Almost MD

Random Links and Renal Cell

2004-10-04T11:35:00.000-05:00

Disclaimer: I write this in the throws of yet another caffeine high. For those who care, my radiology test went great (big shout out to my study partner Ashley Rowatt), so that’s one down three to go. In all reality, psych, path, and neuro make up the majority of my lectures so it’s more like “one down, nine to go” but semantics really aren’t my thing. Loyal readers of my blog will know my feelings about psych, thus right now my focus is squarely on the remaining two. Much like metastatic renal cell carcinoma, the multifocal nature of my study plan is causing some problems. I am now so hesitant to commit to either that I’m beginning to think I should run for office (give me the cheap shots, it’s late).

Time management is an important skill in medical school. It is also one that I don’t have. Thus the question “Is neuro more important than a new episode of Lost?” has an obvious, albeit inverted, answer. After finishing my show I am refreshed and ready to study. Why would anyone ask such an obviously rhetorical question?

Speaking of time management, I don’t have time for a witty rundown of all the happenings in the world of medicine, so here’s a list of some fun ones.

Something smells funny about this year’s Nobel prize.
MRIs can determine your hipness quotient.
Kidney swapping is all the rage.

So there you go, click and learn. Impress your friends. You’ll be the better for it and I, having not had to tell you about it, will have more time throw my psych book over the fence in protest.

Caffeine Highs and Cerebellar Peduncles

2004-09-29T23:39:00.000-05:00

They say to write what you know. So here goes nothing: squamous and small cell carcinomas are typically associated with smokers while adenocarcinoma has a higher incidence in women and nonsmokers. I could go on, but I’m guessing it wouldn’t be conducive to a high hit count. Blogroll me, the random pathology fact blog. I can see my counter spinning.

The truth is that my thoughts are consumed with random facts about lung cancer and the cerebellum. Midterm week is no time to consider trivial matters like food or friendships. There is minutia to cram and slides to study. Sleep? Sleep is for law students, I’ve got work to do. With hundreds of pages of path notes piling up around me I struggle to keep it all straight. Was it 11.p.13 that’s associated with Wilms’ tumor…or was that renal cell? My caffeine high is wearing off. Did Clarke’s nucleus project through the inferior cerebellar peduncle or was it the restiform body? I down my liquid legal stimulant and fight to stay conscious. Consciousness…from the reticular formation…uncal herniation….candy zebras….sadfasfalsk…zzzzzzzzz.

Virtual Reality and Basic Anatomy

2004-09-27T23:11:00.000-05:00

The what goes to the what what? Words so often in uttered in desperation as my friends and I stared down at our cadaver in complete ignorance. Picking through the fat and fascia, it was sometimes hard to understand the rational for our (seemingly) trivial anatomic explorations. Was it really so important that I know where the anterior superior pancreaticoduodenal artery became the inferior pancreaticoduodenal artery? While honesty dictates that I answer a resounding retrospective “No,” this negativity is hardly the general attitude I hold toward my first year anatomy experience.

I view anatomy lab as one of the formative experiences of my first year in medicine. As a second year, I study the pathology of a particular organ system and I remember that organ in my cadaver. How it felt. Where it was. What it looked like. If these facts had been written on a sheet of paper or flashed on a screen, I could say that I had seen the material before, but therein lies the caveat. Seeing with the eyes is almost a passive process that can easily be set to auto; anatomy lab is unique in that it involves a multisensory approach to comprehension. Touch is key to medicine and starts with what our professors referred to as a student’s first patient: his cadaver. I remember cardiac anatomy because I have held a heart in my hand and dissected out its secrets. I know the functions of the extra-ocular muscles because I have explored their movements on an actual specimen. Would I be willing to give up these experiences for a couple of extra hours of study time? No. Would I have learned the same amount of information from a 3-D computer program? No.

I guess this discussion was spurred on by a recent article in the NEJM as well as tonight’s marathon path study session. I just realized how important that facet of my education was to me and can’t imagine a complete medical education without it. Don’t get me wrong, I’m the geek who would be first in line to try holographic dissection, but you gotta admit, there is nothing quite like a good old-fashioned fat pickin.

Butt Sniffing and Bladder Cancer

2004-09-26T23:45:00.000-05:00

Lassie, you’ve come a long way, baby. Although not too long ago the only thing a dog could do was rescue little Timmy from the well, times have changed. It seems that their noses are good for more than a friendly anal greeting and can be trained to detect bladder cancer from a simple urine sample. A new study in the British Medical Journal confirms that the canine’s chances of being correct are about 41%. Indeed, like the piss prophets of Olde England, there is nothing they can’t discern from a simple plate of pee.

You might be wondering what this has to do with anything. Sure it’s cool that you can pee in a dish and run to your oncologist if it scares your Chihuahua, but one wonders why such a prestigious journal would publish such findings. Initially, it’s obvious that these dogs weren’t just guessing. In order for this to occur, there must have been some kind of volatile (i.e. smell-able) organic compound in the urine that indicated the presence of cancer. In oncology, any compound that marks the presence of a tumor is known as (brace yourself) a tumor marker. Thus it is clear that the dogs had knowledge of some previously unknown volatile tumor marker and this in itself is exciting news. Unfortunately, the study was content to hypothesize the existence of such a marker, but offered no indication of it’s proposed identity.

Other problems with the study included the lack of breed normalization and questionable training practices, however for further discussion of the research, I suggest you reference this page where the BMJ allows people to comment on the study. It is amazing to me the different ideas that people come up with in the world of medical research. Now if only we could train a shih tzu to diagnose colon cancer, that would really be a trick.

