Great Stuff

Here are two great products sure to improve our drab lives in the 21 century. The first one will revolutionize home safety, and the second will encourage you to include this item in your food storage plan.

Burger in a Can

Ethics

This week has been one of mixed productivity for studying. We had out ethics exam yesterday which was the first essay exam I've written in 4 years. There was a short answer section and two cases to analyze. The cases were as follows:

1. Elderly woman falls and breaks hip due to MI. Husband and daughter bring her in, she has respiratory failure (presumably put on a vent?). MD is discussing DNR order with family. Dad says no, daughter says sign DNR. Daughter says dad was diagnosed with dementia and that she is the decisional (a real word?) authority. What do you do? Sign DNR? What concerns need to be addressed?

2. Man cares for mom with Huntington's chorea. She dies a lingering death, and he proclaims to his friends that he doesn't want to go that way, he'd rather die. Man is married w/ children. He is depressed and an alcoholic, for which he sees a psychiatrist. He notices facial twitching and sees two neurologists, both of whom diagnose him with Huntington's. He visits his psychiatrist and asks for help committing suicide, which the psychiatrist refuses to do. The man goes home, ingests all of his anti-depressant medications, pins a note to his shirt saying he doesn't want to be rescusitated, then falls unconcious. His wife finds him, and drives him to the ER. You're the ER doc, what do you do?

Kosovo Independance

As we all know, Kosovo recently declared independance from Serbia earlier this week. In their haste to throw off their shackles, they neglected the most important part of any national self-determination movement: good music. Any good nation building time (or unifying) has great songs, from The Star Spangled Banner (yes, I know it's from the war of 1812), Yankee Doodle, the Marseilleise, British Grenadiers, Battle Hymn of the Republic and many others. I have taken the liberty of composing a new anthem for the Kosovars. With help from my fellow lyricisists Mindy and Emily, I present:

(Sung to the tune of "Kokomo" by the Beach Boys)
Kosovo

Slovenia, Croatia, OOH I wanna take you to Serbia and Bosnia
Come on Pretty Mama!
Vojvodina, Albania Baby why don't we go!
'Cross from Italee eee
There's a place called Kosovo

The folk's who're there, they want to get away from it all
Bodies in mass graves, Ethnic cleansing is part of this land
We'll be falling in love to the rythm of machine guns, man
Way Down in Kosovo

Slovenia, Croatia, OOH I wanna take you to Serbia and Bosnia
Come on Pretty Mama!
Vojvodina, Albania Baby why don't we go!
Down to Kosovo,
We'll get there fast and then we'll take it slow
That's where the UN goes, way down in Kosovo

Vukovar, that Kraljevo mystique
Adriatic Sea eee
Ethnic cleansing means purity
By and by we'll defy
Some UN sanctions don't you see

Secession feels right
Rockets and the missile's light
That Slavic look in your eye
give me a Balkan contact high
Way down in Kosovo

Slovenia, Croatia, OOH I wanna take you to Serbia and Bosnia
Come on Pretty Mama!
Vojvodina, Albania Baby why don't we go!
Down to Kosovo,
We'll get there fast and then we'll take it slow
That's where the UN goes, way down in Kosovo


Now the Serbs they know, a little place called Kosovo
Now if they want to be free and get away from it all,
Go down to Kosovo

Slovenia, Croatia, OOH I wanna take you to Serbia and Bosnia
Come on Pretty Mama!
Vojvodina, Albania Baby why don't we go!
Down to Kosovo,
We'll get there fast and then we'll take it slow
That's where the UN goes, way down in Kosovo

Great Medical Words:

I'm something of a word afficionado, and I particularly enjoy sonorous ones that just roll off the tongue. As I have studied, here are a few of the more interesting ones and their definitions:

Chancroid (Chang-kroid?) : STD caused by Hemophilus Ducreyi
Ataxia Telangectasia(just puzzle your way through it. the 'g' is a 'j' sound): Rare mutation in the TP53 (i think) protein that regulates the progression of the cell cycle in the presence of DNA damage. Rather than pausing, the cycle progresses even with damaged DNA, causing tumors. Patients with this mutation have NO tolerance for X-rays, or CT (since this is many sequential XR).
Pica: Basically you eat things that aren't food: clay, paint chips, hair from the barbershop floor, etc.
Schizont (sky-zont): The polynucleated (1000's) stage of life in a Protozoa, particularly the causative agents of malaria.
Gumma :A soft, non cancerous growth resulting from tertiary stage of syphillus

The cycle begins anew, and some other ramblings.

