Pale Blue Dot

Pictures!

2010-03-25T14:27:00.008-04:00

The Dutch neighborhood in Potsdam, the first Western suburb of Berlin. It was part of East Germany, but since reunification has turned into *the* place to live outside Berlin, with large homes, miles of forests and lakes, and many young families. It has a "Dutch neighborhood" because it wanted to attract Dutch immigrants way back when, when the city was a mecca of European immigration. Potsdam was also the home of some Prussian kings (see below), housed part of the Berlin Wall, and is connected to Berlin by the Glienicke Bridge, where the US and Soviet Union traded spies during the Cold War. Additionally (just when you thought this city couldn't get more exciting!), there is a little Russian village within Potsdam, called Alexandrowka, which was built in 1825 for a group of Russian singers. Several houses are still standing, and some are even still owned by the descendants of the original owners. Sorry I didn't get a picture, I was in a moving vehicle, but you can see pictures of it here. It is very cool in person.

Nothing says "Ich liebe dich" like potatoes on your grave. (Disclaimer: This is the "tomb" of Frederick the Great, aka Old Fritz, aka The Potato King [I am not making this up]. It's his "tomb" because he was not actually buried here [though apparently he wanted to be]. He's supposed to be the reason potatoes are so widely eaten in Germany. I'll spare you the details of that scintillating tale.)

I went to see the Berlin Wall in situ, if you will (and I know you will), at a place called the East Side Gallery, where artists have painted a long stretch of the wall with different murals. I would probably put this up there as one of the top three things *not* to be missed in Berlin, even though I just made it out there at the end of my trip. The different murals, by artists all over the world, are so cool.

Munich, etc

2010-03-15T09:48:00.014-04:00

Updates from chilly Deutschland. Things are good here, I'm actually learning a little German, which is exciting. I wanted to post a couple pictures, largely because I don't want to be out-vacation-blogged by Natalie, which I will be ultimately because she a) is in Spain, and b) takes fantastic pictures, but I can at least attempt to keep up while I'm here... :)

I spent the weekend in Munich, which was totally worth the 6-hour train ride to meet my friend Anna, who lives as far away from Berlin as possible while still being in Germany. Munich was equally out of the way for both of us, so it was perfect! I got to experience the "real" Germany (right, Anna??) by drinking a mug of beer the size of a small person, getting hit on by drunk foreign men, and eating pastries soaked in gooey cream and sugar. I tried to wrestle Anna into a Dirndl, but she's surprisingly strong and resisted. So I don't have any pictures of that, alas.

Munich Lions

Anna demonstrating my newest vocabulary word: Schweinshaxe (on a boar outside Munich's hunting and fishing museum). Yum.

This is the Brandenburger Tor (Brandenburg Gate) in Berlin. (I think this picture came out pretty well despite being taken on my phone.) The gate is a major symbol of Berlin, being involved in so much of its history. It was finished in 1791, and the statue on top (the Quadriga) was taken to Paris by Napoleon after a Prussian defeat in 1806. The gate was one of the only structures in the area to remain standing after Berlin was bombed in WWII. The Berlin wall was constructed just west of the gate, enclosing it in (Soviet) East Berlin. It's a pretty impressive structure. I'll try to get back there with a real camera one day. :) On of the things I like about Berlin is that it's so clearly still being rebuilt. The Wall only came down 20 years ago, and there are still areas along where it ran where there's nothing more than weed-strewn lots with nothing there yet. There also isn't that much architecture that is obviously old, like the Brandenburg Gate, like there is in Paris, for example. It's a major capital city that's still becoming itself, in a way.

The other side of Germany

2010-03-15T08:56:00.011-04:00

This weekend I had the (un)fortunate opportunity to visit Dachau, the Nazis' first concentration camp, located near Munich, in south-eastern Germany, about a 6-hour train trip from Berlin. It was a freezing, gray day, which suited the visit just fine. As I was told before I went, it's worse in person than you can even imagine. They have made a GREAT museum in the main building. For more information, and pictures from the camp, go to wikipedia's entry on Dachau.

The entrance - "Work makes you free"

View of where the barracks once stood (they've all since been destroyed, but two have been rebuilt as part of the memorial and museum), from near the crematorium. (I'm not posting pictures of the crematorium or the "oven," they're too creepy and gross.)

Statue outside the main building. The English says (it's a big inscription, but hard to make out in the picture): "May the example of those who were exterminated here between 1933-1945 because they resisted Nazism help to unite the living for the defense of peace and freedom and in respect for their fellow men."

The story of how I went to the opera wearing purple cowboy boots (and other adventures)

2010-03-07T13:28:00.008-05:00

Greetings from frigid Germany! (Note to Germans: it doesn’t matter how many times you tell me “this is the coldest winter we’ve ever had!” or, “Normally it’s spring by now!,” it doesn’t make me feel better about the weather, or make me not wish I’d brought my down coat. Thanks.) Anyhoo, thought I’d write a short update of my travels up to now. I now know a tiny bit of German, and that tiny bit includes phrases like, “My hobby is rollerskating,” and “Klaus-Otto is married,” and does not include useful phrases like, “I’d like a small coffee with milk please.” Ah, well, it’s nice to know beginning language courses are the same throughout the world. :) I spent my weekend going to operas (they’re already in German, yet they put up German supertitles; I guess I never appreciated the Met’s individual screens where you can choose your own language until now) and going to Leipzig. Leipzig is a city about an hour and fifteen minutes from Berlin by train, famous for being the home of, at one time or another, Mendelssohn, Mahler, Schumann, Wagner, and Bach, who conducted the choir of the St. Thomas church for almost 30 years; as well as a pretty interesting role in the reunification of Germany. Leipzig also, as I learned when I arrived, has adopted the wait-until-it-melts method of snow removal, which made my choice of weekend footwear (suede pumas, as there was no snow at all in Berlin when I left) particularly unfortunate, since I was soon up to my ankles in snow and slush. As it was too cold to walk around and take pictures, I went to a few museums, then heard a concert at Bach’s church, which was advertised as a concert, but actually was more of a service, with standing, praying, a sermon (literally the only words I understood were “snow” and “March,” but maybe that’s because I was subconciously listening for them), the Lord’s Prayer in German, etc. (which reminded me of the fact that one of the first phrases I learned in sign language was “In Jesus’s name we pray, amen.” For an atheist I seem to gravitate towards religion a lot.) The whole concert/sermon was quite lovely, but I felt a little bad about disrespecting Bach in his house of worship by having my shoes and socks off, but both were soaked and cold. Afterwards I was wandering around and noticed that the Leipzig opera was doing Lohengrin, and decided to get a student ticket; but decided I couldn’t spend 5 (five! Thanks, Wagner.) hours in an opera with freezing feet and soggy socks, so I decided to buy some new socks. BUT the shoe store was having a major winter boot sale, and they happened to have some kick-ass purple cowboy boots (that’s right) in my size, half off. They also had some practical, black, staid shoes, but why buy practical shoes when you can buy purple cowboy boots? (Note: sorry for knocking the usefulness of my German – the entire shoe-buying transaction was conducted with a sales clerk who spoke no English, which is good, right? Even though it was mostly numbers. But still!) So that’s how I ended up at the Leipzig opera, seeing Lohengrin in ratty jeans (sorry, older and distinguished Leipzig opera-goers, and sorry, mom, I know I should dress better) and the aforementioned purple cowboy boots. Which, now that I’m back in Berlin, you’d better believe I’m going to wear with panache. :)

Bach, presiding over his church

A chandelier I liked in the opera house

The organ inside the Thomaskirche

FAQ: Buruli ulcer

2010-02-16T16:13:00.019-05:00

Today's Global Health topic: Buruli ulcer. What’s that, you say? Never heard of it before? It’s OK, that’s why it’s one of the World Health Organization’s Neglected Tropical Diseases (more on that below). So consider this a public service announcement of sorts about Buruli ulcers.

Q: What is a Buruli ulcer? (Warning: google image at your own risk)

A: It’s an infection of skin, soft tissue, and bone that is caused by a bacteria called Mycobacterium Ulcerans. Mycobacteria are a unique kind of bacteria, and cause other serious infections (M. tuberculosis causes (surprise!) tuberculosis, and M. leprae causes leprosy). It’s called a Buruli ulcer because of a large study done on it in Buruli, Uganda in the 1960’s.

Q: Can I get it?

A: You can only get infected if you live in tropical wetlands. It’s most commonly found in Africa, but it can be found pretty much everywhere in the world if the climate’s right (It used to be called a Bairnsdale ulcer after Bairnsdale, Australia). No one’s sure how people get infected exactly, but at the moment it’s thought that you have to get bitten by a bug that carries the bacteria in its salivary glands. Yum.

Q: What’s it do to you?

A: The bacteria get into your skin and make toxins that cause cell death (How fun! No other mycobacteria do this). Because the toxins also suppress your immune system, you don’t get any “normal” signs of skin infection, like fever, pain, redness, or swelling, because all these symptoms of infection are actually caused by your body’s normal response to invading bacteria. Because people can have little more than a tiny bump or dark spot on their skin, they ignore it, and the infection is allowed to spread and cause serious problems. Untreated, it can cause severe deformity (again, the google image warning), resulting in permanent disability (the most common site of infection is the legs) and death.

Q: How do you treat it?

A: Antibiotics and surgery. Traditionally, surgery was the definitive treatment (to cut out all the dead tissue), but more recent studies show that if you diagnose the infection and start antibiotics early enough, they can cure nearly 100% of infections, with no need for surgery. But it’s a little tricky to diagnose it at an early stage, because there are no real symptoms that prompt people to seek medical attention, and there’s really no good diagnostic test for it, especially one that could practically be used in the rural, resource-poor areas where this infection is endemic.

Q: What’s a Neglected Tropical Disease (NTD)?

A: The World Health Organization has made a list of diseases that affect a large number of people worldwide, with high morbidity and mortality, yet receive relatively little funding and attention. The NTD’s affect one billion people, and together cause 534,000 deaths per year. From the WHO’s website: “Those most affected are the poorest populations often living in remote, rural areas, urban slums or in conflict zones. With little political voice, neglected tropical diseases have a low profile and status in public health priorities.” NTD’s affect 1 in 6 people worldwide. To compare that number to a disease that gets more press time, 1 person in 1,762 has Mutiple Sclerosis. (Ever heard of trachoma? Eight million people are blind because of it. Filariasis? Chagas' disease?) See their website for more info.

Such a pretty lake, but potentially so deadly: Lac Zilé, near Lambaréné, Gabon.

The story of Buruli ulcers in Lambaréné

Although I was doing adult medicine (and BU mainly affects children), I became interested in BU because of the several children who literally lived in the surgery ward, where they were under long-term treatment for the ulcers. All patients at the hospital were cared for by a family member, who was responsible for cleaning, buying and cooking food, giving medications, and many of the jobs that nurses in the US do for patients (even including taking and charting temperatures). Because these kids were there so long-term, they could not have a family member stay with them, so they were essentially on their own. We befriended three of the girls in particular (their picture is in another post), whom I would sometimes sneak away after rounds to visit, or would come over to our house on the weekends.

In the morning, one or two of the girls could be found sweeping the small stoop outside their rooms (all of the rooms opened into a main hallway inside, and had a door to the outside), or washing their sheets and spreading them out on the lawn to dry. I had difficulty picturing American tweens fending for themselves, cleaning their own hospital rooms, entertaining themselves, and finding their own food (even without one arm completely bandaged up). One evening after afternoon rounds, my attending and I passed the entire group of children, most of whom had Buruli ulcers, playing soccer on the large lawn between the surgery and ob/gyn wards. Most were running around, screeching and laughing and playing, enjoying the setting sun with their friends; only two boys sat watching from their wheelchairs, as neither had walked in several months due to surgical debridement for BU that spanned their legs from their hips to their toes. I was truly touched during the three months we knew the girls at how they created a normal childhood for themselves despite their disabling disease: constantly spending time together, choreographing dances to their favorite pop songs, and throwing birthday parties for their friends on the lawn outside the surgery ward.

One afternoon I left the three girls on our porch, and came home to find my camera filled with literally hundreds of pictures they had taken of each other, capturing their adolescence in a way no photographer never could. Looking at these pictures now (I couldn’t bring myself to delete even one) makes my heart break. They are only a few years younger than, but a lifetime removed from, the many young women that would come into clinic with the outlines of their skeletons visible and CD4 counts in the single digits, who would die overnight or the next day from AIDS. So what’s happened to these three girls? They were all discharged within one week of each other in late July, and I only hope they have stayed healthy since then.

Global Health

2010-02-03T20:56:00.003-05:00

Hello everyone, loyal followers of the sporadic postings of PaleBlueDotBlog,

I'm currently taking a course in Global Health, and some of the topics are really really interesting. I didn't get a chance to post as often as I wanted to from Africa, so I'm going to try to post a few topics that come up in this course that I think are interesting. (Let's look at this as a chance to redeem myself for a dearth of postings from abroad about topics that would actually be fun [well, in my geeky opinion] to read about.) Hope everyone's good! :)

-L

Q & A: Rheumatic Fever and Rheumatic Heart Disease

2010-02-03T20:54:00.003-05:00

Q: What are rheumatic fever and rheumatic heart disease?

· A: Rheumatic fever is a disease that can develop as a complication of strep throat. It is rare in the US (for reasons discussed below), but is relatively common in the developing world. Rheumatic heart disease is a long-term result of rheumatic fever (which sometimes you have to get multiple times) which can cause valve deficiencies, heart failure, and death.

Q: How do I know if I have it?

· A: You don’t. But symptoms occur several weeks after strep throat and can include fever, joint pain (without swelling), a heart murmur or heart failure, a rash, and involuntary movements. Kids make up 80% of the cases, and adults 20%. [For people who have taken medical boards and theoretically should remember this stuff: the major (Jones) criteria for acute rheumatic fever are: 1. Migratory polyarthritis, 2. Carditis, 3. Subcutaneous nodules, 4. Erythema marginatum, and 5. Syndenham’s Chorea*.]

Q: What causes it?