Backstabbing and Board Scores

2004-09-25T23:06:00.000-05:00

According to the Wilson Phillips song (or Ecclesiastes, depending on your cultural background) there is "A time to love, a time to hate." This was definitely a time to hate. One of my good friends at Vandy had been humiliated and it infuriated me. The details aren’t important (if you are at Vandy, I’m sure you have already heard), but what was most surprising about the whole ordeal was how shocking it was that it happened at all. One hundred and four type-A overachievers used to being number one in everything: by all rights our class should be one giant ring of continual backstabbing. One would expect this undercurrent of undercutting to be med school status quo, but sometimes expectations and reality are two very different entities.

At Vanderbilt there is a community among the students. I have never felt a spirit of competition from my fellow classmates but rather one of mutual goals and purposes. We might have different backgrounds but we are all trying to tackle the same overwhelming amount of medical knowledge and this common cause unites us. I guess this idealization of our academic interaction was what made the aforementioned offense so egregious. Even if it was provoked (which I doubt) there was no justification for the action.

I guess it is some consolation that the rumor mill is already in full force and the offender will be identified and routinely vilified by our class. However, it’s hard to think that this is the action of a future MD. No doubt this person will have excellent board scores and most likely match highly, but if those are the qualities that ultimately define an excellent physician, I’m in the wrong business.

Sickos and Socialized Medicine

2004-09-23T23:36:00.000-05:00

Prepare yourself American healthcare, you have a new enemy. Villanous traitor to some, ultimate patriot to others, Michael Moore is on the war path again. This time, however, the fight is not on the front lines of Iraq but rather on the wards of the hospital. Inspired by three Canadian teenagers he met while filming Bowling for Columbine, Mr. Moore has decided that Canadians have it better when it comes to healthcare. Sensing controversy, the director has wasted no time getting the cameras rolling on his latest shock doc tentatively entitled Sicko.

While the film’s intentions are not yet clear, it is appropriate to assume (based on celluloid precedent) that they will lie diametrically opposed to the current state of affairs. Mr. Moore is a shrewd businessman who senses the dollar in every contentious statement and knows he can work the public like a cash machine if he pushes the right buttons. To be fair, his high profile arguments have ignited a newfound social interest in many important issues and will no doubt continue to do so regarding the state of healthcare presented in his new film.

Reactions to Mr. Moore’s creations tend to be divided strictly along party lines, but I am interested to see the divisions created by Sicko’s socialized premise. The majority of my friends at Vanderbilt could not praise Fahrenheit 9/11 enough, however I wonder if they will sing a different tune when Mr. Moore’s lens rests squarely on their way of life. Is socialized healthcare a feasible alternative? Do Canadians have it better? For an animated discussion of these issues look no further than the IMDB message board for the film. Just a few quotes from some of the posts:

“As an accident prone Canadian, who has used our healthcare services numerous times in the past few years, I feel lucky to have a socialized health care system.”

“Bush is an imperialistic idiot, but Kerry's running mate, John Edwards, was a malpractice attorney (and always fought on the side of the insurance companies) and made his millions off of doctors.”

And my personal favorite:

“Go drink a Molson and calm down.”

Apparently Mr. Moore is already inciting argument and he hasn’t even filmed a frame. Go dig in your closet and get out your dirtiest pair of scrubs; this is really going to get messy.

Potty Snakes and Policy Debates

2004-09-22T23:35:00.000-05:00

Poisonous snakes in the toilet. Are you at risk? It was a slow day for news in Nashville. Today in our Media and Medicine elective, we took a field trip to a local news station and got to see the filming of, among other things, a follow up story to yesterday’s stunning toilet bowl serpent expose (nicknamed the “Potty Snake Story” at the station). What did all of this have to do with medicine you might ask. On Wednesdays, Channel 2 does their weekly health segment (today it concerned West Nile vaccines and herpes). After mentally commending the station for their contribution to West Nile hysteria, I proceeded to fix my attention on the woman crazily gesturing at a green wall. Turns out this was none other than Lisa Patton, storm tracker extraordinaire. Little inside weatherman tip: Penn State has a top notch meteorology program.

Although nothing was as cool as the green screen, we had a chance later to talk with a representative from the station’s parent company. It seems that the people with the money no longer want any “disease of the week” stories and are not planning on hiring dedicated medical reporters at any of their stations. “People go to cable or the internet for health news, it’s not worth our time.” He explained that there was not only a shift away from health news but also from any news at all. With the retirement of all three major anchors within the next five years, he predicted that news would be relegated to 24 hour cable channels in the near future.

When I asked how we as physicians could make our voices heard at a cable level, he explained that each news channel has its own criteria for story selection. The way he broke it down was you have to pitch to their focus. For example, Fox is all about issues so they would go for a policy debate story while CNN is more about scientific breakthroughs like a new vaccine trial. Overall it was an interesting experience but I can’t really write any more, I think I hear a water moccasin swimming in my toilet.

Boredom and Brain Tumors

2004-09-21T23:35:00.000-05:00

Just give her an Advil and send her home, I thought. It was becoming all too clear that what was meant to be a quick day of clinic was going to take much longer than I thought. How many reflexes can this girl have. Dr. Huffman seemed determine to test then all and, as he poked and prodded, I became more and more restless. Great, she can follow your finger with her eye, so can my parakeet and you don’t see it wasting the doctor’s time. I shifted and waited.

To those readers horrified by the thought that a medical student might be this uninformed and downright uncaring, let me allay your fears. This didn’t happen today (or yesterday for that matter). Although I must truthfully claim these thoughts as my own, they occurred two years ago when I was shadowing a doctor in Kentucky as part of my pre-med acceptance checklist. As a second year student, I now look back at those feelings with a mixture of embarrassment and amazement. Didn’t I care about the patient? (Let's file that question under “rhetorical” so I can avoid an honest answer.) If I had done my homework I would have realized that a headache can be one sign of a life threatening lesion in the brain and that the “finger test” is very important in the assessment of nerve function. The doctor was not wasting my time, he was simply being an excellent physician.

