow man. I work to fill in gaps that will always persist - in my own understanding, between rich and poor, and between sickness and health.
All of this is too vague and flowery for a personal statement, but nothing's off limits for blogs, right? When it comes down to it, I'm training to be a doctor because I love. Walking along side people for a little while in times when they need help doesn't sound so bad to me as a profession. But balancing self-care and care for others is a trick for anyone invested in others' personal lives. For me, it's a lot easier when the facets of life are tied to central principles.
Interconnectivity of personal purpose has worked for me. Is there a reason I do this or that? For me, the answer is yes even though I'm be able to put my finger on it at the time. For example, I started blogging in the dark days (they usually hit around the third year) of graduate school; writing generated in me a greater comprehension of calling. If only because it was so helpful then, you can expect to find me typing my way through future joys and struggles as well.
And now, I must go wake my wife. My goodnight kiss is her good morning. Today, I'm an alarm clock, too.
Blogging My Needle Stick
Taking my lead from ScienceBloggers Abel, who blogged his vasectomy, Dr. Free-Ride, who blogged her mammogram, or Zuska, who blogged her dilation and curettage, I decided to blog a recent personal medical experience of my own: a dirty needle stick.
Working in the Harborview emergency room is a unique experience. Medical students have the unique opportunity to be 'doctor' for a large number of patients. Yes, we have supervision... but if a case is straight-forward, we are permitted, correction, expected to manage the patients' care from start to finish. Students also see a large number of complex cases. Typical large hospitals may see 4 or 5 traumas roll through the door in a day. Regional trauma centers like Harborview commonly receive 50 medivac, airlift or medic arrivals each day. Medical students only manage the most simple of these cases, and even then, it's under the close eye of two residents and an attending physician.
It was in one of these cases that I incurred my first dirty needle stick.
Before this time, I'd never actually stuck myself with a needle. Five hundred rodent thoracotomies and a year in medical school, and never once had I punctured my skin with a suture or injection needle. My clean streak ended in the Harborview ER.
We received a morning transfer from a hospital in Montana. The announcement had come in over intercom that an intubated young man with a gunshot wound to the face was in transit. Only the basics are conveyed in these announcements, the dispatch only relays information critical to receiving the patient and supporting him. Often, GSWs (as they are referred to on the patient board) come with no warning. Rooms are already equipped to handle victims' emergent needs. By the time that "Airlift is through the door" was announced, I was in the room ready to help with the case.
My extensive (for a medical student) experience with delicate surgeries comes in handy in the trauma bays. I am happy to suture head and hand lacerations for the busy residents, and I take pride in my skillful artistry. (Although, I am careful not to tell patients where I got all of my experience.) By some miracle, the large gage bullet missed the jugular vein and carotid artery. It had destroyed most of the right half of the jaw and torn open the neck below where the angle of the jaw had been. Without major vessel damage, it was clear that some temporary repair would be performed before the patient went to the operating room; I made sure I was in the right place to help. By the time the ear nose and throat (ENT) surgeon came down to the ER, I had washed the wound with five liters of warm sterile saline. The surgeon was a young resident. At the time, I made no notice - owing to my extra-medical education, most of the residents are younger than I am. But this guy might fly in the face of a previous argument I made in the debate over whether it's more dangerous to get sick in July than any other month.
In the hierarchy of medicine, there is one way to make suggestions to superiors that helps get around the delicacy of status. It's the "would you like me to" question. Medical students and residents should always pay attention to the friendly nurse who asks, "would you like me to send this blood for lactate and enzymes, too?" or the physician's assistant who asks "would you like me to sign an order for labetasol? I've had good success turning this into a nice approach to suggest we do something with minimal toe steppage. In this case, I asked:
At my hospital, one employee per day experiences a needle stick. It is so common among health care providers that there are highly standardized approaches to dealing with the experience. The first steps occur in the ER. Fortunately for me, I was already there and everyone I came in contact with worked in an efficient manner. Along with the compassionate first year surgery resident who later that day asked if I wanted to talk about my experience, or the attending who checked in by email several days later, the efficiency of the process counter-balance my building worry with a sense of support. None of them knew that my wife was on vacation out of the country and that I might not have anyone at home to talk about this with. They were just there.
So what is the risk of needle stick injuries in contracting blood-borne diseases? My reading suggests the average risk for HIV transmission after percutaneous exposure to infected blood is low - about 3 per 1,000 injuries. And that is with exposure to infected blood. The other killers to worry about are the hepatitis B and C injuries, and they have much greater transmission rates. Transmission in needle sticks with exposure to the hepatitis B virus is 30% and could be as high as 10% for the hepatitis C virus. Like all health care workers, I am immunized against Hep B. There are a host of other diseases transmissible by blood (see this nice Canadian site for more info), but I was most worried about Hep C and HIV. There are no cures or vaccines for these diseases, but there are decent treatments for them. In particular, immediate use of anti-retroviral drugs have good evidence of reducing transmission from needle sticks. But did I want to take them? This returns me to the specifics of my situation. Much of medicine is paying attention to the history; this case's history is obscured because the patient was intubated and communicating via hand squeezes, and that his family was still en route.
The patient was a young man from rural Montana. Epidemiologically, that cuts his risk of having HIV or Hep C. But why was he shot? The story at the time was that he was snooping around a hermit's shack at 2:00 in the morning. My hunch was that illegal behavior was involved. Fair or not, at the time, this element increased my perceived risk of his being seropositive. In my head, I quickly came to the conclusion that my chances of catching one of the big three were very small, but not non-existent. I made the quick decision to take a dose of Truvada.
Whenever there is a dirty needle stick, the potential donor's and the stuck person's blood are sent for testing. This information is used both to treat or reassure the stuck employee and to establish a record of serotype. Usually the patient who's blood contaminated the needle must give consent for the tests, but in the case of an unaccompanied unresponsive patient, this makes matters more difficult. So my blood was sent, and eventually his was. (By the way, this information is divorced from the patient's or my medical record, for both confidentiality and billing purposes.) When the rapid antibody-based HIV test returned negative, I was comforted, but not quite enough to stop taking the anti-retrovirals. Anyone who's taken or given an HIV test should know about the "window period." This is the time it takes for the immune system to seroconvert: it's the interval between infection and a measurable level of antibodies in the blood. For HIV, this is about 6 weeks, but many still use 3 months as a fallback number. The antibody test can therefore only tell you the HIV status of a person three months ago. There's another, more expensive test that measures the virus rather than the human antibody to the virus. It uses genetic amplification to look for viral genetic markers. This can both reveal virus before antibodies are formed and tell physicians how much virus is in the blood (and therefore, more about the patient's symptoms and disease progression). I decided to request this test. After all, if this young man recently took to exploring hermits' shacks, what's to say he hasn't experimented with new drugs or sexual practices?
