Manual Over Autofocus.

I am astounded that in a month I will be one half of the way through my third year of medical school. As I've gone through a handful of rotations and have spent more time than I cared to at the hospitals, I've noticed something that has been irritating me. As a student, for as much as we are active and participating in patient care, we spend a lot of time observing. We watch residents, attendings, and nurses, seeing how they interact with patients and approach the art of medicine. The mantra that is often taught, or supposed to be taught, or ideally taught but secretly thought by some of those teaching as foolish, is that in medicine you should not treat the disease; you should treat the patient.

The sentiment of that statement rings true with how I feel. The execution? Not so much. Many physicians stop short of treating the disease, let alone the patient. Instead, they treat the symptom or a specific manifestation of the disease. An ID doctor treats the infection; the surgeon opens and drains the abscess; the endocrinologist manages the diabetes. This makes sense from a practical point of view. If I have learned anything over the past two and a half years it is that I cannot learn everything. An expert should handle the complexities and nuanced management of certain conditions. But what happened to treating the patient? (This is not to say specialists cannot treat the patient instead of a symptom or aspect of disease; it simply means I haven't seen it yet. I am wanting to, believe me.)

Recently on rounds, the attending reminded us that "In medicine, we treat the patient, not the numbers." This statement was made regarding abnormal lab values. It was meant to remind the students and residents that we cannot simply try to correct abnormalities on paper; we must look at the patient clinically to confirm, adapt, and change plans. Sadly, it was meant on nothing more than a level of clinical correlation. As opposed to a grander statement about the lofty responsibility of treating the patient, it was about confirming laboratory findings clinically. What this statement actually did for me was point out the failures of the medical team to go beyond a talking point and treat more than the patient; I instead wondered: what about the person?

Too often it seems medicine becomes bogged down in labs or physical findings. Sodium is corrected; cholesterol is monitored. While these things are astoundingly important, I do not want to be a physician who works through tunneled vision. I do not want to be a physician who treats the patient instead of the disease.

I want to be the doctor who cares for the person.

Most of the people I have worked with thus far- who no doubt care about patients immensely and typically practice good medicine- do not focus on the patient as a person. Maybe this is naive and foolish. Maybe I cannot actually appreciate the weight of what it means to be a physician and all its struggles because I haven't reached that point yet. Honestly, I do not know and don't get me wrong: there have been a handful of docs who continually impress me both with their control of medical knowledge and their approach to patient care. Such physicians do exist. I just suppose my hope is to join their ranks in one and half years (technically) and four and half years (board-certified-ly).



Until next time.

All Work and No Play

Time is a sneaky mistress. For most of school thus far, any kind of ending has been far off in the future. The slippery and fluid nature of time has changed that. As things currently stand, two weeks of regular lecture, a final exam, a pharmacology shelf exam, and about 250 drugs are all that stand between me and the halfway point of my medical education. Such a time crunch might, as one would expect, explain the severe lack of blogging accomplished by yours truly.

For this I apologize, but sadly, school and all of its craziness take priority. In the mean time I hope everyone else enjoys the spring for me. I'll see you for a week and a half in the summer. (For fun, check out the new countdown at the bottom of the blog.)



Until next time.

Extermination and Creeping

I am lucky enough to report back that the Infectious Disease module -viruses, bacteria, prions, parasites, helminths, and all- has been exterminated and is thankfully tucked away in the "Win" column. (For those keeping track at home: school is still winless while I am undefeated.)

In lieu of summarizing the modules and its disgusting contents, I am instead going to go back to enjoying my spring break and leave you with this photo of my dog creepin'.

                                       So pop-pop-pop your peepers. 




Until next time.

Bugs and More

For the past three weeks, and for the next three as well, I have been and will continue to learn all about infectious diseases. Viruses, bacteria, parasites, fungi. You name it, we're probably learning about it. While we are currently about halfway through the process, we've only just begun the bulk of the material (bacteria) yet have completely finished viruses.

Don't get me wrong: viruses are very interesting. At the beginning of ID I thought they were much more impressive than bacteria could be. I mean, come on, bacteria can at least understandably be viewed as tangible organisms. We can see them move and divide. They are cells just like us. They have a cell wall, sure, but we can see the connection. Viruses? They're pretty much just little grenades with nucleic acid, bits of DNA and RNA covered in a protein capsid. How can we rationalize that? Pretty creepy little things.

                                    Viruses: addressed "to whom it may concern." 

Imagine my shock when we began discussing something that put viruses to shame. Made viruses into pocket-watches while they become the sundial. Of what do I speak? Prions.  They are nothing more than little chunks of protein that infect cells and then screw things up. By "screw things up" I mean "get into your brain and then create tiny holes." They're the culprit behind disease like Kuru and Mad-Cow. They make no sense. Humans, animals, plants, etc? Gobs of cells all chocked full of organelles and DNA striving to make a living in life. Bacteria? Little cuties we can't help but feel sorry for. It's like they're trying to be us but just can't ever quite get there (don't feel too bad for them: Exhibit A).  Viruses? Jerks that just keep trying to take over; the ants at our proverbial picnic.

But Prions? They just want to watch the world burn.

                                       Namely because they would survive it. 

What do I mean by this? In 1986, people in the UK burned over 4 million cows who might have been infected with BSE (Mad cow). And I mean torched. We're talking over 1000F heat. They then buried the ashes underground in a concrete container until 1998. TWELVE YEARS. At that point they opened the container and found the prions still smiling right back, waiting to continue their rampage of destruction. Wicked, eh?

So should we be worried? Pouring buckets of cash into prion research so that we don't all have chunks of protein infecting our brain?!

Not really. Turns out the major way to get a prion disease is via ingestion of infected tissue, also known as eating brains. This is why Kuru has only ever been historically found among people of the Fore tribe in Papau New Guinea (who engaged in cannibalism) and BSE was spreading because of the use of animal feed made up of dead-and-processed-other-animals. I'm going to spare you all the lovely photo of such a mental image that was included in our lecture. (Edit: to clarify, the most prevalent form of prion disease in humans is CJD which comes from ingesting infected beef, which likely themselves had infected food from animal products. Details.)

Oh, medical school.


Until next time.

The Future!

It seems as though my time as of late has been dominated by thoughts of the future. What do I mean exactly? Many things.

Concerning literature, I pretty much read like I'm tearing up the TRON universe. By this I mean I now have a wicked sweet Kindle. While I was formerly a staunch advocate for physical books, I now realize the utility of possessing what amounts to be a Hitchhiker's Guide in my bag (Seriously. Wikipedia and free international 3G? You come up with a better way to describe it). I'll never give up physical books; the weight of the paper and smell of the words are too wonderful, but the sheer ease of reading and on the go access to my library act as a nice addition to my bibliophile-ness.

With school, our attention has been forward-focused on the looming mammoth of Step 1. The first of three nationally required licensing exams, Step 1 is an orgy of all the medical information we've learned or will have learned or will have supposed to have learned over the first two years, all condensed into 8 hours of mind-numbing goodness. Who has two thumbs and is pumped? This guy.

The final sign that I'm obviously future bound? I wrote this whole post from my frakking phone. What?



Until next time.