I went into the office hoping to learn something about medicine. As I look back on the experience, however, I realize that I learned almost nothing about medical practice. Instead, I have retrospectively learned volumes about my personal biases and motivations. Did I care more about the patient or my time? Although it is easy to blame inexperience as the source of my frustration, aggravation is an ever-present emotion on the wards. Maybe next year when I am dealing with a patient who is really being a pain in the neck, I’ll remember that girl with the headache and how my impatience could have cost her everything.

Memory Loss and Anatomical Minutia

2004-09-20T22:50:00.000-05:00

Is it bad to take pleasure in someone else’s pain? It’s not like I’m some sort of sadist, but today was the three hour review for the first year’s first anatomy exam and it made me extremely happy. Happy that I wasn’t sitting there terrified of tomorrow. Happy that I no longer care what arteries branch off of the thoracoacromial trunk. But most of all, happy that I don’t have an eight hour test on Thursday.

I know that this is gonna come full circle in a couple weeks with the arrival of our path midterm, but right now I am definitely reveling in my second year freedom. It was awesome to see just how far I have come since last year. I remember going through all of the rooms in awe of the vast knowledge of the second years and envious of their status. One vivid memory that pops into my mind was last year when I asked a second year how much she actually remembered from the lectures. She quickly responded that all the preparation she needed to teach the review session was a quick review of her notes. Bull crap. As an actual second year, I am now fully aware of just how much the omniscient second year class didn’t know as they pompously expounded on our notes. Granted, you don’t forget the important info, but really, who cares what constitutes the medial border of the quadrangular space (btw it’s the long head of the triceps for all you anatomy nerds).

I need all the encouragement I can get, and tonight was just a neat opportunity to see how far I have actually matured in my knowledge of medicine and (sometimes) life in general. It’s surprising what a little anatomy review can do for your mood. Who needs Prozac when you’ve got the axillary fossa?

Viral Binding and Paris Hilton

2004-09-19T22:27:00.000-05:00

I can’t tell which one looks more computer generated. While both images illustrate the effective application of modern chemistry, this article unfortunately concerns picture number two (me being a science nerd, it’s always a good bet to go with the most boring choice). Something you could ask about both pictures, however, might be “What the heck is it?” The answer, at least in the second case, would be virus but not much else. It seems that while modern science has been able to concoct plastic surgery out of food poisoning, they are at a loss to explain the actions of a little glob of protein. While it might be slightly unfair to blame the lack of knowledge on an academic shift from virus to Paris, the truth is that science knows relatively little about much of the pathogenesis of these organisms.

As we move into the future, however, a glimmer of hope has arisen from the ashes of despair. The source? None other than that tome of knowledge, the journal of Molecular and Cellular Proteomics. It seems that by taking a cell being attacked by a virus and blasting it with electrons, they have the first visual proof of a viral protease binding to DNA. By interacting with the genome the virus can alter the cellular protein machinery to do its will and thus rules forever as the supreme dictator of all things cellular!! Sorry, got a little carried away.

This news really is exciting, however, as it gives researchers the opportunity to make drugs tailored to attack the virus where it binds. These techniques can then be used to study the DNA binding habits of other viruses thus spawning additional meds. It’s like the circle of death (at least for the viruses). Now if you’ll excuse me, I have to go finish my research on the applications of modern science.

Irrational Fears and Journal Articles

2004-09-16T23:36:00.000-05:00

There was a time when I was afraid of the NEJM. The Journal and other medical sources only served to remind me of what I as a first year didn’t know and, more than likely, would never understand. It seems, however, that I am learning more than I think in my second year. Yesterday I encountered no less than five separate stories that not only directly applied to our classroom discussions but also concerned issues that I feel completely qualified to discuss. The debilitating pathologic course of Alzheimer’s disease, the debate concerning drug coated stents in PTCA, the clinical presentation of aortic dissection on an MRI, the mechanisms of ischemic heart disease, and the use of Peginterferon Alfa-2a Alone, Lamivudine Alone, and the Two in Combination in Patients with HBeAg-Negative Chronic Hepatitis B. (Ok, I lied about the last one, but you get the picture).

To be completely honest, my fear has its beginnings long before I started my first year at Vanderbilt. Unlike many pre-med students I was never one to religiously watch ER (in fact, I have never seen a complete episode), I didn’t really keep up with current medical research, and I was never heavily involved in the hospital system in high school or college. It wasn’t that these things didn’t interest me, they just served as reminders of the fact that I wasn’t going to get into medical school. You see, I had myself convinced that I was going to be the one who, no matter how hard he tried, could never make the jump from waiting list to acceptance. I would become the bitter grad student roaming the halls of academia mumbling obscenities at the MCAT and cursing passing med students.

Applying to medial school is an extremely public matter. Everyone you know knows. This knowledge hung over me like a thunderhead ready to strike me dead upon my final rejection letter. My technique of avoiding all that I am not good at has prevented me from publicly failing on numerous occasions (as well as completely stymieing my sports career). The application process, however, was unknown territory. There was no assurance of success, no preset way to win. My current status gives away the ending, but trust me, this was one heck of a step for me to take. The amazing year and half of classes have made it clear that my acceptance was worth the vulnerability it cost me to apply. However, I guess I should have known all along to go ahead with the Gamble; after all…that’s my middle name.