Exam: 1, Spiff : 0. The exam was extremely difficult. I didn't study all of the microbial toxins in detail, and, guess what was tested? Toxins. The next segment of micro will be viruses and parasites, while genetics will instruct me regarding cancer, lysosomal storage diseases ( Tay Sachs, Reffsums, Zellwegers, Gaucher's, etc). Genetics is shaping up to be much easier than my college genetics class. Before medical school, I thought that all of the classes would be much more difficult than in undergrad. The material itself is about at the 300-400 level, maybe a intro level grad course. In other words, it's not too complex. What makes it more challenging is the pace, which, while exhilirating, leaves no margin for error or illness. I would liken a medical school course to taking a 300 level course at 3x speed. We literally spent 1 week on information that it took me 4 weeks to cover in undergrad.

I recently read " Another day in the frontal lobe", by Dr. Katrina Firlink, a neurosurgeon. On the whole, the book is a little disorganized and the subtle traces of a hypercompetitive emotionally isolated author bleed through. Physicians (and nurses too) negotiate critical nexuses in the lives of their patients, which can make for poignant anecdotes. The author of "Another Day in the Fronal Lobe", however, relates these stories in a way that feels contrived, as though she is telling them to be seen as the tortured neurosurgeon, when she is in reality more callous or withdrawn. An amateur gestalt analysis of the author reveals her to be competitive, slightly coarse, and subtly overcompensating for some ancient flaw. Perhaps I judge her too harshly, though, as the practice of clinical medicine is still several years away for me, and I don't know how I will react to the daily grind of illness and pain.

I was particularly astonished at the contrast in my perception of futility versus that of the cowboy neurosurgeon. Why wheel an obtunded, terminal patient into the OR simply to prolong a ''life" by 2 weeks (note, this surgery was not about pain relief)? Especially if this was against the patients explicitly stated wishes? What are we treating here? the patient? or the doctor's own unwillingness to let go?

We have been discussing medical futility in my ethics course recently, and it seems remarkable that the class, as a whole, seems to be in general agreement on what constitutes a 'futile' intervention. Equally incredible is that most people seem to agree that maintaining someone in a PVS (persistent vegetative state: where the patient has no higher brain functions, but can breath and maintian heartbeat. The patient will have normal sleep/wake cycles, but is completely unresponsive to stimuli) indefinitely is ethically wrong. Perhaps it is our callous youth that enables us to judge the family members who choose this course as being wrong. Personally, I do think that such behavior is wasteful and unneccessary, though if it were my child on the bed, I would undoubtedly have a different, or at least more well informed, opinion. With such ticklish issues to discuss, what surprises me is the near unanimity of opinion regarding theses topics. The "right to die" discussion (FYI, there is no legally defined "right" to die. it doesn't exist in US law. ) was slightly more animated, but I think most of the people in my class, if practicing in Oregon, would never intentionally prescribe a lethal dose of medication. I'm not sure where I'm going with all this, but I hope to adress these topics again when I have more experience on the wards.

The Answers:

H. Influenza, Bordetella Pertussis, and Legionella all cause respiratory infections. Respectively they are: eppiglottitis and meningitis, whooping cough, and pneumonia.

Answers to 3 disgusting questions:
Kliebsiella
Psuedomonas Aerugenosa (BAD NEWS. you don't want this.)
Vibrio Cholera (not so common in north america.)

Critical Crud part the Seconde

I recieved a nasty surprise two weeks ago when I realized that "Critical Issues in Health Care", the course I detested fall term was scheduled to continue after Christmas. Fortunately last week, we had to make up our snow day so we cancelled CIHC. This week is an exam week, so, in my opinion, a poor week to have a 2 hour loss in study time. My classmates, judging from their actions, agree. As I have already related, CIHC is composed of medical students, social work students, and nursing students. Since there were assigned seats, I had to sit in the third row where I normally would sit in any class save this one. Looking down the rows in front of me and next to me, every medical student was studying micro on the sly. Without exaggeration, every single one was studying. The social work and nursing students were far more attentive, hopefully providing much needed camouflage while we tried to cram.

