Like Bill Clinton, I believe abortion should be safe, legal, and rare. Putting aside how many that should be, if you had asked me to guess this morning, I would have said that there are about 100,000 per year. I was off by a factor of ten.
Turns out there were about 1,293,000 in 2002 (via AS).
This turns into an incidence of 20.9 abortions per 1000 women aged 15-44 per year. I have no idea why the statistics are presented in this fashion. It would be more accessible to present them as 2.1% per year, which translates to a 50% reproductive lifetime risk of having an abortion.^1 Compare that to the 13% total rifetime risk of developing breast cancer (NCI).
We watched a video in class today^2 that compared embryonic development of different vertebrates, showing how wildly different structures have a common origin. It struck me that all the embryos that were presented in this rather upbeat, positive video were, in fact, dead and never going to complete the developmental journey that they were being used to celebrate. I'm grateful to the embryos and their families for giving me the opportunity to see this, and I thought the video was outstanding overall, but that twinge of sadness...
^1 You wanna quibble over statistics? Ok. Not likely to be productive, but...
Quibble 1: Spock suspects that the eggs are more in one basket, i.e. the same women keep having abortions. This seems to be the case in New York City, but overall it looks like most women are first timers.
Quibble 2: Harpo asserts that relatively few abortions are done on upper/middle class white women. Clearly, gender is a key factor in who gets abortions. Minorities are over-represented. Those who are in poverty or near poverty receive about 60% of abortions.
Clearly, there are more abortion statistics that I can keep track of, but even if 'only' 1 in 3 women will have an abortion, that's still a ton of people.
^2 I believe the video was "Oddesy of Life" from NOVA
Tuesday, July 19, 2005
Saturday, July 16, 2005
Sigh
This blog is intended to be half personal, half professional - that is, my reflections on my day to day professional student life should be the majority of the discussion. Here's something more personal - my personal pictures, on flickr, just to give you some visuals.
http://www.flickr.com/photos/patientetherised/
http://www.flickr.com/photos/patientetherised/
Thursday, July 14, 2005
By the way...
You may find yourself asking, "What's a medical student doing drooling over basic molecular biology papers."
Well, I'm a little MeST uP. (Pronounced "messed up").
You may find yourself asking, "What does that mean?" This is the short of it - an MD takes 4 years. A PhD in biology should, according to NIH, take 4 years. An MD/PhD takes (about) 8 years. At the end of this time you walk out with two doctorates.*
You may find yourself asking, "What can one do with an MD and a PhD?" The answer is this: Anything you fricking want. Seriously - you want to practice, go practice. You want to teach, go teach. You want to do research, of any kind, do so. You want to do some kind of bizarre hybrid in an effort to make all the years sunk into your degrees pay off? Go for it (It's difficult to do this well, but not unheard of).
*They take this very seriously at my institution. When you defend your PhD thesis, you do a hooding ceremony, graduation, parents come out, blah blah blah. When you graduate from Med school, you do a hooding ceremony, graduation, parents come out, blah blah blah. No requirements for either degree are waved. The idea is that we actually are earning two degrees, not two chunks of degree.
Well, I'm a little MeST uP. (Pronounced "messed up").
You may find yourself asking, "What does that mean?" This is the short of it - an MD takes 4 years. A PhD in biology should, according to NIH, take 4 years. An MD/PhD takes (about) 8 years. At the end of this time you walk out with two doctorates.*
You may find yourself asking, "What can one do with an MD and a PhD?" The answer is this: Anything you fricking want. Seriously - you want to practice, go practice. You want to teach, go teach. You want to do research, of any kind, do so. You want to do some kind of bizarre hybrid in an effort to make all the years sunk into your degrees pay off? Go for it (It's difficult to do this well, but not unheard of).
*They take this very seriously at my institution. When you defend your PhD thesis, you do a hooding ceremony, graduation, parents come out, blah blah blah. When you graduate from Med school, you do a hooding ceremony, graduation, parents come out, blah blah blah. No requirements for either degree are waved. The idea is that we actually are earning two degrees, not two chunks of degree.
RNA pathology, dangit
One area of research that I've thought about getting into is non-canonical RNA, that is, RNA which is not tRNA, nor rRNA, nor mRNA. Recently, we've seen big developments in RNA interference (RNAi) where you add RNA to a cell to get it to shut down production of the complimentary gene (Footnote 1). That was fairly interesting, then I stumbled onto microRNA (or miRNA), which are small RNA produced naturally by cells which fulfill various tasks. Most of them are unknown, but one is known to be involved in fly eye development. On my interviews here, I talked to someone working on long non-translated RNA, and also varients to the old standbys. For instance, there are multiple different versions of each of the tRNAs in humans -> what do they do, why do they exist?
