Tuesday, December 2, 2008

Old people

Life expectancy by country
You have to scroll way down for the United States!

Statin use in people with normal cholesterol
Basically, this article states that there may be some indications for statin use in people that have a normal cholesterol level if they have elevated CRP (C-reative protein) in their blood. CRP is a biomarker of inflammation, which may have some role in the developement of heart disease. Statins lower the CRP and may prevent heart disease in these people. Interesting.

Doesn't everyone want to be the enthusiastic, energetic old person that makes everyone laugh and lightens the mood? I sure do. I don't want to be the old fat slug lying in the hospital that won't get out of bed, and just occasionally grunts for food. Life is so amazingly short, I just have to constantly remind myself of these things, in hopes that I won't get much fatter than my present "fatness."

Monday, November 17, 2008

I am Sorry, I can't help you

"I have pain...." Mrs. Robinson said as I took a seat on the stool in the corner. "Ok", I thought. Somehow, I knew where this one was headed. Before making my way into the room, I had informed myself. The patient, Mr. Robinson, had a long and well, painful history with pain. Fibromyalgia, fibroids, endometriosis, restless leg syndrome, and on and on and on. Turns out she had pain with intercourse (dyspareunia) with recent onset. Her symptoms had come and gone over the past several years, with periods of time that offered relief, quickly followed by more pain. I, unfortunately, had little to offer. Nevermind the real issues at hand, probably an overweight, insensitive husband that had been married to a withdrawl, super-sensitive woman for 20 years, and a shell of a marriage that existed in terms of a few minutes of sex once every few weeks. How was I supposed to address this with a woman I hardly knew, with only 15 minutes?!?

She got an ultrasound, an exam, and some lortab.

My pager beeped as I slowly began to rouse in bed. Not that this was a comfortable bed, but more one designed to make sleep as painful as possible. Maybe, that way, it was easier to get up to the sound of this damned pager. Because medical students are the last one to get the most important trauma pages, I rolled around the corner just as the patient rolled into the bay. A 25 year old male, drunk and high, had a not-so-pleasant meeting with a mailbox. Unfortunately, it met his head while he was on a motorcycle at 45 mph. And what a meeting it was....

There was little we could do, and the last memory I will ever remember of this man is his father running down the hall screaming "Mi nino! Mi nino! Mi nino!" all the while, falling and getting up repeatedly, while wailing and mourning like few have ever seen. As he saw his son die before his eyes, the look in his eyes was such that I will never forget. I have never seen such sorrow in a mans face, all the while, we were the doctors, and we were supposed to do something. Something--anything.....and we did. But it didn't matter. We let that father down that day. To this day, I can see that man in my mind's eye like I am still there, and it brings me to tears to even think about it 2 years later.

There is something about the white coat that is reassuring, and arrogant. It says to everyone that sees it, "I have all the answers." (and believe me, I like to think that I do.) The truth though, is shamefully different. While doctors have saved millions of people from diseases like cancers, heart attacks, TB, appendicitis (yes, people died of that); we are only what we are. The man in the motorcycle accident was drunk and high, and the woman was ignorant of her real problems, but medical school taught doctors that we heal. Unfortunately, we can't always do that and although its easy to say, its hard to do.

Life isn't simple or straightforward. That man, did he deserve to die for being smashed out of his mind (quite literally)? No. Its all life and death decisions that are made without knowing the severity of the consequences, and its a bit much for one human being to see unfold in front of his sleepy eyes at 3am on a Tuesday morning. Mrs. Robinson may never find relief, probably because medicine doesn't have time to deal with a problem that has no quick fix. If it isn't ugly, I don't know what to call it.

Sunday, November 16, 2008

First things first

The purpose of this blog is for me to experiment with writing as it relates to medicine. For those of you that might stumble on this blog through the randomness of the internet, I am going to direct my writing and thoughts toward medicine. The majority of my interaction with medicine and the medical world comes through the Air Force, and my general surgery residency at Keesler Air Force Base.

Although I wouldn't necessarily call the Kessler Hopital a true "medical center", that's what I will refer to it for simplicity sake (and because thats what it's actually called). Because many of my experiences are negative, thats how this blog may feel--negative--thus the title, "Ugly Medicine." Sitting in the few interviews for medical school that I was fortunate enough to get (I wasn't the ideal student, i.e. I had hobbies besides reading, eating, and breathing medicine) was enough to make me think that the practice of medicine had simple ideals and goals. That idea was correct, but the implication of those goals is where things begin to fall apart, or at least get sloppy. But, I should have been smart enough to know that where people get involved, things get ugly.

The first two years of medical school were painfully boring. Looking back now, it would have been helpful to have a framework to put the minutia in, but I didn't have a big picture. As a result, knowing the rediculous details of cell biology fell on deaf (and bored) ears. During the second two years, I felt like I lacked a direction. As residency became nearer, I picked what seemed to be a rewarding career and one that allowed free time--Emergency Medicine. However, thanks to my signature on a military contract, I landed in Biloxi, MS doing a surgical internship.

That gets us to now, and I'll fill in the details as the blog progresses.