Sunday, July 31, 2005

A different point of view

Doing my clinical rotations I've become used to being in the hospital. I've gotten used to the sounds and sights -- beeping monitors, medical chatter, patients being transported from one room to another. But I got a different view of the scene today. My father was having chest pain and I took him to the hospital. It was strange sitting down in the ER as a visitor, being without the status and protection provided by my white coat. As we sat in the ER for 7 hours I was struck by how different my point of view has been. It's a much different experience waiting hours for a doctor to arrive, waiting to hear about test results, hearing your father being discussed as a room number -- "did you see the troponins for 7?" I'll have to learn from this experience -- don't keep patients and their families waiting for longer than is necessary, be honest and prompt when discussing test results. And most importantly, be cautious about having discussions in hallways and nurses stations.

Saturday, July 30, 2005

Movie Review: Charlie and the Chocolate Factory

Went to see Willie Wonka for the second time, and it was even better this time. When I saw it opening night I was just really excited and comparing it to the book and the Gene Wilder movie. This time I just watched it for itself... watching Johnny Depp's expressions and paying attention to the scenery and music. It is amazing! Depp does such an amazing job as Willie Wonka... nothing like Wilder's version but somehow closer to what I imagine Roald Dahl had imagined. Darker, more sinister, with a secret and a strange personality just barely beneath the surface. Dahl had an amazing way of writing stories for children that were entertaining but dark. I don't think parents realize just how creepy they can be. I think of that when people say that the Harry Potter books are too dark and scary for kids because evil continues to exist and characters die. Then I remember reading Witches where children are transformed into mice and slugs so that adults will unknowingly kill them -- does children's fiction get creepier? Anyway, Depp really captured that feeling. He really gave the impression that he had planned for the children to be disposed of in just those particular ways... like he knew their character flaws and set them up. A very cool way to play it, I think.

I second that

A cry for help from the Anonymous Clerk.
Here's what I'm looking for. I looking for success stories - inspirational stories. Any attending physicians or residents who happen to be reading, this is a message for you. Tell me how residency really wasn't that bad. Tell me how much you dreaded going from a relatively responsibility-free medstudent to a responsibility-laden physician. Tell me how rewarding your work is and how you could never picture yourself doing anything else.
I'm doing an away rotation at Stanford hospital. I'm pretty sure I saw Graham there today. I just spent 3 successive 14 hour days in the hospital. The shuttle here begins running after I've gone to work and stops running before I can leave. There's some pretty cool stuff that I've gotten to be involved in but in many significant ways IT SUCKS! Is this really what I want to be doing? I'm going to give up 4 of the potentially best years of my life for THIS? I'm a 4th year now, so it's getting to be about that time. My days are numbered. Doctors? Is it worth it?

I hear ya, clerk! So far he's only had one response, but I'm waiting for more. I need to read some more. Just this past week I had two residents tell me that if they didn't owe so much money in student loans they would find other careers. Not what I need to hear. It seems the only people who talk about medicine are complaining -- about the hours, the stress, the lawsuits and decreased compensation. It's so discouraging. I really enjoy seeing patients now, and I don't want to become jaded and cynical. Please say there's hope!

UPDATE: An uplifting post from Dr. Charles.
It’s there when I allow myself to listen, especially when the game clock is turned off with the last patient of each day. It’s there when I see the inimitable charisma of family, born of its individual members’ unique dysfunctions, talents, and stories. It’s there in the crate of homegrown eggplants brought into our office. It’s there in the wedding invitation of a woman I helped through incapacitating asthma and thyrotoxicosis. It’s there in the tears and laughter of the patients in whose life stories I’ve already sewed a few threads.

Sounds yummy

To counteract the previous post, some recipes I've found around the blogosphere. I'll copy them here so I can make them later.
First, from Julie at Glad Gastronome:
Sugar & Spice Drops
The name of this King Arthur Flour Cookie Companion recipe is very misleading. It makes me think of a snickerdoodle type cookie. Instead it is a wonderfully chewy, deep molassy, spicy flavored cookie. A plateful of these disappeared in short time when the book club came over.

Yield: 2 dozen cookies

1/2 cup vegetable oil
1/2 cup brown sugar
1/2 cup molasses
1 teaspoon baking powder
1 teaspoon baking soda
1/2 teaspoon salt
1 teaspoon cinnamon
1 teaspoon ground ginger
1/2 teaspoon nutmeg
1/4 teaspoon ground cloves
1-2/3 cups flour
Granulated sugar, for coating the dough

Preheat the oven to 350 degrees. Lightly grease (or line with parchment) two baking sheets.

In a medium-sized bowl, beat together the oil, brown sugar, molasses, baking powder, baking soda, salt and spices. Mix in flour.