· A: I’d like to just say, “strep throat,” but that’s oversimplifying things. The most common cause of a throat infection (pharyngitis, if you will) is a virus, but the reason doctors always stabbing kids’ throats with long Q-tips is that they are worried about “strep throat,” which is infection of the throat caused by the streptococci bacteria. There are very very few strains of strep which can actually lead to Rheumatic Fever (and these are known as the rheumatogenic strains).

Q: So everyone who gets strep throat with one of these rheumatogenic strains of Strep develops Rheumatic Fever?

· A: Nope, that would be too simple. Rheumatic Fever comes about when someone’s body reacts (for unknown reasons) to the bacteria, causing the body to attack its own tissues (kind of like an auto-immune disease like lupus).

Q: What is Rheumatic Fever vs Rheumatic Heart Disease?

· A: Nope. Rheumatic heart disease is the long-term results of several bouts of (or a bad or long-term case of) rheumatic fever. If you catch and treat rheumatic fever (with literally years of penicillin), it is possible to avoid the heart disease. Rheumatic heart disease is a huge problem in the developing world. It is estimated that 15,000,000 children and young adults have rheumatic heart disease, and 230,000 die of it each year. It is especially bad because once you develop the heart disease, the only treatment is a valve replacement. As you can imagine, the majority of people who actually have rheumatic heart disease don’t have access to a cardiothoracic surgeon to pop in a new valve, as would be the case in the US. Also, dying from heart failure is a drawn-out and painful process.

Q: Why don’t we have rheumatic heart disease in the US?

· A: One hundred years ago, rheumatic heart disease was the #1 killer of children and young adults in the US, and now the incidence is nearly 0%. It would be nice to pat ourselves on the back about our great medical care and widespread use of penicillin in eradicating this deadly disease, but that’s not why it practically doesn’t exist here anymore. For reasons that are unclear, the rheumatogenic strains of Strep have practically disappeared in the US, except when they recur sporadically in specific pockets of the country (like Western PA). The incidence of rheumatic fever was already decreasing rapidly before we even started diagnosing it and treating it with penicillin.

Q: Does this mean we don’t have to test every single kid who has a sore throat for Strep?

· A: Probably, but who wants to open that can of worms? Also, why stop doing something you probably don’t have to be doing when it costs only a half a billion (that’s right, that’s a B) dollars per year??

*The word chorea describes a disorder of abnormal, involuntary movements. Chorea is a kind of ancient Greek dance (and also gives us the word choreography). Syndenham’s chorea is a term only used to describe the chorea of rheumatic fever (cause there are other kinds, like in patients with Huntington’s Disease). The other term for it (cause why only have one term in medicine when you can have two or three for us to memorize) is St. Vitus’ Dance, in reference to the “manic dancing that historically took place in front of [St. Vitus’] statue during the feast of Saint Vitus in Germanic and Latvian cultures.” (Thanks, Wikipedia!)

Bureaucracy: the medical student’s* constant companion

2009-10-26T17:24:00.003-04:00

Or, a crazy stream-of-consciousness rant about my morning:

As a med school “super senior” who has done a fair share of away rotations, I have certainly seen a good amount of red tape, especially in my attempts to prove to away institutions that I am, in fact, vaccinated against mumps, OSHA-trained to safely dispose of needles, and insured against malpractice. But the bureaucracy I experienced this morning was, as my roommate put it, “a caricature of itself.” To briefly sum up the entertaining events of the morning: I started (rather, was supposed to start) a rotation today in toxicology at an unnamed hospital in the Midwest (I am applying for residency out here…can’t be too careful, ya know). After being unable to determine the exact date or time or location for anything this morning, despite multiple emails and calls to several people, I finally found a time and place to aim for. After waiting for ages in a boiling hot room of an ancient building with 40 other short white coats, we filled out some paperwork, then watched a video on proper needle-disposal and hand-washing practices (Really? Turn on the hot water? Ya don’t say), then attempted to get paperwork to get our ID’s (one of the only things I was told about the rotation I was starting was that I was not to show up without an ID). So I enter a very inefficient woman’s office (I already don’t like her…I recognize her name as one of the people who has never returned my phone calls), and am told to find my paperwork from a giant file cabinet, loaded with manila folders theoretically alphabetized by last name (welcome to 1954). She is flummoxed when I can’t find my paperwork. ‘What’s your last name? Are you sure you sent in your paperwork?’ Yes. Three weeks ago. ‘Are you sure it’s not in there?’ Yes. ‘What’s your last name?’ Rinse, repeat. She phones the administrator of my rotation, who…says she’s never heard of me. Despite the fact we’ve exchanged emails in the last week. Finally she admits she received my application. And although the papers themselves cannot be located, I have brought along an extra copy of all my immunization records. I am prepared! Yet I cannot get an ID because there is no list of all the negative TB tests I’ve had. I had a negative one in August (yay! No post-Africa TB for me) and records of one a year for the past 5 years (though with no listed results for the other ones). I explain that if my last one was negative, they’re all negative, because you can’t be positive and then negative. She says, “I know you’re trying to use logic, but I’m telling you I need this piece of paper.” Ah yes, silly me for using logic when I just need to produce a piece of paper. And here I thought the point of this was to show you I don’t have TB. Which I can do with this one paper I’m clutching in my clenched fist. But nevertheless, I understand it’s your job is to push paper, and you need this form. So the form gets faxed from my school’s student health department (good lord they are nice and helpful there), but all the while this is taking place, I am told to vacate my chair several times. Even when I’m not sitting in it (like when I’m in the hall pleading with the student health nurse to find my files, my bag and coat are still on it). But for some reason, this woman wants to have students lined up in a specific way: 1 at her desk, and 3 sitting in the chairs (which are not in a row) in her office. Nevermind that no students are actually lining up like this, they’re just entering her small office when the previous student leaves. And yet…she’s fixated on the fact that she needs her chair so students can sit in it while they’re lined up, even though no one is attempting to sit there. Eventually, just for entertainment purposes, I keep sneaking back in there and sitting in it while I’m waiting for my fax, just to see if she notices. Finally she accepts my vaccination sheet, and sends me off to get my ID. It’s OK that it’s 10:30 am and I was told to report to toxicology conference at 9am. Whatever. So I find my way to the ID badge office, and after telling the man working there I’m a student and handing over my paperwork, I am told, “A student? We’ve reached our quota for the day.” I look around. Quota? But there’s no one in here. There are three employees back there doing nothing. You’re telling me you can’t make me an ID? No, apparently there’s a “student quota” for ID’s which is usually met by 8:30am on a Monday. But, since an initial ‘no’ is rarely the final word, I am nice and persistent and smile and finally get my shiny new ID. (And I’m not even scowling in the photo). So, only two hours late, I start to make my way to toxicology conference. It’s in the Poison Control Center. I figure since no one answered my emails, I’ll just google the exact address and ask at the front desk. Seems simple, no? So I google it, it’s a block away, I go there and can’t find any doors where google maps tells me they’ll be (I know, I know, I should have learned by now not to trust google maps). So I call the administrator of the rotation to ask how to get there. “Oh, conference is at the poison control center downtown on Monday!” Of course, there are several poison control centers scattered around the city. Could NO ONE have mentioned this to me? Ok, deep breath. “And conference will be over soon anyway, so it’s not worth it to go over there.” Ok, that’s fine. I tell her I want to reach the program director to find out where and when I can meet her so I know what I should be doing for the rest of the day (since I can’t talk to her at conference like originally planned). I am told she’s in conference (duh) and won’t answer her phone, so I should send an email to this woman, who’ll forward it on (is anyone still following me here?? I’m confused just re-reading it, and I lived through it a few hours ago). I suggest I can just send the director an email directly, but the administrator would rather I send it to her, and she’ll forward it. Fine. So I hang up and send a one-line email about how to contact Dr. So-and-so. I wait. Five minutes later I get a response from the administrator (I am cutting and pasting this), “Did we speak or is this a recent e-mail. I thought we discussed that the conference was over at the poison control center downtown?” Um, what? I’m sending you an email because YOU TOLD ME TO SEND YOU AN EMAIL. And YES we just spoke it was 5 minutes ago!!! Ok, deep breath, calm response, saying I would like to reach the director I was supposed to be meeting at conference to see where I should go for the rest of the day. Five minutes later, another email, “They r done for the day. Conference is from 9:30 til 11:30. PLEASE CALL ME.” At this point I was beginning to think I was in some parallel universe TP'd in red tape, from which I was unable to escape.
Anyway, here’s hoping to a more efficient and well-organize day two…. ☺

*I realize that bad bureaucracy happens to good people everywhere. I have just experienced 95% of my life's red tape in the past four years.

WOW...

2009-10-26T17:20:00.001-04:00

...I am the worst blog-updater ever. In my next life I'll be better at it, I swear.

A picture, just to make this post a little longer:

Wow, that's an oldie. I promise to update more often. Well, I guess all I can promise is that I'll try to anyway...

The Hippo says Hello

2009-07-14T16:48:00.007-04:00

There he is. Yup, he's looking right at you.

The view of some houses from the river trip. We took a boat down (up?) the Ogooué river, into a giant lake, picnicked on the shore, saw hippos (see above), played soccer, took pictures, and celebrated the end of our roommates' (see below) stage (internship) at Schweitzer.

These are the triplets of the hospital. Not actually triplets, but they're all the same age, two have nearly identical names, they all lived (pretty much) on the same surgery ward, and they all have Buruli ulcers. I loved these girls so much, I will try to write a longer post about them. In this picture they are watching a video I took of them dancing on my bed. (No, they were dancing on the porch, but watching the video sitting on the bed. Goodness English is confusing.)

Two pictures I love of my roommates. L-R: me, the impossibly adorable Larry (girls get boys' names here), Narcisse, and Elizabeth A Point Sack.

new pictures

2009-06-16T16:25:00.007-04:00

Some of the many birds' nests in the trees at the hospital. I just liked this picture.

One of the many posters hanging around the hospital about AIDS ("Everyone together against AIDS").

These roosters are so stupid. I thought roosters were supposed to crow at dawn. These roosters (and there are many of them, some mere feet from my head in the morning) crow at all times of day and night. We now dream of coq au vin.

A haiku, courtesy of my roommate:

Oh, stupid rooster.

Crowing your virility

You're just a small cock

Yay! Gabon's making headlines!

2009-06-08T16:46:00.003-04:00

Oh wait, but not for anything good. Please see the wonderfully-written nytimes article on the recent developments here. In brief, the president of Gabon ("Africa's longest-entrenched autocrat") died this weekend. The government has responded by closing the airport and borders and imposing a curfew. But everything's just fine here, so please don't worry. We are far from the capital, which is where things usually go down anyway. Just wanted to write a quick note in case anyone was worried about me being in the middle of a politically-unstable central african nation. And now back to your regularly-scheduled programming.

New Pictures

2009-06-02T17:31:00.008-04:00

Welcome, indeed. :)

This is the hospital, outside the Polyclinique, where I spend most of the day. This was taken on a particularly muggy morning, normally it's brilliantly sunny. The yellow building is one of the surgical wards, but they all kind of look like that. Those giant trucks are from the military hospital. A large brigade of soldiers descended last week with ophthalmologists and otolaryngologists and their mobile exam rooms and ORs (the above trucks) and saw patients from 7:30 am until midnight. People were sleeping overnight outside to have a place in line.

Typical hairstyle. Women are crazy about their hair here. Everyone has an elaborate weave or a wig. It's pretty awesome.

We went to a culture festival in Libreville this past weekend, and this is a picture from outside the Senate building, where there were a bunch of different dance groups from all over the country. It was pretty cool. :) (Gosh, I'm so eloquent this evening, eh?)

Dr. J- Rant Of The Day

2009-05-24T12:15:00.004-04:00

I work with a rather, uh, charismatic doctor here. He likes going off on rants about various subjects from time to time, that range from the incompetence of some staff to the living conditions of Chinese workers in Gabon. His chosen subject the other day was the state of medicine in Gabon. Which is: not good. The government has been unable (or unwilling) to pay its bills to the hospitals for quite some time, and the result is that all of the hospitals have been on strike since January. (Not this one, it’s funded mostly by international foundations.) So the result of the strike is that sick people are not getting medical care, then when they’re gravely ill, they come here (to the HAS: Hôpital Albert Schweitzer), where often it’s too late (Dr. J-: "Do they think we're magicians?!"). The HAS has also been relatively overwhelmed with patients since the strike started: the maternity service has patients on mats on the floor, because they’re out of both beds and mattresses (“Patients are on the floor, four to a room! That is no way to treat people”). The medicine service sometimes keeps patients in maternity and surgery because there are no medicine beds left. It is frustrating that the government is unwilling to pay for medical care for its citizens, and it’s easy to place blame on any number of factors for the fact that people are suffering and dying of treatable diseases simply because there are no resources available to them, so his next statement caught me off guard: “And who is responsible for this?? We all are.”

Weekend pictures

2009-05-24T10:24:00.009-04:00

We spent the day yesterday going to see a old mission in Sindara, about a 1.5-hour drive from here, picnicked at a "waterfall," (really, rapids), then stopped at a swimming hole on the way home (N.B. ASF Boston: I didn't swim).

Good thing we were in a 4x4.

View from inside the chapel at the Mission at Sindara.

Yes! Just like the real ones.

The swimming hole where we got attacked by the fouroux, tiny insects (so tiny you can barely tell they're not specs of dirt on your arm) that are not, to my great distress, deterred by any amount of DEET.

What is it exactly that you DO do?

