tag:blogger.com,1999:blog-68889342024-03-07T13:29:54.853-05:00Head .S p a c eAdventures of an academicUnknownnoreply@blogger.comBlogger414125tag:blogger.com,1999:blog-6888934.post-79746068873318879032012-04-11T20:30:00.000-04:002012-04-11T20:31:37.226-04:00HateradeWhy are female action stars always in heels?!Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-87073770676632471912012-04-05T22:21:00.000-04:002013-04-20T15:08:34.835-04:00First lines<div style="font-family: Georgia, serif; font-size: 100%; line-height: normal;">
<span style="font-family: verdana, sans-serif; font-size: 12px; line-height: 18px; text-align: -webkit-auto;">“Japanese students blow their brains out when they do not get into the college of their choice; Americans some time after they do.” - Whit Stillman</span></div>
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Damn. That's an opening sentence. </div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-22484188962132637452012-02-19T09:24:00.004-05:002012-02-20T09:58:12.426-05:00Infectious Disease, week #2<b>Day #6</b>: <div>A person with a history of E. coli sepsis (blood infection) who now has findings on a brain scan suspicious for abscess, but could also represent tumor. Abscess is more likely, so we will treat with antibiotics for 4 weeks, scan their head again, and see if there has been any response.<br /><br />A person with an infection of the skull bone behind the ear on the right side, recovered, had a stroke, had a portion of skull removed to accomodate swelling, had the skull replaced and now appears to have developed an infection of the skull bone behind the left ear. Cultured the drainage and tested the susceptibility of the bacteria. Antibiotics recommended, person is recovering.<br /><br /><b>Day #7</b>: </div><div>A person who had their hip replaced, had an infection in that hip, had the replacement removed and a new one inserted, had another infection, had the second replacement removed, now has no hip on that side and is undergoing treatment to clear... infection. They fell and now their knee is swollen too - blood from the fall, blood clot, or spreading infection? Likely from the fall. Continue antibiotics, check inflammatory markers and use ultrasound to rule out clot.<br /><br />A person on dialysis with endocarditis and known brain abscesses. We helped identify the organism, choose antibiotics and he is undergoing pre-surgical workup. Kinda grumpy.<br /><br /><b>Day #8</b>: </div><div>A Chinese immigrant who is coughing up blood. They have a lung disorder that can cause episodic blood, but there is also concern for tuberculosis (which is endemic in China). More likely to be their underlying condition (based on physical exam) - testing confirms. We set them up with pulmonary follow-up.<br /><br /><b>Day #9</b>: </div><div>A person who arrived in liver failure due to purposeful overdose who continued to have fevers despite antibiotics. Given chest x-ray, more likely drug fever or chemical pneumonitis, but will treat with a short course of antibiotics to rule out aspiration given their altered mental status and vomiting on admission.<br /><br /><b>Day #10</b>: </div><div>A person who has cancer and no immune cells due to chemotherapy now has a fever and trouble breathing. Chest imaging is suspicious for fungus. Lots of antibiotics started until we can clarify the nature of the infection.<br /><br />A person with multiple antibiotic allergies who has an infection of the inside of the nose. There is always a concern that if inadequately treated, an infection like this will spread backwards to the brain. Broad antibiotics were started until we can grow the bug in culture and narrow them.<br /><br /><b>Still following</b>: </div><div>The endocarditis patient from last week who has vegetations on their pacer leads. They went to surgery and had their pacemaker removed. Labs are still negative, so a 4-6 weeks course of broad spectrum antibiotics before a new device can be placed. Still unclear what their lung findings are: septic emboli vs pneumonia.<br /><br />The patient with ulcerative colitis who had a blood infection and a clot in their arm... the clot was not surgically removed and they cleared the bacteria from their blood. Was discharged to complete antibiotics at home.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-46170851534930846922012-02-12T11:27:00.003-05:002012-02-12T11:53:20.703-05:00JargonEvery profession has its own language that tends to make it indecipherable to outsiders. I love the medical language; it's succinct and exquisitely precise. But then, I speak doctor, fluently. In my previous post, I left out lots of details because explaining them in everyday English would have made the post three times as long. But for the curious and the fluent out there, here's the untranslated version:<div><br /></div><div><b>Day #1</b>:</div><div>XX year old (gender) intubated and transfered to the unit secondary to AMS and hypercarbic respiratory failure c/b ARF while being treated for LLE L2 dermatome VZV. Concern for dissemination given RLE vesicles. DFA on RLE (-). Unlikely to represent dissemination, however AMS could be VZV encephalitis. LP not possible due to L2 vesicles and body habitus. Treat empirically for 21 days.