Anyway, I had an interest in RNA pathology, that is, finding RNAs that cause or are involved in disease. People laughed. They said RNA was either too fundamental (tRNA, rRNA) or too low copy (miRNA, other non-mRNAs) to have enough effect to be seen on a human scale. Well. Check this out. In summary, there is a cluster of microRNAs (mir 17-92)that, in combination with other oncogenes (namely c-myc) cause tumours to grow faster (Footnote 2). Very exciting. However, it doesn't seem that they know how this newly relevant miRNA oncogene does its thing. Maybe someone (hint-hint) should investigate.
Footnote 1: A short explanation of RNAi with most of the detail stripped out. DNA exists in a double stranded, antiparallel condition, like so:
W: Start->AGTCGTACC->End
C: End<-TCAGCATGG<-Start
We arbitrarily label the strands W and C so that we can keep them straight. Say that W codes for a complete gene, the sequence of which is: AGTCGTAC. When the gene is activated, an enzyme comes along and transcribes the gene, producing a transcript. The transcript is made out of RNA, which uses "U" instead of "T," so it would be:
Start->AGUCGUACC->End
This piece of RNA is called messenger RNA or mRNA, it completes its function by meeting up with the ribosome, which translates the RNA into protein, according to the genetic code. This particular gene would produce a protein whose sequence is Serine-Alanine-Threonine. This has all been known since the mid sixties, major snooze factor.
Here's RNAi -> is you introduce RNA that is complimentary to the mRNA, the gene is shut down. What does this mean?
The mRNA is: Start->AGUCGUACC->End
The complimentary RNA would be: Start->GGUACGACU->End
Wait, that doesn't pair at all! Except that, it does because the pairing is anti-parallel, like so:
The mRNA is: Start->AGUCGUACC->End
The complimentary RNA would be: End<-UCAGCAUGG<-Start
Note that the complimentary RNA bears an eerie similarity to the C strand of the gene, such that if you expressed the C strand, you would produce that complimentary RNA.
So, you have the mRNA, and complimentary RNA. What happens next? They base pair, of course. The product is double stranded RNA (dsRNA). dsRNA is never encountered in multicellular organisms, except for in viruses. Therefore, whenever your cells see dsRNA in them, they interpret it as viral RNA. They then produce enzymes that destroy the mRNA of the gene, and may completely shut it down gene. This is called interference (hence RNAi). In plants, once a gene is shut down, it never comes back. In humans, the gene is only shut down as long as you keep adding the complementary RNA to the cell, and the amount of interference is proportional to the amount of complementary RNA you add. This is great for experimenters, in that you can see what happens if you have a range of expression of a gene, as opposed to the simple on/off allowed by genetic engineering. It is somewhat bad for patients, because if you are shutting down a harmful gene by giving the patient complementary RNA, the effect wears off quickly, and you have to give them a lot of RNA to see an effect (people are trying this as we speak, btw).
Footnote 2: He L, Thomson JM, Hemann MT, Hernando-Monge E, Mu D, Goodson S, Powers S, Cordon-Cardo C, Lowe SW, Hannon GJ, Hammond SM. A microRNA polycistron as a potential human oncogene. Nature. 2005 Jun 9;435(7043):828-33.
PMID = 15944707
I applied to CSHL for grad school, didn't even get called for an interview. I know who Hammond and Hannon, and I wanted to work for them, and if I were... sigh.
Update:
I read the paper. Not bad. I mean, there are holes you could drive a truck through, but I'm still hugely excited. They want to rename their gene oncomiR-1 - that's oncogenic micro RNA 1. Woo. It's like Ras in 1982.
Anyway, I had an interest in RNA pathology, that is, finding RNAs that cause or are involved in disease. People laughed. They said RNA was either too fundamental (tRNA, rRNA) or too low copy (miRNA, other non-mRNAs) to have enough effect to be seen on a human scale. Well. Check this out. In summary, there is a cluster of microRNAs (mir 17-92)that, in combination with other oncogenes (namely c-myc) cause tumours to grow faster (Footnote 2). Very exciting. However, it doesn't seem that they know how this newly relevant miRNA oncogene does its thing. Maybe someone (hint-hint) should investigate.
Footnote 1: A short explanation of RNAi with most of the detail stripped out. DNA exists in a double stranded, antiparallel condition, like so:
W: Start->AGTCGTACC->End
C: End<-TCAGCATGG<-Start
We arbitrarily label the strands W and C so that we can keep them straight. Say that W codes for a complete gene, the sequence of which is: AGTCGTAC. When the gene is activated, an enzyme comes along and transcribes the gene, producing a transcript. The transcript is made out of RNA, which uses "U" instead of "T," so it would be:
Start->AGUCGUACC->End
This piece of RNA is called messenger RNA or mRNA, it completes its function by meeting up with the ribosome, which translates the RNA into protein, according to the genetic code. This particular gene would produce a protein whose sequence is Serine-Alanine-Threonine. This has all been known since the mid sixties, major snooze factor.