2009-05-24T10:00:00.001-04:00

(those able to identify this quote win a travel-sized bottle of DEET)

So…what do I actually do here? Ok, a brief rundown of the day, if you’re interested:
1. Get up, thrash out of mosquito netting
2. Wait for shower (four people who all start work at the same time share one bathroom)
3. Have cereal (fake cornflakes…that’s all we’ve been able to locate) and instant coffee out on the porch (heaven…I’m telling you)
4. Go to the medicine ward, or the Kopp, as it’s known, which is maybe a 5 minute walk from here, depending on how hot it is outside, to start rounds at 7:30. (Actually on Wednesdays and Fridays there’s a grand rounds type of meeting/presentation, where someone presents a topic or case to the staff, which starts at 7:30, so then rounds are after that.)
5. Round with the team, which consists of two doctors, 1-3 nurses, and me. There’s a little cart that we drag around that houses all the charts (really, cards the size of half a sheet of paper in plastic covers that have seen better days) and order sheets (for labs and x-rays and such) and a bottle of alcohol for hand washing and a trash bin and even a little vase of plastic pink and flowers. Next to every bed there’s a wooden board hanging on the wall with a spreadsheet that includes the patient’s vital signs (with the temperature graphed, so you can see its trend with a quick glance) and medications. It’s so simple. Patients get taken care of, medications get ordered and given, vital signs get taken and recorded, and there’s none of the triplicate record keeping that keeps rounds at home dragging on till 1pm.
6. Off to the Polyclinique, which is a giant waiting room with small exam rooms off of it. It is normally anywhere from 90-110 degrees in the waiting room, but, blissfully, the exam rooms have window air conditioners. See patients until noon or 1.
7. Have lunch from 12-1, then a break from 1-2:30
8. See patients from 2:30 to anywhere from 3:30 to 5:30, basically until they’re all seen. (Top reasons for coming seem to be: hypertension, AIDS, fever and headache and/or body aches [treated as malaria, even if the blood test for malaria is negative], and tuberculosis)
9. Go back to the Kopp, where it is now approximately 95 degrees after the day’s sunlight has run its course, and record all the lab values that came back during the day, as well as see any new patients who were admitted.
10. Either do yoga, or run, or sit in a tired and hot heap on the chair in my room directly under the fan.
11. Dinner is at 7 exactly. If you’re not done by 8 there’s a stern talking-to from the ladies who work in the dining hall (who are, I must add, all very nice).
12. Putter around until bed, either watching 30 Rock (a favorite pasttime around here), or going to the lab to use the internet, or going to the nearest town to have a beer, or removing large bugs from one’s room, or duct-taping the screens down, or hand-washing clothes, or…you get the idea…there’s always stuff to do.
13. Go to bed, rinse, repeat…

Some pictures

2009-05-12T13:41:00.006-04:00

The view from the porch

My beautiful room

N.B.: It takes literally an hour (or more) to upload one photo, so pictures are going to be few and far between...sorry. :(

Things I've learned this week...

2009-05-12T08:30:00.003-04:00

1. There is an entire country off the coast of Gabon. It’s called São Tomé and Príncipe, and it’s the second-smalled country in Africa (after the Seychelles). It’s an archipelago of 12 or so islands, the two largest being São Tomé and Príncipe. According to my guidebook (the only one ever published on Gabon, as far as I can tell), the islands were formed from volcanoes, and were unsettled when the Portuguese came in 1470. All the islands comprise 386 square miles and have about 165,000 people, and they speak Portuguese.

2. There are a lot of Chinese people in Gabon. According to an article from the nytimes, Gabon is running out of oil, and to compensate for its lost income it’s allowing Chinese logging companies into protected forest. Not good. But anyway, the hospital has anywhere from 3-6 Chinese men out of 26 beds, all with malaria, none speaking any French. There’s a lot of charades going on on rounding.

3. There are many things I like so far about Africa, but hand-washing, line-drying, and then ironing all my clothes (botflies get killed by the heat) isn’t one of them. I think I’m going to take my chances and put most of my clothes in the hospital’s industrial-sized washers (with notoriously hot water).

AH! A bug just fell down my shirt. Ok, zen with the bugs, zen with the bugs, zen with the bugs…

Buggin' out

2009-05-10T05:33:00.004-04:00

So I've been sitting here for about 45 minutes, trying to be ok with the ants. Because it's Sunday, the research lab where we use the wireless is locked, which is how I find myself sitting on the back walkway using the computer, and trying to be ok with the ants. They are everywhere. They're not the little annoying ones that walk in organized lines by the billion (I can't even describe this, it's so amazing, I'll try to take a picture), they're the bigger black ones. They keep trying to invade my space. I keep shooing them away with (HAR) my shoe. If they get too close I brush them off the balcony to the grass below. I haven't killed one yet, though I think one or two haven't made it off the balcony injury-free. There are too many to try to kill them all anyway, and I think killing animals on the grounds of the Schweitzer hospital is kind frowned upon by Schweitzer himself wherever he is. You know, Reverence for Life and all that. Then I decided to scoot up a bit and give them a little path behind me, so they could still hug the wall and get from one side of me to another (I was leaning against the wall), and I think we've worked out a mutually beneficial situation. I don't have to spend half my time brushing ants away, and they can still go about getting breakfast, or going to ant church, or whatever it is they do on Sunday morning. Letting them mill about so close to me is doing nothing for my near-constant feeling that bugs are crawling on me though. Then I think I'm just paranoid or crazy, but then end up with zillions of bug bites all over (and in clothing-covered places). I have even found spiders biting me. Spiders. I should just stop trying to fight the bugs. There are way more of them anyway, and they can't kill me. I'm going to try to be more zen about them, and just live and let live. I'm probably scarier to them they they are to me, right? I'll just keep putting hydrocortisone on giant itchy red spots and tuck my mosquito netting in real tight at night.

Week 1: And so it begins

2009-05-06T16:13:00.006-04:00

Thus begins our rotations here in Lambaréné. I am doing adult medicine, and the other American medical student (also a white girl named Elizabeth, to maximize confusion) is doing pediatrics. This week so far I’ve been in the inpatient wards in the morning (rounding on 26 patients in as many minutes) and the clinic in the late morning and afternoon (today: 2:30 to 4:30, hardly the schedule we're used to keeping at home, though it is oppressively hot, effectively limiting how many hours one can actually work during the day). On my current to-do list: 1. Learn French, 2. Learn medicine, 3. Learn to understand Gabonese French, 4. Learn names of medicines in French (Esidrex?? Never heard of it. Oh, wait, it’s hydrochlorothiazide? Riiiight, I have heard of that). The doctor I was working with actually left to go get something yesterday and said, “Ok, you can see this next patient while I’m gone,” and I was like, ummmmmm thanksbutnothanks. It takes me 10 minutes just to read the notes from their previous visit, because they’re all in illegible French with abbreviations I can’t figure out. Oy. Adventure! (Ça va aller...at least I hope.) :)

I’m already a little bummed out (for lack of a more eloquent phrase) by the sick people. Not that sick people in the US don’t bum me out, because they do, but I’ve already seen a few people this week who are sick. Like, I look at them and wonder how it is they’re even still alive. I saw literally the most cachectic girl I have ever seen in my life yesterday. She was 22 and weighed maybe 65 pounds. Good lord. AIDS is a scary thing. She'd been sick for a year but hadn't come to the hospital until now. I just think of millions of dollars being spent in the US chasing incidentalomas (translation for non-medical people: incidentalomas are little shadows and blips that are discovered incidentally on CT's and MRI's done for other things, and usually turn out to be absolutely nothing) and it makes me crazy.

Ok, off to bed. Under my recently re-strung mosquito netting. Now hopefully it won't fall on my face in the middle of the night, causing me to brush it off my face in a panic cause my half-asleep brain is concerned it's an ant colony, or a hungry mosquito family, or a bat. Or a spider the size of a yorkshire terrier that we calmly (ahem) removed from my roommate's room the other day. (Picture to follow)

La Petite Union Européenne

2009-05-06T16:06:00.004-04:00

This is a very interesting place, for reasons I didn’t expect. Dinner every night is a veritable melting pot of nations. Some of the faces around the table: A couple from the Ukraine (internist and surgeon), a nurse from Switzerland (the German-speaking part), a man from Switzerland (the French-speaking part), a nurse from Spain (who retired from a career as a lawyer and then became a nurse), two Gabonese students, and a doctor from France (who is on sabbatical from a 20-year career as an internist in the French Antilles and drove here from France). On the way back from dinner the other night in town, we were piled into the back of a big van, and we picked up a German student on the way, and suddenly everyone in the back (except the Americans) started speaking German. (As Other Elizabeth said, “This conversation has taken a turn for the German.”) And I kind of enjoy conversing with someone when neither of your first languages is the one you’re speaking in. There’s no self-consciousness about grammar or pronunciation when the person you’re talking to probably won’t notice anyway.

First attempt at a video...

2009-05-03T09:09:00.006-04:00

Ok, ok...I know it doesn't play. This appears to be a youtube problem (a widespread one). I'll figure it out later. It's too hot to think right now.

Finally in Lambaréné

2009-05-02T06:31:00.006-04:00

Well, the day has arrived. After, oh, 10 or so years of wanting to go to Africa, here I am! I am a little oppressed by the heat to fully enjoy the moment, but I am pretty excited. (Oh god, I just checked and weather.com says it's only 89 degrees outside. Could this possibly be true? I would have bet it was 95.) Luckily, there's no lack of modern conveniences here, including a small library with air conditioning and wireless internet. So...so far it's kind of like home, except for the bats in the walls. Anyway, it's pretty exciting to say you're on a new continent; that doesn't happen often in life.

So, this is not a place you'd pop over to for the week. To get here: a 6-hour flight from Boston to Paris (which landed at 12am Boston time, which was 6am Paris time, and I was very confused by the loss of the night. I mean, you can wake me up at 11pm and serve me coffee and orange juice for breakfast, but that doesn't make my body believe that it's really morning), then a 5-hour wait in the airport (with totally uncomfortable chairs not conducive to napping), then another 6-hour flight to Libreville, Gabon. Then waiting in lines in the airport, then a stay overnight in an airport hotel (it was 6pm by now), then a 4.5-hour drive from Libreville to Lambarene (see car below) the next day. Which included one exciting stop: the equator! We stopped at the sign (also see below) and I stepped across it, my first time entering the southern hemisphere. Yay! Then we finally arrived in Lambarene around 1pm. See photo of the welcoming committee below. Yesterday was a holiday, so there was a party going on, but we were too exhausted to go, we just unpacked and napped. And tried to figure out things like: how to hang mosquito netting, where the toilet seat went, how to prevent the bats from getting into the bathroom, why the towels are the size of hand towels, where to find dinner, etc. It was all very taxing on my jet-lagged and tired brain.

When I have more energy and my computer has more battery life, I will post more. I know you're all on the edge of your collective seat. :)

Stopping on the way to Lambarene

Really white girl on the equator

Part of the welcoming committee at the hospital

(A pelican, the hospital mascot)

(Why don't US hospitals have mascots? Discuss.)

I AM ACTUALLY ALIVE: Life updates, Musings, etc

2009-03-20T18:00:00.003-04:00

So, I haven't lost the URL of this blog, nor forgotten it exists, I've just...I dunno...been lazy. There, I said it. No feeble excuses about being "busy," cause I've found time since the last post to watch 3 seasons of Alias and 30 rock. I have been doing real rotations for the last 4 months, like M-F 9-5 (or 8-6) ones, except this month, which is more hours and days per week than I care to count up. I wrote some posts in the last couple months but never actually edited them and posted them, so maybe I'll do that eventually. Now, though, many exciting things are happening! It is, of course, the vernal equinox, which would be easier to understand if it weren't 40 degrees out and 30 in my apartment. And yesterday was Match Day! NECN was at our school, and you can watch the clip here if you weren't lucky enough to be there. :) People have matched to all sorts of exciting places, and my classmates will soon be (gasp!) residents. And as if welcoming all the fourth-year-med-students-and-soon-to-be-interns back to the hospital today (we had yesterday off...it's kind of a national holiday in the world of medical education), my resident greeted me looking like this:
It's like she was saying, "Congratulations on the Match! Soon you will look like this. Make sure your scrub pants are tied real tight." (In case you're wondering, L-R: personal [hospital] pager, stroke pager [stroke intern off today], code pager, pre-pre call [i.e. back-up admission] pager, PDA.) Oy. I'm glad I'm putting of graduation and internship for another year. :)

What's your personality?

2008-12-02T13:41:00.005-05:00

A topic that I've found a renewed interest in recently is differences in personalities. It started with talking to someone recently about the Myers-Briggs Personality Type Indicator, which basically puts people into one of 16 personality categories. You're supposed to take the "official" test, which you can learn how to do here. There are also a few fake online ones floating around out there. (For what it's worth, I've taken both with the same result.) Basically, there are 16 Myers-Briggs types, because there are two "preferences" for each of the four categories they measure personality with. The four categories are favorite world (introversion or extraversion), how you get information (sensing or intuiting), how you make decisions (thinking or feeling), and how you deal with the outside world (judging or perceiving). For example, your personality could be ENTP, for extraversion, intuiting, thinking, and perceiving. (My personality is, to no surprise to anyone who knows me, INTJ.) I sort of like this kind of qualitative measure of personality, because it's quite non-judgmental, and forgives us for being different (for example, I can't feel guilty about not wanting to socialize for hours at parties; now I can think that it's not a character flaw, being introverted is hard-wired into my personality). I also think that we are pretty much born with our personality, and it changes very little. (Which might explain why I was such a terror as a child, sorry mom and dad.) There are a couple websites where you can read about the different personality types, and from the people I know, the descriptions seem pretty accurate.
The second reason I was thinking about personality differences is because I am doing a psychiatry rotation, and I feel like there's often a very fuzzy line between personality and pathology; i.e. what some clinicians want label psychiatric disorders or personality disorders I sometimes have a hard time viewing as little more than differences in personality. I mean, where does the line between high-energy and hypomanic lie? There are, of course, real, quantifiable criteria for diagnosing, say, depression or generalized anxiety disorder, but people who fall on one side or the other of the diagnosis aren't radically different. I think we're all lying along a spectrum somewhere, and the idea of where personality differences end and pathology begins is an interesting one.
I highly recommend looking into the Myers-Briggs stuff, if you never have. It's very interesting, and might tell you something about yourself or how you interact with others that you never knew before. When I read about my personality for the first time, it definitely taught me something (and, alas, not all of the information was good ;) ).

More pictures...