Divergent Strabismus and Artistic Genius

2004-09-15T23:11:00.000-05:00

Your mother lied to you. Turns out, crossing your eyes isn’t bad for you; in fact, it may be one of the keys to unlocking your inner genius according to this new article in the NEJM (for access, see this website, keyword: www.nejm.com). In a stirring example of academic priorities, one researcher at Harvard spent her time examining the self-portraits of Rembrandt and came to the stunning conclusion that the master may have had a walleye.

This is actually not as trivial as it may seem. According to the article, congenital divergent strabismus can result in the brain shutting off the input from the offending eye thus allowing normal viewing of the world. The affected individual is thus actually only looking through a single eye and subsequently loses all depth perception. If you have ever tried to paint anything, you know that creating depth is a problem. Here’s a hint, close one eye and you lose all knowledge of depth and effectively see a flat image, perfect for painting (ergo baby van Rijn was predestined for artistic superstardom).

Just my luck, the secret to creativity is revealed and my artistic journey has already come to an end. Although retroactive eye crossing provides slight improvement to my current body of work, there is really no telling where my foray in ceramics would have taken me had I known the secret of the lazy-eye. That enormous glazed monkey would have only been the beginning.

Crickets and Olives

2004-09-14T21:36:00.000-05:00

Chirp...Chirp....Chirp...I felt like I was at a campout. You know, the kind where you hike through beautiful mountains and spend the evening making smores around a blazing fire with the crickets gently lulling you to sleep. Except this wasn't the mountains, there was no fire, and I was not making smores. Instead, I was freezing in a smoreless lecture hall trying to distinguish a pyramid from an olive. Obviously for normal people this would not become a two hour ordeal, but (as you probably know) medical students are not normal people.

Let's get back to our insect friends. It seems that Nashville was feeling the effects of hurricane Frances and our second year classroom was flooded, thereby initiating a mini-Armageddon on our A/V equipment. One unforeseen consequence of this electronic holocaust was that the water puddles apparently created the ideal ecosystem to be colonized by Acheta Domesticus, and we are now serenaded by these arthropodal maestros throughout all of our medical lectures.

It is all I can do to keep from laughing when, at eight in the morning, our professor asks our class a question and the only answer is the faint chirp of crickets in the background. As sad as it may be, this has occasionally constituted the entirety of my attendance motivation on several predawn occasions. Currently, I am working on an EPA petition to declare the wet carpet at the front of our classroom an official wetlands. As long as there are olives and pyramids to find, so long shall the cricket sing.

Lifting Weights and Lung Cancer

2004-09-13T22:30:00.000-05:00

I stereotype. I know it’s wrong, but come on, who really wants to interact with strangers on a personal level. Unfamiliar engagement is dangerous. I might be forced to confront something I hate about myself, or worse, make a friend. By cheap classification of unfamiliarity, I can safely float along in my bubble, oblivious to outside culture and society. Now that we have that justification out of the way, on to Exhibit A.

Mr. Smith is a 55 yo obese white male who is experiencing extreme dyspnea upon exertion. Upon closer examination (by me in the locker room of my gym), he is noted to reek of cigarette smoke. After stereotyping his case as a classic “what you smoke is what you get”, I went on with my happy healthy day, congratulating myself on a successful diagnosis.

It never occurred to me to consider the circumstances surrounding our meeting, namely, a health club. It wasn’t like the guy was sitting at home smoking camels and eating nachos on his couch. So what if his clothes smelled. He might have been smoking since the fourth grade and trying desperately to quit. In reality, this guy cares just as much about his current health as I do and deserves nothing but my respect for his efforts. So here’s to you Mr. Smith; without you, I’d have nothing to write about today.

Study Time and Web Design

2004-09-12T21:21:00.000-05:00

Sunday afternoon: A time for picnics in the park, walks with your dog, or (if you happen to be a slave to the medical education institution) intense study sessions where you desperately try to fend off an impending sense of doom. For med students, Sunday is crunch time. As I prepared to face pathology head on, I had a sense that there was something else that needed to be done. So, after cleaning my room, washing my clothes, loading the dishwasher, and organizing my desk, I knew it was time to get down to business. My blog needed an updated design.

Inspired by one of my favorite shows on TV right now, Extreme Makeover: Home Edition (say what you want, it’s quality entertainment), I decided to do a little bit of extreme makeovering myself. As a self-confessed tech junkie, I didn’t think coding would be much of a problem. Apparently, knowing how to work an iPod doesn’t really qualify you to edit your own cascading style sheets. I quickly found this out, but I was determined. There would be an updated design by the 6:00 deadline. If Ty and company could do it, so could I.

While browsing through my seventy fifth help site for Photoshop, I felt the specter of pathology looming and decided that my efforts were sufficient for the day (one major advantage of not having a camera crew record your renovation exploits). Hopefully all you talented web designers can accept my site as a (rather pitiful) metaphor for my life: a work in progress.

Cheap Drugs and Long Lines

2004-09-11T23:16:00.000-05:00

What about Canada? A question I heard many times in our “Ecology of Healthcare” class at Vanderbilt. Privy to the fact that many med students blatantly lied about being caring compassionate missionaries to the uninsured, the administration has ensured our empathy pedagogically. Part of this compassion indoctrination involves the aforementioned ecology class, a roundtable discussion, where the each new issue never fails to bring out the advocate in at least one of my classmates.

It seems that there is a reflex pathway in many of my colleague’s brains that automatically elicits the Canadian query at the slightest invocation of the words uninsured, money, drug pricing, and Avril Lavigne. As tempted as I am to respond with the smart aleck “What about Canada?”, I hold my tongue and understand that their question is meant to be rhetorical. Canada, the land where babies are born for free and you can have a CT scan for less than a piece of bubble gum.