</div><div><br /></div><div>XX year old (gender) with recurrent hospitalizations for HA, n/v. Serial LP with pleocytosis, however HSV/VZV(-). Concern for chronic meningitis. Latest LP wnl. Unlikely to be chronic infectious due to lack of exposure history. Recommend steroids and rheum workup. d/c abx.</div><div><br /></div><div><b>Day #2</b>:</div><div>XX year old (gender) with newly dx UC refractory to steroids, now on Remicade. Blood cx with GPC in clusters, PICC tip cx w/MSSA. RUE DVT from previous PIV. May d/c vanc, start cefazolin. Blood cx remain (+), RUE U/S with abscess. Now dx of septic thrombophlebitis. I&D on RUE performed, cx remain (+). Recommend thrombectomy. </div><div><br /></div><div><b>Day #3</b>:</div><div>XX year old (gender) with Waldenstroms and chronic cough x 18mo. BAL in Jan (-) on AFB smear. Now (+) for M. gordonae. Febrile to 39.1 after second chemo infusion. BAL result likely contaminant; triple therapy not benign so recommend no tx unless sx. Cough dry, not consistent with mycobacterium. Fever likely transfusion rxn.</div><div><br /></div><div><b>Day #4</b>:</div><div>XX year old (gender) hospitalised in Jan for pna/chf, transferred due to vegetations on TV and RV pacer lead. Likely cx (-) endocarditis due to abx use. Continue vanc/zosyn and call EP for lead removal. Call CT surg for valve consult. Possible that pna was actually septic emboli 2/2 large TV veggie. </div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-27047961530240342482012-02-11T14:56:00.000-05:002012-02-12T11:26:27.773-05:00Infectious Disease, week #1For my last clinical (in-hospital) month of medical school, I have registered for an infectious diseases consult month. First I will describe what a consult service is, after that we get to the cases I saw during the first week.<div><br /></div><div><b>Consult Service</b> (n) - a group of physicians called by the treating doctors to answer a specific diagnostic or treatment question because of their subject-specific expertise. </div><div><br /></div><div>It's not really different from consulting in business. You are posed a specific conundrum, you gather data, make recommendations, but have no power or authority to directly enact your plan. From a logistics standpoint, your workflow is also opposite</div><br /><div>to a primary team. You see all your new patients in the morning and round in the afternoon.</div><div><br /></div><div><b>Day #1</b>: </div><div>A person who had altered mental status and shingles. New lesions were appearing and the primary team was worried the shingles was spreading and had become systemic (usually it's limited to a small part of the body). I decided no (lab testing confirmed), however the change in mental status made the idea of it causing an infection in her head possible. We couldn't confirm because the shingles was covering the part of the body we would use to do a lumbar puncture. </div><div><br /></div><div>A person was admitted to the hospital three times in two months for headache, nausea and vomiting. All tests looking for infection in the head were negative each time. We were asked to weigh in on the likelihood this was a chronic infection we simply couldn't detect in the lab. While those infections exist, it was more likely this represented a manifestation of her not-fully diagnosed auto-immune disorder. Steroids, not antibiotics, were more likely to be helpful.</div><div><br /></div><div><b>Day #2</b>:</div><div>A person who was taking immunosuppressive therapy who now had bacteria in the blood. Initially appeared to be a standard line infection (bacteria grow on an IV or central line), however turned in to a septic thrombophlebitis (blood clot with bacteria in it) with an abscess. Despite being surgically drained, the person continued to have bacteria in the blood. More to come.</div><div><div><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguMeeI_UeJe5HppFh3U3kgLZSHIfxZy7BslCWUBugBdqJIcZ7RoSMB9jKQcxw_ENZBn4eKERR8FVaPGj71E_SNP2_5gkV0YdJ9RMcemXpj3GIGZvV8mHzojJQYSrU1idxJ8A_c0A/s200/mycobacterium.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5708284786566970530" style="float: left; margin-top: 0px; margin-right: 10px; margin-bottom: 10px; margin-left: 0px; cursor: pointer; width: 200px; height: 150px; " /></div></div><div><b>Day #3</b>:</div><div>A person on chemotherapy with a chronic cough who had his sputum cultured one month ago. It just turned positive for mycobacterium gordonae; contaminant or infection to be treated? I decided contaminant and we did not treat.</div><div><br /></div><div><b>Day #4</b>: </div><div>A person with two recent hospitalizations for pneumonia who now is found to have growths (vegetations) on one of their heart valves and on a lead of their pacemaker. No detectable bacteria in the blood. I decide to cover with antibiotics and have the pacemaker removed. Also talk to the surgeons about whether they need to operate on the valve, given how big the vegetations are. I don't think it was pneumonia, I think the person is sending bits of clot into their lungs. </div><div><br /></div><div><b>Day #5</b>:</div><div>No new patients, just followed up on existing ones.