Here's RNAi -> is you introduce RNA that is complimentary to the mRNA, the gene is shut down. What does this mean?
The mRNA is: Start->AGUCGUACC->End
The complimentary RNA would be: Start->GGUACGACU->End
Wait, that doesn't pair at all! Except that, it does because the pairing is anti-parallel, like so:
The mRNA is: Start->AGUCGUACC->End
The complimentary RNA would be: End<-UCAGCAUGG<-Start
Note that the complimentary RNA bears an eerie similarity to the C strand of the gene, such that if you expressed the C strand, you would produce that complimentary RNA.
So, you have the mRNA, and complimentary RNA. What happens next? They base pair, of course. The product is double stranded RNA (dsRNA). dsRNA is never encountered in multicellular organisms, except for in viruses. Therefore, whenever your cells see dsRNA in them, they interpret it as viral RNA. They then produce enzymes that destroy the mRNA of the gene, and may completely shut it down gene. This is called interference (hence RNAi). In plants, once a gene is shut down, it never comes back. In humans, the gene is only shut down as long as you keep adding the complementary RNA to the cell, and the amount of interference is proportional to the amount of complementary RNA you add. This is great for experimenters, in that you can see what happens if you have a range of expression of a gene, as opposed to the simple on/off allowed by genetic engineering. It is somewhat bad for patients, because if you are shutting down a harmful gene by giving the patient complementary RNA, the effect wears off quickly, and you have to give them a lot of RNA to see an effect (people are trying this as we speak, btw).
Footnote 2: He L, Thomson JM, Hemann MT, Hernando-Monge E, Mu D, Goodson S, Powers S, Cordon-Cardo C, Lowe SW, Hannon GJ, Hammond SM. A microRNA polycistron as a potential human oncogene. Nature. 2005 Jun 9;435(7043):828-33.
PMID = 15944707
I applied to CSHL for grad school, didn't even get called for an interview. I know who Hammond and Hannon, and I wanted to work for them, and if I were... sigh.
Update:
I read the paper. Not bad. I mean, there are holes you could drive a truck through, but I'm still hugely excited. They want to rename their gene oncomiR-1 - that's oncogenic micro RNA 1. Woo. It's like Ras in 1982.
Sunday, July 10, 2005
...not evil
Classmate 1: I need to relax this weekend
Classmate 2: Need a drink
C1: Smoke some weed
C3: Need something stronger. Get some heroin.
I: Sure, find the saphenous vein. Median malleoulus, 2 fingers up, 2 over, put in a line. You can run 500ml of heroin a minute.
C3: That's just twised.
I: Well, we haven't yet sworn to use our powers for good.
Classmate 2: Need a drink
C1: Smoke some weed
C3: Need something stronger. Get some heroin.
I: Sure, find the saphenous vein. Median malleoulus, 2 fingers up, 2 over, put in a line. You can run 500ml of heroin a minute.
C3: That's just twised.
I: Well, we haven't yet sworn to use our powers for good.
Saturday, July 09, 2005
What's in a leg?
When I tell people (as I just did) that we described the entire anatomy of the leg in three days, many ask me, as my friend Marc did, "is there much anatomy in the leg?" Ummm, yes.
How much?
Bones: 28 plus
Well, the hip (os coxa) is actually 3 bones, the illium, the ischium, and the pubis (aka the pecten). There's the femur, tibia, fibula, then the foot bones - talus, calcaneus, navicular, cuboid, 3 cuneiform (medial, intermediate, and lateral), 5 metatarsals, 14 phalanges, and don't forget the patella. Each bone has several parts which are signifiant because muscles attach there, or they articulate with other bones, e.g. the head of the femur, which is the ball to the hip's acetabulum, which plays the part of the socket.
Muscles: about 70
I'm not naming all of these, but from going through my atlas, there are about 70. Think about it, you can do some pretty amazing things with your leg, and for each of them, several muscles have to work together, many of which are unique to that movement. Something like walking is a lot more complicated than it seems, insofar as some little thing like being able to flex your toes when you push off makes your walking a lot more graceful.
Nerves, blood supply, venous return, blah blah blah: Lots more
Anyway, my point is not just that I have this really long vocabulary list that I have to transcribe to my 3x5 cards, quite the opposite. Flashcards do not help, because I have to be able to identify these structure on any body in the anatomy lab, in anatomical cross section, on x-rays (or CT, or MRI, or angiogram, or, or, or), and tell how they interact (e.g. illium and psoas muscles form up to make the illiopsoas muscle, which inserts on the lesser trochanter of the femur, the blood supply is whatever, the nerve innervation is such and such with a given set of spinal segments), and how they can and can't be injured (i.e. a fracture at the head of the feumr is unlikely to disturb a muscle like illiopsoas that inserts lower in the bone - at the lesser trochanter).
