Two months of medicine wards

Today's one of 8 days off over the next two months. But then third year ends. So the finish line begins to appear. Been great fun so far. It's the little things...

What I Did Today

Talked down a coke-head who had been up for four days, psychotic and possibly delirious tweaked out of his mind, until the anti-psychotic/sedative cocktail could kick in. Psychiatry, it's been fun so far.

Chronic Traumatic Encephalopathy

CTE is back in the news. This time, everyone's suspicious the most recent NFL casualty to suicide was linked to chronic head trauma. CTE researchers will let us know soon.

Grad School in GIFs

The life of a graduate student, explained through witty gifs. It's lulz all around.

I think people might get the wrong idea

Look, I'm definitely astounded and happy to hear about this story, but this is the kind of story which might make folks too overly-optimistic if and when something like this happens to a loved one.

But most of the time, people don't make it in this guy's situation. Yes, anything can happen, but being realistic is as important as having hope and loving your loved ones.

Anyway, something to think about.

Paula Deen has metabolic syndrome

Paula Deen has been diagnosed with an illness that gives her the risk of heart attack equivalent to an individual who has already suffered a heart attack. In other words, she has type 2 diabetes.

This is the woman who has become renowned for her high-calorie and fat foods.

Now she's a compensated spokesperson for Norvo-Nordodisk.

OK guys. But remember, type 2 diabetes is a real, serious disease. And Paula Deen will only get better if she actually does dieting and exercising the right way. But I'm skeptical.

Eugenics

Yep, states used to have "Eugenics" boards. The consequences live on.

A vigorous argument against sexual "performance enhancing" drug use in youth

Here's an interesting quotation from a 2004 NEJM piece by Morgentaler on the treatment of erectile dysfunction.



"...the effects of the recreational use of PDE 5 inhibitors have not been well studied. My major concern is the psychological impact of taking these medications for younger men who are not yet in a stable relationship. I have seen cases where men who lack for nothing except confidence secretly take sildenafil every time they go on a date, in the hope that it will help them please their partner. However, this can create obstacles for a solid intimate relationship. Apart from issues of authenticity, trust, and honesty, it seems to me that the key psychological cost of using sildenafil recreationally is that, by relying on a pharmacologic enhancement to his sexuality, a man loses an opportunity to achieve what we all look for in relationships—namely, to be loved and accepted for whom we really are."


That's some sincerity right there...now, whether you agree with the degree of passion in that statement.

(h/t UCLA IM Residency program IMS morning conference, 1/19/2012).

News Flash

Wow, the NFL is violent.

Charges filed

The unspeakable, tragic death of Sheri Sangji, hit especially close to home to the bloggers on this site: the accident (which left Sangji burned over half of her body) occurred in an Organic Chemistry laboratory at UCLA. And Sheri was an alumna of the Pomona College Chemistry Department, of which Anthony and I were also graduates.

At this time, I do not wish to re-hash the details of her accident, aftermath, death; nor the policies and procedures enacted at UCLA as a result. But in the last two days, some newsworthy developments have taken place. Criminal charges have been filed against both UCLA and the principal investigator of the laboratory in which Sangji worked. This is unprecedented indeed; and Sheri's death was unimaginably tragic for those closest to her. I don't know what else to say.

Economics

I just finished reading Economics in One Lesson, a veritable manifesto of libertarian economics by "Austrian" Henry Hazlitt.

I strongly recommend everyone gain some basic understanding of economics, and although this book was pretty slanted toward "free market," "no government," and all the other tenants of libertarianism, it was thought-provoking. And It forced me to wrestle with assumptions I've had about various government programs over the years.

The point is not to read (and understand) basic economic texts with the hope of becoming indoctrinated. That's easy. The point is to just learn and understand some basic stuff that a large chunk of the population have never considered, save for taking basic econ in high school. And I'm not claiming this based on elitism, just based on how many conversations I've had with people where economics are fundamentally misunderstood.

New Year Readings

Oh hey, Happy New Year! Here are some excellent pieces on the current state of health care. First something optimistic:

Atul Gawande exposes a program in New Jersey which aggressively targets the sickest of the sickest patients, with early promising results for bending the health care cost curve. Obviously, it paints a rosy picture (usually the case w/ AG's work) but still it provides some good stuff to consider.