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-86572318015527299412012-02-01T14:34:00.002-05:002012-02-01T15:17:57.664-05:00Reading list<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFeFeNW3hyphenhyphenOq7xPF-EYFqmJCPR85zBlnzYjbxWyPtOhMNJvYKQh7KkKj5YTPoIQOnvqurhyphenhyphenwScp5YJUlQ4ztuTD6xzLIA4NKDatbzjjlpSVv3PfPm0OthwPlv-tzd5dQHxVuAOzQ/s1600/IMG_0165.JPG"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFeFeNW3hyphenhyphenOq7xPF-EYFqmJCPR85zBlnzYjbxWyPtOhMNJvYKQh7KkKj5YTPoIQOnvqurhyphenhyphenwScp5YJUlQ4ztuTD6xzLIA4NKDatbzjjlpSVv3PfPm0OthwPlv-tzd5dQHxVuAOzQ/s200/IMG_0165.JPG" border="0" alt="" id="BLOGGER_PHOTO_ID_5704253264862342066" /></a>One of the wonderful side effects of having lots more free time during the interview season has been all the reading I've done. Besides the usual suspects (news, entertainment, health) online, I got through a decent pile of really great fiction:<div><br /></div><div>Kalila by Rosemary Nixon - the story of a child born ill, told from multiple points of view.</div><div><br /></div><div>The Rumi Collection edited by Kabir Helminski - collection of sufi poetry, using multiple translators. </div><div><br /></div><div>Brick Lane by Monica Ali - the story of a muslim woman from a small Bangladeshi village, brought to London to marry.</div><div><br /></div><div>The Marriage Plot by Jeffrey Eugenides - the story of a girl navigating life during her graduation from Brown.</div><div><br /></div><div>The Hunger Games Trilogy by Suzanne Collins - ostensibly the story of children forced into battle for sport, but with strong political tones. The Ender's Game for this crop of tweens?</div><div><br /></div><div>Moloka'i by Alan Brennert - the story of a young girl sent to a leper colony in hawaii at the turn of the century.</div><div><br /></div><div>The Tiger's Wife by Tea Obreht - technically the story of a woman finding out how her grandfather died, but really a collection of lovely eastern european fairy tales.</div><div><br /></div><div>Cutting for Stone by Abraham Verghese - the story of twins born in an Ethiopian clinic; their complex family relationships, with the backdrop of the Eritrean unrest. </div><div><br /></div><div>My Own Country by Abraham Verghese - An indian doctor taking care of AIDS patients in TN.</div><div><br /></div><div>I would honestly recommend all these books, but I have to say I do love Abraham Verghese. Still on the list to get to next: A Visit from the Good Squad by Jennifer Egan, Tinkers by Paul Harding, and Unaccustomed Earth by Jhumpa Lahiri. If you have any suggestions, I'd love to hear them! </div><div><br /></div><div><br /></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-60473749994558567032012-01-23T22:34:00.004-05:002012-01-23T23:35:40.670-05:00Gosh darnit, they like you!<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikEVf89hUXKxLm3Aa3ZTsUbrEn2j6S4UU6qYRjPVW_2EmKjMSyH5M_s0_vjAxFiCqO3eaPYtgeqKzJQZyvFWJmHSan-wO0Z8cuquHdLJeRX6wqmu-1UhPdh8iecFY9sZx8warLCA/s1600/kellog.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 87px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikEVf89hUXKxLm3Aa3ZTsUbrEn2j6S4UU6qYRjPVW_2EmKjMSyH5M_s0_vjAxFiCqO3eaPYtgeqKzJQZyvFWJmHSan-wO0Z8cuquHdLJeRX6wqmu-1UhPdh8iecFY9sZx8warLCA/s200/kellog.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5701037183692351282" /></a>On Jan 21st I was part of a team of finalists representing Ross<br />business school in the Kellogg biotech and healthcare case competition. One week prior we had been given a dilemma<br />surrounding the issue of infant HIV diagnosis in a poor African nation. We had to come up with a pilot program for a new point-of-care testing method and justify our strategy. There were thirty-six entrants, of which 11 finalists were chosen. Each finalist team had 1/2 hour to present their solution. <img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQV5KRSoVP_QL5IwqCEqy8v_RKqUHWA3whT2_qfrz32v4KVB0FjK4K0qmY7DHcLJHSowgsSk0qBAikmlWuRn8AYJ05Fo8v7rdT3w0J1KDdbMpKPH6Ce5VCBS1sQxBrJYNacez_4Q/s200/402080_10100157370674811_11004427_44450722_1463319169_n.jpeg" border="0" alt="" id="BLOGGER_PHOTO_ID_5701037416841983362" style="float: right; margin-top: 0px; margin-right: 10px; margin-bottom: 10px; margin-left: 0px; cursor: pointer; width: 200px; height: 150px; " /><div><br /></div><div>We won. Felt awesome.</div><div><br /></div><div>If you can believe it, I did power calculations and threshold sensitivity analysis. I used formulas in excel. I could feel the rust falling off the mental gears I used 10 years ago in my undergrad business degree. It felt really good to be doing something a little different than the past 3.5 years.</div><div><br /><div>It was so much fun, in fact, that I am pursuing the idea of doing a three month project with one of the professors in the Ross business school as an interdisciplinary elective. I'll know more next week on how feasible that is.<br /><br /><br /></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-28646364212069954612012-01-15T12:11:00.002-05:002012-01-15T12:18:19.745-05:00Dr. G has a sense of humorWhile studying a module on asthma, the following practice question came up:<div><br /></div><div>Q. Which of the following issues are concerns for the athlete with asthma?