tag:blogger.com,1999:blog-1503025777097172992024-02-20T21:14:57.143-05:00Off-White CoatThe musings of a medical student.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.comBlogger72125tag:blogger.com,1999:blog-150302577709717299.post-90104533047552658762008-08-13T23:22:00.003-04:002008-09-04T08:28:54.176-04:00New formatOn the advice of a friend, I just ported my blog over to Wordpress. It's much more customizable; the themes are prettier; and I just plain like it.<br /><br />I'll keep this site up, but why not <a href="http://offwhitecoat.wordpress.com/">mosey on over</a> and see what I've been up to lately.<br /><br /><span style="font-weight: bold; font-style: italic;">[Update: You'll be automatically redirected. Just FYI. This message will self-destruct in 6 seconds.]</span>The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-29670844469234778522008-08-13T11:35:00.002-04:002008-08-13T12:02:55.818-04:00This is just to say...<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://picasaweb.google.com/writer1985/2008GlacierYellowstoneTetons/photo?authkey=TyEF1NhzoyQ#5233735878790050322"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 320px;" src="http://picasaweb.google.com/writer1985/2008GlacierYellowstoneTetons/photo?authkey=TyEF1NhzoyQ#5233735878790050322" alt="" border="0" /></a><br />...that Montana is awesome.<br /><br /><div style="text-align: center;"><img src="http://lh6.ggpht.com/writer1985/SKH3DV9_chI/AAAAAAAAB3E/jcxGJkORh90/s400/126_2658.JPG" /><br /></div><br /><div style="text-align: center;"><div style="text-align: left;">I spent 10 days hiking around Glacier National Park, Yellowstone, and the Grand Tetons.<br /></div></div><br />Highlights included:<br />-Climbing to the very top of a snow-laden trail. (Snow! In August!)<br />-Elk grazing on the front lawn of our hotel.<br />-Being chased by an enraged mother bison. Those things can <i>move</i>.<br />-Old Faithful. The lady behind me asked a ranger if the 'stremely accurate timing was "controlled by someone."<br />-Huckleberry ice cream, which has replaced Canadian Maple Walnut as my Flavor of the Month.<br />-"Caulk your wagons and float" down the Snake River. Ah, the postmodern pastiche of comparing a real-life experience to a twenty-year-old computer game.<br />-Generating all the Vitamin D I'll need to tide me over for another year of living in the library. (Almost literally! The second-year classroom is on the fourth floor of said library, and my room is across the street. Hey, at least the commute is non-existent.)The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-34056958182988347782008-08-01T16:10:00.004-04:002008-08-01T16:42:28.527-04:00Last day of workTick-tock, tick-tock.<br /><br />It's a slow day here. Kind of sad to think it's my last one. Although I'm glad my only major project for this week, a presentation on vaccines for substance abuse, went off without a hitch. I am nervous about public speaking, but when one of the other interns tried to steal my thunder with a question that turned into a soliloquy on political ideology, I stole it right back, got everyone back on track, and finished with a bang. (Thunderclap? This analogy is dead.)<br /><br />Putting together the presentation was pretty cool, though. Basically, antibodies "soak up" the cocaine/nicotine/meth and keep it from crossing the blood-brain barrier. Result: no high. It was all fMRIs and mouse studies and made me realize how absolutely awesome neuro is. It was probably the best class of first year. Even if I did fall asleep during the last exam.<br /><br />But the absolute coolest part about putting together this presentation was doing the handout, for which I had to haul out the scissors for some old-school cutting and pasting. (Well, taping, but you know what I mean.) I've <em>never</em> done real life cut-and-paste before. You have to think about orientation and spacing! You can't just resize images! It was ... surreal.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com1tag:blogger.com,1999:blog-150302577709717299.post-56272474721700890482008-07-30T16:24:00.004-04:002008-07-31T22:26:21.745-04:00So much drama on C-SPAN!On a bill to give the FDA regulatory authority over tobacco, especially to ban flavored cigarettes (kids' favorites).<br /><br />Rep. Boehner (R-OH): This is a boneheaded piece of legislation. *handwaving and rant about big government*<br />Rep. Dingell (D-MI): I yield myself 15 seconds of time to respond to my beloved friend. Mr. Boehner, tobacco kills. And you will be the next to die.<br />Entire AAP Office: Whoaaaaaa!<br /><br />(<a href="http://blogs.wsj.com/washwire/2008/07/31/dingell-uses-tobacco-debate-to-scold-boehner-for-smoking/">I wish I were making this up.</a>)The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-32937088820397525522008-07-28T14:13:00.002-04:002008-07-28T15:24:39.965-04:00Textbook time!Late last week, one of my class reps sent out a survey from the class of 2010 (well, a third of the class of 2010) about second-year textbooks. Exciting! I definitely bought way too many books for first year, though, so I'm trying to hold off this time. The top-rated books for pathophysiology are subject-specific (Lilly's <a href="http://www.amazon.com/Pathophysiology-Heart-Disease-Collaborative-PATHOPHYSIOLOGY/dp/0781763215/ref=sr_1_1?ie=UTF8&s=books&qid=1217269113&sr=1-1">Pathophysiology of Heart Disease</a>, Despommier's <a href="http://www.amazon.com/Parasitic-Diseases-Fifth-Dickson-Despommier/dp/0970002777/ref=sr_1_1?ie=UTF8&s=books&qid=1217269157&sr=1-1">Parasitic Diseases</a>), but I'm debating about supplementing with a general pathology book. <a href="http://www.amazon.com/Robbins-Basic-Pathology-STUDENT-CONSULT/dp/1416029737/ref=pd_bbs_sr_3?ie=UTF8&s=books&qid=1217269868&sr=8-3">Robbins</a>, perhaps? Or <a href="http://www.amazon.com/Pathology-Board-Review-Arthur-Schneider/dp/0781760224/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1217269907&sr=1-1">BRS</a>?)