For right now, I am going to ignore the whole “senior citizen drug ring” angle and just focus on what the Canadians get out of their system. The answer, according to a new NY Times article, is crowded emergency rooms, physician shortages, and unbearably long lines (oh yeah, and free check-ups). I’m not going to summarize the article, but I wanted to comment on a surprising statement that was noted on the second page.

“The government statistical agency estimates that more than 3.6 million Canadians, representing nearly 15 percent of the population, do not have a family doctor. That remains better than in the United States, where an estimated 20 percent do not have a regular doctor.”

Huh? It’s free and yet they only have a measly 5% lower rate of people without regular healthcare. This with a system that still rewards their richest citizens with better care. I’m not arguing that there isn’t a problem in the US; I’m just noting the discrepancy between what is expected in their little medical utopia and reality.

Ophthalmoscopes and Crazy Misunderstandings

2004-09-09T23:29:00.000-05:00

Yes, I practiced using this today. No, it’s an ophthalmoscope (charging in the wall socket). We had "retina day" today in neuro and to celebrate the joyous occasion we got to use our brand new instruments and searched for each other’s foveae all morning. After a lengthy debate on the merits of PanOptic vs. Old School, we were finally ready to get down to business.

In about five minutes (the time it took my friends to assemble their panoptics) I was already catching my first glimpse of the “amazing wonders” of the optic disc. To be honest, I didn’t quite experience the love affair that Dr. Norden somehow shares with the fundus (speaking of, this website is too bizarre), but, I gotta admit, it was fairly cool to be able to see the back of the eye for the first time. As we practiced on each other amid the “I know your retina is burning, but I need to see the macula” and “come over and try Patti, she’s got nice pupils” we fumbled through our first introduction to the physical exam.

First impressions, I’m too quick to reach out and touch someone. I noticed my friend’s surprise as my hand was suddenly on his eyelid bearing down with my blinding beam; this reaction from someone that was expecting it. I quickly realized that I needed to let the “patient” know when I was going to touch them and tried to be deliberate in explaining the procedure to my subsequent victims.

Overall, I really enjoyed getting to apply what we learned conceptually in class in a (pseudo) clinical setting. Now, if I can just keep that mindset on prostate day…

Clinical Trials and Cover-ups

2004-09-08T23:15:00.000-05:00

There are some days that just make me glad I’m not the CEO of Pfizer. "Some" being the operative word here. Don’t get me wrong, I like Lear jets as much as the next guy, but new regulations proposed by the editors of everything from the NEJM to the CMJ (that’s Croatian Medical Journal to all you academic philistines) are about to make a lot of drug companies just a little unhappy. Specifically, a letter published today in the NEJM specifies that, in order to be considered for publication, a drug trial must initially be registered with a public trials registry.

The authors defend their position saying that the new registry will make long strides in preventing the practice of “selective reporting of trials” that has long been part of the seedy underbelly of academic medicine. (Ok, so it isn’t exactly Nip/Tuck, but we academics have to get our kicks where we can.) A NY Times’ article on the announcement notes that several major drug companies have recently adopted plans to begin self-reporting of their current and future clinical trials. In a swift critique of these statements, the Times is quick to reference the recent Paxil disaster. (Though not as quick as they were in pointing out the SIGNIFICANT lack of Republican database legislation. So much spin I’m gettin dizzy.)

This time, however, I’m gonna have to side with the Times. Trial reporting shouldn’t be a partisan issue. Drug companies have too much money riding on the next wonder drug to go around airing their dirty laundry in prestigious journals (as I mix metaphors like a mad literary DJ). It’s going to take more than a village to make these power players talk, and I think a little NEJM strong-arming might just be the incentive they need. After all, if it turned out the new treatment for migraines caused spontaneous schizophrenia, wouldn’t you and your (invisible) friends want to know?

Organ Donors and Art Shows

2004-09-07T22:55:00.001-05:00

"I have a historic mission to fulfill." – Gunther von Hagens. Mad man or artistic genius, you make the call. After eight years of touring Europe, Mr. von Hagens’ cadaveric sideshow Body Worlds has finally made the trans-Atlantic trip to California and will be on display from July 2nd to January 23rd. So buy your tickets quickly because Mr. von Hagens' proprietary plastination process isn’t completely effective and this may be a limited time offer.

For those of you who have not heard of the exhibit, Mr. von Hagens has constructed a display vaguely reminiscent of a scene from The Cell (minus JLo) where skinned human bodies are posed in various activities and impregnated with a preserving plastic. While this might sound like art to some and perversion to others, it certainly raises some important issues regarding both the appropriate use of cadavers and the role of the human body in society.

A Wired magazine article concerning the exhibition as well as the donation page on Mr. von Hagens’ own website make me wonder whether these specimens fully understood what their bodies were going to be used for after they died. If I knew, going into the whole donation process, that my naked body was going to be skinned, cut in half, hung from the ceiling, and subjected to a continual barrage of “size” jokes by every middle schooler in California, I might think twice about my decision.

Let’s go ahead and assume, however, that these bodies were donated by individuals fully aware of their post-mortem artistic journey. What then is the benefit to society due to this exhibit? (I guess if I were a true art aficionado, I wouldn’t care. Child porn was a big hit several years ago…see Zygotic acceleration, biogenetic, de-sublimated libidinal model by the Chapman Brothers …but I digress) When asked this same question, the artist evoked his liberation of anatomy from the clutches of the repressive medical society (my own biased paraphrase). While I agree that his works may inspire some to pursue a career in medicine…or serial killing…I wonder if there is a more sensitive way to inspire youngsters.

In all honesty, I am not too worked up about the whole exhibit. I wish there was more emphasis on the importance of organ donation for research and medical instruction than on the entertainment value of bisected pregnant women. However, the article also mentions an organ petting zoo where the kids can feel soot filled lungs and cirrhotic livers. Apparently, Mr. von Hagens ultimately realizes that his work does convey some social responsibility and if his bodies can be used to save the lives of future generations, it’s ok with me.