Shape or scoop the dough into 1-1/2 inch balls. A tablespoon cookie scoop can be used to portion the dough. Roll the balls in granulated sugar and place them on the prepared baking sheets. Use a fork to press a crisscross pattern into the top of each.

Bake the cookies for 10 minutes, or until they're set. Remove them from the oven and transfer to a rack to cool.

Second, from Vodka Pundit:
Heat Wave Penne

You'll need:

Four Roma tomatoes, chopped and seeded
About a half cup of fresh basil, chopped
8oz fresh mozzarella (the round kind you get in the water-filled container), sliced into 1/2" strips
4oz Prosciutto, sliced the same way
3 tablespoons extra virgin olive oil
1 tablespoon red wine vinegar
Enough penne for 2-4 people
Salt & pepper
Got everything chopped and sliced according to the directions? Then the hard work is done. Take everything but the pasta and mix it together in a bowl. Season to taste with salt & pepper. Let it sit out on the counter for an hour while you enjoy a gin & tonic.

Boil the penne for 13 minutes, strain, then pour back into the pot. Throw the tomato/basil/cheese/Prociutto mixture in with it, and gently toss.

If you're feeling really ambitious, you could make a salad, too. One head of butter lettuce, cleaned, torn, and chilled. Make the dressing by beating together a tablespoon or two of olive oil, 2 teaspoons or so of balsamic vinegar, 1 crushed clove of garlic, a squeeze of fresh lemon juice, a pinch of salt and three turns of the pepper mill. If there's any basil left over from the pasta, throw it in the dressing. You can put the salad together while the pasta is boiling.

Enjoy with a slightly chilled Chianti, and try to ignore the heat.

I'll be trying the pasta soon as the current heat index of 110 is killing me.

Diet and Exercise

I found tips for weight loss from the Royal Navy over at Glad Gastronome. Sounds vigorous but promising.
As a public service, SC&A will provide you with the last diet you'll ever use. We're serious. It is commonly used by members of the Royal Navy. The diet is comprised of two parts- diet and exercise, each dictated by certain factors.

Let's say you are a male, weighing 220 lbs, who wants to weigh 180 lbs.

Take the desired weight (in this case, 180), multiply by 10. That is the number of calories you can consume in a day. In this example, the caloric intake cannot exceed 1,800 calories.

That is the first part. Next comes the exercise part.

To calculate the required amount of exercise follows: Take your current weight and again, multiply by a factor of 10 -- in this case, 220 multiplied by 10 equals 2,200.

Each factor of 1000 means 1 hour of exercise. In this case, 2200 means 2.2 hours of moderate exercise, such as walking.

The preferred method would divide the exercise into 2 or more equal sessions.

Let's say you are woman, who weighs 175 lbs, and your desired weight it 130 lbs.

Multiply your desired weight (130) by 10 to yield the number of calories allowed per day -- 1,300.

Multiply your current weight (175) by 10, to yield the amount and time of exercise that must be expended -- in this case, 1,750, meaning 1.75 hours per day.

Remember, it is best if the exercise is divided into at least 2 times per day. For example, in the example, that means about 50 minutes of walking, twice a day.

We have seen the diet work and we have used it ourselves. We have seen in two instances, the loss of up to 60 lbs and 90 lbs respectively, in 90 days or less. Naturally, lesser amounts of weight have been lost in that time.

To be most effective, the amount of exercise should remain constant if you want to lose weight quickly. In other words, if you lose most of the weight, it is still best to do the same amount of exercise as you did when you started.

I won't disclose how much I'll need to be working out, let's just say that 30 minutes of walking won't cut it.

Fave Children's Books

Althouse is dicussing her favorite children's books. An interesting question and one that I find difficult to answer. I was an avid reader as a kid, as I am now, and I enjoy rereading the books that I used to love. I have recently reread all the Rohald Dahl books and have plans to reread the Chronicles of Narnia. But thinking back, I think the book that really had an effect on me and made me think was Summer of My German Soldier.
The summer that Patty Bergen turns twelve is a summer that will haunt her forever. When her small hometown in Arkansas becomes the site of a camp housing German prisoners during World War II, Patty learns what it means to open her heart. Even though she's Jewish, she begins to see a prison escapee, Anton, not as a Nazi, but as a lonely, frightened young man with feelings not unlike her own.

In Anton, Patty finds someone who softens the pain of her own father's rejection and who appreciates her in a way her mother never will. While patriotic feelings run high, Patty risks losing family, friends — even her freedom — for this dangerous friendship. It is a risk she has to take and one she will have to pay a price to keep.