2008-11-12T20:50:00.006-05:00

In Zarzal, near a clinic we went to

Local wildlife (just kidding...we went to the zoo)

Lake Atitlan

Dinner

GST (Guatemalan Standard Time)

2008-11-06T12:28:00.005-05:00

One of the starkest differences between life in the US and life here is the liberal interpretation of time frames, and the lack of a hurried feeling to do anything. It only took a few days to figure out that "I'll pick you up at 8 am" actually means anytime between 8 and 10. And even if it turns into 10, that's no reason to not stop and have a cup of coffee before heading out the door. The sense that there is no rush to do anything pretty much pervades every aspect of life. For example, there is no such thing as dropping someone off, in the sense that we think of it - you pull up at the curb, the person gets out, and you drive off (or, at the most, you go to the door or inside for a few minutes). Here, dropping someone off can turn into hours of sitting and eating and talking. Going along for a ride to bring someone home can mean I'll be sitting having coffee and bread (or sometimes lunch or dinner) for hours in someone else's home. What's particularly interesting is that even if a carload of people arrive unannounced at a home, there's always (always) enough lunch/dinner to feed everyone. I don't know of anyone in the US who makes enough of a meal to feed a potential family of 5 that might drop by without warning. Certainly there is a certain amount of efficiency that is lost when an entire country functions in such an unpressured way. However, what's so wrong with that? People are probably having fewer heart attacks here than in the US. Another example of not feeling pressured to function at a fast pace: at the hospital, there are several doctors who spend good amount of the day lying in the doctors lounge, watching tv. This occurs whether or not there are patients waiting at their desks. Also doctors (a rather hurried group in the US, I think we all agree) spend a good amount of time just sitting around and chatting with other people, or drinking sodas at the little cafe outside the hospital, or stopping to chat in the hall for 30 minutes while they're clearly on their way somewhere. It's quite a difference from the blur of white coats that I'm used to seeing at UMass. And yesterday, we were going to work in a clinic in a rural area, and we decided to leave at "8." I woke up at 8 (ok, let's be honest, someone woke me up at 8...I guess this culture is rubbing off a little...and lord knows I love my sleep....especially after late nights with rum....but I digress), and, figuring I didn't have time to take a shower and whatnot, just pulled on clothes and came out to the kitchen, apologizing, and ran into the other people (we were the entire staff of the clinic for the day...so it's not like it was up and running without us), in their pajamas, just making coffee. Then we sat around drinking coffee and eating eggs and beans, until one person decided it was time to go shower, and one by one they got ready. We left at 10. I asked my first patient what time she arrived at the clinic to wait, and she said 7 am. And yet...no one appeared particularly annoyed, either at waiting or keeping people waiting. My American self is still having trouble wrapping my brain around this. Like (last example...I could go on for pages) at the mall, there's one area where all the banks are, and some nights you go and the lines are snaking around the mall, and you have to wait for an hour just to get inside. Again, no one appears annoyed...they just wait, like it's totally normal, and that's just what you have to do to make a transaction at the bank. Normally I am a total type B personality, and don't get annoyed waiting for stuff for a while, but being down here makes me feel like a typical type-A American.

Medical pictures

2008-11-06T10:37:00.012-05:00

Since I did, after all, come down here to particiate in some medically-related activities, I decided to post some pictures of that part. Central American trips can't be all about tortillas and rum, after all (or can they??). The first four pictures are from the Hospital Nacional de Amatitlan, and the last one is outside a health center in a small town a couple hours north of here (the city).

pre-op and post-op area outside the OR (yup, those are patients on stretchers in the hall)

the ER

EKG

Weekend pictures

2008-10-27T00:54:00.009-04:00

Cows on the farm (the one on the left was scratching his neck on some cement)

Sunset from the hotel Casa de Santa Dominga, Antigua

A marimba and its players, Antigua

When in Rome?....

2008-10-24T00:28:00.005-04:00

Don't get me wrong, I'm a pretty firm believer in "When in Rome, do as the Romans do," but I'm also a firm believer in, and there's no quote for this, not apologizing for who you are (or the country that raised you) when you are elsewhere. For example, I spend quite a bit of time down here with a man who always attempts to take my hand as I get out of his car. Granted, it's a small two-door, and it would be difficult for anyone to get out of the back gracefully, but I have never actually needed help. Honestly, if I did need to grab something/someone, the open door would be a more stable choice. For a while, I said gracias and took his hand, but after a while that got really annoying (if either of us should be helping the other one get up, it should be me helping him), so I just said thanksbutnothanks and didn't take his hand. Apparently he found this quite rude, and thought I was being unappreciative and uncourtious. When the subject came up last night, we had an hour-long argument about it (I'm not normally so pugnacious...especially in another language...must have been the rum talking...). I (ever-practical), tried to tell him that I just didn't need help, but this argument totally didn't fly. (For better or worse, I am of the school of thought that if you want or need something, accept it, if you don't want or need something, don't accept it. If I'm not thirsty, is it really being rude to the host to turn down a glass of water? Maybe I'm just not very good at picking up on how people expect me to behave in certain situations. Whatever.) Anyway, he insisted that taking his hand was the courtious thing to do, and not taking it was rude. Now, if he offered his hand to everyone squeezing themselves out of the backseat of his two-door, that would be another issue. But it only gets offered to girls. Even girls who clearly don't need help, and, in fact, could probably break him in two with one swift roundhouse kick. Then, as the argument continued, the hand-offering was framed in the setting of "Latin culture," along with door-holding, etc. Hence, I was advised to do as the Romans do (ok, they don't reference the Romans in the expression in Spanish, but the message is the same). However, being the practical, independent, American female that I am, I took offense at the idea that because (and only because) I was female, I was a fragile flower (literally, those words were used). I mean, I'm not trying to be rude, and I appreciate gestures of hospitality and help, but where is the line drawn between adapting to local culture and compromising your beliefs and values to silently accept something you find offensive? Granted, it wouldn't kill me to take his hand, but having this argument with him (and kind of with another man, who piped in from time to time) really irked me. Am I being unreasonable? Should I just defer to the whole women-are-fragile-flowers-and-need-men's-help position? Am I being a rude gringa by sticking to my American guns? (and decidedly un-girly guns, at that.) Argh.

picture

2008-10-19T14:54:00.003-04:00

Song of the Week

2008-10-18T00:27:00.008-04:00

I've been listening to (and watching on DVD, and learning to play songs by) the Beatles a lot recently, so...here's a Beatles song. It's a nice one (not that all aren't).

My First Earthquake

2008-10-18T00:07:00.004-04:00

Put that way, it sounds like a children's book. But a scary one! No, just kidding, it wasn't scary. It was just weird, having never before experienced the sensation of the earth shaking. What was weirder, though, is that no one around me (I was sitting with 3-4 people) acknowledged what was going on, they all just kept on chatting like everything was normal (I wanted to shout, "PEOPLE, EVERYTHING'S SHAKING!" but I kept my cool, a.u.). Then after a minute (or maybe after one of them saw my face), one person said, "it's an earthquake," and I said, "huh." (Interestingly, in Spanish a small earthquake is called a temblor, and a large one a terremoto. I tried to explain that English has just one word, and it didn't depend on the magnitude of the shaking. They were perplexed by this.) It lasted for what felt like a while, but was maybe only a minute or so. According to reuters (so it must be true) it was a magnitude 6.1 quake off the Pacific coast. The fun never stops down here...

Happy Columbus Day!

2008-10-13T23:54:00.003-04:00

Or, as my dad put it, have a "very happy Columbus Day, with all the joys, responsibilities, fun and solemnities thereto appertaining." I'm celebrating by watching 'La ley y el orden: UVE' (not dubbed, thank goodness) and wasting time online. Not that I had the day off (they don't exactly celebrate Columbus down here). I hope everyone had a good day off! (If you were lucky enough to).

Pics from the weekend

2008-10-12T23:16:00.010-04:00

Lake AtitlanSantiago de Atitlan

Lake Atitlan

updates, pics, and whatnot

2008-10-10T13:37:00.012-04:00

Hi friends & family,
Hope everyone is doing well up in the chilly(?) northeast. Just wanted to post to check in. No particularly new or exciting things have been happening here. I have a surprise day off, since we were supposed to go away for three days, but something happened with the car (information relayed over the phone in Spanish...never a recipe for thorough understanding) so we're not leaving till tomorrow. So I find myself lounging around the house, playing the guitar, reading the nytimes.com....essentially exactly what I would be doing if I were home. With the exception of going out somewhere, cause I live in a locked, gated community and there's nowhere to go except around the small neighborhood. Which I did (pics included).
Other than that, not too much happening. I've been enjoying the hospital (it's called the Hospital Nacional de Amatitlan), and have been amusing myself by comparing it to American hospitals I've been in. 1, at home you don't have to bring your own toilet paper. 2, our sterile scrubs aren't see-though (literally and seriously). 3, men and women have separate OR changing areas. 4, patients in the ER have some semblance of privacy, and don't have, you know, foleys placed in front of a dozen other people. One similarity: there are drug reps (complete with expensive suits and trinkets to give out).
I've also been keeping up on politics (the debates are shown here in English, and it's in the paper every day) and fighting people about why Obama is better than McCain (somewhat difficult in Spanish). I live in a house of Democrats, but the extended family is Republican (two people actually high-fived about McCain the other night at dinner...and a piece of my soul died), partly because they seem to all be evangelical Christians. Which is a somewhat, uh, interesting situation to find myself in. I was actually in the backseat of the car the other night, and we stopped short, and a Bible came flying off the back shelf and hit me. Maybe God is trying to talk to me.
Take care everyone, and step on some crunchy leaves for me. :)

My street
The world outside the walls

Pictures

2008-10-07T00:07:00.007-04:00

Pictures of the beautiful Antigua, Guatemala, a city about 30 min from here.

Day 1 in la emergencia

2008-10-06T18:38:00.005-04:00

Ok this has been quite an interesting day. I was supposed to spend part of the day in surgery, but I never ran into a surgeon (nothing is too pre-planned here), so I just spent the day in the emergency room. By 10 am I had seen an arma blanca wound to the buttocks (side note: it was not explained to me what an arma blanca is. It was just stated to me as the mechanism of injury, as if I was supposed to know what it was. I was foiled in googling it because it´s also the name of a Spanish rap group. I finally had to inquire around the house, and it turns out it´s a long piercing knife-like thing. I guess everyone in the ER knows what this is, and people come in with these wounds all the time, like everyone in the UMass ED knows what a switchblade is.), a cockroach-from-the-ear extraction, and two amputated fingers (on the same person). And I seriously got to put my rusty suturing skills to good use today. And every time I sutured I was surrounded by 3-8 students, who I gather were the Guatemalan equivalent of pre-med (they said they were in high school but were wearing matching uniforms...they were probably 17 years old). At one point the (only) doctor said, "I´m going to a meeting. You can finish suturing this cut then sew up that head wound over there?", and before I could process the fact that she had just annouced she was leaving, I was on my own. (HELLO?!? Imagine leaving a fourth-year in charge of the UMass ED. Disaster couldn´t be far behind.) At the time I felt ok, I could definitely suture these people up in a vaguely competent fashion. But of course in short order there were trauma victims coming in, and paramedics (we´ll call them that...I mean the people that bring patients in on stretchers) were telling me about car and motorcycle accidents, and nurses were coming up to me saying, "Doctora, (something in Spanish I barely understood and even if I understood the question I didn´t know the answer)." One of the nurses located the doctor´s stamp, which she had left behind (with her name; it´s what you need to write orders), so I could write xray orders (hey, it takes hardly any Spanish to elicit C-spine tenderness). And of course, everywhere I went there was a gaggle of white-uniformed students following me, who may or may not have been under the impression that I had any idea what was going on. FUN TIMES. Everyone lived though, and everyone eventually stopped bleeding. (i.e. no harm came to anyone, in case there´s some liability lawyer or med school administrator that´s eventually going to read this.) More later. I took some pretty (I hope, I haven´t seen them yet) pictures yesterday that I want to upload. Besos a todos. :)

Life is good

2008-10-03T19:28:00.013-04:00

Alright! I have figured out a way to update this blog. I have to type the entry into word on my computer, then transfer it via USB drive to the house computer and upload it when the internet works. Thus far, the internet has stayed working long enough to let me check one email account. (addendum: this post took more than 24 hours between writing and uploading due to the vagaries of the internet connection. So...I guess they´ll be a little like snail-mail in the sense that 'today' isn´t actually today (or the posted date).)
But life is good. I wish I had very exciting things to report, but I don’t. I don’t actually start working in the hospital until tomorrow. But for now, some observations for you:
1. It’s wet. Very wet. Only after 2 pm though. How is it sunny all morning, then every day at 2 pm for 6 months it pours? Mother nature is a mysterious lady. I belive “winter” (what the rainy season is called) ends at the end of October.
2. Mayan (or whatever you want to call them) women stash cell phones in small pockets sewn into the inside of the neck of their (traditional) shirts.
3. Mayan/indigenous women wear traditional dress consisting of a high-waisted extremely colorful skirt that goes to mid-calf, and a tucked-in blouse. And, often, heels. The men for some reason wear regular old western clothing. Why is this.
4. Guatemala is nowhere near as poor as Nicaragua is. I kind of expected it to be similar (being the only other central American country I’ve been to). Wrong. We went to a shopping mall the other night that was bigger and fancier than most malls I’ve been to in the US. The cars here are all pretty nice and new (whereas the cars in Nicaragua looked like if they went over a big enough pothole they would collapse into a heap of parts). Homes have computers! And cable TV! (Confession: I watched ‘Gossip Girl’ last night. I know, I know, that’s hardly advancing my Spanish or medical knowledge. But lord was it enjoyable.) And washing machines! Obviously there is still exteme poverty here. But there was extreme poverty in Nicaragua, without the obvious displays of wealth right alongside.
I have been lucky enough to land in the middle of an extended family of musicians. The father in my house is trying to teach me how to play American songs on the guitar, which are apparently “classics” but because I was raised on a diet of Mozart and Gilbert & Sullivan (thanks, dad!), I have never heard any of them before (or my strongest recognition is “hmm this part sounds sort of familiar”). I’m amused that he’s teaching me songs from my own culture. And the doctor who’s organizing my entire trip (I’m living with his sister’s family) is a good guitar player and singer, but mostly plays the marimba. Heaven.
Um, so if someone could please locate some information on the Mayans and what exactly happened to them, that would be great. It hurts my eyes to read this computer screen too long, and the bookstores only carry books in Spanish or something. But I’m curious, so if someone could find out a little history there and get back to me, that would be great. Thanks, Nat. :)

Hope everyone’s good! Thanks for reading. :) If you’ve just skipped to the end, well, thanks for visiting anyways.

p.s. Dear Dad,
I have not been trapped beneath a mudslide, fallen into a volcano, had my car hijacked, been kidnapped by rebels, or contracted Dengue fever. I am in fact alive and well, and for the most part feel pretty much like I’m in the US, except for the cold showers and the volcanos.
Love,
Your daughter

Pictures!
This is my new best friend, Chispa. I tried to take her picture sitting upright looking at the camera, but every time I tried to get her attention by calling her name or touching her, she flopped over pathetically on her back.

