I become the patient

I came out of the shower and dried myself with a huge white towel. Something caught my eye. What was that on my back? It was dark, but I couldn't get a good look at it, even with all the mirrors in my bathroom. I'd never noticed it before.

A few days later, I became more worried. Could it be the dreaded melanoma? I had recently seen several patients die of metastatic melanoma in the hospital, and they were terrible, slow, painful deaths. I was rather young for such a thing, and I tend to wear sunscreen and keep out of the sun when I can. But there was still a chance. And if it was the real deal, catching it early was my only hope. If it invades more than 1 millimeter into my skin, my five year survival (the odds that I would live longer than five years) drops off a cliff. I couldn't let this go.

Since I couldn't see it well, I took pictures of it with my digital camera. I saw that it met all the ABCD's of melanoma. It was Asymmetric. Its Border was ragged. It was comprised of two or more different Colors. And its Diameter was greater than a pencil eraser. Shit. This could be bad. Should have used more sunscreen. I suddenly remembered the blistering sunburns of my youth. That time in Saudi Arabia when my skin was peeling right off my back. All those times I went water-skiing without sunscreen. Those blistering sunburn drastically increase your odds of skin cancer.

So I went to the Dermatology department to try to make an appointment. They asked to see my insurance card. Then they told me that the first available appointment was in late November. Really? I'm supposed to wait more than two months with a time bomb on my back?

That afternoon, I decided to take matters into my own hands. I would not wait that long if I could help it. I left the pediatric neurology clinic in which I was working, and headed towards the derm clinic. I tracked down the doctor I was after, and introduced myself. "Hi Dr. B! I'm me. You worked with my dad a while back. I have this thing on my back, and I think it might be a melanoma."

He was so nice. He immediately took me into a room so he could look at it. He thought it was suspicious, so a few minutes later, he took a biopsy of it. He asked for my pager number so he could give me the results as soon as he read the slides (he's also a dermatopathologist). Now I have quite a few stitches in my back, but at least I know that I, and the little piece of my back, are in good hands.

The Nile

A patient comes in today. Middle-aged man, slightly balding. He had headaches that just wouldn't go away. So we got a MRI of his brain. The official report hadn't come in yet, but the images were on the computer. So I glanced through them.

MRI is an amazing thing. With the click of my mouse, I can fly through cross sections of a person's brain, seeing it in exquisite detail. I can see, millimeter by millimeter, what makes you who you are.

As I flew through the cross sections, I started to see bright spots at the junction of the gray and white matter. There were ar least four to my untrained eye. I called over the resident (a junior doctor). He agreed. Lesions at the gray-white interface are pathognomonic for metastatic cancer. The patient's prognosis was dismal.

The resident and I went into the patient's room to tell him the news. His wife was there.

"The results of the MRI are not good," the resident told him. "We think you have cancer in your brain. The prognosis is not good."

He looked at us for a while, not showing much emotion. I tried to picture myself in his position, but couldn't. I had no idea what I would do or say or think.

He said, "Jesus will heal me!" "I'll be fine, 'cause Jesus will heal me!"



Denial ain't just a river in Egypt.
-Mark Twain

Crazy People

Mr. T came to the hospital to detox for his sixth time, and he was only 25 years old. He was taking large amounts of Valium, booze, and opiates, as usual. So we detoxed him, giving him meds that would make him more comfortable while he withdrew from the drugs.

He would come up to me, seemingly from nowhere, and beg for more. He said the withdrawl was unbearable. He hadn't slept for days. He was anxious. He was sweating. He felt like he was crawling out of his skin.

And then he started to pee blood. A lot of blood. Oh shit. And on top of that, he had a urinary tract infection. He had a history of kidney stones, which can cause bloody urine as they pass through. And he described in perfect detail the exact location and excrutiating pain a kidney stone can cause.

He wanted opiates for his pain. If it were anyone else, we would have given it to him.

So we got a consult from Nephrology. They said that the bacterium cultured from his urine usually didn't cause UTI's. We started him on antibiotics. A CT scan confirmed that there were stones in his kidneys, but unless the stones actually pass through, they shouldn't cause any pain.

Then we got a Urology consult. They said his bloody urine was almost certainly due to "self manipulation." This translates to him shoving a coat hanger into his penis, all the way through his urethra, and then into his bladder, and then whirling it around. All to get opiates.

We discharged him a few days later. He was supposed to go to an inpatient drug treatment program the very next day (we had set up everything for him). But he relapsed, again, and nearly died, again. So now he's detoxing at yet another hospital.

At first I was furious. Furious that he had misled us. That we had wasted thousands of dollars for needless tests and consults. Money that could have probably saved several lives elsewhere in the world. All because this idiot was a druggie.

And then I felt sorry for him. Genuinely sorry. I wondered how a person would have to feel to do such a thing. To fake kidney stones with a coat hanger just to get some drugs. Never before had I realized the power of addiction could be so strong. So strong as to take over everything that you have been, or ever will be.