People who know me know that I sail through most academic things. They may wonder why I have to study constantly for this, and this is why.
How much?
Bones: 28 plus
Well, the hip (os coxa) is actually 3 bones, the illium, the ischium, and the pubis (aka the pecten). There's the femur, tibia, fibula, then the foot bones - talus, calcaneus, navicular, cuboid, 3 cuneiform (medial, intermediate, and lateral), 5 metatarsals, 14 phalanges, and don't forget the patella. Each bone has several parts which are signifiant because muscles attach there, or they articulate with other bones, e.g. the head of the femur, which is the ball to the hip's acetabulum, which plays the part of the socket.
Muscles: about 70
I'm not naming all of these, but from going through my atlas, there are about 70. Think about it, you can do some pretty amazing things with your leg, and for each of them, several muscles have to work together, many of which are unique to that movement. Something like walking is a lot more complicated than it seems, insofar as some little thing like being able to flex your toes when you push off makes your walking a lot more graceful.
Nerves, blood supply, venous return, blah blah blah: Lots more
Anyway, my point is not just that I have this really long vocabulary list that I have to transcribe to my 3x5 cards, quite the opposite. Flashcards do not help, because I have to be able to identify these structure on any body in the anatomy lab, in anatomical cross section, on x-rays (or CT, or MRI, or angiogram, or, or, or), and tell how they interact (e.g. illium and psoas muscles form up to make the illiopsoas muscle, which inserts on the lesser trochanter of the femur, the blood supply is whatever, the nerve innervation is such and such with a given set of spinal segments), and how they can and can't be injured (i.e. a fracture at the head of the feumr is unlikely to disturb a muscle like illiopsoas that inserts lower in the bone - at the lesser trochanter).
People who know me know that I sail through most academic things. They may wonder why I have to study constantly for this, and this is why.
Anatomy update
Just finished the third week of anatomy. Started with a test on the 'upper extremity,' and then we covered the entire 'lower extremity' (what a normal person might refer to as the 'leg') in 3 days. I've never studied so much in my life. On the other hand, I have exactly one responsibility - pass anatomy. If I'm doing that, nothing else matters (including getting my window fixed). Thus, I can justify sleeping 9 hours a night, because it improves memory.
Anyway, despite doing the leg in three days, the test isn't until next monday, so we're going to spend the next week being lectured by leg surgeons, radiologists, and other clinical types on the leg. This is good partially because it helps you remember, but it's bad in that whatever the clinical guys say is testable. For instance, an orthopedic surgeon came in and told us about different types of nerve damage - nerves can be bruised, they can be cut, or only the conducting part (axon) is cut, while the insulation (epineurium) is fine, or it can be pulled out at the spine. Then he chuckles and tells us, "Of course, we don't call it that, we don't want anyone to understand." All of a sudden, we have to know neuropraxia, neurotmesis, axonotmesis, and avulsion (in that order).
Anyway, despite doing the leg in three days, the test isn't until next monday, so we're going to spend the next week being lectured by leg surgeons, radiologists, and other clinical types on the leg. This is good partially because it helps you remember, but it's bad in that whatever the clinical guys say is testable. For instance, an orthopedic surgeon came in and told us about different types of nerve damage - nerves can be bruised, they can be cut, or only the conducting part (axon) is cut, while the insulation (epineurium) is fine, or it can be pulled out at the spine. Then he chuckles and tells us, "Of course, we don't call it that, we don't want anyone to understand." All of a sudden, we have to know neuropraxia, neurotmesis, axonotmesis, and avulsion (in that order).
Friday, July 01, 2005
You're in the city now!
I've got to eat just like anyone else. So, despite my dissection schedule, I put aside some time today in order to go grocery shopping. I unlocked my car, opened the door, and was shocked to find some kind of white powder sprayed all over my seat. On closer examination, I realized that the powder was actually the facets of small, otherwise transparent cubes. Then I noticed that the passenger side window was missing.
I circled around to the passenger side, and gaped at the fractured remnants of the safety glass. I looked inside and saw that window sprayed all through the car. Damn.
I looked around the inside, trying to find something missing. Harry Potter on tape - still there. Car CD player - still there. Change - still there. Then I remembered. I had been leaving a few bucks in the cupholder to pay tolls with. That was the only thing missing.
Someone broke my window for $3.
On the other hand, I'm keeping the brick they tossed in as a souvenier. Also, my roommates helped me clean up, and we went out afterwards for diner food to celebrate. Since I've been having trouble making friends with them, the progress seems worth the cost. One of my roomates thought the glass actually looked rather pretty, and insisted I get a photograph. The almighty brick lurks in the background.