PS: To all my loyal readers, sorry about the lateness of this post. Blogger has been down all day.

Bioethics and Frozen Testes

2004-09-06T22:27:00.000-05:00

Whether “right wing fanatic” or “liberal nutcase,” most people have consummate convictions when it comes to the sensitive subject of bioethics. As soon as certain topics are breached, tempers flare and pundits exchange fire. Topics like cloning, stem cell research, post-mortem sperm retrieval, and…wait…did I just type post-mortem sperm retrieval? That’s right. Welcome to 21st century bioethics where you can have that family you never wanted, even after you’re dead!

A new article in the Times tells the compelling story of Mrs. Leisha Nebel-Taylor and her quest to procure a sample of her dead husband’s sperm. Luckily for her, Mrs. (or I guess Ms. given her hyphenated last name) Nebel-Taylor has discussed this idea with her husband previously (In all honesty though, who hasn’t?) and he gave his full blessing to the entire icy escapade. Bioethicists are fearful, however, that this growing trend of spermatic stockpiling may raise important questions concerning informed decisions.

Informed decisions by whom, exactly? By the father? I guess it depends on your worldview, but if he is hanging out in the sweet hereafter, I am guessing he wouldn’t get too worked up about his wife’s fertilization habits. So if the hubby doesn’t care, I guess the next logical part of the decision process would concern the family of the deceased. I can just see them in the waiting room: “Gladys, you don’t own him, you never did and if I want to aspirate a sperm sample, by golly I’m gonna aspirate.”

However beyond the classic mother/daughter-in-law testicular property rights debate, one must seriously consider the implications for the cadaverically conceived child. There are questions that will need to be answered at puberty and it might get a little tricky: “Johnny, when two people really love each other, sometimes the mommy takes the dead daddy’s sperm and…” I envision hours of post-“birds and cryogenic spermatozoa talk” therapy.

Turns out Mr. Taylor’s sperm weren’t too happy about his death and yet another bioethical disaster was narrowly averted. Just goes to show that any time you are dealing with these nuclear warheads with a tail (as one of my esteemed professors lovingly refers to sperm) you have to be sure what your motives are in searching for the weapons of mass destruction.

Web Counters and Admission Hints

2004-09-05T23:55:00.000-05:00

One hundred twenty two. I have to admit, I was surprised by the number of people that have visited my site since I started posting. Even if you don’t count the number of hits by my mom (Hi Mom!), it seems like there are a lot of people interested in what goes on in medical school.

I don’t have a lot to talk about tonight, but if you are reading my site and have a question about anything, just drop me a note. I would love to help out any students that are thinking about applying to med school or just answer general questions that anyone else might have. The reason I started this blog was to give people a chance to see what my life is like. So, if you have anything that you want me to cover, just let me know. Thanks for the visit.

Methylene Blue and Bacon

2004-09-04T22:32:00.000-05:00

With former President Clinton once again upstaging Kerry in the area of news coverage, the collective media mind has again become fixated on the number one killer of Americans. It turns out however, that there is more to fear from your bacon than artery clogging fat. In a shocking expose of sensational salt switching, the new drama “Medical Investigation” (which you have no doubt heard of if you saw more than thirty seconds of Olympic coverage) kicks off its first season with a classic case of mistaken molecular identity and subsequent blue New Yorkers.

I can’t speak for the entertainment value of the show, but Harold Varmus’ review of MI for the Times is one of the more amusing critiques I have read in a long time. From the title to his masterful use of sublime understatement, Varmus effectively deconstructs the premise of the show and rips into its obnoxious cast members and unrealistic epidemiologic research. (I would love to meet the producer who thinks that epidemiology makes for riveting prime time.) The most interesting thing about the article, however, is not its critique of the show, but rather the CDC article that Varmus links to at the end.

It’s a sad time for entertainment when a CDC report can generate a more interesting story than some of the more talented writers on television. I guess I should just be content that it isn’t some medically themed reality show. It is such a relief that no member of our profession would ever degrade themselves to that level. Who me? Cynical? Never!

Natalie Portman and Scrubs

2004-09-03T23:28:00.000-05:00

Just got back from seeing Garden State, the (semi) new movie from our "medical" friend Zach Braff. While a little overly quirky at times, the movie was overall an impressive debut. It was entertaining to see the way Mr. Braff seemed to deal with all the recent posts of my blog, moving from psychiatric issues to the pain of lost love to the vulnerablility of relationships. Guess universal themes are called that for a reason (granted, psychiatric issues aren't usually universal themes, but cut me some slack, it's late). Gotta get some sleep. Natalie Portman will be in my dreams tonight...

Cuckoos and Lewy Bodies

2004-09-02T22:17:00.000-05:00

Lewy Body Disorder: The fear that small silent people are living on your furniture (I paraphrase).

Just one of the fascinating facts that I learned today in our first psychiatry class. I hesitate to write about this subject because it forces me to make a somewhat embarrassing confession. I have always thought that psychiatry was a bunch of bunk (Insert Scientology joke here). I know that sounds horrible as someone going into the medical profession, but I have seen one too many criminals duck jail time by citing their extreme craziness. That, and my love of One Flew Over the Cuckoo’s Nest have instilled in me a inherent and, yes, irrational dislike of this subset of medicine.

It doesn’t help that I am constantly reminded of lesser nature of this specialty by every resdient who isn’t in psychiatry. Citing a defintion I heard recently: Psychiatry, the care of the id by the odd. I apologize to all the budding psychiatrists out there for my ignorance, but honestly, when our first reading contains the phrase “psychic energy,” I start thinking crystals, Stonehenge, and Enya. While this meditative state is enlightening, it doesn’t explain why these people are crazy.

