I’m not a big protest or demonstration person; the large Midwestern portion of my personality frequently makes me feel vaguely embarrassed about such group efforts when I’m not rolling my eyes at certain protests that seem more an opportunity to pat oneself on the back than to actually do anything to change the situation.
The national Day of Silence (to bring attention to the way LGBT students are silenced) is a demonstration I certainly support, but have never participated in. Nevertheless, I was very moved to read about the Golden Rule Pledge, and how it played out at Appalachian State University:
Many Christians are confused about how to respond to this day because they do not agree with homosexuality, but they do agree that hatred based on it is not acceptable. […] The slips I made said this:
“Today I am pledging to be silent to bring attention to the name-calling, bullying and harassment experienced by LGBT students.
Do unto others as you would have them do unto you. Luke 6:31
As a follower of Christ, I believe that all people are created in the image of God and therefore deserve love and respect.”
Yesterday morning, when I went to the SAGA (Sexuality and Gender Alliance) table to receive my piece of duct tape, I showed them my slips and told them that several ministries would be participating as well. The look on their faces was priceless. They were shocked, but ecstatic. This alone would have been enough to make my day. …
The pledge made a real impact on both groups. That’s great!
(via Culture Watch)
One of the things you have to learn in order to sound smart while presenting a case (in other words, telling a patient’s story) is how to make generous use of signs. In general, signs are objective manifestations of illness, as opposed to symptoms, which are subjective: for example, in strep throat, severe pain is a symptom while white patches on the tonsils are a sign. Obviously, it is very important to make note of these.
Lots of them are eponyms: for example, Lhermitte’s sign is a sensation of electricity shooting down the spine while bending the neck forward; it’s considered classic for multiple sclerosis. (It’s also technically a symptom, not a sign, if we’re going to be pedantic about it, which of course we are.) Kernig’s sign and Brudzinski’s sign are pain when the leg is raised by an examiner, and pain causing involuntary hip flexion when the neck is flexed by an examiner, respectively; both are classic for meningitis, and I can never keep them straight. Grey Turner’s sign, bruising in the flank area, indicates internal bleeding and is frequently checked for in cases of pancreatitis. (Most of these signs have not been exhaustively investigated and it’s unclear how useful they actually are, but we love them anyway.)
When reporting these, we generally say something like “The patient has a positive Brudzinski sign.” This formulation is apparently so catchy that it has spawned a whole slew of other signs, most not particularly respectful.
Some are flippant terms for actual helpful diagnostic findings. For example, patients with pelvic inflammatory disease usually exhibit exquisite cervical motion tenderness. This is sometimes referred to as a “positive chandelier sign,” as in, the patient is jumping up to the chandelier during the pelvic exam. Of course, no one would write this in a medical record, but it’s not uncommonly heard in emergency rooms.
Then there are some terms that grow up in particular institutions. One that I’ve heard several times is the “10 allergies” sign. Patients who list more than a small handful of allergies are much more likely than others to have multiple vague complaints that are beyond the powers of modern medicine to solve, and I’ve heard more than one resident grumble “positive 10-allergy sign” before going in to see a patient.
I think the best (and also worst, in some sense) of the irreverent terms is the “fish sign.” You see, our hospital has a big fish tank stocked with many beautiful tropical fish. There’s a camera which broadcasts a view of the fish on the hospital’s closed-circuit TV system. Patients who are comatose, severely demented, or otherwise unable to express their viewing preferences often have their TVs set to the fish channel. That’s a positive fish sign. It’s considered a poor prognostic indicator.
Tim and I got engaged!
We spent the weekend with my family at Lake Hope, our traditional fall vacation spot. Sunday morning, Tim took me for a walk to a picturesque spot overlooking the lake, and asked me to marry him. Of course, I said yes!
There’s not a specific date yet but we are planning to marry in spring or summer 2009, in either Cleveland or the Twin Cities. Suggestions for attractive and reasonably-priced venues will be taken.
Since the proposal location was so pretty, we did a re-enactment photo shoot later in the day (thanks for photographing, Ellen!). You can see those pictures, as well as a few shots of the gorgeous ruby ring, in the gallery here.
Sometimes it seems like the emergency room at my hospital is a wormhole between two universes: one where I and the other medical professionals live, and one where the patients live. Some of the differences between these two were unsurprising to me: I already knew that our patient population tends to visit the ER for situations where I’d just pop some Tylenol, for example. (And there are a lot of reasons for that; if you don’t know much about medical issues you might not have any way of knowing whether something’s life-threatening, and if you don’t have access to a primary doctor there’s no one to call when you’re not sure whether to come in, nor is there any way you can just go see your doctor in a week if it doesn’t get better.)
