I’m also troubled by, not what Senator McCain says, but what members of the party say. And it is permitted to be said such things as, “Well, you know that Mr. Obama is a Muslim.” Well, the correct answer is, he is not a Muslim, he’s a Christian. He’s always been a Christian. But the really right answer is, what if he is? Is there something wrong with being a Muslim in this country? The answer’s no, that’s not America. Is there something wrong with some seven-year-old Muslim-American kid believing that he or she could be president? Yet, I have heard senior members of my own party drop the suggestion, “He’s a Muslim and he might be associated terrorists.” This is not the way we should be doing it in America.

I feel strongly about this particular point because of a picture I saw in a magazine. It was a photo essay about troops who are serving in Iraq and Afghanistan. And one picture at the tail end of this photo essay was of a mother in Arlington Cemetery, and she had her head on the headstone of her son’s grave. And as the picture focused in, you could see the writing on the headstone. And it gave his awards–Purple Heart, Bronze Star–showed that he died in Iraq, gave his date of birth, date of death. He was 20 years old. And then, at the very top of the headstone, it didn’t have a Christian cross, it didn’t have the Star of David, it had crescent and a star of the Islamic faith. And his name was Kareem Rashad Sultan Khan, and he was an American. He was born in New Jersey. He was 14 years old at the time of 9/11, and he waited until he can go serve his country, and he gave his life. Now, we have got to stop polarizing ourselves this way.

The picture to which he’s referring:

The show was quite the interesting experience. It was out on the patio, and I would say that about half the attendees were homeless, including one woman who sat in the front row and made incoherent requests. She actually had an excellent ear; during breaks she’d be singing the songs. There was also a woman who spent most of the concert trying to get the very last bit out of her Pepto-Bismol bottle (adding water and swishing it around, standing it upside down then licking the cap and the opening of the bottle, etc).

The actual music was really good! Several of their songs reminded me a lot of the Pogues. They covered a few old-school country songs, as well as Alice in Chains’ “Rooster” with fiddle runs in place of guitar riffs - it was great. Sadly, as with too many live shows, their sound was poorly mixed with the amps turned up way too high, and we couldn’t make out the lyrics most of the time. Song topics that were either announced or audible included temptation, politics, drinking, heaven/hell, unlucky love, and dyslexia. The last had a refrain beginning with “oh my Dog.”

It turns out that their latest CD is available as a DRM-free digital download so I think I’m going to buy it.

• Windows 3.0 operating system made IBM PCs user-friendly the year they were born.
• Caller ID has always been available on phones.
• GPS satellite navigation systems have always been available.

Some of them are true of me (class of 2003):

• They have always been looking for Carmen Sandiego.
• Lenin’s name has never been on a major city in Russia. (I am of course aware of Leningrad, but I don’t think I learned geography with it. Presumably it’s the same for the class of 12.)
  Shampoo and conditioner have always been available in the same bottle.

And some of them don’t make very much sense:

• The Warsaw Pact is as hazy for them as the League of Nations was for their parents. (I don’t know what this one is supposed to mean - our parents were unfamiliar with the League of Nations? That seems unlikely. But I do feel more familiar with the LN than with the Warsaw Pact, so maybe this one is true of me and that’s why I don’t get it!)
• Michael Milken has always been a philanthropist promoting prostate cancer research. (Who TF is Michael Milken?
• As a precursor to “whatever,” they have recognized that some people “just don’t get it.” (Is the latter supposed to be some sort of cultural catchphrase?)

So then I looked up the ones for the class of 2003 and some of them were great because they’re now outdated:

• They were born and grew up with Microsoft, IBM PCs, in-line skates, NutraSweet, fax machines, film on disks, and unregulated quantities of commercial interruptions on television.
• The moonwalk is a Michael Jackson dance step, not a Neil Armstrong giant step. (I’m going to guess that for the class of 2010, it’s the latter.)

Then some again seem wrong:

• Yugoslavia has never existed. (I had to look this up to be sure, but it existed until 2003! Or maybe they’re talking about the one that disintegrated in 1992, but still, I was definitely familiar with there having been such a country.)
• Ketchup has always been a vegetable.

And some don’t apply - apparently I was really not with the times, because I don’t (and never did) know the names of at least half the members of the “Brat Pack”, who Tina Yothers or Max Headroom is, which dolls had “Xavier Roberts” on their ear, what Willis was “talkin’ ’bout”, or what a Doozer is.

It’s true, though, that I have no idea why “Solidarity” is spelled with a capital “S”! (Wikipedia actually didn’t shed a whole lot of light on this one; I now know about a whole bunch of different leftist and socialist organizations called that, but it isn’t obvious what the list writers were referring to.)

We also were standing right on the edge of the sidewalk while Joe Lieberman’s entourage passed. He greeted us very pleasantly, while one of his bodyguards knocked a cameraman out of the way (I’m pretty sure it was accidental, but it was still funny).

Inside the debate hall, I had an “obstructed view” seat and they weren’t kidding - I could see the moderator’s desk (but she herself was obscured by a camera) and nothing else. Also, it was really freaking cold in there.

Nonetheless, impressions:

• I didn’t have to see Palin to be annoyed by her smirk. It comes through loud and clear. Good Lord.
• maverick and 4 billion dollar tax cut for Exxon Mobil tied in the no-one-cares-but-we-can’t-think-of-anything-else contest
• I love how the change Washington needs comes in the form of a man who’s been in the Senate longer than I’ve been alive and a George W. Bush with lipstick on
• fairly impressed that Palin knows the name of the US commander in Afghanistan*, especially since Biden (who brought him up) didn’t seem to
• although both candidates basically held up garlic and crosses at the idea of gay marriage they were both adamant about equal civil rights otherwise. Obviously we still have far to go, but I think that’s great progress in not too long a time.
• nucular? Again? Seriously? Come on, you can’t say “doggone” AND “darn right” AND “you guys” AND “up there in Alaska” AND “nucular”. I guess the put-on folksiness worked pretty well for GWB though.
• by far the biggest laugh line of the night was Palin’s crack about a joke that must have fallen flat because nobody got it - unfortunately I couldn’t actually hear what she said, but assume she must have been poking fun at Biden.
• I wish Biden would have said he voted for the war because Bush & Co misrepresented the evidence rather than trying to pretend that he voted for peacekeeping powers or something instead of a war.
• obviously after the Katie Couric interview somebody told Palin she doesn’t have to fully answer every question. Given that, it was brilliant for her to come out and say that she wasn’t necessarily going to answer the questions the moderator asked but talk about what the American people want to hear. Though I did wish she’d answer the questions!
• I could tell Palin was flagging by the end when she sort of fizzled out on her answer and then said “so, um, yeah, I agree…” She’s going to be embarrassed when she has to listen to that on tape.
• Overall I thought both did quite well and I don’t see this changing very much in the race.

Oh, I also have to mention that on my way through the security checkpoint, I asked the Secret Service officer if I should remove my belt before passing through the metal detector. He responded, very pleasantly: “Ma’am, this isn’t an airport.” We all got to keep our shoes, too.

*I am informed that she actually got the name wrong - it’s McKiernan not McClellan. Eh, I’m willing to call that a slip of the tongue - she didn’t say Petraeus or even MacArthur.

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)

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.

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.

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.]

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.

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.