This argument was barely enough to convince the employee health director to proceed with the genetic test on the patient's blood and required me to take two more days of the one-a-day emtricitabine/tenofovir combo drug. After several conversations opening with my telling her my mother's maiden name, I learned that my serologies and the patient's were all consistent with no infections or infectivity. By then the stress of this experience had faded into just another experience in the Harborview ER. I'll probably be stuck again, and next time, probably won't seek the viral PCR test. But will I take the anti-retroviral immediately after the exposure? You betcha! With no side effects and once a day treatment, the only reservation is cost. I don't know how much one Truvada pill costs because my hospital paid for it. By the time the next stick occurs, the state of diagnosis and prophylaxis for HIV and Hep C may have changed. Perhaps there will even be vaccines.
Perhaps.
Working in the Harborview emergency room is a unique experience. Medical students have the unique opportunity to be 'doctor' for a large number of patients. Yes, we have supervision... but if a case is straight-forward, we are permitted, correction, expected to manage the patients' care from start to finish. Students also see a large number of complex cases. Typical large hospitals may see 4 or 5 traumas roll through the door in a day. Regional trauma centers like Harborview commonly receive 50 medivac, airlift or medic arrivals each day. Medical students only manage the most simple of these cases, and even then, it's under the close eye of two residents and an attending physician.
It was in one of these cases that I incurred my first dirty needle stick.
Before this time, I'd never actually stuck myself with a needle. Five hundred rodent thoracotomies and a year in medical school, and never once had I punctured my skin with a suture or injection needle. My clean streak ended in the Harborview ER.
We received a morning transfer from a hospital in Montana. The announcement had come in over intercom that an intubated young man with a gunshot wound to the face was in transit. Only the basics are conveyed in these announcements, the dispatch only relays information critical to receiving the patient and supporting him. Often, GSWs (as they are referred to on the patient board) come with no warning. Rooms are already equipped to handle victims' emergent needs. By the time that "Airlift is through the door" was announced, I was in the room ready to help with the case.
My extensive (for a medical student) experience with delicate surgeries comes in handy in the trauma bays. I am happy to suture head and hand lacerations for the busy residents, and I take pride in my skillful artistry. (Although, I am careful not to tell patients where I got all of my experience.) By some miracle, the large gage bullet missed the jugular vein and carotid artery. It had destroyed most of the right half of the jaw and torn open the neck below where the angle of the jaw had been. Without major vessel damage, it was clear that some temporary repair would be performed before the patient went to the operating room; I made sure I was in the right place to help. By the time the ear nose and throat (ENT) surgeon came down to the ER, I had washed the wound with five liters of warm sterile saline. The surgeon was a young resident. At the time, I made no notice - owing to my extra-medical education, most of the residents are younger than I am. But this guy might fly in the face of a previous argument I made in the debate over whether it's more dangerous to get sick in July than any other month.
In the hierarchy of medicine, there is one way to make suggestions to superiors that helps get around the delicacy of status. It's the "would you like me to" question. Medical students and residents should always pay attention to the friendly nurse who asks, "would you like me to send this blood for lactate and enzymes, too?" or the physician's assistant who asks "would you like me to sign an order for labetasol? I've had good success turning this into a nice approach to suggest we do something with minimal toe steppage. In this case, I asked:
- Would you like me to make a sterile field around the wound?
- What size gloves do you wear?
- What do you think about clamping this small artery? and
- Would you like me to move the sharps off your field?
At my hospital, one employee per day experiences a needle stick. It is so common among health care providers that there are highly standardized approaches to dealing with the experience. The first steps occur in the ER. Fortunately for me, I was already there and everyone I came in contact with worked in an efficient manner. Along with the compassionate first year surgery resident who later that day asked if I wanted to talk about my experience, or the attending who checked in by email several days later, the efficiency of the process counter-balance my building worry with a sense of support. None of them knew that my wife was on vacation out of the country and that I might not have anyone at home to talk about this with. They were just there.
So what is the risk of needle stick injuries in contracting blood-borne diseases? My reading suggests the average risk for HIV transmission after percutaneous exposure to infected blood is low - about 3 per 1,000 injuries. And that is with exposure to infected blood. The other killers to worry about are the hepatitis B and C injuries, and they have much greater transmission rates. Transmission in needle sticks with exposure to the hepatitis B virus is 30% and could be as high as 10% for the hepatitis C virus. Like all health care workers, I am immunized against Hep B. There are a host of other diseases transmissible by blood (see this nice Canadian site for more info), but I was most worried about Hep C and HIV. There are no cures or vaccines for these diseases, but there are decent treatments for them. In particular, immediate use of anti-retroviral drugs have good evidence of reducing transmission from needle sticks. But did I want to take them? This returns me to the specifics of my situation. Much of medicine is paying attention to the history; this case's history is obscured because the patient was intubated and communicating via hand squeezes, and that his family was still en route.
The patient was a young man from rural Montana. Epidemiologically, that cuts his risk of having HIV or Hep C. But why was he shot? The story at the time was that he was snooping around a hermit's shack at 2:00 in the morning. My hunch was that illegal behavior was involved. Fair or not, at the time, this element increased my perceived risk of his being seropositive. In my head, I quickly came to the conclusion that my chances of catching one of the big three were very small, but not non-existent. I made the quick decision to take a dose of Truvada.