I guess that has always been my hang-up with psychiatry, I never thought these doctors knew why any of it happened, they just shocked and drugged people until something worked. However, shrinks everywhere rejoice, my beautiful mind has reached a higher plane (sadly Enyaless) and I am learning a lot, even on my first day. Turns out, neuroscience is good for something after all and our textbook covers, in explicit detail, the proposed pathological changes in the brain leading to Schizophrenia. (For those who don’t already know, it has to do with functional hyperactivity in the dopamine system of the brain).

So science has once succeeded in elucidating an explanation for the seemingly inexplicable…now if only they could do something with the new Bjork album.

Hypertrophy and Hypochondria

2004-09-01T21:50:00.000-05:00

Eleven. The number of individuals that I passed in the Vanderbilt Hospital hallways on my way home from classes today. Included within this total were five obese people and two non-obese people (who, it should be noted, were smoking at the time). Who were the remaining four? Physicians, who all looked like they were training for the triathlon next weekend.

Why the discrepancy? Sure, my experimental methods might not be completely faultless. I mean there are fat doctors, we are almost all Type A, and you can’t forget the slimming effects of sleep deprivation and starvation. I feel, however, that my limited observations reflect a greater trend in the medical profession: nosophobia. We doctors (and students) are scared of getting sick and so we do everything in our power to prevent it. Eating healthy and working out are the norm rather than the exception among the med students I know.

Honestly, if we let obese people go into a cadaver lab and see what is truly going on inside their bodies, they would never again get a second helping. It worked for me. Granted, I wasn’t quite obese, but the eyeful of fat that I got every Tuesday and Thursday (both literatively and figuratively) made me rethink my frequent Frosty consumption. As I got to crack open the sclerotic aorta of someone dead from heart disease, I suddenly felt like a salad. Forty pounds later, I work out three times a week and do cardio for another three.

I still don’t like whole grain bread and consume more Pop-Tarts than a kindergarten class, but I am hoping that my healthier lifestyle might ward off an early heat attack or some other fun clinical correlation. I have to admit, after today’s path lecture, I am convinced that I will probably die in six months from aggressive pancreatic cancer (the hypochondria never really goes away), but at least I’ll present the coroner with one healthy heart.

Friendships and Hyperkeratosis

2004-08-31T21:34:00.000-05:00

"We can't have the happiness of yesterday without the pain of today. That's the deal." -Joy Gresham, Shadowlands.

Today in neuro, we discussed the books that we had read on Alzheimer's. If you have been following my posts, you know that mine was Losing My Mind by Thomas DeBaggio. I figured that it would just be a simple discussion about the sad nature of the disease and then I could go on with my day. Although the book was interesting and poignant, as someone who has no immediate family afflicted with this disease, I thought it wouldn't be a big deal to discuss it.

I was wrong. Dr. Norden has this way of approaching a topic so as to directly relate it to your personal life. I had never thought of having an individual that I love slowly slip away and become someone that they are not. Forty years of marriage obliterated by a simple little illness. How vulnerable we become when we truly love someone.

My friends in my pictures might be gone tomorrow and with each new friend, my odds of being hurt are increased. Should I gamble?

As a practicing physician, the stakes will be even higher. How can I empathize effectively and not be injured emotionally with every death on the wards? As I progress through medical school, the emotional callous is slowly forming. I am aware of this change and grateful to Dr. Norden for stressing the importance of emotion. What a shame to blindly pursue clinical competency at the expense of compassionate healing.

Cadavers and Cruises

2004-08-30T21:57:00.000-05:00

“Being dead is not terribly far off from being on a cruise ship. Most of your time is spent lying on your back. The brain has shut down. The flesh begins to soften. Nothing much new happens, and nothing is expected of you.” –Stiff: The Curious Lives of Human Cadavers by Mary Roach.

I love this book. Not many attempts at humor make me laugh out loud, but I was in tears throughout most of Ms. Roach’s hilarious tome. I first discovered her work in Reader’s Digest; her “My Planet” column is one (albeit small) highlight of my month. Although I can’t quite discern what makes her so funny to me, I think it’s her tone. The straightforward sarcastic nature of her columns is carried over into Stiff and makes for one of the most entertaining reads of my first year of medical school.

On a side note, on page 56 of the book, she quotes Dr. Art Dalley, Director of the Medical Anatomy Program at Vanderbilt University, who, by the way, happens to have taught me anatomy.

In this same chapter on medical cadavers, she is able to capture the awkward feelings that first year students often have from dealing with a dead human for hours on end. (Not to mention exposing the myth of the “well-endowed” cadaver.) As her anecdotes continue, she explores other aspects of cadaver history including human head transplants and medicinal cannibalism with humor black as night but funny as anything. Required reading for the first year student.

Wheelbarrows and Neurofibrillary Tangles

2004-08-29T21:44:00.000-05:00

The Red Wheelbarrow

So much depends upon
a red wheel barrow
glazed with rain water
beside the white chickens

-William Carlos Williams

Words that are no doubt familiar to many of you. I have heard it said that context is everything, and, while this poem certainly has significance to the human existence on its own merit, the context that I encountered it in today was both arresting and profoundly moving.

For our neuro class, we are required to choose a book that deals with the issue of neurological disease. Dr. Norden has stressed in class the profound impact that these problems have on the lives of those afflicted and their families and she wanted us to have some insight into their stories. I chose Losing My Mind by Thomas DeBaggio.