Tuesday, June 28, 2005
High yield
So, the first week I thought to myself, "It can't possibly be hard enough to justify all the study time everyone else is putting in." Yeah. Now, I'm putting in that much time, and more. The hackneyed metaphor seems most appropriate - we're drinking from the firehose now. Time to only pay attention to what's helpful, time to start living off of ramen noodles, time to get "high yield."
So, what does high yield mean? Means the source that will give you the answers to the most questions on the boards for the least amount of work.
What are these "boards"? A series of tests you have to pass if you want to be a doctor. The first test (called, 'steps' for whatever reason) is an overarching final for everything in the first two years of medical school.
The class that I am in is high-yield. I will study high-yield materials, and even higher-yield supplements.
I think back to undergrad, a mere month ago. I always thought the question, "will this be on the test?" was so undignified. I was always trying to learn more, to get outside the material, and play around with it. There simply isn't time here. The pace of the curriculum seems to demand memorization (aided by as much anatomical reasoning as I posses). Elaboration is provided by clinical considerations, which are memorization fodder, as well as aides in memorization. One set of material reinforces the other. Anyway, it's all spoon-fed. I guess otherwise it wouldn't be high yield.
So, what does high yield mean? Means the source that will give you the answers to the most questions on the boards for the least amount of work.
What are these "boards"? A series of tests you have to pass if you want to be a doctor. The first test (called, 'steps' for whatever reason) is an overarching final for everything in the first two years of medical school.
The class that I am in is high-yield. I will study high-yield materials, and even higher-yield supplements.
I think back to undergrad, a mere month ago. I always thought the question, "will this be on the test?" was so undignified. I was always trying to learn more, to get outside the material, and play around with it. There simply isn't time here. The pace of the curriculum seems to demand memorization (aided by as much anatomical reasoning as I posses). Elaboration is provided by clinical considerations, which are memorization fodder, as well as aides in memorization. One set of material reinforces the other. Anyway, it's all spoon-fed. I guess otherwise it wouldn't be high yield.
Thursday, June 23, 2005
ID!
I have a whole new life - new student ID, new swipey RF "ass-badge" to open doors, new bank card, new keys, now - first hostpital ID. Exciting. I am a "student intern." Ooh. Means I can go get scrubs when my laundry is running low. Also means I got a nifty little card that explains what all the hospital codes mean. For instance, at my hospital:
When they say: Dr. Cart
They mean: Cardiac arrest
When they say: Dr. Suess
They mean: Infant / Baby security alarm
When they say: Dr. Strong
They mean: Patient disturbance
They also gave me a handy mnemonic to use whenever Dr. Red (a fire) comes calling... R.A.C.E.R. As if I don't have enough acronyms to memorize.
Don't ask me what any of this means. As I have previously indicated, I am not a doctor (and it would be illegal for me to claim otherwise!)
When they say: Dr. Cart
They mean: Cardiac arrest
When they say: Dr. Suess
They mean: Infant / Baby security alarm
When they say: Dr. Strong
They mean: Patient disturbance
They also gave me a handy mnemonic to use whenever Dr. Red (a fire) comes calling... R.A.C.E.R. As if I don't have enough acronyms to memorize.
Don't ask me what any of this means. As I have previously indicated, I am not a doctor (and it would be illegal for me to claim otherwise!)
Legal immunity
Every normal person has been vaccinated. It is a requirement for getting into kindergarten, elementary, middle, and high schools. When I graduated from HS, they gave us empty leatherette cases, and told us to go to the commons to get our diplomas, and our immunization records.
Proof of immunization is also required to enter as an undergraduate. Ergo, an undergraduate diploma is proof of immunization. However, in my packet of 'little things to do in the two weeks before school starts,' immunization forms! No problem. However, they indicate that, rather than proving that I have had my shots, I need to prove that they did some good via blood titer.
Now, I'm not a doctor, yet, but something about this strikes me as odd. Under what conditions could someone be immunized, yet no longer be immune? I'd believe that the polio shot my mother got 40 years ago is starting to lose its impact, but my shots are much younger. The only way I wouldn't be immune would be if I had no immune system whatsoever. Anyway, I am, indeed immune to MMR, do not have tuberculosis, etc. thus I am here, and can get my hospital ID (see above).
Proof of immunization is also required to enter as an undergraduate. Ergo, an undergraduate diploma is proof of immunization. However, in my packet of 'little things to do in the two weeks before school starts,' immunization forms! No problem. However, they indicate that, rather than proving that I have had my shots, I need to prove that they did some good via blood titer.
Now, I'm not a doctor, yet, but something about this strikes me as odd. Under what conditions could someone be immunized, yet no longer be immune? I'd believe that the polio shot my mother got 40 years ago is starting to lose its impact, but my shots are much younger. The only way I wouldn't be immune would be if I had no immune system whatsoever. Anyway, I am, indeed immune to MMR, do not have tuberculosis, etc. thus I am here, and can get my hospital ID (see above).