CIHC is not a class that provides a lot of useful information. Given that we're expected to memorize over 400 slides for micro, let alone master genetics, how can we be expected to pay rapt attention to a 2 hour presentation on "Using the Inter-disciplinary Team Effectively"? I think that as 3rd years, we'll learn pretty fast that: nurses see the patients more than we do and can provide useful information, that social work is helpful, so is PT, and the pharmacy can help as well. I doubt very much that anything more substantial than that will stick in my mind, at least from this lecture. I realize that there is more to medicine than science and data. In the first two years however, trying to drink from the fire hydrant is pretty pre-occupying . My feeling is that if you're already a jerk or someone who can't communicate effectively, then a 2 hour lecture once a week as an MSI is not going to make a great deal of difference. Well, my friends Hemophilus, Bordetella and Legionella are calling. (bonus points to the reader who can tell me what organ system these guys infect.)

Questions for the readers who thought the first question was too easy:
1.Pt coughs up "red currant" sputum. After being disgusted, you make the presumptive diagnosis of ______?
2. Your burn patient has fruity smelling blue pus coming from his wound. Immediately you suspect _______?
3. Your Sri Lankan patient has loose, "rice-water" stools. Fasting has no effect on the flow, which is nearly constant. After resourcefully cutting a hole into the mattress to facilitate drainage, you tell the patient he has _______?

OK, so those were gross. I only realized this after I wrote the questions, which I guess proves how far i've fallen. Answers will be posted on the next post.
-Spiff

Kodos For President

So, one day Kodos and Kang ran for president on opposing tickets, one Republican and one Democrat. When they confronted the skeptical public, they reminded them that:
Kodos: " you can't win! It's a two party system, one us will be president"
Lenny: "What if we vote for a third party candidate?"
Kang: Go Ahead! Throw your vote away!

And this neatly summarizes the race for the white house as I see it. I don't often wax political, but since this is an election year, this blog is my forum to rant. Currently there is no candidate that I want in the white house. Romney is now out, though I thought he had integrity and economic know-how. Hillary is not my choice, thank you, I don't think that her brand of American socialism is a sustainable model for "universal" health care. Barack? I don't know. Again, the ugly spectre of "universal" care is present.
Who is going to pay for it? Health care costs are rising geometrically, which means that a corresponding portion of the governement budget allocated to pay for it (either now with Medicare and Medicaid or through some future single payer plan) will rise commensurately. Easy! you say. We'll just pay more taxes, or more elegantly, we'll re-allocate current tax dollars. Hmm. possibly. Say we do raise taxes to match the increase. My high school econ (which, I admit, is rusty) says that taxation and revenue are related to the old Laffer curve. Theoretically, in the limit of infinite (100%) taxation, government revenue would paradoxically be $0. Why? because people won't work if they don't have some take home income. DUH you say. Of course they won't, and the government won't tax 100%. Yes, obviously. But the point is, as tax rates increase, government revenues decreases, above a certain point. So, if the cost of health care is increasing geometrically, theoretically there will be a point at which 100% of the federal budget will be allocated to health care. Dire? yes. Inevitable? I don't know.
All this brings us back to presidential canditates and why I am loathe to choose either Democrat candidate. So that leaves us with: McCain, the septugenarian war hero, Huckabee the Evangelical Yokel, Ron Paul, who wants to defund the government and return us to the American republic familiar to Andrew Jackson in the 1830's (from a political standpoint, not socially or technologically obviously). Since I am officially not registered with either party, I have no party lines to cross, and am free to vote as I please. What will happen in November? I don't think that the electoral process should involve voting for one candidate only to keep his/her opponent from attaining office. I did just that in 2004, and I regret it. I will probably write in a candidate, perhaps Colin Powell. He doesn't want the office, which means he's qualified to hold it. I don't care that he won't get elected (unless the readership of my blog consists of 55% of the US population and I convince them tool), at least I will have voted for the best candidate.

KODOS AND KANG '08