<br /><br />Truly, though, I'm nerd enough to be looking forward to the start of second year. I went ice skating this weekend with some high school friends, one of whom is now a pharm tech. He was lecturing pharm to everyone who would listen -- basically, me. So exciting to think that in a year, I'll know everything he was talking about! :)<br /><br />I mean, second year will probably be scary. More volume, more detail. That pesky little board exam in June. Building on previously learned material. Which I have pretty much completely forgotten. (Bones of the wrist? What? I only vaguely remember our rotund little professor with the sweat issues, standing in front of a slide of a giant hand and telling us a dirty mnemonic about Tillie's pants.) But also really cool! I mean, parasites! What could possibly be more interesting than that!The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com2tag:blogger.com,1999:blog-150302577709717299.post-85750825319093394812008-07-21T15:14:00.003-04:002008-07-21T16:37:31.886-04:00I've spent most of the last few weeks at work on the phone, trying to scheduling meetings on Capitol Hill but mostly getting transferred from voicemail to voicemail. An awful lot of Congressional staffers are away from their desks, all the time. I have this vision of them wandering the Halls of Power, like zombies in a <a href="http://www.imdb.com/title/tt0049366/">a 1950s scifi flick</a>, searching for the Mother Ship.<br /><br />Big news today: the leaked <a href="http://www.rhrealitycheck.org/emailphotos/pdf/HHS-45-CFR.pdf">HHS proposal</a> that seeks to redefine "abortion" to include contraception. (Ummm... <a href="http://en.wikipedia.org/wiki/Griswold_v._Connecticut">Griswold v. Connecticut</a>, anyone?) The so-called "conscience" clauses grant financial (and possibly legal) immunity to those who deny services based on religious beliefs. What I can't seem to find is the HHS definition of contraception. Is this just Plan B, which prevents implantation of a fertilized embryo? Or shall we include barrier contraception, which prevents fertilization? What about hormonal contraception, which prevents ovulation itself? (Apologies if I got any of this wrong. I went to a school district that had abstinence-only sex ed, and despite passing both Human Development and Endocrinology/Reproduction in med school, never had a lecture about pregnancy.) If women and men don't have access to basic contraception, and education about its use, abortion rates ("real" abortion, that is) will just climb.<br /><br />What I find especially interesting (disturbing?) is that the proposal cites a <a href="http://content.nejm.org/cgi/content/full/356/6/593">NEJM study </a>that found that 86% of physicians feel they should present all available options to a patient (and 71% would refer the patient to another physician in the case of religious/moral conflict), yet promptly rejects that overwhelming professional opinion in favor of a 2001 Zogby poll that found that 49% of respondents believed "abortion destroys a human life and is manslaughter." Dunno how the Zogby people feel about contraception, but given that 40% of American women use hormonal birth control, I think I can guess.<br /><br />As a future physician, I'm aware that my personal beliefs may, at times, conflict with those of my hypothetical patients. But, like 86% of physicians, I think that patient need is superior to provider religion. Hey, HHS? What's your definition of paternalism?The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-4533476929354955512008-07-15T21:46:00.002-04:002008-07-15T22:31:37.947-04:00The objections of the President of the United States to the contrary notwithstandingRaise your hand if you thought "Congressional action" was an oxymoron. <br /><br />Yeah, me too. The system was, of course, designed to move as sloooooowly as possible. Between committee referrals and hearings and filibusters, it's a procrastinator's dream come true up there on Capitol Hill.<br /><br />Which makes today's events all the more surprising. After just 4 of his allotted 10 days of consideration, Bush vetoed the Medicare bill this morning. After lunch, the AARP held a rally on the West Lawn of the Capitol. Two hours later, the House voted to override the veto; the Senate vote took place about two hours after that. This is the equivalent of hyperspeed for Congress! Good for them! (Even more surprising: more people voted to override the veto than voted in favor of the bill in the first place. Buh?)<br /><br />My other task today was attending a Global Health and Poverty luncheon. Irony is eating ham and havarti on rye and drinking raspberry white tea while copying down statistics on how many sub-Saharan African children suffer from malnutrition.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-45569653665021940752008-07-11T15:44:00.003-04:002008-07-11T16:51:10.656-04:00High drama on the Senate floor!While I was in New York, stressing over where I'm going to live next year, the Senate was tackling a sliiiiightly more important issue: the Medicare vote.<br /><br /><strong>Act I: The Exposition, or Let's Screw Doctors</strong><br />For those of you who didn't hear, Medicare was set to have a 10.6% reimbursement cut, effective July 1. CMS, which handles claims, said they'd put a hold on processing claims for two weeks until Congress decided whether to delay the cuts, as they have done every year since Time Immemorial. (I learned today that CMS doesn't process claims for 14 days anyway, so the hold was more semantic than real.)<br /><br /><strong>Act II: The Rising Action, or Let's Put on a Band-Aid (TM)</strong><br />The House rushed through a bill on June 24 to delay the cuts. (355-59; definitely veto-proof; <a href="http://clerk.house.gov/evs/2008/roll443.xml">See</a> how your guy/gal voted.) Following the procedures outlined in Schoolhouse Rock (and, you know, the Constitution), the bill went to the Senate. Given the time crunch, Sen. Reid of Nevada moved to invoke cloture, which meant that the Senate would skip committee, debate, amendment, and the inevitable compromise-with-the-House quagmire and pass or reject the bill in its House form. That motion fell 2 votes short of passage. Not voting were Sens. Kennedy of Massachussetts (understandably) and McCain of Arizona (not so understandably). <a href="http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=110&session=2&vote=00160">Here's</a> the roll call.