Tuesday, June 21, 2005
Body rap
First day of anatomy lab today. First we got our bone sets - half of a body, plus the skull. I was forced to admit that I don't know the names of most of the bones during checkin, but I got some help, and I don't think I'm likely to forget them after this summer. I dropped the skullcap on a dissecting table, and one of the TAs said, "if you had to drop one, that would be the best." The bone was undamaged.
After the bones, we had a quick ceremony to honor the deceased, then wrapped the bodies. First the TAs showed us how. They just unzipped the body bag that it came in, and here was this naked guy, his hands and ankles tied with coarse rope. They lifted the body, whipped out the old bag, and brought in the new one. They didn't give any indication that the body was fragile, or something that could be broken - they moved it around as you would a living body, yet when I tried to splay the fingers on our dead woman, they were stiff.
To keep the bodies from decomposing, we wrap them in a rags (actually cut bits of sheets) that are dipped in phenol. Phenol doesn't smell as bad as formaldehyde, but it still gives you that smell of death. I've taken up swimming in hopes that the chlorine will either react away or cover the phenol. Phenol, by the way, is a local anesthetic that also causes irritation - i.e. it deadens the skin, then messes it up.
After class I went back to the lab and got out my bones - we have reading this week on anatomy of the upper extremety (what normal human beings might refer to as 'the arm'). I figured it would be helpful to have the physical bones in front of me while the textbook talked about them. I was amazed at how the bones articulated... by this I mean, I was surprised at how closely they fit together. Somehow, I had it in my mind that the joints would be large, fluidy things, and thus the marriage between two bones would be more a function of connective tissue, rather than physical connection. This is not the case.
I feel like I should be diving into the more researchy stuff, or getting into some kind of social thing, but I keep telling myself I don't know how busy I will be...
After the bones, we had a quick ceremony to honor the deceased, then wrapped the bodies. First the TAs showed us how. They just unzipped the body bag that it came in, and here was this naked guy, his hands and ankles tied with coarse rope. They lifted the body, whipped out the old bag, and brought in the new one. They didn't give any indication that the body was fragile, or something that could be broken - they moved it around as you would a living body, yet when I tried to splay the fingers on our dead woman, they were stiff.
To keep the bodies from decomposing, we wrap them in a rags (actually cut bits of sheets) that are dipped in phenol. Phenol doesn't smell as bad as formaldehyde, but it still gives you that smell of death. I've taken up swimming in hopes that the chlorine will either react away or cover the phenol. Phenol, by the way, is a local anesthetic that also causes irritation - i.e. it deadens the skin, then messes it up.
After class I went back to the lab and got out my bones - we have reading this week on anatomy of the upper extremety (what normal human beings might refer to as 'the arm'). I figured it would be helpful to have the physical bones in front of me while the textbook talked about them. I was amazed at how the bones articulated... by this I mean, I was surprised at how closely they fit together. Somehow, I had it in my mind that the joints would be large, fluidy things, and thus the marriage between two bones would be more a function of connective tissue, rather than physical connection. This is not the case.
I feel like I should be diving into the more researchy stuff, or getting into some kind of social thing, but I keep telling myself I don't know how busy I will be...
Monday, June 20, 2005
Cruel Summer
I just finished my first real day of classes. The more I learn, the less intimidated I feel, yet the workload is immense. The instructor seems friendly (e.g. he invited us out to his place to watch the fireworks on the 4th), and I guess the lowest anyone got last year in the class was an 82% (which, like anything between 75-100 turns into a P), but I'm still somewhat apprehensive. There's a ton of stuff to learn... At least this is my only responsibility at the moment. Later this summer, we're going to watch an autopsy. Seems like a good review, something I should get a feel for if I intend to hang out with the dead for my whole life.
We had a talk with a woman here who acts as a sort of medical ethics person - I think I'd like to hang out with her a bit.
We had a talk with a woman here who acts as a sort of medical ethics person - I think I'd like to hang out with her a bit.
Friday, June 10, 2005
One good thing
I know what kind of doctor I want to be -
The kind that snorts cocaine off the huge, fake, naked breasts of his female patients.
The kind that snorts cocaine off the huge, fake, naked breasts of his female patients.
*, a.k.a. Thoughts on privacy, BS
I'm not sure I want the people in my program reading my blog. I certainly don't want to have my awareness that they're reading my blog cramp my writing. I don't expect to get kicked out of the program, but this business is all about recommendations. If I want my next job to be in Bethesda or Baltimore, rather than Billings or Bismark, I need to get good recommendations. If I'm gunning for a medical residency, do I really need all my skepticism held against me?
