Same Blog, New Location

Hi Everyone -

My blog has been added to Medscape's medical student blog, The Differential. I hope you will continue visiting us at our new home: http://boards.medscape.com/forums/.29ef0439/

Just a heads up, you will have to log in to the site to view the blog, but anyone can register, so I hope you all do.

Thanks for reading!

story of med school

Rebecca: oh i have a better story for you. i forgot to tell you.

Rebecca: ready to vomit?

me: i mean, why not?

And then she proceeded to tell me a story, like most of patient encounters, that was too disgusting to blog.

baby mama drama

This summer I'm working on an infertility research project, and I have had the opportunity to go to clinic with my PI once a week. I've already been introduced to several ethical and legal issues that face the rapidly evolving field of reproductive endocrinology and infertility. One hotly debated topic is surrogacy.

The legal hurdles to using a surrogate mother point to the question 'who is your mother?' The medical procedures for surrogacy have been efficaciously developed, but now the legal cost and process pose the major barriers for many.

In Texas, even before beginning the process of in vitro fertilization, a couple must present to court with their surrogate and obtain a court order signed by a judge and all parties involved dictating that the child, who will be their's genetically, will also be their's legally. This is because in the state of Texas, if a woman delivers a child, she is the mother, unless otherwise legally specified.

If in utero epigenetic effects alter DNA expression of the developing embryo, then the child born to the surrogate may exhibit altered functioning (i.e. cardiovascular function, metabolism, etc.) from the same embryo had it been implanted in its genetic mother.

So then, do these differences make the genetic mother less of the mother? Or, does this even matter? If it does, where do adoptive mothers stand?

Maybe a mother is created only after birth, as the one who nurtures her child.

"The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new." - Rajneesh

Mama's boy/daddy's girl

"Since all male brain cells contain X chromosomes of maternal origin, they will be obliged to express these particular genes. Females share this possibility of having maternally expressed X-linked genes, but they will also have paternally expressed X-linked genes in the brain. Through X inactivation, the female brain will typically express the genes of only one X chromosome within a cell. The resulting random pattern of alternating maternal and paternal X-linked gene expression in the female brain is called mosaic expression. In direct contrast, males are obliged to express maternal X-linked genes." - Dr. Cykowski's lecture on "Sexual Differentiation of the Nervous System"

Could this explain the mama's boy/daddy's girl phenomenon?

How to date a med student.

I like how said med student is the boyfriend (#6). I totally get #12, because I'm getting increasingly forgetful of things not contained on my syllabus, I don't know what she's talking about - #9 sounds fun, and #7 talks about the biggest lesson I've learned in medical school - PEOPLE ARE GROSS!

http://www.foxnews.com/story/0,2933,452186.html

How to Date a Med Student

Friday, November 14, 2008 | FoxNews.com
Marissa Kristal

Getty Images

Dating a med student? Check out these tips for a "healthy" relationship.

1. Don't expect to see them. Ever.

2. Accept the fact they will have many affairs. With their books.

3. Learn to hide your “ew, gross” reactions when they tell you all the stuff you never wanted to know about your bodily functions.

4. Support them when they come home after each test, upset because they failed—and gently remind them after they get their well above passing grade how unnecessary the “I’m going to fail out of medical school and never become an MD” dramatics are.

5. Each week they will have a new illness. Some will be extremely rare, others will be more mundane. Doesn’t matter. They will be certain they have it (no second opinions necessary.) Med school can, and will, turn even the sanest into a hypochondriac. Date them for long enough, and you’ll become one too.

6. There will be weeks you'll forget you even have a boyfriend—friends will ask how he is and you'll say, “What? Who? Oh....right. He's well...I think.”

7. They'll make you hyper-aware that germs are everywhere and on everything. Even though you used to walk into your home with your shoes on, and sit on your bed in the same clothes you just wore while riding the subway, or sat on a public bench in, you'll become far too disgusted to ever do it again. Believe me, it's going to get bad...you'll watch yourself transform into the anal retentive person you swore you'd never become. And when you witness others perform these same acts that, before you began dating your med student, you spent your entire life doing too, you'll wince and wonder, “Ew! How can they do that? Don't they know how many germs and bacteria they're spreading??!”