</div><div><br /></div><div>A. Cold air</div><div>B. Exercise</div><div>C. Restrictions on drug use</div><div>D. Brent Musberger</div><div><br /></div><div>The correct answer, for those non-medigeeks, is all of the above.</div><div><br /></div><div>For those whose knowledge of athletics is limited (as is mine), Musberger has been quoted stating, " While anabolic steroids have no place in high school athletics, I think under the proper care and doctor's advice, they could be used at the professional level."</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-18015490773096875732012-01-12T16:19:00.000-05:002012-01-15T12:47:45.751-05:00Life after medical school<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPZzJH2HolaIkdG2TstXTyYLM1tzgHNKMoDIdnbUN9uGGb0hm0v4P9LBdxY3CekRVo0i9pez6MTajqpPwTZAopO4nVH15uT4UNP27kMeg3KIpCmp15pC3nnnPelS3Yro4LqAl_LA/s1600/simpsonified.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPZzJH2HolaIkdG2TstXTyYLM1tzgHNKMoDIdnbUN9uGGb0hm0v4P9LBdxY3CekRVo0i9pez6MTajqpPwTZAopO4nVH15uT4UNP27kMeg3KIpCmp15pC3nnnPelS3Yro4LqAl_LA/s200/simpsonified.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5697916632886653810" /></a>It occurs to me that most people outside of medicine don't really know how the medical education system works after medical school. So here is a combined primer/update.<div><br /></div><div>Upon completing medical school, you are an MD, however you cannot practice clinical medicine without supervision until you complete a minimum of one post-graduate year. Typically, this is accomplished by entering into a residency program. The vast majority of people complete a full residency, upon completion of which you sit the board exams in a particular specialty (or specialties). If you pass that exam, you are then "board-licensed" in that area of medicine. You can further specialize within that category of medicine by completing a fellowship and sitting sub-specialty boards. </div><div><br /></div><div>Example: You could complete an internal medicine residency to become a board-licensed internist and subsequently complete an endocrine fellowship to become a licensed endocrinologist. </div><div><br /></div><div>You cannot complete a fellowship without first completing a residency. Theoretically you can practice medicine without board licensure, however you would never get the malpractice insurance required and no hospital would hire you/give you privileges.</div><div><br /></div><div>Okay, so how does a medical school graduate get into a residency program? The answer is the national residency match process. In your final year of medical school you apply to residency programs at a variety of hospitals using a central database called the ERAS. You fill the application out once and select the programs at which you would like to be considered (and pay $$). Generally, people apply to only one type of residency (ie anesthesia, pediatrics, ob/gyn), however occasionally people will apply to a less competitive option in case they do not get a spot in something coveted (ie, someone applying for dermatology may also apply to internal medicine). </div><div><br /></div><div>Programs that found your application compelling will invite you to interview with them. An interview involves flying out to the hospital the day prior, attending a dinner with current residents the evening prior, followed by a full day of interviews/presentations/tours. You pay for this yourself, so you can imagine that a person who interviews with 10-12 programs will burn though a chunk of change accomplishing this. Interview season is November-January.</div><div><br /></div><div>In February, the applicants submit a ranked list of places they interviewed at. The list does not have to include all the programs, however, not ranking a program means you would refuse to work there even if given an offer. Applicants cannot rank programs at which they did not interview. Simultaneously, each program ranks the applicants they interviewed. Again, they do not have to list all the people they interviewed, but they cannot list someone who did not interview.</div><div><br /></div><div>In March a computer goes through and attempts to create the optimal pairing of applicants to programs. If multiple programs rank an applicant, the applicant is generally assigned to the program they preferred. If no programs rank an applicant high enough, that applicant will not get a residency placement (ie they will not have a job). On March 16th, 2012, all applicants will get an email telling them where they have been assigned. If an applicant did not match, they are generally notified the Monday prior and they go through something called the scramble.