<br /><br /><strong>Intermission</strong><br />Then Congress went on a ten-day picnic and the American Medical Association went beserk.<br /><br /><strong>Act III: The Climax, or Let's Applaud for Two Minutes</strong><br />On Wednesday, more than a week after the cuts were scheduled to go into effect, the Senate reconsidered cloture. In possibly the most dramatic moment in Senate history since Preston Brooks <a href="http://en.wikipedia.org/wiki/Preston_Brooks#Sumner_Assault">caned</a> Charles Sumner, Sen. Kennedy <a href="http://youtube.com/watch?v=YpxK65563RI">arrived</a>, specifically to vote in favor of cloture. He flew back to MA for more chemo directly afterwards. But thanks to his appearance, the hard work of the AMA and AARP, and plenty of grassroots pushing, the motion passed, <a href="http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=110&session=2&vote=00169">69-30.</a> Again, a veto-proof majority. Again, Sen. McCain did not vote.<br /><br /><strong>Act IV: ?, or What You Will</strong><br />Bush has repeatedly threatened to veto the bill. Schoolhouse Rock (I mean, the Constitution!) says the president can sit on the bill for 10 business days before deciding what to do. Probably he will veto it after all, so the veto-proof majority in both houses is an important fact. So important that I spent most of the day today writing to my senators to thank them for their votes in favor of cloture and urging them to continue to support access to care. You should too! There's a cool new online system accessible at [lastname].senate.gov, so you don't even have to spend on stamps! And you get automated replies:<br /><br /><em>Senator Warner is snuggly<br /></em>Thank you for your email. It is my goal to reply in a timely fashion to every email that I directly receive from a fellow Virginian. I appreciate your views and look forward to responding to you.<br /><br /><em>Senator Webb is not</em><br />Your comments have been submitted.<br /><br />In any case, it's all very restorative in the Power of Democracy: Congress CAN do things, grassroots letter-writing and phone calls DO make a difference, legislation DOES affect you, me, and that old guy who sits outside the Metro station and plays the pan pipes. <br /><br />I think I'll go home now and watch <em>Mr. Smith Goes to Washington</em>. Sappy enough for you?The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-41482910789688582812008-06-30T22:02:00.003-04:002008-06-30T22:34:19.465-04:00We have summer reading! Again! As BH, who is in math grad school (taking classes like "topological algebra" and "partial semi-differential hand-waving") said when I told her: "Buh?"<br /><br /><a href="http://offwhitecoat.blogspot.com/2007/07/more-on-spirit-catches-you.html">Last year's</a> summer reading was on <span style="font-style: italic;">The Spirit Catches You and You Fall Down</span>, a rather sad story of cultural clashes. It frustrated me no end, which I suppose was the point. We were supposed to discuss in small group but never actually got around to it, so my understanding of cultural competence, $60k later, is not really much better than what it was around this time last year. (I do, however, have a <span style="font-style: italic;">much</span> better understanding of rotation of the gut, for what it's worth. <span style="font-style: italic;">Everyone</span> has situs inversus.)<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://www.concurringopinions.com/archives/Mountain%20Beyond%20Mountains.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 102px; height: 102px;" src="http://www.concurringopinions.com/archives/Mountain%20Beyond%20Mountains.jpg" alt="" border="0" /></a>This year's summer reading is <span style="font-style: italic;">Mountain Beyond Mountains</span>, Tracy Kidder's biography of Paul Farmer. I'm holding off judgment until I actually receive it (could be a while, given the Fourth of July shipping delays), but it should be an interesting read, if nothing else. I'd like to do international work eventually, and Dr. Farmer's kind of a Big Deal in the global health arena. It <span style="font-style: italic;">is</span> gratifying to see that idealism can actually work.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com2tag:blogger.com,1999:blog-150302577709717299.post-31474552849312103012008-06-26T09:49:00.003-04:002008-06-26T10:23:44.151-04:00Slow day at work?I've settled into a bit of a summer routine by now. Up at 6:30, out of the house by 7:15. I carpool with my parents, who drop me off outside their office and I walk across to my own. I usually get there well before the office opens, so I duck into a Borders across the street and read till 9. (Currently working on Kate Atkinson's <em>Behind the Scenes at the Museum</em>; highly recommended to anyone who liked <em>Middlesex</em>.)<br /><br />I go to a lot of Congressional hearings. They are becoming a commonplace now, but when I stop and think about them, it's really a remarkable experience. I always seem to arrive just after a tour group of obese Midwesterners; that's summer in DC for you. After I shuffle out of the oppressive humidity (the city retains the atmosphere of its swampy origins) through metal detectors, I head up a marble circular staircase to whatever committee room the hearing will be in. There's usually a long line for the public; often I have to stand in the back or along the sides. The committee sits at a large dais, Democrats and Republicans on either side of the chairman's throne. Witnesses sit facing the committee at a long table, with microphones and water glasses. After opening statements by committee members and testimony by witnesses, the fun part -- the questioning -- begins. I've seen committee members rip into witnesses, and you can really tell when someone loses their cool or has been "rehearsed." The whole thing takes an hour or six. Then I go back to the office and write up a summary for whoever is in charge of that issue.