8. Romantic date = Chinese take-out in front of the TV on their 10 minute study break.

9. A vacation together consists of a trip down the street to Walgreens for new highlighters and printer paper.

10. Their study habits will make you feel like a complete slacker. For them, hitting the books 8-to-10 hours a day is not uncommon, nor difficult. You'll wonder how you ever managed to pass school on your meager one hour of studying per night.

11. They're expected to know everything. Everything! The name of the 8 billion-lettered, German sounding cell that lives in the depths of your inner ear, the technical term for the “no one's ever heard of this disease” disease that exists only on one foot of the Southern tip of the African continent. But ask them if your knee is swollen, or what you should do to tame your mucous-filled cough, or why the heck your head feels like someone's been drilling through it for oil for two weeks straight, and they won't have a clue.

12. “My brain's filled with so much information, I can't be expected to remember THAT!" will be the standard excuse for forgetting anniversaries, birthdays, and, if you get this far, probably the birth of your first-born.

13. You'll need friends with unending patience who pretend never to get sick of listening to your endless venting and complaints. Or, you'll need to pay a therapist who will pretend never to get sick of listening to your endless venting and complaints.

But take this all with a grain of salt. It's not like I'm speaking from experience or anything...

It takes two to tickle.

"Tickle (middle English, tikelen: "to touch lightly") is a tingling, itch sensation produced by light external moving stimuli and may be pleasurable or irritating. Light tickling ('knimesis') may or may not induce laughter. Heavy tickling ('gargalesis') may also produce laughter but may be perceived as annoying and often includes a withdrawal response.

Heavy tickling by oneself of one's own body does not lead to laughter. Imaging studies suggest that the cerebellum anticipates the tickling movement, thus unconsciously nullifying the required element of surprise." - Dr. King's neuroscience lecture notes, Nociceptive (Pain) Pathways

Tickling is processed by the same neurological pathway as pain. Now, that explains my love/hate relationship with being tickled.

One of my favorite things about medicine is how normal things become exponentially funnier when explained in scientific terms. We use esoteric terms for everything (e.g. emesis = puking; hirsutism = excessive hairiness on a female vs. hypertrichosis = excessive hairiness on a male or female; redundant tissue = FAT - the list goes on).

Clearly this is done for precision, and a doctor's knowledge encompasses the subtleties of human anatomy, physiology and pathology, but there is just something ridiculous about all of these new words you must learn in order to grasp even an ounce of doctor-doctor conversation.

After years of training and practice, it must be easy to forget how abnormal this lingo is, increasing the rift between doctors and the rest of the world, patients included.

So, think before you tell your patient that they have a calcified melatonin-producing gland rostro-dorsal to their superior colliculus visualized on skull x-ray. They might think something is wrong.

Be warned.

Apparently if you watch TV after studying, you forget most of what you learned.

"Let's say you like to study and then go watch TV - bad idea! Bad idea. Your brain only has a certain number of little cogs it can keep in there, in your short term memory, so you study and you've got the material down and then you go and listen to a bunch of jokes. What's happened to the material you've just put into your brain? It gets dumped out the other end of the tube so to speak. You might remember the joke the next morning, but we're not asking you for the joke."
-Dr. Vaughan, first neuroscience lecture, on what not to do before an exam

Those late night infomercials really jipped me of some points. Fie, Magic Bullet, Snuggie, ThighMaster, Proactiv solution, Susan Powter...!

Into this world.

The flight to Nicaragua is shorter than to New York, but after working in a public hospital in Jinotepe for a week with a group from my medical school, I was amazed to see how different medicine can be so close to home.

There, the patient-doctor relationship is one of utmost trust and the standards of sanitation are non-existent, yet lives are still saved. "I don't know how, but we help people," Dr. Garcia, the chief of pediatrics, told us.