In another recent piece by the NYT, the disturbingly prevalent problem of patients staying in hospitals due to placement issues (lack of insurance, housing, or transitional care). I saw this all the time during the first six months of third year.

Lots to do. Lots to do.

Outpatient surgery

Six weeks of waking up at 4:15 AM six days a week, albeit learning a ton about the field of surgery and management of patients, and it's now six weeks of sampling.

Outpatient is all about getting exposure to as many surgical subspecialties in one week increments. This is both awesome because 1) weekends are free, and 2) outpatient (well, predominantly outpatient) surgery services tend to operate at more reasonable hours (no earlier than 6 or 630 start times), while less awesome in that your participation is less essential (you can't really contribute a lot when you get only one week on a service). But this is fine because it gives time to attend to other things in your life. Like writing on some blog.

Third year keeps moving along: so much shit to learn, so many more experiences to be had, so much so much. So much to constantly both pick up, question, and actively and passively absorb. It's a learner's playground. The only challenge is staying constantly vigilant, enthusiastic, and inquisitive. Sometimes this is more easily said than done.

An intern on a previous rotation summed it up best, speaking to me after I'd made a small error in patient management: "It's OK, we picked it up. No harm done, no need to apologize. We do this and learn for our patients' sake. Patients first."

Indeed.

S@&! just got real, part 3

Had to break some bad news to a patient today. Not fun, obviously. But it's what I signed up for.

Specialty Watch

The most likely specialty I will choose, as of 23 October 2011 is:

Obstetrics and Gynecology

Black cloud

Second Peds overnight call, almost just as crazy as the first. The residents, for good reason, don't want to look me in the eye. I'm a black cloud. Take that for sending me out to Riverside County for peds. Ha.

But the learnin' and "stick with you for a long time" type of experiences are plentiful during the wee hours, so I ain't complainin'.

No Joke

5 admissions, after midnight, that's a call night, ladies and 'gents.

Tom Cruise for leishmaniasis?

Today the Muscular Dystrophy Association (MDA) hosted its 46^th annual telethon, the first without its poster boy, Jerry Lewis. The broadcast raised 61.5 million dollars for its array of services related to neuromusuclar disorders like muscular dystrophy and amyotrophic lateral sclerosis.

The MDA is vague about its origins. The website states that the association “was created in 1950 by a group of adults with muscular dystrophy, parents of children with muscular dystrophy and a physician-scientist studying the disorder.” Whoever helped jump-start and manage the organization did an excellent job. The MDA is incredibly visible and vocal. The website lists abundant corporate sponsors: 7-Eleven, Taco Bell, 7UP, Harley Davidson, etc.. The telethon attracts the public eye with its celebrity hosts: this year alone Celine Dion, Boyz II Men, Jennifer Lopez, Barbra Walters, Whoopi Goldberg, and Dwight Howard donated some face-time.

I want to know how the MDA is so successful and how this success can be transferred to other conditions.

Physician scientists in-training learn how to do science: research, generating data; write grants, acquiring funding; write papers, publicizing our findings. Physician scientists, for the most part, stick within that system, writing grants and papers. I want to know how things work outside of the system; how the government and private institutions obtain funding; and how they fund the research that interests them.

A recent and interesting example of organization-driven research is the California Institute of Regenerative Medicine (CIRM). CIRM, California State-funded research initiative, was passed in 2004 as Prop 71. Over ten years, CIRM will distribute three billion dollars worth of grants to human embryonic stem cell researchers. While CIRM has not provided any immediate cures, it has driven a lot of fascinating basic research that would have not been funded in past years due to the controversial Dickey Amendment.

How did CIRM come into existence? With a lot of hard work, money, and star power. See Robert Klein, Bill Gates, Micheal J. Fox. Maybe it's time for me to start networking... I do live in LA.  

week 2 goals

Goals for week #2 of peds (outpatient for two more weeks):

1. Don't make any more children >7 years old cry.
2. Introduce more kids to the Tickle Monster. (The lucky few who have been introduced are more than a little amused by him).
3. Use more suckers/stickers bribery.
4. Figure out how to seem cooler to adolescents (Probably impossible).
5. Keep wearing bow ties.
6. Don't get sick (Good luck with that).

Pediatrics

It's sort of like seeing my entire childhood flash before my eyes, every day, for the next six weeks. What a trip.