<br /><br />What has struck me most about these hearings is the almost total lack of clinical representation. Since these are mostly Health subcommittee hearings, the witness panel usually includes a physician, but generally a researcher rather than a clinician. Lots of MPHs, lots of PhDs. It's a little surprising, given that members of Congress appear to respond better to "clinical vignettes" about anonymized children than statistics about disease prevalence. So why not bring in the people who actually care for these kids? Demands of the profession? Less experience with law? 'Tis unfortunate, because it means that Congress is dictating from on high with very little input from the people who would actually be affected by this legislation. <br /><br />Grassroots stuff -- letter-writing and phone calls and petitioning -- can work, but there's nothing as effective as sitting in front of ten or fifteen Senators arguing your case.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-45899093487306577872008-06-04T20:33:00.002-04:002008-06-04T21:29:12.084-04:00Today for work, I went to scope out the "Green Our Vaccines" autism awareness rally on the steps of the Capitol. A little background: In spite of <a href="http://www.nichd.nih.gov/publications/pubs/autism/mmr/">repeated</a> <a href="http://www.cdc.gov/vaccinesafety/concerns/thimerosal.htm">scientific</a> <a href="http://www.webmd.com/brain/autism/vaccines-autism">evidence</a> disproving the purported link between autism and vaccinations, many parents still blame the vaccines for the devastating condition their family has to live with. Thimerosal, a mercury-containing preservative in MMR and other vaccines, has been targeted in the past. Thimerosal was removed as of 2001; autism incidence rates continued to rise. (Now it appears that aluminum is the fashionable suspect, but that's <a href="http://pediatrics.aappublications.org/cgi/content/full/112/6/1394?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Offit&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT">another story entirely</a>.) As I am interning at the American Academy of Pediatrics, they asked me to go over and see just what was going on.<br /><br />I expected a lot of rhetoric and a lot of emotion at this rally; that was kind of the point, after all. The speeches took a two-pronged approach: "We are not anti-vaccines, we just want to spread them out more" and "There is a big government cover-up."<br /><br />The cover-up allegation was really not so surprising -- as the saying goes, you can't spit in DC without hitting either a lobbyist or a conspiracy theorist -- but what really struck me was that they had expanded their conspiracy net to include Big Pharma, the media, and physicians.<br /><br />Here's the clincher: Robert Kennedy, Jr. stepped up the microphone and rehashed a <a href="http://dir.salon.com/story/news/feature/2005/06/16/thimerosal/index.html">Salon.com</a> article of his, in which he completely misrepresents a CDC conference in 2000. <a href="http://skeptico.blogs.com/skeptico/2005/06/robert_f_kenned.html">Skeptico</a> does a solid analysis of the article. In his speech today, RFK Jr went over the same old points: that everyone is sleeping with everyone else and the pillow talk is all about how best to screw over the American public. He then "quoted" from the transcript of the CDC conference with one of the participants, whose name I didn't catch, saying "There is no way to massage the data to eliminate the link [between vaccination and autism]."<br /><br /><span style="font-style: italic;">Whoa!</span> I thought. <span style="font-style: italic;">That's some damn serious accusation, Senator. That's <span style="font-weight: bold;">fraud</span>.</span> So when I got back to the office, I did what any self-respecting scientist would do: went back to the source. In this case, <a href="http://www.safeminds.org/legislation/foia/Simpsonwood_Transcript.pdf">the transcript</a> of the Simpsonwood conference. It's massively long, so after the first ten or so pages, I took advantage of the Handy-Dandy Finder in Adobe Reader and looked for "massage."<br /><br />No hits. So how's <span style="font-style: italic;">that</span> for fraud?The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com1tag:blogger.com,1999:blog-150302577709717299.post-86620962554464632332008-05-21T11:39:00.002-04:002008-05-21T12:00:21.986-04:00What just happened?I am DONE with first year! It really doesn't feel like summer yet -- for one thing, it's <span style="font-style: italic;">freezing</span> -- but it's Very Nice Indeed to take a break from studying. I went out to dinner with med school friends on Monday (the day of our last exam), and last night I finished off the leftovers in my defrosting minifridge while watching <span style="font-style: italic;">Bleak House</span> on DVD -- guilt-free! It's awesome.<br /><br />One really good thing about being done -- I get to spend more time with my friends who <span style="font-style: italic;">aren't</span> in med school.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com1tag:blogger.com,1999:blog-150302577709717299.post-76175083639748184592008-05-17T09:37:00.004-04:002008-05-17T10:09:16.307-04:00You know those anxiety dreams where you go to take an exam and as soon as you get the paper you <span style="font-style: italic;">blank out<span style="font-style: italic;"><span style="font-style: italic;"></span></span></span>? That was me and the neuroanatomy exam yesterday. I was exhausted from a marathon study session the day before, and apparently I actually fell asleep during the exam. The parts where I was awake weren't much better.