</div><div><br /></div><div>So, where am I in all of this? Well, I'm applying to a combined residency program, called medicine-pediatrics. It's four years in length. At it's conclusion, I will sit both the internal medicine and pediatrics board examinations (ie I will be double-boarded). I applied to 19 programs and was offered interviews at 14 of them. I completed 11 interviews, but have not yet settled on what order to rank them. </div><div><br /></div><div>Places I interviewed: UPenn/CHOP, Univ. Minnesota, Univ. Maryland, Univ. Michigan, Georgetown, Brown, Baystate (Tufts), UCLA, USC, UNC, Univ. Rochester</div><div><br /></div><div>Places I declined to interview: UCSD, Vanderbilt, Univ. Chicago</div><div><br /></div><div>Places I was rejected: Brigham & Women's, Mass Gen, Yale, Duke</div><div><br /></div><div>Places I never heard anything from: Univ. Pittsburgh</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-63788642571814591432012-01-05T18:37:00.000-05:002012-01-13T14:31:27.658-05:00Free timeFor those of you not in medical school, it's residency interview season. My particular medical school gives me two months off (read: vacation) in order to travel and complete interviews. Two months is more free time than I have head since, well, since I went to Thailand. So what did I do with this precious time? I intended to learn Spanish. That did not happen. Instead, I:<div>- traveled to 11 interviews (and saw friends!)</div><div>- took Step 2 CS</div><div>- visited my parents for two weeks</div><div>- met my boyfriend's parents (I took them to the anatomy lab)</div><div>- did crossword puzzles</div><div>- baked (a lot)</div><div>- tasted several varieties of gourmet cupcakes</div><div>- improved my skills at Burnout 3 on the PS2</div><div>- played Betrayal: House on Haunted Hill (board game)</div><div>- watched The Lives of Others and Lawrence of Arabia</div><div>- trained new SPIs at school</div><div>- taught the M2s pulmonary classics</div><div>- slept. slept more.</div><div><br /></div><div>All in all, it was quite nice to live life at a reduced pace, however I don't think it really generated any interesting or funny stories for blogging. Except for that time I found $20.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-21162068766269608282011-12-20T14:13:00.001-05:002012-01-13T14:18:32.139-05:00ContrastWhat he does...<br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2CLcHsG_aNwgj20Mnv65waqr3jwq8KjiyMES-FTI6ronZ8HWCcwJp2DRtSBM4IqbtCJyUWCoXALe6yxTEsWWA0kPOXX13R0PFyXzwJpqIj1wTGMOjM72pxPXNCvwtqNbPH98HtQ/s1600/math.JPG"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2CLcHsG_aNwgj20Mnv65waqr3jwq8KjiyMES-FTI6ronZ8HWCcwJp2DRtSBM4IqbtCJyUWCoXALe6yxTEsWWA0kPOXX13R0PFyXzwJpqIj1wTGMOjM72pxPXNCvwtqNbPH98HtQ/s200/math.JPG" border="0" alt="" id="BLOGGER_PHOTO_ID_5697197063081886466" /></a><br /><div><br /></div><br /><br /><br /><p><br /></p><p><br /></p><p><br /></p><p>What I do...<br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYsQ9hgld2hf7sOM3M7TdNudbcDdFoL3g_68QiqRuVrR7q_Vgy4A1vxcw_5IMWS3lDMnp8HYHavqYTvIwzykxLM3k25uYhUPbbXw718q46efkJGCPZifVxlgL_fUPRWtqkaVC61Q/s1600/hearts.JPG"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYsQ9hgld2hf7sOM3M7TdNudbcDdFoL3g_68QiqRuVrR7q_Vgy4A1vxcw_5IMWS3lDMnp8HYHavqYTvIwzykxLM3k25uYhUPbbXw718q46efkJGCPZifVxlgL_fUPRWtqkaVC61Q/s200/hearts.JPG" border="0" alt="" id="BLOGGER_PHOTO_ID_5697197512563995442" /></a></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-61222258748955482322011-11-24T22:43:00.001-05:002012-01-25T20:21:17.045-05:00Dutch Thanksgiving<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyXUxeQxG6SCGp5P2kYRabesPc0P6U8iEKksWJ9bbJfuDf1ALZBbSe6Vhk5A6TvOgDso6rZz7EpRroXBKFDpohffrHXTceFX1jdPuRXShfDXp5PoVybkhC1Qytfnwoqt6hOh_QhA/s1600/photo.JPG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 150px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyXUxeQxG6SCGp5P2kYRabesPc0P6U8iEKksWJ9bbJfuDf1ALZBbSe6Vhk5A6TvOgDso6rZz7EpRroXBKFDpohffrHXTceFX1jdPuRXShfDXp5PoVybkhC1Qytfnwoqt6hOh_QhA/s200/photo.JPG" border="0" alt="" id="BLOGGER_PHOTO_ID_5681000764399813874" /></a>Reasons I don't generally go home for Thanksgiving:<div>1. It's six hours and three time zones away by plane</div><div>2. We're European, it's not really a family tradition</div><div>3. Most of the food is not on mom's Atkins diet</div><div><br /></div><div>Lucky for me I have generous friends and am usually adopted by someone else's family on a temporary basis. For the past two years, it has been by AH, a classmate. Her family, back in the day, were Dutch and oma (grandma) in particular finds my authentic Dutch self charming. Last year she had me read a Dutch cookbook and indicate which foods were familiar. So this year I baked some Boterkoek and brought it with me. It's super simple and looks fairly plain, but let's face it, anything that's 25% butter is going to be tasty. I like mine with a hint of almond flavouring.</div><div><br /></div><div>Try something Dutch:</div><div><br /></div><div>1 cup butter, softened</div><div>1.5 cups granulated sugar</div><div>2 eggs</div><div>1 tablespoon almond extract</div><div>2.5 cups all-purpose flour</div><div>1.5 teaspoons baking powder</div><div><br /></div><div>Mix butter and sugar. Add eggs, 1 at a time. Add remaining ingredients. Press into two 8" pie or tart tins. Bake for 30 minutes at 350 degrees Fahrenheit. For best texture, leave uncovered for 12-24 hours. Thereafter, store in an airtight container. </div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-67017987486856921642011-10-21T18:42:00.001-04:002011-10-23T18:48:38.541-04:00Emergency Dept: week 4Monday: chest compressions and a resident too busy to staff with me<br />Tuesday: no cath for you, more abdominal pain<br />Wednesday: just had his nose done and now it's broken, back pain, allergic reaction<br />Thursday: it's not your shunt but we'll scan you anyway, can't stop pooping<br />Friday: exam (that doesn't count)Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-37504954374409138692011-10-19T14:49:00.002-04:002011-10-19T14:58:00.213-04:00Emergency Department: Week 3Monday: name that heart rhythm...