Mr. DeBaggio is one of the unfortunate sufferers of early onset familial Alzheimer’s. Losing My Mind chronicles his descent into the shadows of the disease with stark detail and frank honesty. In reference to the poem above, he cites the verses as a reference to “the relevance of small, familiar things, how they comfort and steady our lives.” These small familiar things were slowly being taken away from him as the tau protein in his brain became tangled knots of useless protein. Barriers on the path to memory.

I have discussed before how frequently I encounter difficulty when trying to relate to my patients. One of the exceptional remedies to this, I believe, common malady among physicians is the emerging genre of medical media. Through the stories of Mr. DeBaggio and others, I feel that I finally able to understand just a little of how they experience their illness. Perhaps true empathy depends on these brief glimpses of the red wheelbarrow.

Kupffer Cells and the Fornix

2004-08-28T13:55:00.000-05:00

Full disclosure…I can be a complete nerd. That being said, I get out and party with the rest of them. Last night at the John Mayer concert, due to my unfortunate reference of some random fact from path as a joke, I was routinely and, for the most part, rightly lambasted by my fellow classmates. No one wants to hear about school when we are supposed to be partying to forget our crazy lives.

My question is: How can we expect to separate our lives from medicine when medicine is our life? I know this is an important part of being a balanced individual in any profession. Certainly the idea of separating business and pleasure is not a new one. Maybe the conspicuous absence of a significant other makes my life more “educentric” than it would be otherwise. It just sometimes seems like learning this is more difficult than memorizing the clotting cascade…guess it’s all part of the medical maturation process.

Autoantibodies and American Football

2004-08-27T16:07:00.000-05:00

Crippling deformity, premature mortality, excruciating pain: Autoimmune diseases aren’t for wimps – Dr. McCurley. Basically, when you have one of these diseases there is a civil war going on inside of you and you are powerless to stop it. It was sobering to sit in class today and think about the thousands of people afflicted with rheumatoid arthritis, lupus, or scleroderma. As a student, I desire to relate to my patients and understand their conditions, but I can’t imagine what it must be like to experience terrible pain with every minute movement of your tiniest joint.

Judging by our lectures this morning it seemed like there isn’t much modern medicine can do for these patients. However, just recently, the NEJM (basically the “Bible” of medical research) published some encouraging articles concerning new drugs for the treatment of rheumatoid arthritis.

I think it is so amazing how much medicine has progressed in the last fifty years. Just yesterday Dr. Norden (my neuro prof) was telling us how all the information we know about communications in the brain (synapses for all you budding MDs) was less than fifty years old. How awesome that science has grown at such a tremendous rate. I am involved in some research here at Vandy and uniquely driven to learn more because I know that, ultimately, my findings may actually contribute positively to the quality of someone’s life.

So the NEJM article was a bright spot in a somewhat sad day, but tonight a group of us (meaning med students) are going to the John Mayer concert in Nashville. Should be fun, but since I didn’t have any pics for you yet of our auditory adventure, I wanted to post a pic collage I made of our VMSI vs. VMSII Annual Football Game. Vandy is full of traditions; this being one of the more violent ones. At the beginning of each year we all get together on one of the intramural fields and the girls of each class cheerlead while the guys pummel each other (Don’t get all worked up about gender stereotypes, a role reversal game is planned for next week). Good clean American fun!

Check back later tonight to find out about the concert. Surprise…some of us med students actually do go out.

Neuronal Cell and Tired Bodies

2004-08-26T21:20:00.000-05:00

Tangled axons shooting off synapsing with distant dendrites; my day was as chaotic as this picture (more on that later). Let’s start at the beginning: neuroscience. While this might not seem like your typical beginning, I have quickly found out that everyday in medical school has some kind of atypicality about it.

On Thursdays at Vandy we have neuro (as all of us MD wannabes call it) from 8:00-12:00. Our professor, Dr. Jeanette Norden, is an amazing lady. Every Tuesday and Thursday she inspires me to become a neurosurgeon.

Did you know that there are over 100 billion neurons in your brain and that each one of these cells has a specialize function and characteristic appearance (See fig. 1 above)?

The level of complexity in the brain awes me every time I go to study. Like Dr. Norden always says, the fact that any of us developed normally is a miracle. Simple but profound.

After lunch, we watched a video on the Tuskegee Syphilis Study and had discussion groups about the ethical issue surrounding the study. This experiment was documented in the Pulitzer Prize winning play Miss Evers' Boys by David Feldshuh. As someone from a neighboring county in Alabama, it was hard for me to hear Feldshuh’s story. I know how insidious this problem still is in the South and not much can make me angrier than the thought of racism to anyone in any form.

On a happier note, my new 20GB 4G iPod came in today and I am in love all over again. Did you know that an iPod can give you a better body? I am living proof. Working out is fun when you have a soundtrack.

After working out, I went to sing in Immune Response, our men’s choir at the medical school. It’s my first time and I am really excited. I was in glee club all four years at my undergrad (Asbury College) and the songs we are singing, Coney Island and For the Longest Time, are a lot of fun. If you have suggestions for us, just post a comment and let me know.

Working out was immediately followed by Bible study, shower, dinner, laundry, and an intense study session. Like I said, crazy day…but awesome…visual metaphors are cool.

Little Bit of Intro

2004-08-25T22:32:00.000-05:00

Rob Thomas, VMSII. My name and the little acronym that will define much of my life for the coming year. Letters that signify my place as a second year student at Vanderbilt Medical School. I figure that most people know someone who has been through the experience of a medical education. Still, as someone in the midst of it all, it seems like such an amazing experience that I want to share it with whoever is interested. So whether you are a pre-med student looking for some insight or simply an interested observer, my goal is to give you a glimpse into the amazing and challenging reality that is my life. If that sounds interesting to you, check back soon for updates. I am really excited about what this year has in store for me!