One of the differences I saw this month really struck me, though. I saw quite a few young women with complaints of nausea, vomiting, abdominal pain, tiredness, missed periods, etc. Many of them received a diagnosis of “normal pregnancy.” What got me was that none of these teenagers seemed upset to find out they were pregnant! If I had turned up pregnant at 16, I would have thought my life was over. Apparently (I didn’t see any with their moms there) the mothers are excited to find out that their daughters are pregnant, too. Again, if this had happened to me, I know my mom would have still loved and supported me, but her first word would not have been “Congratulations!” (Of course, my mom did not have me when she was 16, either.)
This is the first thing in med school that has made me feel naive and idealistic. I thought that education was key, and if young people knew about their bodies and their options for preventing pregnancy, and birth control was made available, the teenage birth rate would decline. Now I’m not so sure - if pregnancy is seen as a *happy* thing for high school kids, if they don’t see it as a huge roadblock on their paths in life, what’s the motivation to abstain or use condoms? I guess it’s good that girls who become pregnant aren’t ostracized, but I think this might be a little too far in the other direction!
The other day, I saw another interesting and weird aspect of this. I went in to see a patient whose chief complaint was “nausea/vomiting/need pregnancy test”. She’d been waiting for a few hours in the waiting room, then maybe 20 minutes in the exam room, which really isn’t bad for people who show up with non-urgent complaints. During those 20 minutes she’d been out to the nurses’ station multiple times asking for food (so apparently her nausea wasn’t so bad) and to use the phone. So I went in to see her with the thought that we’d do her pregnancy test, let her know what was going on (at least she wasn’t going to be too surprised if it was positive), and send her out.
ME: [Introduce myself.] So, what’s been going on?
PATIENT: I need a pregnancy test.
ME: OK, we can do that here. When was your last period?
PATIENT: The beginning of August. I’m healthy, I’m 20 years old, I weigh 160 pounds, what else do you need to know, can we just do the pregnancy test and get me out of here?
ME: Well, we can do that, but whenever somebody comes in to the hospital we have to talk to them and examine them to make sure we aren’t missing anything serious.
PATIENT: Fine. Can I have something to eat? I’m hungry.
ME: So your nausea and vomiting is better?
PATIENT: Yeah I just throw up in the mornings. And I’m tired and hungry the rest of the time and my nipples hurt. I’m pregnant, OK? I took a home test.
ME: Oh, you did? What did it say?
PATIENT: It was positive. Three of them.
ME: So… are you expecting this one to be different? [probably not an example of good doctor-patient communication skills, but I was just really confused about why she’d be there if she already knew she was pregnant.]
PATIENT: No, I just need a paper that says I’m pregnant so I can go on WIC.
So I finished examining her, counseled her to stop smoking, told her about getting prenatal care, etc. She ended up being pregnant (surprise!) and very unhappy that she’d had to wait another hour or so to see the doctor to get discharged. I don’t know what the actual WIC requirements are, but it seems like it would be cheaper for them to accept the results of a home pregnancy test with verification in the WIC office, than having the taxpayers pay for emergency room visits for pregnancy tests.
[As always when I post about patients, some details have been changed.]
The October Atlantic’s Primary Sources feature has a bit titled “Mrs. Pascal’s Wager?”, about research into why women are consistently more religious than men; a new study contradicts the popular argument that women, being more risk-averse than men, attend church out of fear of going to hell.
Researchers studied people who believed in an afterlife and people who didn’t, and found not only that women who don’t believe in life after death are more religious than men who don’t expect an afterlife, but that the gap between the sexes was larger among those who don’t anticipate an eternal reward or punishment.
So far so good; it’s an interesting finding in itself and consistent with my impression that the gap is larger in less-traditional religious groups.
The next sentence was what made me do a double-take:
Women who don’t believe in the afterlife are nearly twice as likely as men with similar beliefs to view the Bible as the literal word of God…
Unfortunately, I wasn’t able to access the full text of the paper, because I want to know, just how large is this population of Biblical literalists who don’t believe in heaven or hell? If this is a significant number, and the reporting is accurate, this is a pretty interesting finding. Maybe women are more willing to tolerate contradictions and inconsistencies, either in their own belief systems, or between what they believe and what their church dictates. Why this would be the case, I have no idea, but it could go a long way towards explaining a gender gap in religiosity.
I’m halfway through my Emergency Medicine rotation, having already completed three months of Internal Medicine (general adult medicine). Unfortunately I don’t think I’m any closer to knowing what I want to do with my life, except I guess that it’s definitely some branch of medicine!
My first month was ambulatory medicine (general adult care in the office setting) except that it wasn’t; I was with a pulmonologist who spent half of his time in the hospital and half in the office. Probably 80% of the time was lung-related problems, though he did an admirable amount of general medicine work, which I have the impression is unusual for specialists though I don’t know for sure. He would, for example, notice that a patient was extremely anemic (or, even better, he’d pay attention when I noticed and pointed it out), and make sure that the patient got the appropriate workup and treatment. And he saw some patients in the office who were just general practice, or who were not really his patients but were really in need of treatment (his dry cleaner’s wife, or some such person, was having trouble with depression and he let her come in that same day; as he told me, she might be better served by a psychiatrist but she’s not about to see one, is she?). So I did actually get a good picture of medicine.
