Thursday, December 28, 2006

What I Did on My Winter Vacation

The semester drew to a close in mid-December. Since then, I've made a deliberate effort to get out and see some of the New York nightlife and not to sit inside getting a head start on the embryology and physiology reading for next semester. The fiancee and I went out to what I was told was a "bar" on my first night off. The next day, I spent a luxuriously quiet morning and afternoon cleaning and organizing the apartment, followed by an early night watching the most recent disc of Carnivale delivered via Netflix. The next night, the fiancee and I met up with a med school friend and a couple of my buddies from college for a rollicking night of celtic rock in midtown followed by an equally rollicking, non-celtic rock extravaganza on the upperwest side.

And that was about all of the nightlife I could handle. The fiancee and I, along with the future in-laws, needed to kick back and spend a relaxing day visiting the Bodies exhibit at the South Street Seaport. Much less lame than cracking that physiology text, right? Right.

Before we saw the exhibit, the father-in-law-to-be voiced some ethical concerns about the show. Some folks claim the bodies on display were those of Chinese prisoners who were executed in order to feed a booming black market organ industry. One might guess that these people never gave explicit permission to have their bodies dissected and put on display for gawking foreigners. At the very least, the origin of these bodies is uncertain. The folks who run the exhibit maintain that "the bodies belonged to people from China who died unidentified or unclaimed by family members." You can read more about the controversy here and here, but believe me when I say that nothing takes the fun out of flayed corpses like nagging ethical concerns.

Undeterred, we marched on down to the South Street Seaport to get us a look-see. And we weren't the only ones with the idea. The place was mobbed with all sorts of people. The crowd comprised folks of all colors, ages, backgrounds, and views on personal hygeine. The young and the old walked hand-in-hand past men cut in half to expose their viscera ("Grandma, why doesn't the man have any skin?" "That's what happens when you write an inflammatory letter to the editor in the Shanghai Gazette, Timmy."). There were people who had obviously studied human physiology for much of their lives, and others who evidently had only a cursory understanding of the typical number of human limbs or the placement of skin relative to the rest of the body. But everyone appeared equally fascinated.

Grown men and women would walk up to a display of the preserved vasculature of the kidneys, they'd grab the little box with both hands, bring their noses right up to the glass, and squawk excitedly about how little the blood vessels are and how amazing it was that, without any of the surrounding flesh, those vessels still make two distinct little kidney shapes. You'd see a dozen people standing around a body that's posed holding a football, and every one of them would be reading the display while mimicking the motions needed to hold and throw the football. They'd be feeling for tendons in their hands and reaching around themselves to feel the movement of various muscle groups. Surrounding the display of a smoker's lungs, I could see high schoolers glancing anxiously at their friends, their hands migrating unconsciously to cover the box-shaped bulges in their pockets.

I no longer meet new people who aren't in my class, but I used to meet new people on occasion before I started school. Invariably, when those folks found out I was going to be a medical student, the first thing they mentioned was gross anatomy. "Oooh, are you going to have to cut open a dead person? I couldn't handle that," and less frequently, "awesome, I've always wanted to cut a guy." Either way, this seems to be the aspect of medicine that most universally intrigues people. Nobody's ever said to me, "Oooh, do you have to spend hours hunched over textbooks highlighting? That sounds gross," or "awesome, I've always wanted to slowly turn every page of a book flourescent yellow."

Of course, gross anatomy is one of the things that really excites me about this upcoming semester. I fully expect to be one of any number of students grabbing those kidneys with two hands, pressing my nose up against the retroperitoneum, and exclaiming, "look how kidney-shaped these little guys are!" Logistically, it only makes sense that this experience is usually reserved for medical students and communist prison wardens. However, it's apparent through the wild success of the Bodies exhibit, that there are lots of folks out there, folks of all ages, colors, and creeds, who've always wanted to cut a guy.

So, you know, heads up.