<br />Tuesday: just plain crazy x2, abdominal pain<br />Wednesday: off! pumpkin surgery.<br />Thursday: immunosuppressed and febrile, attending gave me homework?!<br />Friday: chest compressions, large bore IVs and a bladder scan<br />Saturday: mr anxious, mrs crazy and the guy smoking though lung cancer<br />Sunday: off (again)Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-42068677426604147152011-10-09T14:08:00.000-04:002011-10-10T12:20:58.861-04:00Emergency Dept: week 2Monday: Lupus, vomiting blood, strep throat, passing out.<br />Tuesday: Multiple orbital fractures, pelvic exam and a cheerleader with the flu.<br />Wednesday: Tech shift - peripheral IVs, appendicitis.<br />Thursday: Splints x3. Asthma. Oops, the baby ate mommy's pills.<br />Friday: Stitched up a chin, a forehead and an ear. <br />Saturday: Biliary colic, drunk, drunker and drunkest.<br />Sunday: offUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-28546685953792829992011-10-02T21:20:00.004-04:002011-10-02T21:35:16.935-04:00Emergency Dept: week 1Monday: orientation. started an IV on a classmate.<div>Tuesday: orientation. splinted a classmate.</div><div>Wednesday: abdominal pain x2, chest pain and hypoglycemia. started an IV.</div><div>Thursday: seizure, abdominal pain x2, chest pain. did an NG lavage and placed an a-line.</div><div>Friday (peds): poison ivy, lip abrasion, abnormal labs, abdominal pain, seizure</div><div><br /></div><div>Funny thing about that poison ivy... the little boy had a small patch of it on his hand and a big patch of it in his groin area...</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-83180574204564038892011-09-30T21:16:00.000-04:002011-10-02T21:20:38.132-04:00really?!<div>Me: What illnesses run in your family?</div><div><div>Patient's mother: My high blood pressure was giving me seizures so they took out my spleen.</div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-21618010974253612962011-09-26T21:20:00.002-04:002011-09-26T21:29:01.174-04:00Emergency Medicine orientation"Sometimes the facial structures are traumatized, complicating the intubation. Although, it is a lot easier to get the jaw and tongue out of the way when they are disconnected."<div><br /></div><div>"You want to make sure the NG tube is not in the lungs; it can't really decompress the stomach from there."</div><div><br /></div><div>"He came in with a skeleton of a finger, no flesh, and said 'fix me.' Well, sorry dude, you're f*cked. There's no saving that finger. Degloving injuries require amputation."</div><div><br /></div><div>"In Europe, not everyone who goes into a trauma bay gets a rectal, but here we log roll everyone and do a rectal exam. The surgeons love it."</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-16250576750411547862011-09-05T13:30:00.003-04:002011-09-05T14:31:06.018-04:00it shouldn't bother me, but it doesI'm talking about medical inaccuracies on television. We won't even get into the inaccurate representation of resuscitation, which is so egregious that there is published research on it. Recent errors I've noted:<div><br /><div>1. Nurses, unless they are CRNAs, don't intubate patients.</div><div>2. There is no such thing as part-time medical school.</div><div>3. You don't get a long white coat at the white coat ceremony, you get the short one.</div><div>4. Diabetics requiring insulin do not leave needle impressions on their hip bones. </div><div>5. Hospitals cannot turn away acutely ill patients because they don't have insurance.</div><div>6. You are not forbidden from speaking with a person after neurosurgery because getting them emotional could cause their brain edema to worsen.</div><div>7. If you coded, you would be moved to an ICU, not put on a stretcher along the hallway. And a lot of people would show up, not just one nurse.</div><div>8. I don't care if there's a killing spree, a random nurse would not be authorized to read confidential patient data (about a potential victim) over the phone to a police officer. She would be fired.</div><div>9. If a trauma victim is talking, they don't go straight to the OR. They go to the ER to be stabilized or for images. There is no magic hallway connecting the outside door to the OR.</div><div>10. If you sprained your pinkie finger, you would not have a hard cast placed on your hand.</div><div><br /></div><div>Another time I'll let loose on the absolutely ridiculous depictions of medical school. I have yet to see anything that remotely resembles actual medical training on television. </div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-2656702005705353502011-09-02T21:11:00.003-04:002011-09-02T21:24:29.353-04:00QuatrainsI'm apparently late to the party, but I just stumbled across the poet Rumi. Some favourites:<div>
<br />You think you are alive
<br />because you breathe air?