Whenever there is a dirty needle stick, the potential donor's and the stuck person's blood are sent for testing. This information is used both to treat or reassure the stuck employee and to establish a record of serotype. Usually the patient who's blood contaminated the needle must give consent for the tests, but in the case of an unaccompanied unresponsive patient, this makes matters more difficult. So my blood was sent, and eventually his was. (By the way, this information is divorced from the patient's or my medical record, for both confidentiality and billing purposes.) When the rapid antibody-based HIV test returned negative, I was comforted, but not quite enough to stop taking the anti-retrovirals. Anyone who's taken or given an HIV test should know about the "window period." This is the time it takes for the immune system to seroconvert: it's the interval between infection and a measurable level of antibodies in the blood. For HIV, this is about 6 weeks, but many still use 3 months as a fallback number. The antibody test can therefore only tell you the HIV status of a person three months ago. There's another, more expensive test that measures the virus rather than the human antibody to the virus. It uses genetic amplification to look for viral genetic markers. This can both reveal virus before antibodies are formed and tell physicians how much virus is in the blood (and therefore, more about the patient's symptoms and disease progression). I decided to request this test. After all, if this young man recently took to exploring hermits' shacks, what's to say he hasn't experimented with new drugs or sexual practices?This argument was barely enough to convince the employee health director to proceed with the genetic test on the patient's blood and required me to take two more days of the one-a-day emtricitabine/tenofovir combo drug. After several conversations opening with my telling her my mother's maiden name, I learned that my serologies and the patient's were all consistent with no infections or infectivity. By then the stress of this experience had faded into just another experience in the Harborview ER. I'll probably be stuck again, and next time, probably won't seek the viral PCR test. But will I take the anti-retroviral immediately after the exposure? You betcha! With no side effects and once a day treatment, the only reservation is cost. I don't know how much one Truvada pill costs because my hospital paid for it. By the time the next stick occurs, the state of diagnosis and prophylaxis for HIV and Hep C may have changed. Perhaps there will even be vaccines.
Perhaps.
Thursday, July 24, 2008
Market Research
Hi there,
Every so often it's nice to hear from regular readers. Toward that end, DrugMonkey threw out a meme that I thought was worth a try. But instead of posting something on your own blog, all you have to do is post an anonymous (or nominous, I guess) comment. If you read regularly and I don't know about it, it would be nice to hear a little bit about who you are. These days, I think most of my readers come in via google searches because I am not putting much content out, what with my insane schedule. Anyway, here's your charge dear reader:
Every so often it's nice to hear from regular readers. Toward that end, DrugMonkey threw out a meme that I thought was worth a try. But instead of posting something on your own blog, all you have to do is post an anonymous (or nominous, I guess) comment. If you read regularly and I don't know about it, it would be nice to hear a little bit about who you are. These days, I think most of my readers come in via google searches because I am not putting much content out, what with my insane schedule. Anyway, here's your charge dear reader:
Tell me about you. Who are you? Do you have a background in science or medicine? If so, what draws you here as opposed to meatier, more academic fare? And if not, what brought you here and why have you stayed?Have a nice day.
Drug Seekers
We see a lot of folks looking for pain meds in the ER. I collected some thoughts in a piece at The Differential that you may be interested in reading.
My hectic schedule precludes me from writing around here these days. After my county hospital ER experience, I'll be back! I'm taking notes (on regular paper!) about entries for later.
My hectic schedule precludes me from writing around here these days. After my county hospital ER experience, I'll be back! I'm taking notes (on regular paper!) about entries for later.
Monday, July 21, 2008
The Switch
The emergency room is open for 24 hours. And the bigger ones are busy the whole time. A career in emergency medicine requires the ability to work at odd hours. Not long hours - 'full time' in many big ERs could be ten 8-12 hour shifts a month - but odd ones. Who wants to work the 10P to 6A shift every time? As such, ER docs must learn to sleep at any hour and work at any hour. The same applies to medical students. My emergency medicine rotation is 4 weeks long. Students spend two weeks on a day shift and then two weeks on nights. In 90 minutes I start my first night shift.
"The switch" as some call it is tough; there's probably a reason humans evolved with circadian rhythms. (I wonder what's been done in the evolution and development field on that!) I tried a couple of adaptation techniques. Who knows if they will help me to be alert tonight. So far, I:
"The switch" as some call it is tough; there's probably a reason humans evolved with circadian rhythms. (I wonder what's been done in the evolution and development field on that!) I tried a couple of adaptation techniques. Who knows if they will help me to be alert tonight. So far, I:
- Worked an extra shift (Saturday night after a day shift, for a total of about 22 hours) I figured this would make me tired enough to sleep through the days. But then I didn't work Sunday night... And it was impossible to stay awake at home.
- Slept whenever I felt like it... naps here and there - atleast 90 mins to increase the likelyhood of getting a full sleep cycle in.
- Rested when I was awake: reading, writing, watching a movie. Nothing that would make my body tired.
- Took some benedryl around noon. I wasn't sure I would get any napping in, so wanted to seal the deal. It's a pretty good sleep aid for me.
- Abstained from caffeine. I think it works well for me in regular intervals, and maybe if I have a can of DMD on my way in tonight, that will help me get back on track.
Thursday, July 17, 2008
Three More Shifts
I've the day off today! For those of you reading for updates from my time in medical school, here's another bullet list. It's not as comprehensive as the last one, but still gives a picture. I'll have more substantive entries later, but I must finish my residency personal statement and the paper resubmission today. Here's an abridged sum list from my most recent three shifts:
- 1400: estimated calories consumed, per day
- 1 femoral stick for blood gasses
- 21 smelly socks removed
- 2 trauma patients under my care (As in my name was on the board as the doc, but several people were helping me/watching my back as I was placing the orders)
- 1 advanced directive conversation
- 2 cases of gout
- 207/156: BP of one of the gout patients
- 6 cans of Mountain Dew consumed
- 1 needle stick
- 2 doses of Truvada taken
- 6 different bus routes ridden
- 5 IV's placed in one day (my highest count)
- 1 thoracotomy in the ER (observed, only!)
- 2 severed fingers
- 7 consultations with social work
Mistakes in Medicine
Rarely a day goes by in the medical student's day without him making a mistake. Some are more grievous than others. Yesterday, for example, I lost my clipboard for about 45 minutes. Fortunately, I only was looking for it for 10.
Anyway, early in my emergency medicine rotation, I made a mistake that is one from the category, "to learn from."
Then I wrote a little about my experience over at The Differential. Go there to read it.
Anyway, early in my emergency medicine rotation, I made a mistake that is one from the category, "to learn from."
Then I wrote a little about my experience over at The Differential. Go there to read it.
The Internets
The internets are back at my house!
After almost 3 weeks without the line, we now have connectivity.
You'll see a few more posts from me here and elsewhere, but not many, owing to the insane schedule I've been keeping.
Later!
After almost 3 weeks without the line, we now have connectivity.
You'll see a few more posts from me here and elsewhere, but not many, owing to the insane schedule I've been keeping.
Later!
Saturday, July 12, 2008
Shift Work
I was amazed to learn that in one month, a full-time emergency medicine physician works about 10 shifts of 8-12 hours each. That hardly seems fitting for a 6-digit salary.