What does privacy have to do with the claim that my institution invented the white coat ceremony? Well, if my institution really did invent the white coat ceremony, all of a sudden the pool or people I could be narrows considerably, from the ~16000 incoming MD students, to the much smaller number at my institution. It would be like saying our dean is a woman, or that I can't wait to count all the sunny days and see if Phoenix really does have more than 300 per year.
I'm vaguely confidant that I wont get found out because I'm sure that half the medical schools in the country are passing out the same palaver to their students. Most aspects of medical practice are like the internet - everyone says they invented it, no one says they control it.
Please treat this as a formal request for privacy. I don't want to be found, don't look for me, the momentary satisfaction that you gain is not worth the possible damage to me.
Bad news on the medical front III
I haven't had a single medical class yet, and already I'm acting like a doctor. I told my uncle (the one from BNOTMF1) that he should look into taking two more drugs - just pulled them out of my ass. I know like, 10 drugs - what are the odds that I know one, much less two, that will help him, especially absent anything other than talking to him?
Second, I suggested that two of my other family members might have some kind of social anxiety disorder, and recommended that they consult with mental health professionals (while hinting that drugs could 'make them better').
Third, I have been getting giddy about my white coat ceremony. Some things, they celebrate when you leave, like graduation. For medicine, they celebrate when you show up. They put on a big pseudo-religious (or religious) ceremony, administer the hippocratic oath and symbolically induct you into the priesthood with your white coat (the modern oath is a bit more PC).
With all my heart, I realize I should just forget about it, collect my white coat when necessary and get on with my life. But then I said, "don't I want to meet my classmates?" Of course! And what better opportunity? (Don't answer that). So I was like, "Oh, I'll invite my mom!" (She'll be in town, moving me in). And then I got an admitted student mailer, and they're like "You can invite up to five people - they get really nice invitations." And I'm thinking, "cool, nice invitations." By they way, my institution claims* to have invented the white coat ceremony, so you just know it's going to be overblown.
Then I spent all afternoon trying to figure out if I want a size 38 or a 40, and whether I should get long, or standard size. Yeesh. The final answer, by the way, is 38 long. Why? 1) I'm probably not going to be wearing the coat over my winter jacket and 2) When I was a little kid, I always wanted a cape. In fact, my entire fascination with science and medicine might be traced to the fact that these people get to wear cape-like things every day as a matter of course. A longer 'cape' enhances the super-hero experience. Although, if I were to pick a super power, it would be "making people do whatever I want by scratching them behind the ears"** as opposed to, "pushing drugs."
** We're going to have a facebook, and one of the questions was, "What super power would you have, and what would your name be." I'm 'catnip' if you must know. It was either that or have the super power of always having tea no matter what, and the tea is really good (I was going to call myself, 'The Teabagger' so this one obviously wins on the name). Seriously.
* This is getting it's own post, as it sprawls into a larger issue.
Second, I suggested that two of my other family members might have some kind of social anxiety disorder, and recommended that they consult with mental health professionals (while hinting that drugs could 'make them better').
Third, I have been getting giddy about my white coat ceremony. Some things, they celebrate when you leave, like graduation. For medicine, they celebrate when you show up. They put on a big pseudo-religious (or religious) ceremony, administer the hippocratic oath and symbolically induct you into the priesthood with your white coat (the modern oath is a bit more PC).
With all my heart, I realize I should just forget about it, collect my white coat when necessary and get on with my life. But then I said, "don't I want to meet my classmates?" Of course! And what better opportunity? (Don't answer that). So I was like, "Oh, I'll invite my mom!" (She'll be in town, moving me in). And then I got an admitted student mailer, and they're like "You can invite up to five people - they get really nice invitations." And I'm thinking, "cool, nice invitations." By they way, my institution claims* to have invented the white coat ceremony, so you just know it's going to be overblown.
Then I spent all afternoon trying to figure out if I want a size 38 or a 40, and whether I should get long, or standard size. Yeesh. The final answer, by the way, is 38 long. Why? 1) I'm probably not going to be wearing the coat over my winter jacket and 2) When I was a little kid, I always wanted a cape. In fact, my entire fascination with science and medicine might be traced to the fact that these people get to wear cape-like things every day as a matter of course. A longer 'cape' enhances the super-hero experience. Although, if I were to pick a super power, it would be "making people do whatever I want by scratching them behind the ears"** as opposed to, "pushing drugs."
** We're going to have a facebook, and one of the questions was, "What super power would you have, and what would your name be." I'm 'catnip' if you must know. It was either that or have the super power of always having tea no matter what, and the tea is really good (I was going to call myself, 'The Teabagger' so this one obviously wins on the name). Seriously.
* This is getting it's own post, as it sprawls into a larger issue.