<br />Shame on you,
<br />that you are alive in such a limited way.
<br />Don't be without Love,
<br />so you won't feel dead.
<br />Die in Love
<br />and stay alive forever.</div><div>
<br /></div><div>
<br />It is your turn now,
<br />you waited, you were patient.
<br />The time has come,
<br />for us to polish you.
<br />We will transform your inner pearl
<br />into a house of fire.
<br />You're a gold mine.
<br />Did you know that,
<br />hidden in the dirt of the earth?
<br />It is your turn now,
<br />to be placed in fire.
<br />Let us cremate your impurities.</div><div>
<br /></div><div>
<br />I am so drunk
<br />I have lost the way in
<br />and the way out.
<br />I have lost the earth, the moon, and the sky.
<br />Don't put another cup of wine in my hand,
<br />pour it in my mouth,
<br />for I have lost the way to my mouth.</div><div>
<br /></div><div>More at http://www.rumi.net/rumi_poems_main.htm</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-77800172249823117202011-08-20T21:17:00.002-04:002011-08-20T21:34:33.513-04:00Little m, big PIt occurs to me that I haven't really talked about residency applications, which actually comprise a lot of time and mental energy during the beginning of M4 year. I'm applying for a medicine-pediatrics residency. It's a four year program, at the end of which you sit the boards for both internal medicine and pediatrics. You are then eligible for any fellowship in either medicine or pediatrics, though 60% of graduates go into primary care. Not me - of course - I will be headed to fellowship. <div>
<br /></div><div>There aren't very many med-peds residency programs, and each one takes very few candidates. Thus, this residency is competitive because demand outstrips supply. Nevertheless, my advisors tell me I will match.</div><div>
<br /></div><div>For those of you who don't have relatives in medicine, I will briefly mention what "the match" is. Basically, as a 4th year you apply to some residencies. The ones interested in you will invite you to interview. You rank all the places you interviewed. The hospitals rank all the people they interviewed. It goes into a big computer program called the NRMP. In March you get an email telling you where you matched - not all the places, just the one place you will go to. It's not a choice and you are not guaranteed to be chosen anywhere. Rather appropriately, this process causes a tremendous amount of anxiety - will I match at all? Will I match somewhere I actually want to go?</div><div>
<br /></div><div>Right, so I've been told I will match, it's just a question of where. My current list of programs is 19 deep and I hope to get 10 interviews. I've had to get four letters of recommendation, two of which must come from the chair of the peds dept. and the chair of the internal medicine dept. I have to get a letter of endorsement from the dean of the medical school as well. I have to put my CV and all my publications into the online program (one item at a time). I have to provide transcripts and copies of my USMLE step 1 and 2 scores. I have to write a personal statement and include a photo. I have to pay money (of course). All of this gets submitted September 1st, so you can imagine the past three months have been spent getting all of this together. But soon - so soon - I hit submit and then... I wait. Wait and hope. Hope for interviews. </div><div>
<br /></div><div>I will keep you updated.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-39121872035745448822011-08-10T21:02:00.000-04:002011-08-20T21:16:25.502-04:00Heartbreak cardiomyopathy<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYNzLh366Ajxkyc5mPiDx0De5shJ87WxPERjd4t2uuF9aKocDKRoZpxUXeVrhPtraDAeDzlGToqvc6AFLgWaJF7FPHsN6jXzDlI17SCbWQZg_VrjLntbPnnvwRze-OA5jkPvtzJg/s1600/takotsubo.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 83px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYNzLh366Ajxkyc5mPiDx0De5shJ87WxPERjd4t2uuF9aKocDKRoZpxUXeVrhPtraDAeDzlGToqvc6AFLgWaJF7FPHsN6jXzDlI17SCbWQZg_VrjLntbPnnvwRze-OA5jkPvtzJg/s200/takotsubo.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5643109216609733714" /></a>This month I had a patient with an interesting and rare condition called TakoTsubo Cardiomyopathy, also known as "broken heart syndrome." It involves myocardial stunning after a highly stressful event such as the death of a spouse or a natural disaster. Basically, you are so overwhelmed that you literally go into heart failure. The physiologic mechanism is incompletely understood, but leading theories revolve around catecholamine release. Thankfully, the significant majority of people recover their full heart function in days to weeks. It is most commonly seen in Japanese post-menopausal women, however it has been described in the US and Europe as well. It can be accompanied by an NSTEMI (heart attack) and frequently QT prolongation (repolarization abnormality - sorry, I don't know how to translate that better without a tutorial on EKGs).<div>
<br /></div><div>It gets its name from Japanese octopus traps. Why? Because this particular heart failure displays what we call "apical ballooning." Basically, the upper and middle parts of the ventricle contract, but the apex (the point) of the heart does not. That means that blood, which is ordinarily squeezed from the bottom of the heart towards the top, is now being simultaneously pushed up and down. the down-going blood has nowhere to go so the tip of the heart balloons out (see diagram). </div><div>