After four back-to-back 12 hour shifts at Seattle's Level 1 trauma center, I think I understand what's going on here. Half a week at Harborview's ER kicked the crap out of me! Here are some relevant random statistics from my four day marathon:
By the way, others are currently blogging about time in the Harborview ED. Check out Constructive Procrastination. Noel is my diametric opposite in terms of shifts: he is medicine nights and I am surgery days. That doesn't keep us from feeling some of the same things about the rotation.
After four back-to-back 12 hour shifts at Seattle's Level 1 trauma center, I think I understand what's going on here. Half a week at Harborview's ER kicked the crap out of me! Here are some relevant random statistics from my four day marathon:
- 1 showdown of thumb vs. nail
- 11 IV placements (15 attempts)
- 3 rectal exams
- 10 hours on Metro buses
- 7 rainbow series (fresh sticks, not from IV access)
- 17 log rolls
- 2.5: number of hours extra I slept on my day off
- 4 admissions
- 13 hot dogs eaten
- 3: number of times I checked my email
- 1 shoulder reduction
- 1 patient departure against medical advice
- 5 assaults
- 2 codes
- 8 pounds lost
- 4 drug seekers
- 1 call to a friend for moral support
- 5 mistakes (that I know of)
- 0 patients signed-out
- 2 injured firemen
- 3 interpreters
- 2 times I wished I could go home
- 5 times I wished I was still at the hospital
- 21 clothing fibers removed from wounds
- 5 digital nerve blocks
- 2 abscesses drained
- 3 patients seen on the street after I treated them
- 10 minutes: the amount of time I felt in control
- 4 injuries involving balls
- 2 radial artery blood gas samples
- 2700 calories eaten per day (approximate)
- 5 different running lists of what I've experienced
By the way, others are currently blogging about time in the Harborview ED. Check out Constructive Procrastination. Noel is my diametric opposite in terms of shifts: he is medicine nights and I am surgery days. That doesn't keep us from feeling some of the same things about the rotation.
A Big Burly Joke
A few weeks ago, I came up with what I thought was a great riddle. After none of my hand-picked readers figured it out, my wife suggested I rephrase it in the form of a joke. One intrepid reader offered a good guess (Burl Ives Trio) that was not what I was looking for.
So for those of you reading this for the first time, here is an (improved?) version of the joke:
A surgeon, a pathologist and an oncologist are hiking through forest when they encounter a burly tree (shown at left). Curious by nature, they sit down to ponder their discovery. Of course, the surgeon proposes to cut open one burl. The pathologist thinks that's a good idea; she whips out her pocket microscope to examine it. The oncologist goes on about a two-hit hypothesis and proposes dumping toxic chemicals onto the tree's base. What do you call this conclave of MDs which also happens to be a name for the piece of wood being examined by the pathologist?
A Tumor Board!
I tried to tell this riddle/joke at a recent party I held at my house when I realized that a few years ago, I had actually sliced up a small burl with the intent to make a set of coasters out of them. (The slices warped, and will need additional work to make them functional.) I got some laughs, but not because of the joke. Mostly, my guests thought something about the back-story was hilarious.
This group of mostly medical professionals proceeded to hypothesize the origins of burls. We all decided burls are some sort of tumor. Perhaps it's caused by a genetic cancer, but also perhaps by insects, fungus or viral disease. (Viruses cause tumors in humans, too!) That burls often congregate in groves could support a genetic or infectious cause. But the tendency for burls to form on golf courses and orchards speaks to a traumatic origin. Maybe the burls I saw in Alaska are residual from moose antler scraping behaviors or aborted assaults by beaver?
For those out there who have never heard of the second meaning of "tumor board," you will probably not think this as funny as I did (and still do, by the way). At most hospitals, there is a special meeting of specialists every week that serves to discuss the new, complex or complicated cancer diagnoses. Since every cancer is a little bit different, and every patient is different, you can imagine there could be a very large number of approaches to cancer therapy. In an effort to provide the best care, pathologists (who have the final word on diagnosis), surgeons (who provide the important skills to remove some tumors) and oncologists (typically the doctor in most contact with the patient) all meet to present and deliberate information. This meeting is called a tumor board.
So for those of you reading this for the first time, here is an (improved?) version of the joke:
A surgeon, a pathologist and an oncologist are hiking through forest when they encounter a burly tree (shown at left). Curious by nature, they sit down to ponder their discovery. Of course, the surgeon proposes to cut open one burl. The pathologist thinks that's a good idea; she whips out her pocket microscope to examine it. The oncologist goes on about a two-hit hypothesis and proposes dumping toxic chemicals onto the tree's base. What do you call this conclave of MDs which also happens to be a name for the piece of wood being examined by the pathologist?A Tumor Board!
I tried to tell this riddle/joke at a recent party I held at my house when I realized that a few years ago, I had actually sliced up a small burl with the intent to make a set of coasters out of them. (The slices warped, and will need additional work to make them functional.) I got some laughs, but not because of the joke. Mostly, my guests thought something about the back-story was hilarious.
This group of mostly medical professionals proceeded to hypothesize the origins of burls. We all decided burls are some sort of tumor. Perhaps it's caused by a genetic cancer, but also perhaps by insects, fungus or viral disease. (Viruses cause tumors in humans, too!) That burls often congregate in groves could support a genetic or infectious cause. But the tendency for burls to form on golf courses and orchards speaks to a traumatic origin. Maybe the burls I saw in Alaska are residual from moose antler scraping behaviors or aborted assaults by beaver?
For those out there who have never heard of the second meaning of "tumor board," you will probably not think this as funny as I did (and still do, by the way). At most hospitals, there is a special meeting of specialists every week that serves to discuss the new, complex or complicated cancer diagnoses. Since every cancer is a little bit different, and every patient is different, you can imagine there could be a very large number of approaches to cancer therapy. In an effort to provide the best care, pathologists (who have the final word on diagnosis), surgeons (who provide the important skills to remove some tumors) and oncologists (typically the doctor in most contact with the patient) all meet to present and deliberate information. This meeting is called a tumor board.
July is the Cruelest Month
Have you heard the medical maxim that you shouldn't get sick in July because that's when new residents take over in training hospitals?
I take issue with this perspective over at Medscape's student blog, The Differential. Check it out.
I take issue with this perspective over at Medscape's student blog, The Differential. Check it out.