This is a tree. Um, I forget what it’s called, but it’s the national tree of Guatemala. And…they look cool. (I´m pretty sure I´m going to be able to parlay this eloquent blog into a lucrative book deal.)
This is one building of the main public university in Guatemala; it’s in Guatemala City, and it’s called the Universidad de Juan Carlos. I enjoyed the placement of a centuries-old Mayan sculpture in front of a university named after the leader of the people that invaded and decimated the indigenous culture.

I´m alive

2008-09-30T17:31:00.004-04:00

in case you were worrying. :)

I arrived in Guatemala city this afternoon, after almost missing my connection in Miami (but making it!). I am staying with a v. nice family with two girls living here (and a son living elsewhere). I have my own room, and, most importantly, the house comes equipped with a very small white fluffy dog that likes to have its stomach rubbed and 3 (three!) beautiful guitars in the corner of the living room. I have met my soulmate, Guatemalan-houses-wise. Since I am lucky enough to have internet in this house, I really have no excuses for not updating this regularly. So...feel free to harass me for a post if I seem to be slacking. :)

I just...love this picture

2008-09-27T10:17:00.011-04:00

I love how Republicans are talking about how they're going to be a "change" in Washington. Give me a break. I guess they think voters are actually dumb enough to forget that they have been the ones tanking this country for the last eight years. Well, a picture is worth a thousand words. It beautifully and clearly displays how the current Republican candidate feels about W and his s*****y policies.

Thank god, only 115 days left

2008-09-20T00:15:00.011-04:00

(or, however many...see widget below) (I tried to find one that fit in a more streamlined way into the layout of this blog, but I couldn't. So...it's big and bulky but it's ok, it does its job.)

So I was having dinner with an old friend the other night, who's very level-headed (well, like most of my friends...but her in particular) (Caroline I'm talking to you), and we were discussing the inane stupidity of the current administration. And how mad they make us. Thinking about George Bush is actually one of the only things on earth that makes me mad. Like, heart-rate-up mad. So rather than sit here with steam coming out of my ears, I'm gonna channel the anger into enjoying some lovely music, courtesy of everyone's favorite folk singer, Antje Duvekot. It's a new song called Christian Boys. And it's the new Song of the Week! (See the little mp3 player to the right.) Lyrics below:
How does a poor man on a bench become a criminal
While the rich man on the hill hails to the thieves?
How does revenge equate to pride until the flag becomes a gun
How will the sun go down after the war is won?
How come the wise man is so quiet
While the killer speaks so loud?
He is hollering from out of my TV
And he is claiming that he knows me
He is taking little bows
But he is drinking from the silver palms of greed

And Mama, aren't you proud
Oh, he plays with such big toys
And he thinks it's all a game
Your little virtuous Christian boys

So you're playing by the rules
But every time it is your turn
He moves the net a little higher up
And you think it must be fair
'Cause that is what you've learned
But he scores every time
And you score none

And Mama, aren't you proud
Oh, he plays with such big toys
And he thinks it's all a game
Your little virtuous Christian boys

Oh but this is an impressionist painting
And we are standing way too close
We are sitting in the circus tent
Just waiting for the show
While the cannibal elite
Eats from their sacrificial plate
And they are lying through their teeth
Making a mockery of faith
And your dollar lets you buy
Yet another empty cup
And that is how they fund their lies
And they hope we don't wake up
And they are feeding us this fear
They are feeding us the news
And they know we're biting off
Less than we could chew

And Mama, aren't you proud
Oh, he plays with such big toys
And he thinks it's all a game
Your little virtuous Christian boys

It's here! It's finally here!

2008-09-19T23:37:00.010-04:00

What we've all been waiting for for the past 364 days...International Talk Like a Pirate Day! Before you think I'm totally crazy, this day is bona fide: it was in the New York Times crossword puzzle today (8 down: "Well I'll be" as might be said on Sept 19. Answer: Shiver me timbers). And no holiday can be solely in the counterculture if it makes it into the crossword puzzle. So why have TLAP day? Why not! According to the website, the whole point of TLAP day is that there is no point. So have a great day! And remember, today's the one day of the year you can't make too many harrrrrible pirate jokes. :)

p.s. whoops, somehow I neglected to actually post this one. okay, it's now a week after TLAP day. well...close enough. :)

New feature! New feature! Read all about it!

2008-09-04T01:48:00.007-04:00

I decided to embed an mp3 player into this site, at the advice of a friend. It's taken me several attempts, and several hours at each attempt, sadly, to figure out, but it's finally up and working. I think I'm going to change the song every week or so (or maybe longer, if I forget about it). So the inaugural song is Beethoven's Heilige Dankgesang. At times other than 2am I could extoll its virtues and tell you why I love it so much. But not now. I'm too tired. Sorry it's so long, but have a listen, it's really nice. If you're interested, you can read a bit about the piece here (it's a little verbose though).

Some pictures from last weekend

2008-09-03T14:36:00.015-04:00

View from the 38th floor of East 42nd Street.

Sunflowers on the farm, Tarrytown, NY

Brooklyn Bridge, the waterfall, Manhattan Bridge

Lerner Hall, Columbia University

Sheep's Meadow, Central Park

Waiting for the train at Bleecker Street

Freakin' social conservatives

2008-09-03T14:26:00.009-04:00

What is wrong with you people?? Sorry to have a random post about politics and bat-shit-insane Republicans, but I need to get this out of my system. How is it possible that gay couples, some of whom have been partners for 40 years, are ruining the "sanctity of marriage" by getting married, and yet when 17-year-olds get pregnant, the right moral thing to do is to get married? How are shotgun weddings preserving the institution of marriage, yet marriages of long-term couples eroding it?? Argh! Crazy Evangelicals and their moral high ground. Thanks for letting me vent, I feel a little better.
p.s. Dear Conservative America,
Please teach your children about birth control. When they decide abstinence-only isn't cool anymore, they will need it. Thank you.
Fondly,
Liz

Finally!

2008-08-25T12:51:00.007-04:00

Third shift's a charm: I finally got up in the LifeFlight Helicopter today. There was a lot of waiting around for things to happen, but I had (had) to get up there before I graduated.

photo:umasslifeflight.com

You can't make this stuff up...

2008-08-19T02:26:00.007-04:00

Patient (looking at me intently): You look like Amy.
Me: Who's Amy?
Patient: My cat.

A night out in Worcester

2008-08-15T01:53:00.012-04:00

So as part of my Emergency Medicine rotation, I have to do two ride-alongs with Worcester EMS. I had kind of a crazy and interesting night, which I feel like sharing parts of semi-publicly. We had quite a few calls tonight, which usually came in right as we were nearing a coffee shop (did the dispatcher know what we were doing and where we were going? perhaps). There were a couple non-interesting calls, so I'll leave those out. But even amid the mundane, the two paramedics I was with were quite a duo. They were hilarious and inappropriate, and just as I was on the brink of rolling my eyes at their adolescent humor, they quickly and smoothly sedated and intubated an old woman in respiratory distress. I mean, I had barely opened the bag with the equipment and I looked up and the tube was in her mouth (paramedic: "When you look in and see their teeth come out, you know you're golden"). Preceding her florid respiratory failure, she had just been having some difficulty breathing. Her rapid decline (this was the most serious gasping for breath I have ever witnessed) while we were on our way to the hospital forced me to poke my head up toward the driver and ask, in a polite and high-pitched voice, "um, excuse me? could you please pull over?" and as soon as we stopped she was intubated and we were on our way again. And the medics were nothing but patient with me as I fumbled with IV tubing and squirted saline on them (and on me) (Medical Students: Always Cool Under Pressure). Actually the scene wasn't as frantic as I would have imagined an emergency intubation on the side of the road to be. (End result: we brought her to the hospital, and I have no idea what eventually happened to her.) (Unsatisfying, I know.) What's also interesting about this lady is that she kept saying over and over she didn't want a breathing tube (known in medicalspeak as being DNI: Do Not Intubate), but then when she actually started gasping for breath and frothing at the mouth, she said she wanted the tube. This is not the first time I have seen this happen, where people swear up and down they want no "heroic" measures, then when it comes down to it, they want everything. I guess your feelings are different when you're thinking about what may potentially happen in the future and experiencing what is actually happening. I can't imagine the terror of knowing you're about to die, even if you're very old and very sick and have thought about it a lot. But this is a discussion for a whole other post.
Anyways, we had this other call which was to a "man down" in downtown Worcester. He ended up being a drunk guy with new and old cuts, scrapes, and bruises all over him, and large switchblade hanging out of his back pocket (which, upon noticing it, the paramedic and police officer quickly took). At first I was thinking, this guy's totally drunk, he was stumbling around and fell and hit his head, he's refusing to go to the hospital, why are we here? Then I got more of an idea of what was going on, and it turned out he was well-known to all parties on the scene, he's a sometimes-resident of the PIP shelter, he's pretty skinny and pathetic and gets jumped all the time, and had been beaten up today because he had $20 that someone else wanted. He carries the blade for protection. The officer told him he understood it was for protection, because there were some dangerous characters out there (I'm cleaning up his language in paraphrasing here), and then told him, after seeing a bottle of gatorade in his bag, to "pound that shit." I was kind of surprised (and then felt guilty that I was surprised) at how patient and respectful and just plain nice everyone was being to him. The man eventually decided to come to the hospital, and as we were getting out, the medic reminded him to please be polite and treat people with respect, and that's how he would get treated by the doctors and nurses. I'd like to think that's true, but I'm not sure the bleeding drunks sleeping in hall stretchers get treated the same as other patients. I know if there were a choice of two patients to go see, I probably wouldn't choose the drunk man in the hall. (I wish that wasn't true and I didn't think like that, but I'm being totally honest). But it was nice to see this man from a different angle; fine, he's an alcoholic (who am I to judge), but he's also just trying to survive (and has probably had a pretty bad life so far), and ends up bleeding on the sidewalk every couple of weeks because Worcester's Finest want to mug him for his $3.50 bottle of vodka. Life's a bitch for some people...so who am I to judge them and not treat them with respect??
[Side note: talking about this man brought up one of UMass' family physicians who works at the PIP shelter, Worcester's only (I think) wet shelter, and an all-around rough place. We quickly concluded that this particular doctor is a bald, male version of Mother Theresa, in that he is compassionate and respectful and patiently treats everyone, even if they walk out the door and start shooting heroin into their eyeballs; then they come back the next day and he treats them again. We are certain that he has an express, speed-of-light ticket to heaven. He's the kind of doctor that before medical school we all wanted to be like, treating everyone, being kind, being non-judgmental. Now most of us are just in awe that someone like that exists, and we mull over his saintliness as we elbow each other out of the way for the few open derm slots.]
And just when I thought I'd seen enough for one night, we got a "FDGB" (fall down go boom) call. We walked into the house, and it was (I'm not making this up) a family of deaf people. Most people that know me know that I love sign language and that learning it has been a hobby since college. It's not really a handy life skill (even though ASL is the third most common language in the country, after English and Spanish), and I don't think I've ever been called upon to actually use it. Needless to say, the paramedics were kind of stunned that I could communicate with this family and figure out what happened, and then talk to the patient on the way to the hospital. I ended up waiting there until the interpreter got there, leaving my ambulance to go out and take more calls, cause I felt bad leaving this poor person in a cervical collar strapped to a backboard staring at the ceiling and unable to communicate with anyone. I'd imagine that would be a pretty scary situation for a deaf person, only able to look up, not really able to move at all. At the end of the night I was pretty pleased that I hadn't totally forgotten all my ASL, though certainly it could use some work.
I feel like I packed a bunch of crazy experiences into one short shift. Thanks for reading this very long post (if you even did...and didn't skip right to the last sentence...I have a short attention span too, I know how it works). I don't think my next ride-along will be quite as adventure-packed, but we'll see... :)

Pittsfield happenings

2008-07-31T22:04:00.011-04:00

This is getting blogged about, per request...
There was one hell of a fire the other day at an apartment building across the street from the hospital. Of course being voyeuristic like we are we rushed out to watch (and take pictures). And mingle with Pittsfield's Finest. I'm not sure what time the fire actually got put out, but it was after 11pm (and it started around 8). From what I read in the newspaper, no one got hurt, and the fire started on someone's stove. It was pretty impressive. And HOT (I know, I know, you think that'd be obvious, but it still surprised me). Plus I was watching the firefighter on top of the giant ladder hanging over the burning building, thinking, we must be made of different stuff, or have different neural connections (see?? I'm tying this into my neuro exam tomorrow, so it's totally like I'm studying) than me, cause WHAT would possess someone to do something like that?? I mean, this was a giant ladder and a big fire (see above image). Now, alas, the building is very sad and burnt-out looking. But it's still there, and at least the fire didn't jump onto the house next door (it was close - you can kind of see the roof next to the bottom of the ladder in that pic).