<br /><br />Oh well! The other exams were alright, and I really am not stressed about anything. (Sleep-deprived, yes, but not stressed.) I took yesterday night off to recuperate and eat applesauce and watch a melodramatic costume drama on DVD. Good times. There's one more to go, and then I am <span style="font-style: italic;">done</span>.<br /><br />It's really shocking to think that the year is almost over. In a lot of ways, I feel like we just got here. I'm moving back home on Thursday; starting work the day after Memorial Day. Perhaps I should have looked into something international -- I'm very interested in global health as a possible career, and I'm exceedingly jealous of my friends who are going abroad (postcards, please!) -- but I think the job will be interesting, and I'm not going to deny that it'll be nice to be home and taken care of for a few months. (I'm grown up, really!)<br /><br />----------------<br />Now playing: <a href="http://www.foxytunes.com/artist/virginia+hullabahoos/track/your+song" title="'Virginia Hullabahoos - Your Song' - open on FoxyTunes Planet">Virginia Hullabahoos - Your Song</a><br /><span style="color: rgb(153, 153, 153); font-style: italic; font-size: 10px;">via <a style="color: rgb(102, 102, 102);" href="http://www.foxytunes.com/signatunes/" title="FoxyTunes - Web of music at your fingertips">FoxyTunes</a></span>The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-43599687862035778042008-05-11T13:02:00.002-04:002008-05-11T13:04:56.975-04:00Not that I loved trees less, but that I loved passing moreYesterday I printed:<br /><br />-a 22 page review guide for epidemiology<br />-a 14 page review guide for psych<br />-a <span style="font-weight: bold;">124 page</span> review guide for neuro<br />-a 54 page review guide for endocrine<br /><br />Also miscellaneous practice exams, one-off review sheets, etc. The goal for today is to quit slacking and get through at least the epi and psych.<br /><br />Poor rainforest.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-64560093959216891762008-05-08T18:43:00.000-04:002008-05-08T18:44:00.251-04:00AnatomyThe anatomy memorial service was this afternoon. As far I could tell, there were no families there -- I don't know if that's a common occurrence or just because the date got switched around a lot this year. Several of my classmates read poems or short essays. One theme that came up over and over in the student readings was the difficulty of knowing the body so intimately and the person not at all. I understand the need for privacy, and knowing too much, especially at the beginning of the course, would have made it even harder to do what we had to do. Over the course of the year, as we got to know each other, we got to know her as well: she had severe scoliosis, blue eyes, pierced ears. Something of her past medical/surgical history as well: a hole in her skull for trepanning, a stent in her inferior vena cava, no gallbladder. But knowing the little things would have provided a little closure. What was her occupation? Did she have children? Grandchildren? How old was she? What language(s) did she speak? Did she live alone? What did she like to do in the evenings? I don't mean to sound sentimental, but the relationship with the cadaver is such a unique one -- intimate strangerhood -- that I can't help but compare her to my grandfather, who was a donor as well. Presumably, she had a family as well.<br /><br />Looking back, I don't really know how I got through anatomy. I detested lab; dissection never came naturally to me, and the phenol made me tired and cranky. I still can't recall the goalpost labs without wanting to throw something at a wall. There were good moments, though. My group was perfectly amazing, and those friendships are the best thing to come out of lab -- better even than my actual knowledge of anatomy, which is tenuous at best.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-14173693011616023842008-04-25T22:17:00.003-04:002008-04-25T22:44:21.814-04:00Amazing! Things are happening hereEver since I read Panda Bear's <a href="http://pandabearmd.com/blog/2008/04/13/medical-school-pre-clinical-twenty-questions-years-part-3/">post</a> about the futility of student governance in med school, I've been dying to write a rebuttal. I graduated from a university where student self-governance was practically a founding principle, like liberty in the Declaration of Independence. I had plenty of examples of students effecting change in undergrad, but med school's a very different system, so I decided to hold off until I had a more concrete success than "They modify lectures based on student feedback after each block."<br /><br />You see, since about January, there have been rumblings of eliminating Honors from the second-year grading scheme. (We are pass/fail for first year, H/P/F for second, and actual grades for third and fourth.) We all felt honors was a carrot of competition they held in front of us, creating extra short-term stress with little long-term yield -- "everyone knows" residency directors don't really care about grades in the pre-clinical years. Anecdotally, there's also a lot of faculty support for the change. There is a big curriculum reorganization in the offing, and the Big People already decided to make the preclinical months honors-free. So why not for us?<br /><br />A couple of weeks ago, we had a curriculum survey of the entire first year. On the question of honors, almost 80% of the class voted to remove it and go to a straight P/F system. In light of that result, we had an open meeting with the dean of students and the curriculum committee chair. It was remarkably well-attended, much better than lectures for sure. I got the impression that Dr. D, the chair of the curriculum committee and kind of an old-school guy, was very pro-honors and that he would be the one we'd have to win over if we wanted this change to occur.<br /><br />After the meeting and question/answer session, we took another survey, which revealed that 86% of the class wanted to remove honors from the system. The results were presented at the curriculum committee meeting this morning, after which we received an email informing us that second-year, like first, would now be pass/fail.