<br /></div><div>My patient began recovering heart function very quickly, but her QT prolongation was impressive. Almost write-it-up-in-a-journal impressive. Thankfully, that also resolved quickly. We never got a good sense of what her precipitating event was, but I suppose all stress is relative. </div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-2405602307272564222011-05-09T11:04:00.002-04:002011-05-09T11:29:41.671-04:00Welcome to M4!<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuyIRfUGU9c9y5nATGmZTjJT5SG6r00kYxO0shRcmdP-fK9VvyA8Un8pGXaFvWzakMcgSrVPj9yAeA22mWWLWdRDgpYGnW1hsrm3JD3RXUNzrd_I2VgomNpcb_BaF7-t9fWWDS1g/s1600/Photo1.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 135px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuyIRfUGU9c9y5nATGmZTjJT5SG6r00kYxO0shRcmdP-fK9VvyA8Un8pGXaFvWzakMcgSrVPj9yAeA22mWWLWdRDgpYGnW1hsrm3JD3RXUNzrd_I2VgomNpcb_BaF7-t9fWWDS1g/s200/Photo1.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5604734684798875842" /></a>One whole week into my fourth year you may be wondering, what have I done with myself? Well, I am starting the fourth year much the same way I started the third year: studying for a USMLE exam. <div><br /></div><div>This week I have covered cardiology, dermatology, GI, endocrine, biostatistics and some infectious disease. I am reading, highlighting, making flashcards and doing lots of practice questions. Fun fun.</div><div><br /></div><div>However, life is not all work. I had a lovely day and night out (we started a little early) after completing third year: there was sangria, there was gin, there were pancakes the next morning.</div><div><br /></div><div>I've also been helping to orient the rising M3s, which is a nostalgia-inducing process. It really makes me realise how far I've come in the last year in terms of my comfort in talking to and evaluating patients. It also points out how different the focus in teaching is now - I spend much more time thinking about details: drug choice, dosing, treatment length, etc - whereas before it was about having a workable list of potential diagnoses. A lot of what I struggled with at the beginning of my third year is assumed knowledge in the fourth. My review books don't even bother to classify antibiotic types, for example, it's assumed I know azithromycin is a macrolide that acts on the 50S ribosomal subunit and has good efficacy against gram positives and atypicals. The new questions is: how much and how many days worth for a patient with strep pharyngitis in a COPD patient?</div><div><br /></div><div>In an effort to stay balanced while studying, I've joined a tennis clinic. I had my first practice yesterday and got a little sun (oops) as well as losing half a toenail jamming my foot in my shoe on some abrupt directional change. Worth it. I'm horrendously inconsistent at the moment, but I hit a few aces and a couple of solid put-away shots. I'm considering joining a USTA team this summer, but I'm not sure I'll have time with the sub-i's etc.</div><div><br /></div><div>Motorcycle lessons start next week and I'm now involved with admissions for the medical school too - so hopefully those will yield some good stories for a post. In the meantime... nose to the grindstone to (hopefully) pull out a good Step 2 score. </div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-6888934.post-44917176730086220762011-04-26T20:16:00.002-04:002011-04-26T20:21:01.395-04:00?! #492I was reading a NYT article on hospital compliance with hand-washing when I came across this gem of a comment:<div><br /></div><div>"I'm confused. I thought the only way hand washing would kill bacteria is if the water was boiling hot."</div><div><br />Um, have you heard of SOAP?</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-6888934.post-59402491314568498822011-04-25T21:08:00.002-04:002011-04-25T21:20:09.999-04:00Little old manI had a cute four year old patient today with two old-man problems: a bald spot and urinary hesitancy. His mother brought him in because of the bald spot: an oval stripe towards the front-top of his head roughly the size of a kiwi. It first appeared a month ago as a painless, small spot the size of a dime and it had steadily grown. He was otherwise well. <div><br /></div><div>While the attending conferenced with his mother, he came up to me and announced "I have to go potty!" I took him by the hand and we walked to the clinic bathroom. I waited outside the door. Thirty seconds go by and I hear "Mr. doctor. Mr. doctor!" I crack the door and he's standing there with his pants around his ankles. "I want to use the giant bathroom!" I pull his pants up, take him by the hand and walk him to the other end of clinic where a more spacious bathroom is located. Again, I wait outside the door and soon hear "Mr. doctor, mr. doctor!" I crack the door. "I'm scared!" I enter the bathroom, kneel and say "How can I help you? Do you want me to lift you up or get you a stool to stand on?" He replies "I just kidding. I don't have to go potty!"</div><div><br /></div><div>The question everyone in the office is asking me all day: what happened to that little kid's head? The answer: he's pulling his hair out. </div><div><br /></div><div>Maybe the grown-up sized toilet at home is freaking him out. </div>Unknownnoreply@blogger.com0