I very much enjoyed working in the office, seeing lots of patients but getting to know them, and coming up with plans. Most of the downsides were due to being a student - it’s somewhat stressful to spend all your time with one person for a month and depend on them for your grade, no matter how great they are, and having little control over what you’re doing is rough as well. The hours were a little hard, but we were only working 10 hours a day; the bad part was that it was far away so I was also spending up to 2 hours a day in the car, which does eventually get tiring. So while there was some unavoidable stress (tracking down lab results, getting staff to do things that needed to be done, making difficult decisions, etc) that is always going to be part of a physician’s life, I thought outpatient internal medicine sounded overall like an excellent choice.
Thoughts on other rotations to follow, at an as-yet-undetermined interval.
The St. Louis Public Library is running a program this month called Read Down Your Fines. For kids 17 and younger, every 30 minutes they spend in the library reading erases one dollar of library fines. How cool is that? When I was a kid I could have used that. I used to have to spend my lunch money to pay my library fines, then I would have to eat lunch on a dollar a day. (Don’t ask why I didn’t ask my parents for more money. I was a weird kid.)
Tyler Cowen at Marginal Revolution asks, what is the proper pairing with dark chocolate? He offers the following schools of thought:
1. Wine
2. Spirits
3. Strawberries
4. A pinch of red chili powder
5. A quick swig of mineral water immediately afterwards
I can get behind any of these except perhaps the mineral water (I have never heard of this school of thought and suspect it exists primarily in Cowen’s mind, not that that’s a strike against it); I am all about potentiating the chocolate effect, not washing it out. With wine I like big reds; port is frequently recommended with chocolate but I don’t find it to be a great combination, and whites seem to be either too acidic or too sweet.
Strawberries are good; raspberries are better.
It was near the end of the comment thread before anybody suggested stout; Guinness and chocolate is one of the great flavor combinations as far as I’m concerned.
Many people suggest oranges; my favorite truffle flavoring is orange, but I am not so sure about actually eating chocolate and eating oranges/drinking orange juice at the same time. I prefer having the orange essence infused into the chocolate rather than as a separate entity.
I can’t leave out my lowbrow favorite: plain potato chips. Salt plus chocolate, yum. I don’t waste very good chocolate on this combination, though.
I’m spending a lot of time in the hospital now that my clinical rotations have started, which is leaving less time and energy for other things like blogging, and I decided to simplify my life by just not doing anything that I’m not finding necessary or fun, hence the paucity of posts. I am very much liking the rotations though. The first month I was on outpatient medicine, which is supposed to be kind of a vacation but actually turned out to be half inpatient medicine and quite the challenge, but I loved the work. For the past five weeks I’ve been on inpatient medicine, first general internal medicine and now cardiology. I really like this too; taking care of patients is interesting and fulfilling. So that’s good.
Other good stuff (some a bit belated since my internet surfing has been curtailed):
Why blogs should provide full-text RSS feeds: it’s good for business. You’re not going to keep people from using RSS readers (especially the high-volume readers who, really, are who you most want reading your blog), and providing partial text is more likely to just make them stop reading than click over every day. There are some great blogs that I used to read before I made the RSS switch, but their crappy feed quality means I haven’t really kept up - there is so much else out there. And there’s more than one blog where I’m not interested in all the posts, but I am interested in many of discussions in the comments, so I usually do click over if there are interesting posts, even once I’ve already read the whole text.
The Pantsuit Paradox: “How do women signal power at the boys’ club?” It’s an excellent article about a real dilemma: women have no equivalent of the suit and tie, an outfit that projects professionalism and authority and nothing else. We have to worry about whether we look too girly or not feminine enough, too sexy or too matronly, too trendy or too stodgy-librarian. (I do think there’s an excellent role for the businesslike pantsuit well-cut for the female shape; I am not sure why female politicians don’t seem to use them more, but then the viewpoint that for women, dressing up = skirt is still definitely out there.) Luckily a white coat and stethoscope go a long way toward projecting professionalism and authority, so I don’t have to worry too much about this anymore. Although I did see in one of the dress codes that women are supposed to wear T-shirts under scrubs; no word about men. I guess risking a hint of cleavage is much more unprofessional than letting all your chest hair hang out.
My mouth literally dropped open when I read this article on the “gender bending” birth control pill that stops periods.
It’s unclear whether women will embrace this new pill, which contains the same formulations of estrogen and progestin used for birth control pills for decades, but its arrival marks yet another step toward the blurring of the genders.
As 21st century women dominate the universities and continue to climb the executive ladder, and metro-sexual men explore their feminine side, it’s harder to define what it means to be a woman.
If being a woman doesn’t mean being discriminated against, bleeding every month whether you want to or not, and having a monopoly on caring what you look like, what DOES it mean? I’m having an identity crisis here.
(H/T Amanda.