<br /><br />So you see, the administration, at least at this august institution, can and does listen to student input.<br /><br />Now, if we can just convince them to waive our tuition....The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com1tag:blogger.com,1999:blog-150302577709717299.post-34554605812397367092008-04-06T11:56:00.002-04:002008-04-06T12:40:58.086-04:00MSEI've been back for a week now. Without anatomy (I passed!), I have copious amounts of free time, which I fill by watching videos on youtube and strolling around the city. It's <span style="font-style: italic;">wonderful</span>.<br /><br />We started psych med on Tuesday and have thus far learned about the Mental Status Exam. The examples given in the book are very novelistic ("She seductively sweeps her bangs away from her face....") and so I present for your amusement a quick game of Guess the Patient.<br /><br /><span style="font-style: italic;">Patient X is a student (age debatable), about 5'10 and 160 pounds. His facial appearance is marked by distinct pallor, which contrasts sharply with the inky black of his open doublet and dirty socks that fall around his ankles. He enters the room in a distracted fashion, looking around him as though afraid of being followed. The knocking of his knees also suggests fear. As the interviewer rose to greet him, Patient X drews his right hand slowly to his forehead, then extended it in a flowing motion to meet the interviewer's outstretched hand. He then sank into a chair, where he remained for the duration of the interview.</span><br /><br /><span style="font-style: italic;">The patient answers all the interviewer's questions readily. His speech pattern alternates between slow, monotonous responses and garrulous outbursts. When asked about his mood, he says that he is "very like a whale." On being asked to explain, he winked at the interviewer but did not elaborate. </span><br /><br /><span style="font-style: italic;">He has a full range of affect, although occasionally a question about his family causes a shadow to pass over his face and shuts down his emotional response. This is brief, however. Thought process is circumstantial and tangential; long digression of the death of an older man who played with him as a child and appears to have been a surrogate father figure. Some loosening of associations. Thought content is obsessive, centering on the recent death of his father and his mother's subsequent remarriage. Grandiose delusions of his "destiny" as the savior of his family and friends. His girlfriend recently broke up with him, an event he attributes to the influence of her father, a friend of his stepfather. <br /><br />Some evidence of visual and auditory hallucinations, primarily of his father. These hallucinations command him to avenge his father's death. Admits to passive suicidal ideations (longing for the "sleep of death") but has not made a plan due to fear of the afterlife he believes to exist. He also shows evidence of homicidal ideation against his mother, stepfather, and girlfriend's father.</span><br /><br /><span style="font-style: italic;">Cognition: fair. Alert and oriented to self; described interviewer as "fishmonger." Recalls 3/3 objects in two minutes. Digit span 7 forward, 5 reverse. Does not know own age or age of father at death. Frequently confused two childhood friends. Fund of knowledge good on current events, somewhat shaky on chronology and dates of the past. Above average intelligence, reflected in sophisticated vocabulary. Occasionally invents words.</span><br /><br /><span style="font-style: italic;">Poor insight. Patient is aware that his friends and family are "concerned" about his recent behavior. He insists that he is "but mad north by northwest."</span><br /><br /><span style="font-style: italic;">Judgment: Patient does not appear to understand the need for treatment. Recommend hospitalization for suicidal and homicidal ideations.</span>The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com3tag:blogger.com,1999:blog-150302577709717299.post-12737224272893296772008-03-26T11:57:00.004-04:002008-03-26T12:16:39.711-04:00On break!I love being on Spring Break. I'm just chilling at my parents' house -- sleeping, reading novels, watching movies. It's absolutely what I needed after March block.<br /><br />Our grades still aren't up yet, but unlike during Winter Break, I'm not so worried this time. Not to say that this block was any easier (it wasn't), but even if I didn't pass anatomy, I'd just have to retake that exam in May, as opposed to spending the summer retaking the entire course. Also, I am personally satisfied with my level of knowledge of the head, neck, and upper extremity.<br /><br />A few days ago, a friend from high school asked me for medical advice, for a friend of hers. I've been getting this on and off for a while. It's different when it's family though; I have no qualms telling my parents that I know nothing and that they should go see an Actual Doctor. Which is what I told my friend, too, but I felt bad about it. I did have some ideas, and if this were small group, I'd have been fine discussing them. It's somehow different with a real person, though, especially someone I've never met. (Small group cases are drawn from what our preceptors have seen, but since there is an official diagnosis -- a correct answer -- they might as well be hypothetical.)<br /><br />But you know what? It's break. I'm not going to think about medicine any more until next Monday.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-90803367314405955222008-03-18T23:18:00.002-04:002008-03-18T23:21:48.446-04:00Exams continue to dominate my life, but Thursday is Match Day, when fourth-years find out where they are going to be training. Even the Times has <a href="http://www.nytimes.com/2008/03/19/fashion/19beauty.html?hp">taken notice</a>.