Of everything I saw in Jinotepe, the newborn babies fascinated me most. On my first day, I worked in obstetrics and saw four deliveries. There is nothing more beautiful than watching a baby enter this world, hearing its first cry as it gasps for its first breaths and to watch as pink seeps over its initially blue squirming little body.

Later in the week, I learned to review neonates cranially to caudally, inspecting fontanels, noting heart and respiratory rates, checking for distended abdomens, testing palmar and plantar grasp reflexes and looking for any abnormalities. They were the most precious, tiny things lying there innocently, swaddled, sleeping or crying, and I wished each of them everything good in this world even though I will never really know who they are.

My new knowledge of embryology made the perfection of babies so much more wondrous to me. There is so much that could go wrong – incorrect folding, misalignments, signals left on or off – but for so many, everything comes out just right, and a single cell grows into a embryo then a fetus which becomes a living, breathing, thinking, capable human being.

Some think science impedes faith. For me, medical knowledge has augmented my belief that there must be a higher power, because I have seen no person who could create a machine so beautiful and flawless as another human.

As I saw mothers hold their babies for the first time, the universal, natural mother-child bond was clear.

“WHENEVER I WENT OUT TO PLAY, MY MOTHER WANTED TO KNOW EXACTLY WHERE I WAS GOING TO BE

When I’d come in, she’d call me into her bedroom, take me in her arms, and cover me with kisses. She’d stroke my hair and say, ‘I love you so much,’ and when I sneezed she’d say, ‘Bless you, you know how much I love you, don’t you?’ and when I got up for a tissue she’d say, ‘Let me get it for you I love you so much,’ and when I looked for a pen to do my homework she’d say, ‘Use mine, anything for you,’ and when I had an itch on my leg she’d say, ‘Is this the spot, let me hug you,’ and when I said I was going up to my room she’d call after me, ‘What can I do for you I love you so much.”’

Krauss, Nicole. The History of Love. New York: W.W. Norton & Company, 2006.

M Fact - Cretinism

The term "cretin" may etymologically stem from the meaning Christ-like, indicating that these individuals are so severely mentally impaired that they are unable to sin.

Help cope.

In learning the art and science of medicine, we are privileged with countless "Aha!" moments - when embryology explains a congenital defect, when etymology helps decipher conditions and anatomy, when biochemistry demystifies the symptoms of a disease.

But, with each "Eureka!" comes at least as many "You’ve got to be kidding me’s" and "Oh no’s.”

Today’s was: "I have to bisect and clean the rectum in order to dismember my cadaver? You have got to be kidding." After a momentary freak out, I suppressed my gag reflex, came back to my tank, told myself to suck it up and got the job done. Yuck!

Last week it was worse. It was an "Oh no."

I’m sure many of you saw Barbara Walters' interview with Patrick Swayze, who was diagnosed with pancreatic cancer, the same terrible disease that killed the man whose body I’ve learned so much from this year. This is one disease I have seen with my own eyes, and the understanding that comes with seeing something so destructive first hand is incredible heavy.

As Swayze spoke of hope, my heart sunk, and so many questions rushed to mind. Does he understand how pernicious, rapid and incurable this disease is? Does he know how advanced it must be to be diagnosed? Does his family? Does he really think there will be a cure before his time is up?

I recalled the sutures throughout my cadaver’s abdomen combining portions of the bowel that were never meant to be together, his cirrhotic liver, the cancer’s penetration of organ after organ, and I imagined the pain he must have endured. For the first time in my life, I felt that hope was a waste. I momentarily equated hope with denial.

Then I caught myself. My perspective was perfectly incorrect.

The future looks grim for him, however, right now, Patrick Swayze is alive. And, I realize now that the extent of his medical understanding may be irrelevant, especially if hope is driving him to really live the rest of his life.

In a terminal case a physician’s role is to help manage pain and disease progression, to provide support and to maintain quality of the patient’s life to the best of their means. Yes, physicians must deliver the truth to patients and their loved ones, but that does not mean we should be a constant negative reminder of impending doom.