New post - I am alive

2008-07-27T11:29:00.012-04:00

Sorry for the month-long delay in blog-posting. Life got in the way. You know how it is. :)
So, I wanted to write about an awesome music festival I went to yesterday, on my last (oh, the horror!) weekend in the Berkshires. It's the Falcon Ridge Folk Festival, and it's a four-day festival held on a farm in Hillsdale, NY (just across the MA line near Great Barrington). And let's just say the crowd was, um, unique. We were actually keeping a tally of the number of men we saw wearing skirts (and I don't mean kilts). Bras appeared to be optional. There was a woman wearing a flowing skirt, bikini top, and butterfly wings (like from a halloween costume or something), playing with devil sticks all day. There were multiple canoodling same-sex couples (which shouldn't make me, a super-liberal from the most liberal state in the nation, even really notice, but somehow it still did). There was (when the sun when down) a giant peace sign made out of tiny lights hung way high up in a tree casting a nice glow over the audience. I mean, there were adults hula-hooping. Needless to say, it was some of the best people-watching I have ever had the privilege to enjoy. There was also (and this was the main, draw, really), some awesome music. We saw (in one day!): Dar Williams, John Gorka, The Nields, and many other singers who were also great, but who I've never heard of before and I'm now too lazy to look up their names. At one point, Dar Williams sang with John Gorka, and I thought I would die of happiness. (And it goes without saying that she's a pirate's favorite folk singer, right, Hoyt?) And the weather was beautiful, except for about 20 minutes of rain (but it was a serious rain). Normally my days are filled with old sick people and bad cafeteria food, but yesterday it was chock-full of acoustic guitars and peace signs and organic smoothies. I wish I could bottle up that feeling of zen-happiness and unleash just a little bit every day. :)

Aaaaaand we're done!

2008-06-27T09:35:00.009-04:00

With this year, that is. Perhaps most importantly, we (we're employing the collective "we" here) are DONE with our medicine rotation. We weren't entirely sure we'd make it emotionally, physically, and cognitively intact. It was touch and go for a while there. So, sorry for the lack of posts...and this is just gonna be a brief one to let you know I'm alive. I hope everyone has a lovely weekend! And J&E, have an excellent birthday! :)

An Ode to Inpatient Medicine

2008-06-10T17:25:00.009-04:00

This morning, I decided to channel my energy away from thoughts of strangling my attending (or at least re-doing her hair) and into more creative places. Hence, a poem for you:

O inpatient medicine, please listen to me
I can't take too much more of ACS and PE
Of blows to my ego, of sickness, of death
Of five-to-five admits, and of course M.Ed.'s

O inpatient medicine, send me a sign
You take over my life, and up all my free time
I used to have friends, and hobbies, and fun
Now my guitar gathers dust, and I can't hold my wine

O inpatient medicine, what can I do?
Your lights are fluorescent, your halls smell like poo
I'm ensnared by your monster, caught in its grasp
It will haunt me forever, till I'm old and sick too

O inpatient medicine, do you see those blue skies?
While I'm locked in this labyrinth, a part of me dies
I'm dreaming of summer, of drinks with umbrellas
But you're immune to my pain, and deaf to my cries

O inpatient medicine, I'm doing my best
Help me through these last days, through third year's last tests
Give me strength to come in, and motivation to learn
And - oh, fuck it, I've got just two weeks left

Picture time

2008-06-07T20:35:00.018-04:00

Some pictures from when I was home over Memorial Day weekend, cause this blog needs some color:

Happy Saturday!!

2008-06-07T07:55:00.007-04:00

I hope everyone is having a fantastic day. If you're even up. So...it's 8am. I've been at the hospital for almost an hour. I'm just thankful there are no windows anywhere around this fluorescent labyrinth so I can't see the blazing beauty of the sunlight dancing off the lake. I'd like to say I'm saving lives, but in reality I'm nursing a giant coffee, reading the nytimes online, and half-heartedly looking for my senior resident. Occasionally I'm working on a discharge summary for my patient who was admitted a whopping 6 days ago, and I'm utterly unable to remember what he presented with when he came in or what his problems were before yesterday. I could go get his chart, but that would require more energy than I can muster at this particular moment. Anyway, I hope you all have a v. good day! Go to the beach. Or sit inside in the air conditioning, if that's more your style. To friends whose emails/calls I've been ignoring: it's not you, it's inpatient medicine. I'll resurface soon. I really do love and miss you all. :)

Pica

2008-06-03T20:41:00.015-04:00

A quick google search turned up that pica stands for: 1. The Portland Institute of Contemporary Art, 2. the Podiatry Insurance Company of America, and 3. the Printing Industry of the Carolinas. However, the Pica that I am endlessly fascinated with is the "persistent eating of nonnutritive substances." According to emedicine, people with pica eat substances, "including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches." Um, ew. Though pica has always held a morbid fascination for me, this post is inspired by a patient today (not mine, hipaa) who was found by the nurse eating baby powder, and subsequently found to have an earring in her colon on xray. And I had a patient a couple weeks ago who admitted to eating cigarette butts (seriously), but flat out denied eating coins (her exact words: "I save money! I don't eat it!"), though clearly there was a quarter in her cecum on xray. Crazy. Factoids about pica: eating ice chips can be a sign of iron deficiency; and eating clay or dirt is acceptable and a learned behavior in some cultures. Not helping Worcester's infant mortality problem: pregnant Ghanaian women eat clay (though I've heard that this problem gets more press than it's really worth in terms of actual harm to infants). Anyhoo, I got off track. Pica is weirdly cool. Except for the people that eat, you know, razorblades and whatnot.

Whither must I wander

2008-05-29T20:43:00.009-04:00

My dad spoke at his high school's candlelight ceremony yesterday (kind of like graduation, but more introspective and less celebratory), and his speech (which was awesome, in my unbiased opinion) focused on a poem by Robert Louis Stevenson, which I really liked. I think I've been drawn to literature/songs/themes of wandering lately, as I have recently become nomadic (seriously, it takes a minute in the morning to figure out where I'm waking up). So anyway, here it is (the poem, not the speech):

Home no more home to me, whither must I wander?
Hunger my driver, I go where I must
Cold blows the winter wind over hill and heather
Thick drives the rain and my roof is in the dust.
Loved of wise men was the shade of my roof-tree
The true word of welcome was spoken in the door
Dear days of old with the faces in the firelight
Kind folks of old, you come again no more.

Home was home then, my dear, full of kindly faces
Home was home then, my dear, happy for the child.
Fire and the windows bright glittered on the moorland
Song, tuneful song, built a palace in the wild.
Now when day dawns on the brow of the moorland,
Lone stands the house, and the chimney-stone is cold.
Lone let it stand, now the friends are all departed
The kind hearts, the true hearts, that loved the place of old.

Spring shall come, come again, calling up the moorfowl
Spring shall bring the sun and the rain, bring the bees and flowers
Red shall the heather bloom over hill and valley
Soft flow the stream through the even-flowing hours.
Fair the day shine as it shone on my childhood
Fair shine the day on the house with open door
Birds come and cry there and twitter in the chimney
But I go forever and come again no more.

FAQ: glioma vs glioblastoma

2008-05-21T21:08:00.007-04:00

Been getting a couple questions about brain tumors lately. Obviously because of Ted Kennedy (so sad) but also because of a family member recently diagnosed with glioblastoma (also very sad). Here goes:
A glioma is a tumor that arises from cells in the brain called glial cells. Basically these are all the cells in the brain that aren't neurons; they are the "glue" that holds the neurons together. Any tumor that comes from glial cells is called a glioma. But each kind of glial cell (for example astrocytes or oligodendrocytes) can have its own tumor arise from it, and each tumor has its own name. A tumor arising from astrocytes is called an astrocytoma. A tumor arising from oligodendrocytes is called an oligodendroglioma. These are types of gliomas.
Astrocytomas comprise 80% of primary brain tumors in adults. (Primary simply means that the tumor doesn't originate as cancer somewhere else in the body and metastasize to the brain.) There is a spectrum of badness for astrocytomas. Grade IV astrocytomas are the most aggressive and have a special name: glioblastoma. (I didn't come up with this naming system, people.)
Contrary to popular belief (or my interpretation of popular belief, I guess), brain tumors rarely present with headaches. This is because there are NO nerve endings in the brain, so tumors don't cause pain. Crazy, right??? (If there was some way to get inside your skull pain-free, you could undergo brain surgery without anesthesia.) They usually present in one of two ways: with seizures (a la Ted Kennedy), or with something called mass effect. Mass effect means the signs and symptoms that arise from having a mass in the brain, since the brain really doesn't like to be pushed around inside the skull. Symptoms include mostly nausea and vomiting, though a classic sign is vomiting without nausea. One more time: headaches rarely mean brain tumor.
Hmmmm....any other burning questions about brain tumors?....

Why didn't I become an I banker??

2008-05-18T21:48:00.008-04:00

I'm pretty sure that inpatient internal medicine is going to get the best of me. I am 2 (two) weeks in out of 7 (seven!!!) and I'm already ready to throw in the towel. I'm not entirely sure how/why anyone actually goes into internal medicine, and ends up alive with cognitive and emotional function intact at the end. As my resident put it (he's only a PGY-2), "When I was in medical school I wanted to save the world. Now I just want to make it through each day alive." This is seriously the most draining rotation I've done this year. Thoughts about that? Other opinions on the most exhausting one? I'm not even sure the hours in surgery were worse, given that you had post-call days off q4. As an example of my morning: We worked up a new patient (obviously I'm not revealing/changing the details...I know you're reading this, HIPAA) for new-onset weakness, and she ended up having f***ing mets all over her brain from an as-yet-unknown-but-probably-lung cancer. That was real fun. And my patient from last week with ten zillion medical problems that we managed to stabilize was just discharged back to her nursing home. She's 45 years old. How can people do this day after day?? Maybe one day it'll make me so numb that it won't depress me anymore. But then that in itself might depress me. Oy. I leave you with the eternal wisdom of Scrubs:

Dr. Cox: You see Dr. Wen in there? He's explaining to that family that something went wrong, and that patient died. He's gonna tell them what happened, he's gonna say he's sorry - and then he's going back to work. Do you think anybody else in that room's going back to work today? That is why we distance ourselves; that's why we make jokes. We don't do it because it's fun. We do it so we can get by. And... sometimes because it's fun. But mostly it's the getting by thing.

Slow Medicine

2008-05-08T21:04:00.007-04:00

This has been on my mind for a while, but I read a cool article on nytimes.com that really brought the issue forward again. Seriously, why do we treat death like it's something we can avoid??? We're all going to die. Deal with it. I am, you are, everybody is. You can't put it off forever. Why do people think that good medicine is just curing everything?? Shouldn't the goal at the end of life be maintaining a good quality of life for as long as possible, not merely delaying death?? So this article: it's about a movement at Dartmouth Medical School called Slow Medicine that emphazises comfort rather than cure at the end of life, and you can read it here. Think about it: if you were diagnosed at age 85 with cancer, would you choose surgery, chemo, and radiation, possibly ending up bedridden with DVT's and PE's and urosepsis and godknowswhat else, just for the possibility of another year or two, and not a healthy year or two at that, or would you rather say, "no thanks, I think I'd rather die on my own terms." I feel like I might go for option B (though in reality hopefully I'm quite a few years removed from a decision like that...maybe I would think differently if I were actually 85). It's certainly understandable to be afraid of death and to want to live as long as possible. I mean, life's short and pretty damn fun. But it ends for everyone eventually. When can we make the shift that the goal of good healthcare is helping people live good, quality years at the end of their life and then dying with dignity and with as little pain and suffering as possible? When will our collective mind stop treating death like something that can be avoided forever? Ok, please read that article, it's short and so interesting. And don't pay too much mind to my ramblings. Inpatient medicine is making me bitter and cynical about drastic end-of-life care, and incredibly sad about the state of some unfortunate people's lives. But that's a depressing story for another post. Please go outside and enjoy your working lungs, healthy muscles, the fact that you aren't paraplegic from a freak accident, or have crippling rheumatoid arthritis, or have had 3 strokes, or live in a nursing home at the age of 37. (This has been a fun week.)

Spring has Sprung

2008-05-04T15:51:00.011-04:00

The grass has riz. I wonder where the birdies is?

So, it's officially spring. I think it took a little longer to arrive in the Berkshires than other places near here (like Tarrytown, NY, where that pic of flowers was taken a couple weeks ago). The trees here have pretty much blossomed, and although the temperature has taken a nose-dive over the past week, the flora have still managed to explode. We (Berkshire friends and I) are spending the day in Lenox, and it's so beautiful here. Some of the houses are crazy huge mansions. And we saw the "house" where Cider House Rules was filmed (well, the outside of it). I am trying to pack in non-medical stuff before I start inpatient medicine tomorrow. When I think about it starting I picture a large black sheet being lowered over my life. I may be fatalistic and pessimistic, but maybe this way there's no way I can be disappointed by the experience. If you expect to stay til 9 every night, when you get home by 7 you're happy, right? Well, I hope everyone is enjoying spring. Go outside and smell the flowers, like this crazy kid. :)

I sold a piece of my soul, but the wine sure was good

2008-04-26T12:12:00.010-04:00

I finally went to my first drug company dinner last week. I really just wanted to get a free dinner at a yummy-sounding restaurant in town, as I always feel pretty guilty taking anything from drug reps (normally I don't even take pens or anything, just on principle). But the prospect of a free dinner got the better of me, and I justified it to my conscience by saying that they're selling a drug I'm never going to prescribe (it's for osteoporosis...and EM people don't really treat that chronically), and I could write about it here to sort of make up for it. (right??) It was pretty interesting, and overall pretty bizarre. The main speaker was (I think) an endocrinologist, and she told some made-up story about how her own mother was thrilled to learn about this new osteoporosis drug (which obviously I'm not naming here...I'm not doing free name-advertising for them). The whole thing made me pretty uncomfortable, what with the knowledge that drug companies spend almost 30 billion dollars (I can't even get my brain around that) a year on advertising, most of it directly to doctors (i.e. not direct-to-consumer advertising like on TV). And rising drug costs are at least partly responsible for the rising cost of health care and insurance, leading to fewer insured people, etc etc etc. But I digress. I enjoyed the dinner (it was actually pretty yummy, and had lots of free-flowing wine), but with every bite I could taste a little bit of guilt. It sucks that a for-profit industry is so entrenched in (and in a big way driving) what should be an essentially non-profit, for-the-greater-good industry and profession. If sales tactics didn't result in increased use and prescription of drugs, companies wouldn't take entire offices out to dinner or give stethoscope tags or free pens. The office where I had outpatient medicine had free lunch every single day sponsored by drug reps. One day I walked into the kitchen and the rep was holding up a big brochure and describing the effects of her new lipid-lowering medication, while trays of (literally, I am not making this up) KFC fried chicken and mac and cheese sat on the table. I guess she was trying to create future customers?? I'm going to stop here, before thoughts of the current state of health care in this country cause me to become apoplectic in public. I hope everyone is doing well!!