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-6107356669191287482008-03-16T21:04:00.003-04:002008-03-16T21:28:05.561-04:00The run-up to the last anatomy exam.A good family friend, now in his fourth year of med school, was studying for Step 1 some years ago. I was incredulous at what he said his study schedule was: essentially study hardcore for 5 hours, take an hour break for lunch and some TV, and then back to the books for another 5 until dinner. I thought he was exaggerating, counting "study time" when he was actually online.<br /><br />Now, I'm incredulous at the memory of my own naivete. To recap the weekend: on Friday I took a 3 hour exam on GI and spent the afternoon (from 12:30 PM to 1 AM, with a half-hour dinner break) studying either in the library or in the lab. Saturday, I went hardcore from 10 AM to 1:30 AM. Today, I took a practice practical at 11 AM and went to the study lounge in my dorm directly after. Study breaks limited to trips to the vending machine, water fountain, and bathroom. And all this for one measly exam.<br /><br />The strange thing is, I don't feel tired at all. In college, this sort of schedule would have left me exhausted and murderous. Now, I don't really mind it so much. Yeah, it sucks, but I don't feel as mentally blank as I would have even a year ago. Maybe I'm building up some of that magical stamina that is supposed to get residents through their 80-hour weeks. (Or third-years through their unregulated work hour weeks.)<br /><br />Life <span style="font-style: italic;">is</span> going to be weird after anatomy. I expect it will be rather like after I gave my undergrad thesis to the bindery. It's consumed my life since the end of August. I really don't know what I'm going to <span style="font-style: italic;">do</span> with myself.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-52246057326083349942008-03-11T09:13:00.005-04:002008-03-11T09:26:40.773-04:00It's that time of the month againExams start on Friday and continue through next Thursday. March Block is acknowledged by all to be absolute hell, but I'm trying to stay positive. In less than a week, anatomy will be over forever! And then we have Spring Break. I'm planning to go home and pass out on my parents' couch for <span style="font-style: italic;">at least</span> three days.<br /><br />I've always thought of our class as very cohesive and cool and not at all competitive. But atlases have started disappearing from the anatomy lab, which puzzled me until I saw some people wrapping them in the red biohazard bags and stashing them in their lockers. Seriously? Maybe I just missed out on all this in college, because I avoided the regular premed classes as much as possible (I took the Chemistry for Chem Majors sequence, AP'ed out of bio and calculus; baby physics was the only "premed" class I took), but I thought we were cooler than that.<br /><br />This year is P/F, but second year they throw honors into the mix. We are trying to convince the administration to change that.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0tag:blogger.com,1999:blog-150302577709717299.post-86798875542473584052008-03-03T19:13:00.003-05:002008-03-03T19:38:56.372-05:00On autism<a href="http://tinyurl.com/2lwo6z">Parents "shun" inoculation for their children</a>.<br /><br />This makes me sad, because while you don't have to vaccinate <span style="font-style: italic;">everyone</span> (<a href="http://en.wikipedia.org/wiki/Herd_immunity">herd immunity</a>'s a wonderful thing), the threshold is always somewhere in the high 80%s. Also, the link between vaccines and autism is completely unsupported by scientific evidence. In fact, we had an entire small group session devoted to debunking it. I should've taken notes on the "miracles" required for the link to be true.<br /><br />Moreover, after the Wakefield paper was published in the <span style="font-style: italic;">Lancet</span> (and subsequently reported all over the popular press), there was a scare in Britain where parents refused to consent to vaccinating their kids. Result: increased incidence of measles and mumps, with two kids suffering measles encephalitis (read: permanent brain damage). Similar effect in Ireland: 1500 cases and 3 deaths. It's all nicely outlined, with citations, <a href="http://en.wikipedia.org/wiki/MMR_vaccine_controversy#Disease_outbreaks">on Wikipedia</a>.<br /><br />Now, autism is an illness that hits very close to home -- one of my family members has been diagnosed with autism. It's a frightening label to put on your kid, because although there are various therapies, there is no cure. I completely understand why parents would want to avoid anything that might cause it. (Current evidence suggests it's genetic, but obviously very complex and non-Mendelian.) But also frightening: encephalitis. Death. You'd think parents would want to avoid these, too.<br /><br />On a slightly related note: there are ads in the subway for some medical malpractice firm. In large and glitzy letters, they proclaim that you can win $1.5 million suing for autism. Who do you sue for a complex genetic trait, anyway? The worst part is the testimonial from a "satisfied customer" who notes how pleased she is that her child's incurable neurological condition has netted her some bling. I wish I were kidding.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com1tag:blogger.com,1999:blog-150302577709717299.post-87697457210621783492008-02-27T23:39:00.006-05:002008-02-28T00:14:01.956-05:00Today, in clerkship, my preceptor, a peds gastroenterologist, was running behind, so he threw a chart at me and told me to go in there and talk to the patient. The chart was completely empty except for a photocopy of their insurance card.<br /><br />So I did my first Real Medical Interview today. For about half an hour. Completely unrealistic to have that kind of time, I know, but I got a ridiculously detailed history involving a rather dramatic family dynamic playing into the medical condition. Really, it was almost novelistic.