Bad news on the medical front II
And I think, maybe we're just toys of the pharma industry... they obviously know what they're doing. They wouldn't be bombarding us consumers with ads if they didn't think it would have an effect on sales.
To kind of fit in with this, here's a look at things from the perspective of a drug detailer (i.e. a sales rep)
What if I'm just one of this guy's stereotypes? Somebody hold me.
To kind of fit in with this, here's a look at things from the perspective of a drug detailer (i.e. a sales rep)
What if I'm just one of this guy's stereotypes? Somebody hold me.
Bad news on the medical front I
I've been asked (in comments below) why physicians in general are unwilling to 'stand up' to their patients. That is, when someone sees an ad on TV and they come to the doctor's and ask for the drug, why does the doctor roll over and give them the drug?
I actually ran into a counter-anecdote, in that my uncle's physician refuses to perscribe drugs that he suggests, apparently for the bloody-minded reason that my uncle has suggested the treatment.
I'm going to disregard this anecdote, partially because it's an anecdote (even if true it proves nothing), and partially because there's a question of whether my uncle's ideas for treatment are good - he goes in for alternative medicine treatments that are untested, both in terms of safety and efficacy.
So... let's go to the literature:
Mintzes B, Barer ML, Kravitz RL, Kazanjian A, Bassett K, Lexchin J, Evans RG, Pan R, Marion SA. Influence of direct to consumer pharmaceutical advertising and patients' requests on prescribing decisions: two site cross sectional survey. BMJ. 2002 Feb 2;324(7332):278-9., PMID: 11823361 (free full text here)
In summary:
1. About 74% of patient visits result in a drug being prescribed - this is the accepted figure.
2. Patients that ask for drugs in general are more likely to get drugs
3. Patients that ask for advertised drugs are likely to get the drugs they ask for.
So, the observation that physicians bend over backward for their patients checks out. However,
4. When patients asked for drugs, in general or in particular, the physician was more likely to be 'ambivalent' about the treatment.
What's going on here? I can't find a study on that. The establishment guess would be that it's either business or law at fault. If I won't deal to you, you'll find someone else who will -> I lose business -> I starve. If you suggest a treatment for X, I don't treat you for X, and then you die from X, I get sued.
Of course, the study is all self-report, which causes all kinds of difficulties. Still, this is a definite plot hole in the 'physicians think they're gods' story.
I actually ran into a counter-anecdote, in that my uncle's physician refuses to perscribe drugs that he suggests, apparently for the bloody-minded reason that my uncle has suggested the treatment.
I'm going to disregard this anecdote, partially because it's an anecdote (even if true it proves nothing), and partially because there's a question of whether my uncle's ideas for treatment are good - he goes in for alternative medicine treatments that are untested, both in terms of safety and efficacy.
So... let's go to the literature:
Mintzes B, Barer ML, Kravitz RL, Kazanjian A, Bassett K, Lexchin J, Evans RG, Pan R, Marion SA. Influence of direct to consumer pharmaceutical advertising and patients' requests on prescribing decisions: two site cross sectional survey. BMJ. 2002 Feb 2;324(7332):278-9., PMID: 11823361 (free full text here)
In summary:
1. About 74% of patient visits result in a drug being prescribed - this is the accepted figure.
2. Patients that ask for drugs in general are more likely to get drugs
3. Patients that ask for advertised drugs are likely to get the drugs they ask for.
So, the observation that physicians bend over backward for their patients checks out. However,
4. When patients asked for drugs, in general or in particular, the physician was more likely to be 'ambivalent' about the treatment.
What's going on here? I can't find a study on that. The establishment guess would be that it's either business or law at fault. If I won't deal to you, you'll find someone else who will -> I lose business -> I starve. If you suggest a treatment for X, I don't treat you for X, and then you die from X, I get sued.
Of course, the study is all self-report, which causes all kinds of difficulties. Still, this is a definite plot hole in the 'physicians think they're gods' story.
Friday, June 03, 2005
A man walks into the doctor's office
The doctor says, "It gets really boring doing physicals on healthy guys."
Seriously, though, I had to get my immunizations updated for med school, so I went in. I have nothing of interest to report. They're letting me rate my own TB test - apparently my medical student status qualifies me to feel my arm for a bump. Also, the nurse was telling me how to do the various shots (e.g. a TB test is subdermal and only to produce a weal).
I did not badger or bully my doctor, though I should have... I guess in situations where nothing seems wrong I'm not excited to go looking.
Seriously, though, I had to get my immunizations updated for med school, so I went in. I have nothing of interest to report. They're letting me rate my own TB test - apparently my medical student status qualifies me to feel my arm for a bump. Also, the nurse was telling me how to do the various shots (e.g. a TB test is subdermal and only to produce a weal).
I did not badger or bully my doctor, though I should have... I guess in situations where nothing seems wrong I'm not excited to go looking.
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