Saturday, July 05, 2008
Back Home
My past two weeks included travel to locations that were either the furthest north I have ever been or the furthest south. I left Fairbanks, Alaska on a Wednesday, took an exam in Seattle on a Friday, then flew for a vacation in Ixtapa and Zihuatenejo on Monday. That expanded my latitude latitude by 9.5° north and 1.5° south for an expansion of 11°
Fairbanks: 64° 50' 16" N
Zihuatenejo: 17° 37' 59" N
Previous North: Northern Ireland 55° 10' 0" N
Previous South: Hawaii (Big Island) 19° 3' 51" N
Anyway, I'm back home and studying in preparation for my emergency medicine rotation at Seattle's county hospital and trauma center: Harborview Medical Center. I'm also getting a bunch of entries ready for posting here, at Clashing Culture and at The Differential. Now all I need is to finish setting up internet at home!
Want to figure out the latitudes and longitudes for city places? I found this website helpful.
Fairbanks: 64° 50' 16" N
Zihuatenejo: 17° 37' 59" N
Previous North: Northern Ireland 55° 10' 0" N
Previous South: Hawaii (Big Island) 19° 3' 51" N
Anyway, I'm back home and studying in preparation for my emergency medicine rotation at Seattle's county hospital and trauma center: Harborview Medical Center. I'm also getting a bunch of entries ready for posting here, at Clashing Culture and at The Differential. Now all I need is to finish setting up internet at home!
Want to figure out the latitudes and longitudes for city places? I found this website helpful.
Saturday, June 28, 2008
Zihua Update
We've been a couple of days in Zihuatanejo (and its neighbor, Ixtapa)... still no sign of Tim Robbins or Morgan Freeman.
The small fishing village in the 50's has exploded into a twin city of 100,000. Zihua still has a small-town feel, but the planned tourist destination of Ixtapa is a jungle echo of Waikiki. Smaller, more wild, cheaper, less crowded, but still a service oriented place. What caused the population explosion? First, a paved road from Aculpolco, then one from Mexico City.
I have found some Wunderkammern specimens. So far, the skull from a large reef fish, a beautiful lobster tail, and some ribs and fin bones - some of which are 40 cm long. I'm still trying to figure out what they are. A women on a little taxi boat thought they might be dolphin; she also thought the skull was a chicken bone...
The small fishing village in the 50's has exploded into a twin city of 100,000. Zihua still has a small-town feel, but the planned tourist destination of Ixtapa is a jungle echo of Waikiki. Smaller, more wild, cheaper, less crowded, but still a service oriented place. What caused the population explosion? First, a paved road from Aculpolco, then one from Mexico City.I have found some Wunderkammern specimens. So far, the skull from a large reef fish, a beautiful lobster tail, and some ribs and fin bones - some of which are 40 cm long. I'm still trying to figure out what they are. A women on a little taxi boat thought they might be dolphin; she also thought the skull was a chicken bone...
Thursday, June 26, 2008
Much Needed
As I type this entry, I am sitting under a thatched beach umbrella in Ixtapa, Mexico. My hotel's wireless internet extends all the way to the breakers, so I can take in the sea and salty air with my feet in the sand, a limonada con gas in one hand, the internets at my fingertips and my head in the shade. (For added fun, try mixing the phrases above... head in sand etc.)
I'll be back to Seattle and to life as a fourth year medical student in a few days.
I'll be back to Seattle and to life as a fourth year medical student in a few days.
Clue
Activity on this blog been down of late, mostly 'cuz I've been busy finishing my Ob/Gyn clerkship. Well, then there's that pesky truth that I mostly write for myself.
But I thought I might get one guess for my previous riddle. Yes, it was complicated and as my first blog riddle, maybe too hard. My wife suggested I turn the puzzle into a joke. So here's your first clue:
A surgeon, a pathologist and an oncologist are on a hike in the forest when they encounter a burly tree (See the recent post for a picture). Curious, they sit down to ponder their discovery. The surgeon proposes they cut open the burl. The pathologist thinks that's a good idea; she whips out her pocket microscope to examine it. The oncologist goes on about a two-hit hypothesis and proposes dumping toxic chemicals onto the tree's base. What do you call this conclave of MDs?
And your clue is this: the answer is the same as one of the items in the pathologist's possession.
But I thought I might get one guess for my previous riddle. Yes, it was complicated and as my first blog riddle, maybe too hard. My wife suggested I turn the puzzle into a joke. So here's your first clue:
A surgeon, a pathologist and an oncologist are on a hike in the forest when they encounter a burly tree (See the recent post for a picture). Curious, they sit down to ponder their discovery. The surgeon proposes they cut open the burl. The pathologist thinks that's a good idea; she whips out her pocket microscope to examine it. The oncologist goes on about a two-hit hypothesis and proposes dumping toxic chemicals onto the tree's base. What do you call this conclave of MDs?
And your clue is this: the answer is the same as one of the items in the pathologist's possession.
End of the (Medical) School Year
I've a couple recent posts up at The Differential. One about how to approach your medical school or residency personal statement was followed with an excellent comment by an admissions officer. My recent piece is a friendly parody on Jonathan Larson's "Seasons of Love (525,600 minutes)" from Rent. It is after all a new year for medical trainees. While you're over there, check out the introductions from The Differential's two newest bloggers.
Sunday, June 22, 2008
A Woodland Riddle
Anyone out there up for a riddle?
When I was in Fairbanks for my obstetrics and gynecology rotation, I was fortunate to have a few days off so I could get out and experience the Alaskan landscape. Alaska is so big that it is impossible to make generalizations about the land. The people, the flora, the geology, the weather - it's difficult to write about the place without over-generalization.
One thing about interior Alaska that is hard not to notice is the trees. Having lived in the Pacific Northwest for several years, I've rediscovered a connection with the colossal organisms that define the landscapes here. Evergreens are, after all, the reason Seattle can claim the title of Emerald City. It isn't surprising that one of the first things I noticed after landing in Fairbanks was the diminutive stature of the area's trees. Black and white spruce, paper birch, alder and poplar are the main species there. And none of them grow much taller than 40 feet! Old growth forest consists of tree trunks less than a foot in diameter. The short growing season conspires with the extreme winter cold to limit tree height and diameter.
There is something else peculiar about interior Alaska's trees. There is a much higher frequency of burl formation there than any place I've been.
Woodworkers know burls to be valuable sources of figured wood. Laminates, sculptures, and bowls derived from burls are things of beauty. Hikers and orcharders know burls to be those funny bulbous growths along the trunk, roots and limbs of trees. One of the more affected trees I encountered on a hike is shown at the left.