Adventures in the Berkshires

2008-04-26T10:07:00.010-04:00

So to continue drinking up the Berkshires experience, last night we took a trip through the woods (literally) to the famous Dream Away Lodge in Becket, MA for some dinner and music. According to its website, it's a 200-year-old farmhouse that used to be a brothel and speakeasy. Now it's a restaurant/bar/lounge that appears to have few patrons but many children and dogs roaming about. Although the website says "reservations for dinner are very much in order," we (there were 11 of us) seemed to make up over half of the customers, though there were many other people standing around that appeared to live there (and our waitress took our order while holding her 5-week-old baby, just to give you some idea of the atmosphere). There was also some really good music by Heather Waters, and we ended up getting our own private concert while we lounged on comfy couches. The whole experience was kind of odd but very enjoyable. You seriously think you're in the middle of the woods when you come across the place. (The directions on the website say, "Turn right on Watson Road and proceed slowly for three winding miles through the forest.") I'd definitely recommend going there (but don't get the fixed price menu...the food's not good enough for the high price), and also checking out that singer, cause she was pretty good. (Where else but western MA can you get good music in an old farmhouse that used to be a speakeasy??)

Picture(s) of the day

2008-04-20T21:49:00.013-04:00

Wow, this page needs a picture. Words can get boring. These are pics from the Berkshires, where I am currently doing my medicine rotation (fyi: 'medicine' means general adult medicine, as opposed to pediatrics or surgery). Living in the Berkshires for free during spring and summer is quite a sweet deal. Our school likes to call it "required third year clerkship at Berkshire Medical Center." We like to call it "summer camp" (but with sick people during the weekdays, alas). There is lots of fun to be had out here. I'd recommend either taking a trip out here (tanglewood! and hiking!) and/or doing a rotation out here (if you're at UMass). We all live in a giant med student frat house. Tis quite the experience. :) I feel vaguely guilty for not even knowing the Berkshires existed for nearly my entire life up until now (hey, what can you do, I'm from the total opposite end of the state, and my dad calls everything west of route 128 "the midwest"), so now I sort of feel like it's my duty to extoll its virtues to people who remain oblivious to the fact that it even exists. So please enjoy the pics!

The only thing I DO have: hypochondriasis

2008-04-18T18:37:00.010-04:00

So as I lay in bed the other morning, awoken from sleep by back pain (am I really that old?) and sweating because of the extreme lack of temperature regulation in the house out here (which rendered the temperature in my room probably 85 degrees), all I could think about was that I would be dead of meningitis by the time the sun came up. I had pain on extension and flexion of my neck, fever and chills, and as soon as there was light there was no question I would also have photophobia. Obviously it's Sunday evening and I'm very much alive and meningitis-free. Which lead me to think of all the other horrible diseases I thought I've had at one point or another since med school started. Things like Hodgkin's lymphoma, rheumatoid arthritis, appendicitis (x5), congenital malrotation (it's not even physiologically possible for me to have this), and of course leukemia (every time I'm feeling run down...which has been a lot over the last couple years). And yet I make fun of my mother for thinking that a small lump on her lower left abdomen is pancreatic cancer (Me: "Do you know where your pancreas is?" Mom: "No, not really." Me: God, what else do you worry about? Mom: [long pause] "Well, I worry that all the gin in the world will dry up"). Though I'm not entirely sure I deserve a DSM diagnosis of hypochondriasis, because I rarely if ever actually go to the doctor. The only medical professional I go to repeatedly is my dentist (dentist: "It's not a cracked tooth. You're a hypochondriac because you're in med school") because he is rather good looking (read: totally hot). Other than that I just stew about it in my own head (hmmm...let's add 'anxiety disorder' to that list...)

Dead Horse Trampoline

2008-04-13T01:29:00.011-04:00

So I had the pleasure of seeing Antje Duvekot (again) in concert tonight. She was, as always, completely fantastic. (Actually I've seen her a few times recently...I think I'm becoming quite a groupie and I don't want to be) (though tonight I got to meet her, which was quite cool - funny story for another post.) ANYHOODLE. She sang a hilarious song at the end called - I'm not making this up - Dead Horse Trampoline. And I with my twisted sense of humor thought it was endlessly amusing, and would so much like to share it with others. You can watch Justin Roth (who I believe wrote it) singing it on YouTube here, and you can read the lyrics here (personal favorite line: That's what he gets for being so mean, He was the victim of a dead horse trampoline). So I figured most people have likely never heard this song before (the YouTube video has had 185 views), and with the convenient medium of the blog (and all 3 readers! just kidding...I know more of you are reading than that), I decided to spread the joy. So please, enjoy. :)

Awesome names

2008-04-10T09:37:00.009-04:00

There was a post the other day in TierneyLab, a blog of the nytimes, about the "Boy named Sue" theory: the idea that people with bad names turn out just fine, or even better off because of their bad name. [The winner of TierneyLab's bad names contest was a woman named Iona Knipl ("really? I have two!"), but this is besides the point.] In the comments section, someone posted about an OB/GYN in Fairfax, VA whose name is (and I'm not making this up, I did some googling): Harry Beaver. I mean, if that's your name, is there any profession other than obstetrics and gynecology that you could really go into?? And it made me remember reading something a while back about how people really do tend to go into professions suggested by their names, and it's actually been studied as something more than anecdotal evidence. There is a dentist in Salem named Dr. Fang, and dentists in Needham (they're in practice together) named Drs. Needleman and Yelland. Though a friend reminds me of the OB/GYN at UMass named Harrison Ball (he doesn't go by Harrison...and yet why not??) who maybe reacted against his name in choosing a specialty. In an awesome-sounding book called Bertha Venation: And Hundreds of Other Funny Names of Real People, Larry Ashmead talks about people like the environmental engineer Hugh Fish, and what happens when Ms. Gay marries Mr. Beech. (I heard about this book on NPR.) And there's some debate as to what comes first: is your name your destiny? According to the New York Times (really, where I get most of my information), people who study names (called onomastics), call it "nominitive determinism" when Dr. Fang grows up to be a dentist or Dr. Fish becomes an ichthyologist. Ashmead also wrote a chapter on funny names that arise when people marry each other, like Ms. Coffee marrying Mr. Bean, or Ms. Gay marrying Mr. Beech (she hyphenated it to Gay-Beech, according to the book, and didn't actually find it all that amusing). Luckily, Dr. Beaver's children say that they got many laughs out of their father's name (according to their posts on Dave Barry's blog, and he never makes stuff up). :)

Sleepy Sunday in Marblehead

2008-04-06T11:53:00.015-04:00

Picture yourself lying in bed on a Sunday morning (at your parents' house, because you no longer have an apartment): the distant sounds of NPR, the smell of brewing coffee, the smell of smoke from the fireplace....the sound of smoke alarms, then the sight of lots of smoke from a fire. Then the realization: shit, there's something on fire. That something being: the chimney and fireplace. Cue the call to the fire department (from a neighbor who saw flames leaping out of the chimney), the arrival of 3 (three!) firetrucks and a police car, and an improptu gathering of neighbors on the street wearing sweatshirts and pajama pants and wondering what the heck was going on. I can't decide if it's good or bad that my second thought, after it's smoky: we should get out of here, was god it looks cold out, I wonder where my fuzzy shoes are? Then I spent a minute in the mess of boxes and open suitcases that is my bedroom attempting to locate said shoes and my down vest. Long story short: the chimney and fireplace caught fire and was put out in about an hour. Apparently, the floor of the ash pit of the fireplace was made out of wood. Hello?? I've heard stories about the insane level of cheapness of the person that built this house (an uncle of a current neighbor, I think), but I think lining an ash pit with wood is taking cheap to a new level. The fire department said we were really lucky the living room didn't catch on fire. It's a little disconcerting to go from the normal lazy Sunday of coffee and the new york times to being happy that your house is standing. Although, really, I guess we should always be happy for stuff like an intact house on normal days; though obviously no one really thinks about that sort of thing on a daily basis. It was pretty nice seeing all my neighbors, some of whom I've known for my entire life. And lord knows I enjoy watching the firemen parade around with their equipment. And I was also enjoying taking zillions of pictures with my new camera (that I love). One fireman said, "Are you from the Reporter?" and I said, "eh?" and he said, "oh, there's a new girl who works for the Reporter," and I looked down at my blue fleece pajama pants with the white snowflakes and thought, hm, she must dress casually. So aside from the fact that my parents almost got to downsize real quick and now the house smells like soot and is covered in a fine white chemical powder, this has been quite an interesting (and dare I say enjoyable?) day. And the fleet of cleanup crews arrives tomorrow.

Saludos de Puerto Rico

2008-04-03T18:11:00.023-04:00

You may be wondering why I'm in my hotel room on my computer in San Juan instead of at the beach. I'll tell you why: it's been raining/cloudy all day. Although one of only two full days we have here is far from being a beach day (and yesterday was pretty windy and cloudy as well for parts of it), we had fun anyway. Right? Right! We walked around, browsed in fancy shops next to many sunburned white people (I shouldn't poke fun...yours truly managed to get a sunburn yesterday through a frickin blanket of clouds), and ate and drank frequently. Oh, and visited the church where Ponce de Leon is buried, just to say we took in a little history/culture. It was a bit rough getting here, as our plane took off, flew for a while, then turned around and landed at Logan again (something with the oil filter, I think? Something that probably could have been dealt with before we took off? Something for which there must have been some kind of warning light on in the cockpit while we were still on the ground?), but it's been a very relaxing few days. Back to freezing Boston tomorrow, alas. And while we're all thoroughly enjoying ourselves, it's unfortunate that we have two days of interclerkships looming over our collective heads for when we return on Monday. Oh, and three months of medicine (for me). And before you say I'm being negative for thinking about school when I'm on vacation, I have seen 8 (eight!) of my classmates since I've been in San Juan, only one of whom I actually came down with. All in all, PR seems to be quite a nice place to be. So for people in snowy, cold, work-filled places, please enjoy the pictures. :)

Nica

2008-03-27T20:35:00.014-04:00

I just noticed that this blog has WAY too many medical/school-related posts. True, that's where my brain spends 95% of its waking hours, you know, when it's not thinking about coffee, or thin mints, or Britney Spears, or cosmos, or...you get the idea. The point is, I actually care about Other Things. And do Other Things. So...a bit about the beautiful country of Nicaragua.

Almost two years ago I went to Granada and San Juan Del Sur, a town on the Pacific coast. Granada is gorgeous, and it's an old colonial city, with a beautiful main square (whose cathedral is pictured at left) and houses that are colorful and all have holes in the roofs. It's on Lake Nicaragua, the largest lake in Central America. The picture at the end is from the island of Ometepe, which is in Lake Nicaragua. I stayed with a family in Granada, and they were amazing. The family consisted of Goyita, the matriarch, her two daughters, and her oldest daughter's two daughters. They were very warm and welcoming and fed me lots of fried rice and fried cheese with cheese on top (seriously). This is a picture of Goyita, Marta, and Triana:I could write about Nicaragua for pages and pages, but I'll spare you. In short: the people are really friendly, everything is super cheap, they speak highly comprehensible Spanish, and the country is beautiful. I will write more about it some other time, but until then, I leave you with this serene image: (I wish a camera could capture sound and smell.)

Would you want a computer program deciding your fate?

2008-03-20T20:29:00.009-04:00

Well, it's that time of year again. No, not the first day of spring (though that it is), but Match Day. Match Day is quite the event in the world of medical education, though it is possible that people who don't have a friend or loved one going through the process (or will go though it soon themselves) have never really heard of it. (What? How could you have not woken up this morning with a start, already feeling the excitement in the air?) Anyhoodle, what is this 'match,' you may be asking yourself. Well, basically at 12pm eastern time on the third Thursday in March, all the soon-to-be-graduating medical students gather at their school, get an envelope handed to them, and find out where in the country a giant computer program has placed them for the next 3-7 years of their life. Fun, right?? Lest you think that the computer can send you anywhere, all the applicants rank which programs they want to get matched to, in order. For example, if you want to go to BU, Harvard, and NYU (as your 1st, 2nd, and 3rd choices), the computer will first look and see if BU ranked you on their list; if BU didn't rank you, then it looks to see if Harvard ranked you (it probably didn't). Then they go to the next one on the list, Tufts, and if Tufts has ranked you then that's where you're Matched. Get it? I don't either really, but that's the story they give us of how the system works, anyway.
So instead of spending the afternoon diligently caring for my patients (my friend Rachel: "If one starts bleeding, they'll page you"), I instead pored over UMass' match list. Some interesting tidbits:
-It appears that the majority of MGH's pediatrics program will be comprised of UMass grads, many of whom seem to be going there
-A whopping 19 people out of 104 are going into pediatrics. I think it'll be even higher next year (at least partly because of that wacky and charismatic peds attending we all know and love).
-Zero people are going into dermatology, which is kind of surprising, considering derm is so popular (though it is competitive).
-About half of the grads are staying to do residency in MA. Surprising or not? I dunno, but it's interesting to think about since all the students are from here. Perhaps this cold and snowy winter has pushed people further south and west than in other years, like when the third snowstorm in a week hit right in the middle of interview season. (The pediatrics residents told of interviewees who got stranded in Worcester and couldn't get back to Logan on more than one occasion: applicants from California who likely ended their interview day curled up in the fetal position in a snow drift on Route 9.)
I thought that going to the Handing Out Of The Envelopes today was pretty fun (my senior resident: "Come on, team, we're going on a field trip!"), but seeing it all made me wish I were going through it next year, instead of in two years. Hey, even though I made the choice to extend and graduate in 2010 doesn't mean I'm not allowed to whine about it sometimes. :)

addendum: Our very own soon-to-be-Dr. Brant has matched at Tulane in internal medicine, her first choice! Yay!! :) Though we in the north will certainly miss her.

Fun on the wards

2008-03-13T20:52:00.012-04:00

So I started inpatient pediatrics this week, and while traipsing around 5 East listening to stuffed animals' hearts and lungs and placing bets on which pregnant resident is gonna pop first, I've started playing a little game (in my own head...yes, I'm easily amused) I like to call, "Pediatrics and Surgery: same or different?"