<br /><br />It was a little frightening, I admit. With less than a year of medical school under my belt, I have no clue what sorts of questions I need to ask. "So, what brings you here?" was my opening gambit. We rehashed the same topics over and over as I racked my brains for the best thing to say. At one point, the mother asked me, point-blank, for a diagnosis.<br /><br />"Well," I demurred, "I'm just a medical student, so I can't tell you much."<br /><br />"Oh." The corners of her mouth turned down. I felt terrible for not having an answer.<br /><br />So I said, "I just learned about how sometimes, there might be a sort of block between the colon and the brain. Like the nerve cells in your intestine don't work properly, so your brain can't sense when to go to the bathroom. That might be something you could ask the doctor about when he comes in."<br /><br />Very confident, as you can see.<br /><br />Then I felt even worse, because I had no clue what I was talking about. All I know about GI, after three weeks in the block, are celiac sprue, Hirschsprung's, and cholera. Oh, and situs inversus. <span style="font-style: italic;">Everyone</span> has situs inversus.<br /><br />Luckily for me, the doc arrived; I fumbled my way through the presentation (first presentation as well!); and when he went in, his explanation also involved damage to the vagus nerve. So I didn't <span style="font-style: italic;">completely</span> mislead the mother.<br /><br />In short, my faith and interest in medicine are renewed once again. Thank God for clerkship.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com2tag:blogger.com,1999:blog-150302577709717299.post-16993317840990669242008-02-22T18:08:00.005-05:002008-02-22T18:39:31.228-05:00Overtired and undermotivated.I feel like I'm in over my head again and kind of want to shut the world out. Or at least the med school part of it. I just want to flit from one social engagement to another -- tonight I'm going to a play, tomorrow to a dance -- instead of being holed up in my room or the library wondering why, exactly, apical ENaC channels are so important. And because my heart isn't really in it, my studying is very unproductive. I stare at the wall a lot.<br /><br />It snowed today, you see. Snowfall is always beautiful, but in New York the beauty is fleeting. Already, the streets have turned to brownish slush. I really wanted to make it down to Central Park to take pictures, but, like I said. Studying. Death.<br /><br />Sometimes, I wonder if I'm missing out on life. I am living in the greatest city in the world, and I feel like I can't enjoy it because I have to study. And I know that these demands on my time will only get bigger as I move through the ranks of medicine.<br /><br />*deep breath*<br /><br />I am reading Jerome Groopman's <span style="font-style: italic;">How Doctors Think</span> at bedtime, and it's wonderful. I wish that this, rather than <span style="font-style: italic;">The Spirit Catches You</span>, had been our summer reading. The cultural dynamics of <span style="font-style: italic;">Spirit</span> were fascinating and obviously relevant, but Groopman's book is more immediately applicable, I feel. Also better-written. Like Oliver Sacks, he revives the case study as a narrative form. Although it's billed as "how to avoid misdiagnosis," it's really just about listening to the patient and the patient's body. And <a href="http://www.medterms.com/script/main/art.asp?articlekey=10636">zebras</a>.The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com1tag:blogger.com,1999:blog-150302577709717299.post-1177336148701415822008-02-18T19:39:00.003-05:002008-02-18T20:04:03.045-05:00It's been a good week or so. The formal and afterparty were a lot of fun, just what I needed after exams. And my mother was visiting this weekend, so she and I had a good time exploring New York. We saw <span style="font-style: italic;">Curtains</span>, a murder mystery musical about a theater troupe, set in the later 1950s. Think <span style="font-style: italic;">Kiss Me, Kate</span> meets <span style="font-style: italic;">Radioland Murders</span>.<br /><br />Last week I went to a talk on the Science of Meditation, partly because there was food and partly because it seemed an interesting topic. The speaker, an alum of my med school, presented a bunch of data on melatonin as a contributer to tissue regeneration, which was intriguing. But then he started talking about the pineal gland being the "third eye" they talk about in Vedic scriptures (uh, did you ever think that might be a ... metaphor?), and yoga as promoting vagal maneuvers. Something about how standing on your head makes your diaphragm go slack? Didn't make a lot of sense to me, either. I'm cool with herbalism as a potential source of drug development, but this business of chakras and reiki and acupuncture is uncomfortably vague. Not to mention Orientalist. It is "Eastern," therefore it brings wisdom to the spiritually-deficient West. I am very, very tired of East-West Othering.<br /><br />I know yoga and meditation are now trendy, stress-reducing ways for yuppies to achieve nirvana, but because of my background, they are very much a <span style="font-style: italic;">religious</span> activity for me. And therefore intensely personal. And not scientific at all. Take yoga, for instance. It's not supposed to be about flexibility. It means "union," and it is supposed to be a way of moving past materialism and illusion into a spiritual plane in order to commune with God. I'm glad that people have some way of keeping fit and healthy, but it just seems, well, odd to me.<br /><br />----------------<br />Now playing: <a href="http://www.foxytunes.com/artist/adam+pascal+++rosario+dawson/track/light+my+candle" title="'Adam Pascal / Rosario Dawson - Light My Candle' - open on FoxyTunes Planet">Adam Pascal / Rosario Dawson - Light My Candle</a><br /><span style="color: rgb(153, 153, 153); font-style: italic; font-size: 10px;">via <a style="color: rgb(102, 102, 102);" href="http://www.foxytunes.com/signatunes/" title="FoxyTunes - Web of music at your fingertips">FoxyTunes</a></span>The Scrivenerhttp://www.blogger.com/profile/07089372155526171987noreply@blogger.com0