The strangest thing about burls is that no one really knows what causes them. Theories range from insect infestation, mechanical damage, genetics, fungus and soil contents. What I know is that when a medical student who has been a biomedical researcher and is an amateur woodworker encounters these misshapen trees in the forest, the first thing he thinks of is a riddle. That's right, the trees speak to me! This one said:
When I was in Fairbanks for my obstetrics and gynecology rotation, I was fortunate to have a few days off so I could get out and experience the Alaskan landscape. Alaska is so big that it is impossible to make generalizations about the land. The people, the flora, the geology, the weather - it's difficult to write about the place without over-generalization.
One thing about interior Alaska that is hard not to notice is the trees. Having lived in the Pacific Northwest for several years, I've rediscovered a connection with the colossal organisms that define the landscapes here. Evergreens are, after all, the reason Seattle can claim the title of Emerald City. It isn't surprising that one of the first things I noticed after landing in Fairbanks was the diminutive stature of the area's trees. Black and white spruce, paper birch, alder and poplar are the main species there. And none of them grow much taller than 40 feet! Old growth forest consists of tree trunks less than a foot in diameter. The short growing season conspires with the extreme winter cold to limit tree height and diameter.
There is something else peculiar about interior Alaska's trees. There is a much higher frequency of burl formation there than any place I've been.
Woodworkers know burls to be valuable sources of figured wood. Laminates, sculptures, and bowls derived from burls are things of beauty. Hikers and orcharders know burls to be those funny bulbous growths along the trunk, roots and limbs of trees. One of the more affected trees I encountered on a hike is shown at the left.The strangest thing about burls is that no one really knows what causes them. Theories range from insect infestation, mechanical damage, genetics, fungus and soil contents. What I know is that when a medical student who has been a biomedical researcher and is an amateur woodworker encounters these misshapen trees in the forest, the first thing he thinks of is a riddle. That's right, the trees speak to me! This one said:
You doctors, you searchers, you cutters of flesh;
You sawyers, you sculptors, you dry aesthetes:
Gather together to crack my mystery.
So then, my witty readers... What do you think it all means? What was this telling me? How and when might we be able to figure the etiology of this I'll put up what I think it was telling me next week, and provide grades on your responses. I hope some brave readers will offer solutions to this mystery, first.
You sawyers, you sculptors, you dry aesthetes:
Gather together to crack my mystery.
So then, my witty readers... What do you think it all means? What was this telling me? How and when might we be able to figure the etiology of this I'll put up what I think it was telling me next week, and provide grades on your responses. I hope some brave readers will offer solutions to this mystery, first.
Thursday, June 19, 2008
Exam Branching Diagram
To assist your complete understanding of my medical school experience, I have prepared the following flow chart detailing the way I feel before taking an exam, immediately after the exam, the grade result and what I think on my way home from the exam. Granted, we usually don't get the grades until weeks after, but I'm the blogger, so I'll present the information the way I want to.
I bet you want to know how I felt after each of my clerkship exams... Even if you don't want to know, there's a reason I want to tell you:
I bet you want to know how I felt after each of my clerkship exams... Even if you don't want to know, there's a reason I want to tell you:- Pediatrics: Blue-Green-Orange-Red
- Family Medicine: Orange-Red-Blue-Blue
- Medicine: Green-Blue-Green-Orange
- Surgery: Blue-Orange-Orange-Orange
- Ob/Gyn: Blue/Green --> The exam is tomorrow! --> Green
- Psych: Ask me in September
- Readiness for an exam
- Whether I knew the answers
- What grade I'd get on the exam
- My mood after taking the exam
Tuesday, June 17, 2008
5 x 10^6 Firefox Downloads!
It's time you thought about updating your browser. Version 3 of the free open-access Firefox web browser is live! What? You don't surf using the best web browser? Only 18% of all browsing is done on the Firefox platform? (Microsoft's Explorer carries 75%.) You better get busy and download
src="http://pagead2.googlesyndication.com/pagead/show_ads.js">
now!
src="http://pagead2.googlesyndication.com/pagead/show_ads.js">
If you can see it (some people block pesky ads), click on this button to download Firefox with the especially useful Google toolbar. If you do it today, you'll contribute to the world record goal of 5 million downloads in one day. And I think I get a dollar for referring you. Need any more rea$on to jump on the bandwagon?
src="http://pagead2.googlesyndication.com/pagead/show_ads.js">
now!
src="http://pagead2.googlesyndication.com/pagead/show_ads.js">
If you can see it (some people block pesky ads), click on this button to download Firefox with the especially useful Google toolbar. If you do it today, you'll contribute to the world record goal of 5 million downloads in one day. And I think I get a dollar for referring you. Need any more rea$on to jump on the bandwagon?
Grand Rounds
From Alaska to the South Pacific, they're blogging about medicine. And David at Marianas Eye has got the best from this week. Head over there for a large collection of clever lead-ins for each entry to Medicine Grand Rounds.
Monday, June 16, 2008
Workshopping a Personal Statment
So you're trying to write your medical school or residency application personal statement? Are you stumped? Do you feel like your missing something? Do you have writer's block? Here's a little exercise modified from my school's residency application handbook to help you get your ideas out. I've been pondering drafts of my personal statement for a while, but the exercise of sitting down and answering these questions helped me fill in some of the gaps.
* What are the skills valued by specialty? How have you demonstrated them?
* Has coursework shaped your specialty decision? How?
* Have you had any experiences outside of school that were significant to you personally and professionally?
* Do you have any other interests and experiences that demonstrate your values and individuality and may be a resource to a residency program? List them!
* What is the reason for applying to your specialty of choice?
* What are the characteristics of an attractive residency program?
* What are your personal and professional goals? Including practice location, style, and emphasis...
* Does your family status impact your vision?
I left some space so that you can imagine your answers. Or print this out and write them down. Or type between the gaps. It's not enough to think about them. Put your ideas in writing and your statement will come together more fully!
* What are the skills valued by specialty? How have you demonstrated them?
* Has coursework shaped your specialty decision? How?
* Have you had any experiences outside of school that were significant to you personally and professionally?
* Do you have any other interests and experiences that demonstrate your values and individuality and may be a resource to a residency program? List them!
* What is the reason for applying to your specialty of choice?
* What are the characteristics of an attractive residency program?
* What are your personal and professional goals? Including practice location, style, and emphasis...
* Does your family status impact your vision?