For example, our senior resident was gone yesterday, but left us a paper to fill out about newborns as "homework." She came back today (she's very cheery and blond...just painting a picture of the peds residents for you) and said, "So, guys, did you do your homework?" and we said, "Why, yes we did," and she said, "Great! We'll go over it during ice cream tomorrow." Because, you see, Friday is Ice Cream Day on 5 East. So for this one the answer to my game is: different. There is no Ice Cream Day in surgery. Instead, sometimes if you're really lucky you can swipe Lorna Dunes while you're doing a consult in the ER.

Round two: My (blond, cheery) intern seems to have something of a policy of doling out no less than 18 warm fuzzies every minute. Like, I retrieve one piece of paper (that I probably should have had in the first place), and she'll say, "You're doing such a great job!" or the other student and I might, you know, see our own patients for 5 minutes, and she'll say, "Oh my goodness, you two are just so fantastic!" I think you can guess the answer to this one: that's right, different. The surgery residents don't have time for warm fuzzies. Maybe inside they think we're doing a great job, but their outside is too busy saying, "This is a lap pad!! I wanted a four-by-four!!!!" or, "Cut! I said cut here!!!!" to really tell us out loud.

I actually had to phone a friend today to ask for a same one. She said (and she's right): Pee remains very important. I continue to monitor the urine output of my patients at near-OCD levels, and pediatrics adds the added twist of forcing me to calculate everything in cc/kilogram, exposing my horrendous math skills for all the world to see (sorry, mom). Actually, I never knew I was so bad at mental arithmetic until I had to calculate stuff like: how many teaspoons of tylenol should a 23-pound child get if the tylenol suspension has 160cc/mL and the dosage is 15mg/kg? Oy vey. (Usually I end up scratching my head and blindly pressing buttons on my calculator, until I eventually admit defeat and start rummaging around in the drawers for the acetaminophen dosing chart.)

Anyhoo, all in all this has been a fun game for me. I'll definitely try to keep playing as I'm enjoying a sundae tomorrow, while making sure to keep the caramel sauce off the expensive end of my stethoscope.

Happy International Women's Day!

2008-03-08T17:37:00.017-05:00

International Women's Day was first celebrated on March 8, 1909 (well, that year it was National Women's Day), a year to the day after 15,000 women marched in the streets of New York demanding shorter work hours, better pay, voting rights, and an end to child labor. The day is an official holiday in many countries, such as those of the former Soviet Union. You can read more about its history on the IWD website.

On the first IWD of the 21st century, the UN issued this statement:

"...members of the Security Council recognize that peace is inextricably linked with equality between women and men. They affirm that the equal access and full participation of women in power structures and their full involvement in all efforts for the prevention and resolution of conflicts are essential for the maintenance and promotion of peace and security."

The UN has taken on Women's Rights, and specifically the Elimination of Violence against Women, as a major issue in the past 30 years; gender equality is one of its Millenium Development Goals. Two weeks ago, at the opening meeting of the Commission on the Status of Women, the UN Secretary-General said:

"Violence against women is an issue that cannot wait. A brief look at the statistics makes it clear. At least one out of every three women is likely to be beaten, coerced into sex or otherwise abused in her lifetime....No country, no culture, no woman young or old is immune to this scourge. Far too often, the crimes go unpunished, the perpetrators walk free."

Lest we delude ourselves into thinking that women and men live as equals in the United States in 2008, consider an article from today's Boston Globe about a professor of anesthesiology at the BI who is filing a lawsuit against the hospital, its president, and the chief of surgery, alleging years of sexist treatment (the chief of surgery reportedly told a group of nurses that he preferred to hire residents who were "tall, light-skinned, Western-taught men"), at the end of which she was demoted. And although women enter medical school at nearly the same rate as men, they are still under-represented in the upper ranks of academic medicine and in certain specialties such as neurosurgery. It would be naive to think that the dearth of full-fledged female professors in medical schools and teaching hospitals is because women haven't been entering medicine at high rates for long enough. Discrimination, both overt (like that referred to in the lawsuit against BI) and subtle, is everywhere, and the lack of female professors (of all specialties) and mentors creates a dangerous pattern of not encouraging young women to take career paths so often taken by young men after medical school. There was an interesting article in AMSA's magazine this month called Breaking into the Boys' Club. You can read it here.

Ok, enough on this (albeit interesting) topic for today. (*alights from soapbox*)
[But this is IWD, after all. If you can't rant about gender bias today, when can you??]

Fun in the ER

2008-03-03T23:09:00.011-05:00

I was asked a question by a parent yesterday that caught me off guard: "Is this one of the first lumbar punctures you've ever done?" And I answered honestly (though sorta lied by omission): Yes. She certainly didn't have to know that her son was the recipient of my very first LP. Sure, I tried to make it look like I'd inserted thousands of long needles into young kids' spines before, but I don't usually hide my panic well. When I had explained to her why her kid needed one an hour earlier, part of my explanation was something along the lines of, "Don't worry! Dr. Attending has done millions of these before!" even though I knew full well I was going to be the one doing it. I couldn't very well have said, "Actually I'm going to practice my first one on your eleven-year-old. Don't be alarmed! I passed my anatomy of the back exam."
[side note: When she asked me that question I had a flashback to the very first Kaplan SAT class I taught, in which one girl asked me if it was in fact the first class I had ever taught. I went with honesty and told her yes: bad idea. I lost them. I might as well have written on my forehead: DON'T RESPECT ME, I'M NEW HERE.]
I mean, parents have a right to know when semi-competent medical students are learning how to do invasive procedures on their loved ones. However, if they truly knew, no one would ever consent to that. Right? I feel like if it were my kid I would have said, "No way! Dr. Attending will be performing this procedure, thankyouverymuch." It's been pretty well-documented that patients receive better care at teaching hospitals (ones with residents and students), but that piece of information seems quite abstract and theoretical when you're in a place like the one I found myself in yesterday. I do feel kind of guilty that I didn't come clean from the beginning and make sure she knew I'd be the one doing the procedure, but I also am pretty sure she would have said no. So what to do??
(p.s. Tap went well. Kid lived. Clear fluid. Discharged home.)

Let it snow

2008-03-01T14:53:00.010-05:00

Well, Mother Nature has decided in her infinite wisdom to welcome March with a snowstorm. Actually I was ok with this one, since I didn't have to go anywhere during the 12 hours that it was snowing (heavily). And I went for a walk this morning and took some pictures when it was really pretty. There weren't that many people out, and everything felt very calm. I came thisclose to making a snow angel on the lawn in the center of town, but thought plopping down on my back near a busy intersection might cause someone to wonder if I'd keeled over (since I'm not, you know, 8 years old). Yesterday we had a class on adolescent medicine, and the professor said it's hard to teach people how to recognize when adolescence is over. I think I recognized the end of my own adolescence the first time I saw snow and felt annoyed. I caught myself and was then annoyed that I felt annoyed, when I used to love snowstorms, and how the snow lining all the tiniest tree branches made everything look so magical. God, adulthood is awful sometimes. So I was especially happy that I got to enjoy last night's storm, and not let my grown-up curmudgeoniness (word?) get to me. Nevertheless, I won't protest when spring decides to grace us with her presence. :)

This is the church in the center of my town.

My lovely house in the snow.

Happy February 29th!

2008-02-29T11:22:00.008-05:00

It only comes around once every four years, so savor it. I never knew the leap year had such an interesting story until I heard about it on NPR the other day. How all this business started was that the world used the Julian calendar from the first century, until people noticed that the date Easter was celebrated (the vernal equinox) kept drifting slightly forward, since the calendar year (365.25 days) was just a little longer than the time it took for the earth to circle the sun. That meant people were one calendar day forward every 128 years. Pope Gregory XIII found that unacceptable, so created a new calendar (the Gregorian calendar), which we use today. He kept most of the Julian calendar, but added the rule that years that are divisible by 100 are not leap years. However, years that are divisible by 400 are leap-years. (The 400 rule overrides the 100 rule, apparently.)
A couple cool factoids arise from all this:
1. February is so short because Caesar's son Augustus was a brat, and wanted his month to have as many days as his father's (July), so they rearranged a bunch of days, the end result being that February has fewer days than all the other months.
2. The Russian and Greek Orthodox calendars still use the Julian calendar, so Easter falls later for them than on our (Gregorian) Easter.
3. The whole world didn't adopt the Gregorian calendar at the same time. When it was adopted, 10 days were cut out so they could start fresh. Most of the world cut the 10 days in 1582, but Russia held out until 1918. Alaska cut the 10 days when it was purchased from Russia in 1867. Can you imagine the confusion of losing 10 days? And of having different areas be so off from one another? Think of all the birthdays that got thrown off!
The moral of this post being: Who knew calendars could be interesting and cool? And savor today a little more, cause you won't see it again for a while. :)

Nec fasc./Flesh-eating bacteria/Chompers

2008-02-28T23:03:00.009-05:00

"Necrotizing fasciitis. Explain...with pictures please."
Many names for one nasty disease. Necrotizing fasciitis is a type of deep tissue infection. (Fascia is the stuff between and around all your organs and muscles and blood vessels. Fasciitis is an inflammation of the fascia. Necrotizing means it kills cells and tissues.) It's caused by toxins that are produced by certain strains of bacteria, the most common of which is Group A Streptococcus (Group A strep is also known as Strep pyogenes and as GAS). There is no one type of bacteria that causes nec fasc. The bacteria destroy the deep tissue of the body, and it's fatal if not treated quickly and effectively.
Keep this bacteria away from me, please.
You might have toxin-producing GAS all over your skin right now, for all you know. (sleep tight!) But people who carry bacteria on or in them don't necessarily develop infections. Certain people can develop infections after surgery, or because they have breaks in the skin (like with eczema), or because they have a weakened immune system. Only very rarely do people actually develop necrotizing fasciitis.
So how do I know if I have it??
There are no specific symptoms, which makes it a bugger to pick up. And it progresses rapidly and is fatal if not treated quickly enough. Initial symptoms are similar to those of a soft-tissue infection, such as pain, swelling, or redness. But the infection doesn't always occur where the bacteria get in (like an open cut on your hand). They can travel around your bloodstream and set up shop anywhere they'd like.
A rapidly fatal disease with nebulous symptoms sounds like a nightmare to diagnose.
But that's what makes medicine fun! Sometimes you can put on your monacle and play Sherlock.
This sounds familiar...where have I heard of nec fasc before?
It's in a 'Scrubs' episode, where JD correctly diagnoses his patient with it (which he calls "Chompers") after watching a Friday night TV special on it. There was a recent article in The Boston Globe Magazine about a woman from central MA who developed this infection after having a C-section, and is now a quadruple-amputee (yes, you read that right). You can read about her amazing story here.
What about those pictures?
No way am I posting pics here. Google image "necrotizing fasciitis" at your own risk.
So how do you treat it?
Surgery! All of the dead and infected tissue has to be cut out, along with a margin of healthy tissue. Plus some potent antibiotics. Still, the mortality rate is 30%.
That's gross.
Yes. It is.

Antje Duvekot

2008-02-28T19:13:00.005-05:00

I thought this would be a good time to extoll the virtues of my newest (as of last fall, anyway) favorite singer. Her name is Antje Duvekot, and she's a German-American folk singer who lives in Somerville. I saw her a few weeks ago with a friend, and she was fantastic live. You can listen to some of her songs here. Though the Indigo Girls continue to hold the #1 spot in my heart, this chick is coming pretty close. You might have heard her in the new Bank of America ads (that show different pictures of the earth). You can read more about her on her website. I hope you like her stuff!

Post Questions here

2008-02-27T21:36:00.006-05:00

If you have random/fun/burning medical/health-related questions you'd like me to attempt to answer, please post 'em here. Thanks!

Pic

2008-02-27T20:30:00.006-05:00

At the request of Ms. Dennen: a photo to brighten up the blog. (Taken by her, of course.) Let's see if I'm computer-savvy enough to successfully post a photo....

Medical FAQ

2008-02-27T19:57:00.005-05:00

So what does ringworm look like?
It looks like a reddish ring on the skin. Like this or this. It can also be lighter than the skin color. The border is usually slightly raised and red, and the center is flat and lighter (so if you run your finger over it, you can only feel the edges). It can be found in areas of lighter hair growth, or, alternately, it may be in an area with some hair (like the forearm) but have no hair growing within the ring.
So it's a worm infection?
Nope, it's a fungal infection. Unclear etiology of the name ringworm, however, except that it's in the shape of a ring.
How do you get it?
Any type of contact with kids'll do it.
Ew, get it off me!
You can use any topical (meaning you put it on your skin) over-the-counter antifungal, like Monistat.

Jazz Music (aka Culture! Right here in Worcester!)

2008-02-27T19:07:00.005-05:00

So last night some friends and I decided to do something cultural (not quite making our quota of one Worcester-based cultural event per rotation, but close enough), and went to Mechanics Hall to see the Monterey Jazz Festival on their 50th anniversary tour. Although it was never fully explained why or how a festival can go on tour with 6 individual musicians, it was an awesome concert. The sax/flute player was 82 (!) years old, and the trumpet player just won a Grammy. We also felt very grown up (and thus like imposters) by drinking wine and schmoozing with members of the Worcester District Medical Society before the show. Until one of us (she remains nameless) (but not me) fell asleep during the show and then we collectively whined about the coat check line afterwards. Then I felt we were acting our age(s).

Welcome!

2008-02-27T19:00:00.005-05:00

Well, I've been thinking about starting a blog for a while, but, as so often happens, it remained a pipe dream until Natalie inspired me to do it. Even if this blog has only one reader (hi, dad!), I still think it'll be a fun thing to keep up for a while, especially if I'm traveling next year. While this is not intended to be a medically-themed blog, its creation was partially inspired by near-daily phone calls and emails I get from friends and family asking various random medical questions, most of which I don't know the answers to. So I thought it would be fun to 1. find the answers, and 2. post them up here, because maybe other people will be wondering what ringworm looks like, too.
Enjoy! And thanks for visiting. :)