I remember laying in bed at night and reading this book. Feeling so sorry for Patty because her father is so cruel to her, and admiring the courage she had to live through his treatment. And the courage it took to befriend Anton. I felt esp drawn to the story as my father is German and moved to the US after his father died serving in the German army during WWII. I was impressed by the sympathetic portrait of Anton. It is so easy to demonize the German soldiers since the Nazis did such horrible things, but it should be remembered that not all the soldiers believed in Hitler's vision. Many were forced to fight or had no other means of making money in the depression that followed WWI.

Movie Review: Must Love Dogs

As a movie junkie I go to the theater every weekend to see the latest release. And I've been seeing previews for Must Love Dogs for months. It looked great and what's not to like about John Cusack. So I went to see it, and I was very disappointed. John Cusack was wonderful, as usual. He was awkward but adorable, with random comments just falling out of his mouth. Sometimes funny and sometimes touching, he's the kind of guy I would fall for. I esp. loved him watching Dr. Zhivago over and over again. Just the kind of thing that I do. Unfortunately he just wasn't given enough to work with. The script was flat with even the great lines that appeared in the preview not seeming as funny when viewed in context. And Diane Lane's character held little appeal. Another movie where I can see all the qualities in the male lead that make him appealing, but the female lead is... attractive. Not smart, funny, personable. Just generic and pretty. I also didn't get the feeling that she really fell in love with John Cusack's character. More that she was lonely and couldn't find anyone but hey, that guy from the dog park really likes me, so why not.

Mirror moment of the movie: "What about all the women who are alone, reading Jane Austen, and eating tubs of ice cream?"

Stem Cell Research

Since I'm involved in health care I see the possibility offered by stem cell research, but as a Catholic I believe the practice of destroying embryos for this research is immoral. As such, I agree with the ban on federal funding for such research. It obviously still occurs, I just shouldn't have to pay for it.
Bill Kristol at the Weekly Standard weighs in on the latest debate, and says it all much more eloquently that I would.
For four years, embryo research advocates have claimed that the Bush administration has "banned stem cell research." Not so. The issue in question is federal funding for embryonic stem cell research--research in which new embryos will be destroyed. Such research has been, and is, legal, and while the president has endorsed a ban on human cloning, he has not proposed to outlaw the destruction of embryos created through in vitro fertilization (IVF). He simply does not want the federal government to fund or promote research that requires the ongoing destruction of embryos.

Read the whole thing.

Not more tests!

Ah, the joy of the USMLE exams. I took the new Clinical Skills exam last week... what a waste of time and money. Had to drive 3 hours to the nearest testing site, stay overnight in a hotel, and then spend 7 hours interviewing standardized patients and writing encounter notes. All to show that I have some social skills and command of the English language. And it only cost me $1000! If they really want med students to show that we are capable to taking H&Ps, developing a differential diagnosis and treatment plan, and having some bedside manner, then there should be a required OSCE given at each med school. My school has them anyway, and they are much better run than the national one. The USMLE CS cases were ridiculous -- patient with abdominal pain, clearly not surgical but a history diverse enough to account for all possibilities and a completely normal physical exam. In writing my note, what do I proove? That I can look at a chief complaint and come up with a differential and list of labs that cover every possibility. Not exactly what happens in the real world. Real patients have specific complaints and physical exam findings that point the doctor in a certain direction. But not the SPs. They often seemed deliberately vague. "Describe my pain? Well, it's pretty bad."
The worst part about the CS exam is that it takes up time. I felt ridiculous trying to prep for it -- read through the First Aid book with case examples -- but felt like I had to because failing it would be more than embarressing. But the Clinical Knowledge exam -- ya know, the real test -- is in 3 weeks and I really need to devote all my study time to it. I wish they would just admit that this whole thing is about getting more money from us. Then they could just up the price of the other steps and save us all some time.

Resuming Life

I've dropped off the face of the earth for awhile... I guess that's what happens during the dreaded Surgery rotation. It really was 8 weeks of hell. Eventually I stopped hating the OR and was able to make it through cases without wanting to kill myself, but I just wasn't a fan of the people. Some of the residents were such jerks! I really thought that the "you're insignificant, now go get me some coffee" mentality had ended, but apparently not. I can handle a certain level of arrogance from attendings, but the interns really piss me off. I mean, they just graduated a year ago and really don't do much more on the team than I do. Actually I get to scrub in on a lot more cases then they do. But a few of them were horrible to work with. My problem is that I can only put up with assholes for a finite amount of time and then I start to crack. The end came when, 5 weeks into the rotation, my intern told me to answer the phone. Nevermind that he was sitting right next to it and he was expecting a call. My reponse? "You're kidding, right?" Yeah, definitely the beginning of the end.
Good news: It's over and I passed.
Bad news: Even though I kicked ass on the shelf test, my evals dropped my a letter grade. Gotta watch the attitude in the future.