I left some space so that you can imagine your answers. Or print this out and write them down. Or type between the gaps. It's not enough to think about them. Put your ideas in writing and your statement will come together more fully!
Butting Heads
All evening, I've felt like I'm butting heads with this manuscript I'm trying to rewrite for resubmission. Now that it's midnight where I am, it's too late to finish everything to my satisfaction. It's also too late for me to strap on my antlers. When I return to this paper tomorrow night, it better be ready... ready, that is, to butt heads with CaribouTom!
No caribou were harmed in the filming of this post.
No caribou were harmed in the filming of this post.
Sunday, June 15, 2008
On Blogging in Medical School
Nick Genes, an MD/PhD emergency medicine resident, was recently asked the question, "What is your advice for medical students?" It was part of a feature of him in the Student British Medical Journal. He answered:
Start a blog. As I wrote in a column for Medscape, medical school is a transformative but isolating time. A public journal can update friends and family who might otherwise not hear as much from a preoccupied student. Blogging also prompts reflection and records intellectual and emotional growth. Medical student bloggers also make connections with other students who are considering the same specialties or places to train.I'd say this is spot on. Whoa - an MD/PhD blogger who went into emergency medicine... Cool!
Arms
My experiences in the Ob/Gyn clerkship these past weeks have revealed to me that being up in arms about something is very different than being up to your arms with something. Or up to your elbows. Whatever. I'm going to keep the field at arm's length.
Google Me!
Just to be clear: I, Thomas Robey am neither a senior vice president of investor relations for Time Warner nor an otolaryngologist in Milwaukee, WI. Nor am I a Khoros computer language programmer or a Rotten Tomatoes film reviewer. As fun as those things all sound, I'm happy with who I am and what I'm doing now.
The Liability of Academic Blogging
It's been almost 8 years since I've had to sell myself. I'm again at that stage in life. It's coming time for me to shape up my curriculum vitae and personal statement for residency applications. And here's the dilemma: do I talk about blogging in my essay?
First, a step back for context: I'm fortunate in that I have some friends at hospitals where I hope to match. Some of them are even in the programs I'm applying for. One friend, in particular, has volunteered to be my insider agent at that school. I'm quite happy about this, because she is a very good student and will be an excellent ER doc - probably a professor - someday. It's nice to have folks who believe in you, but sometimes I worry about favoritism. Where is the line between the good-old-boy cronyism and networking? Anyway, she's already connected me with folks who will be helpful in my application process. My interest and dedication to the ethics and policy of science and medicine is one thing that makes me unique compared to other applicants, so this is part of her description of me. A description which often includes 'blogger.'
Ethics and policy is the way my commitment and passion for improving 'the system' takes form. In graduate school, the main way that I did this was by organizing events and bringing people together under the umbrella of the Forum on Science Ethics and Policy. Now that I'm busy with medical school, I work in ways that allow me to contribute to and learn about the contextual issues of science and medicine on my own time. Reading and writing, mostly. And this is where blogging comes in. I write other things - like the review article about urgent care clinics' impact on the ER safety net I've been working on for a couple of months, or the syllabus for a med student clinical ethics course, or those pesky responses to reviewers for my work in graduate school, but blogging is where I transcribe a majority of my ideas.
My blog does not have a lot of readers. At first, my main goal was to increase readership. Readership does grow slowly with quality content, but it grows much more quickly via self-promotion, links from big bloggers and writing on oft-searched topics. I even wanted to be assimilated by the ScienceBorg at one point. Getting this attention is no longer my priority. When I started blogging, it was primarily to find a voice. These days, I use my blog as a laboratory where I experiment with writing. I had no idea how cathartic the activity would be, and my interest in writing has since spilled over into two other (much more widely read) blogs and a (sorry, no public access) personal diary. Dare I say that 'blogger' is now a key part of my identity?
So how does this all fare in the world of residency applications? Despite efforts on the part of a philosophy professor in the bay area, the notion of blogging is still taboo in academia. (Note to said philosophy professor: is there any way you could seed this trend of legitimate academic blogging in some of the institutions just to the north of you? :-) --> j/k) I believe that in the right format, blogging is a legitimate academic activity. Even so, I still tend to de-emphasize blogging and use words like columnist and writer to describe what I do. Blogging is just a means to ends activity anyway: the end could be as broad as 'increased understanding' or 'better writer,' or as specific as 'a book' or 'drafts of opinion pieces in journals and newspapers.' And all of these ends should help me be a better academic, right? So why am I afraid to present the means in my personal statement?
First, a step back for context: I'm fortunate in that I have some friends at hospitals where I hope to match. Some of them are even in the programs I'm applying for. One friend, in particular, has volunteered to be my insider agent at that school. I'm quite happy about this, because she is a very good student and will be an excellent ER doc - probably a professor - someday. It's nice to have folks who believe in you, but sometimes I worry about favoritism. Where is the line between the good-old-boy cronyism and networking? Anyway, she's already connected me with folks who will be helpful in my application process. My interest and dedication to the ethics and policy of science and medicine is one thing that makes me unique compared to other applicants, so this is part of her description of me. A description which often includes 'blogger.'
Ethics and policy is the way my commitment and passion for improving 'the system' takes form. In graduate school, the main way that I did this was by organizing events and bringing people together under the umbrella of the Forum on Science Ethics and Policy. Now that I'm busy with medical school, I work in ways that allow me to contribute to and learn about the contextual issues of science and medicine on my own time. Reading and writing, mostly. And this is where blogging comes in. I write other things - like the review article about urgent care clinics' impact on the ER safety net I've been working on for a couple of months, or the syllabus for a med student clinical ethics course, or those pesky responses to reviewers for my work in graduate school, but blogging is where I transcribe a majority of my ideas.
My blog does not have a lot of readers. At first, my main goal was to increase readership. Readership does grow slowly with quality content, but it grows much more quickly via self-promotion, links from big bloggers and writing on oft-searched topics. I even wanted to be assimilated by the ScienceBorg at one point. Getting this attention is no longer my priority. When I started blogging, it was primarily to find a voice. These days, I use my blog as a laboratory where I experiment with writing. I had no idea how cathartic the activity would be, and my interest in writing has since spilled over into two other (much more widely read) blogs and a (sorry, no public access) personal diary. Dare I say that 'blogger' is now a key part of my identity?