Death

The thought of death is terrifying to me. You would think, being a medical student, that it would be natural... In some ways it is. But in almost all ways it's not. The permanance. The feeling of never feeling anything ever again. The emptyness. The abscence of anything. That scares me. I will be zero. Just a memory in someone's mind.
It really came home today when one of my professors, in Neurology, said it quite plainly: We are only future cadavers.
In many ways, I had only dealt with death superficially. It happened to other people. My job is to help prevent it, or if I can't, I am to make it as comfortable and palatable as possible.
Now I understand why people want children so badly. It is their way of cheating death. The one way of outliving one's self.
But still I can hardly imagine myself dead. The stagnation of it all. I would think it boring, but that implies consciousness. I can only hope that the purpose of my life is to provide comfort to those who need it the most. To those who have nothing else. To those who know the end is near.

Coxing while intoxicated?

So this saturday, I got up at 6 in the morning so I could be rowing at 7. The only problem is that our coxswain was half an hour late. Her mom dropped her off at the lake. She said she was really sorry, and that she had had a late night (going to bed at 5 in the morning to be exact). She said she was still drunk from the night before, after having quite a few drinks with her friends. And from the way she coxed the boat, she still clearly was. The smell of vodka on her breath was still strong. We joked weather she could get in trouble for coxing while drunk. But all was good, and we had a good row, even if I got quite sunburned in the process.

I spent most of last night and this morning figuring out how to replace the battery in the cox box (the thing that amplifys the coxsain's voice). I went to wal mart and found some RC car batteries, which were perfect (600 Mah NI-CD's). After a lot of soldering, the cox box is working again. Yay for saving a few hundred bucks.

So much has happened

So I spent this summer in England, studying for Step I of the NBME examination (the first step to becoming a licensed physician). This was probably not the best decision I've ever made, since there were plenty of distractions and other stuff to do.

We went to the Isle of Man for a vacation. This cost a fortune (as everything does when the dollar is so weak) but it was well worth it. We stayed at the Wicklow Hills hotel, which is within a half hour walk of the ferry terminal. A guy was waiting outside, and greeted us as we walked up to the place (at 1 in the morning). "Mr. and Mrs. XXXXXX? Welcome to the wicklow hills!" He showed us to our room, and told us that we could arrange payment the next day. Fucking amazing service.

Wow, so much has happened since I last posted. I went to England to study for my step I board exams, and that seemed to go fairly well. While in England, I went to the Isle of Man, went to the Cambridge Beer festival, got chased down an alley by a drunk guy bent on hurting me, and had a jolly good time overall.

I got back to the US. I studied a lot. I took the boards exam, and think I did ok. And now I'm starting the third year of med school.

Wow, I'm half of a doctor already. Who would have known?

MedWars

So let me tell you about MedWars. It's an adventure race with a medical theme to it. This year it was held in Augusta, Georgia at an army fort there.

We left Nashville an hour late because V screwed up her schedule. We got there late, but I slept like a log on my wonderful thermarest.

The next morning, we registered and got everything ready. V hadn't brought a pack with her, but by some miracle, I decided to bring two, just in case I wanted to use a larger one. Then I saw V in jeans. She was the only one there with jeans on. I tried to get her to put on my spare north face pants (which would have fit her fine) but she refused. "If my jeans get wet, I'll put on my other pair of jeans!"

The race started at 11 AM. We got slightly lost, but not too bad. Three hours in, we had to cross a swamp - and the only way across was to wade (swim) through. I was up to my neck in water (and I'm 6' 2") and decided it would be easier to swin than to try to keep my pack dry by holding it over my head.

Afterwards, V changed into her spare jeans. I simply took off my shirt and hopped around to keep warm.

And then it started to pour. And it got much colder - into the 50's. V forgot to bring a jacket. All she had were her soaking wet jeans and a tank top. I gave her my jacket to keep her from serious hypothermia.

And then her hip started hurting. She walked slowly, and would sometimes simply stop and sit on the side of the trail. I ran in place to try to keep warm. At this point, I was shivering constantly.

At the last checkpoint, me missed the time cutoff my 15 minutes, and were disqualified. It continued to rain constantly. We walked back to the campsite. The tents were soaked. M had no clothes, so I put her in my car and warmed it up. My hands had trouble gripping anything.

And after 7 hours of driving, we were finally home, and I got to bed at 3:30 in the morning.

Purgatory?

I was talking with a few med school friends the other day. One had just recently gotten divorced after six months, because his wife was a giant bitch (anyone could have told him that). He said "I think I need to find a new church." I said, "What do you need a church for; it will just cost you time and money."

The girl in the group scoffed. Like I had said something heretical.

The conversation went on from there. The girl said how her grandmother kept a bottle of holy water with her, and splashed it on every kid she saw so they would not have to go to purgatory.

I said, "I thought they got rid of purgatory."

She said, "I guess she didn't get the message."

Music

Have you ever discovered a new song on your computer, one that you had never heard before? Has it brought you joy - a feeling of happiness and euphoria that you haven't felt in a long time.

This happened to me today. "Prize Fighter" by The Velvet Teen popped up on Itune's Party Shuffle. I have not been the same since.