So how does this all fare in the world of residency applications? Despite efforts on the part of a philosophy professor in the bay area, the notion of blogging is still taboo in academia. (Note to said philosophy professor: is there any way you could seed this trend of legitimate academic blogging in some of the institutions just to the north of you? :-) --> j/k) I believe that in the right format, blogging is a legitimate academic activity. Even so, I still tend to de-emphasize blogging and use words like columnist and writer to describe what I do. Blogging is just a means to ends activity anyway: the end could be as broad as 'increased understanding' or 'better writer,' or as specific as 'a book' or 'drafts of opinion pieces in journals and newspapers.' And all of these ends should help me be a better academic, right? So why am I afraid to present the means in my personal statement?
Saturday, June 14, 2008
UpToDate Up To Date
Earlier this year, medical students from Wyoming to Alaska were up in arms about the University of Washington's canceling a heavily-used electronic medical reference called UpToDate. I was in the minority of voices saying, "Good Riddance." Not because I didn't use or like the resource, but because the company exerts a profit-motivated monopoly on medical guidelines. UpToDate wanted to charge gazillions of dollars to provide articles that the authors write for free!
I had gotten used to the slightly less organized and less thorough eMedicine articles when my university's library portal indicated,
I had gotten used to the slightly less organized and less thorough eMedicine articles when my university's library portal indicated,
UpToDate - Good News!
The so-called confirmation hasn't come yet, but it looks like the threat of cancellation and the uproar from UW docs and students combined to renew the subscription. Whatever. I'll still use UpToDate, but I have another arsenal of tools at my disposal now, too.
Renewal for the coming year pending. We expect confirmation the first week of June ...
Wednesday, June 11, 2008
Reducing and Reusing, if not Recycling in the OR
Over at The Differential, I recently wrote about waste in medicine; lots of stuff gets thrown away, especially in hospitals. One of medicine's most egregious offenders is the OR. Items ranging from blue towels to cautery equipment to paper drapes to laparoscopic instruments to suture to bowel staplers all are pitched at the end of each case. In the past few weeks I've enlisted the help of scrub techs and circulating nurses to cut down on the footprint of the cases I'm involved with. Here's what we came up with in the reusing category:
Recycling will be a tough thing to implement in the OR. Most paper gets contaminated with blood, poop or iodine. I don't think we want that stuff getting into the recycling waste-stream. In the end though, shouldn't reducing and reusing decrease carbon footprint even more than recycling? Anyone have other ideas about reducing waste in the OR? Or in the hospital?
- Suction irrigators run on 8 AA batteries and are designed to run for two hours. After the case, the irrigator is pitched - including the pump. If you salvage the batteries from each suction irrigator used for ectopic pregnancy or cholecystectomy cases you assist with, you'll amass 10 hours of digital camera usage per irrigator, or put another way, a lifetime powering of remote controls per surgery clerkship.
- Blue towels are the sterile, lint free linens that surgeons dry their hands and arms on after scrubbing but before donning gown and gloves. For folks like me, who 'scrub' using the germicidal alcohol-based Avagard chlorhexidine cleanser and come into the room 'dry,' there's a good chance that towel will go unused in the case. This makes a perfect car-drying towel. (For after you go through the automatic car washes, of course - they save water and reduce toxic runoff.)
- Specimen containers are especially useful for my natural history collections. (See my entries on Wunderkammern for clarification.) The sterile cylindrical canister that comes with Foley catheter kits is good for spices when you go camping. Unused but opened pathology specimen containers work well for storing small parts. Any clean container works well for storing captured insects or categorizing bark samples or some other random hobby.
- Sutures are thrown away all the time. Many ORs save the packets for student use and practice. Before grabbing extras off of the scrub tech's Mayo tray, be sure to ask. Not only because there's a chance open suture is contaminated with patient parts, but NEVER TAKE ANYTHING FROM THE SCRUB TECH'S MAYO TRAY!
Recycling will be a tough thing to implement in the OR. Most paper gets contaminated with blood, poop or iodine. I don't think we want that stuff getting into the recycling waste-stream. In the end though, shouldn't reducing and reusing decrease carbon footprint even more than recycling? Anyone have other ideas about reducing waste in the OR? Or in the hospital?
Tuesday, June 10, 2008
Denali!
Details later. I've got to focus on school for a while.
The abbreviated version is: phenomenal views, lots of animals, fantastic hiking, a national park anyone could fall in love with...
Friday, June 06, 2008
Interior Alaska's Granite Tors
Tors are spires of metamorphic rock at the top of hills, bluffs and mountains, often in stark contrast to rolling hills on which they sit. In most cases, tors are the residual volcanic rock from old mountains that has not eroded like its surrounding substrate. They often appear as old and weathered spires. Remember the hilltop ruins where Frodo Baggins was stabbed by the witch king in The Fellowship of the Ring? That's what tors look like. Over the years, humans have associated tors with sacred places. The celts thought them to be hilltop sanctuaries of the gods. I think some of them look like chickens.
And yes, my mind's eye does often employ MSPaint highlights in the field. Maybe the spruce grouse we saw on the way up to the ridge put poultry on my mind. Perhaps I was a little hungry 10 miles into our journey. Or maybe I was thinking about my friend Atis. It was the first weekend we had off since his wedding!These chickens - I mean tors - are important clues to interior Alaska's natural history. As a nice little article from the University of Alaska Fairbanks points out,
they have a special significance, for they are monumental proof that Pleistocene glaciers did not cover the areas where the tors are found. If glaciers had covered the areas, the tors would have been scraped away by the ice. Thus, the tors demonstrate that central Alaska was open to the migration of plants and animals even during the height of the last glaciation.Interior Alaska has been a really nice place to see a surprisingly diverse collection of flora and fauna. Not being frozen for thousands of years is a good reason. Another (much more recent) cause is that the area around Chena Hot Springs was recently scorched by a sizable forest fire so the areas we hiked through were in various stages of recovery. GoogleMaps actually caught the fire with its satellite! It wasn't the exact location of the hike, but it's close enough...
What the satellite could not capture was this cute hoary marmot. If the rodent had known the satellite was taking pictures, however, I'm pretty sure she would have posed just as much as she did for me.
This hike was unique in that its primary goal was to explore a geologic formation. It was a mammoth walk to see some mammoth rocks. We did the entire 15 miles in one medium to long day. Stopping for lots of scenery and snack breaks,
we finished in about 8 hours. The granite tors trail is one of a quite nice collection of trails in the Chena River valley. Trailheads are along Chena Hot Springs Road as you drive from Fairbanks to, well Chena Hot Springs. If you're okay with walking though some burnt forests, this hike will reward you!All photos may be enlarged for better viewing...
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