Friday, December 08, 2006

Your chart indicates that you've recently visited the hospital cafe...

Sitting through a few hours of lectures on biological molecules is no easy task. It requires a good night's sleep, a good magazine, and a good cup of coffee. Yesterday, I stopped by the medical school's cafe to pick up some coffee only to find that it had been shut down because of health code violations.

That's right. Our coffee shop, housed in the same building as one of the nation's top 10 hospitals, is no longer allowed to serve coffee because the Department of Health can't ensure that it won't make people sick.

Now, I'm no health inspector, nor am I a mathematician, but the cumulative score on the cafe's Inspection Report (which is displayed proudly on its door) was a negative 64. That seems bad, doesn't it?

Wednesday, December 06, 2006

The voices in my head want you to get the hell out of my office

In all fairness, I was warned that everyone else is crazy.

During my first day meeting with patients, I watched a doctor elicit a woman's family history. The patient had high blood pressure and high cholesterol, so the doctor asked if there was any history of heart disease in her family. The reply was quick, "Nope."

"Any high cholesterol in your family?"


"High blood pressure?"


"None? No high blood pressure or high cholesterol in your family?"


"Do you have any brothers or sisters?"

"Yeah, two brothers."

"Any high blood pressure or high cholesterol in either of them?"


Was he serious? Did the doctor think his questions were unclear? I was incredulous. I almost felt as if he were insulting the patient by asking the same thing over and over again.

"Your mom, does she have high blood pressure or high cholesterol?"

"Oh, yeah. She had real high cholesterol. I think her pressure was high, too. She had a heart attack last year."

The doctor nods, making notes in the patient's file, "what about your dad?"

"He passed from a heart attack 8 years ago."


Is it possible that this patient is so uncomfortable in an examination room, that the doctor has to ask the same question a half dozen times before he can get an answer? It's not really so far-fetched. This patient has just been told that she her body doesn't work properly, and then was asked by a serious-looking guy in a white coat, "Is there any history of heart disease in your family?" Should I really be surprised that she rushed to her own defense? "Back off, Doc, my family's fine. And I feel great."

The simpler answer though, is the one I've heard a dozen times from family members, employers, teachers, friends, cab drivers, space aliens, coworkers, and unicorns: Everyone else is crazy. And watch out for them. But once you hear that advice a dozen times from a dozen different people, it turns into a logic problem. I've come to believe that, perhaps, those aliens aren't as smart as they think they are.

It seems more likely that we all think in a way that is fundamentally incongruous with the way everyone else thinks. A not-so-insightful observation that, if true, would make patient care much more difficult than I'd imagined it would be.

We take two classes right now, a science class and a touchy-feely class. Last week in the touchy-feely class, a speaker came in to discuss his experiences as a patient. He's had a string of serious ailments that brought him in contact with a number of doctors and other health care providers over the last thirty years. One of the earliest doctor visits that he recalls took place during his first year of college. While showering, he felt a tender lump on his butt and immediately became anxious. He quickly dressed and headed over to the student health office on campus, where he was seen by an amiable, outgoing doctor. The doctor gregariously inquired about the man's ailment, and subsequently examined the affected area. The doctor declared that the lump was "just a hemorrhoid" and "nothing to worry about." He explained that hemorrhoids will resolve on their own. He suggested that the man try soaking in a hot tub and maybe eat more roughage. The visit lasted about 25 minutes.

I've tried to convey this story in a manner similar to the way I heard it from the patient himself. The only thing I left out were the patient's frequent references to the doctor as a "jerk" (though the description of amiable and gregarious comes straight from him). The interaction described above INFURIATED the patient, so much so that he still recounts this story - now thirty years later - with a seething, undisguised hatred. During his senior year, the patient came down with a horrible infection and refused to return to student health because of that doctor. He finally gave in when his temperature neared 105 degrees.

I heard this man's description of his trip to student health, and I thought the doctor sounded competent, professional, and engaging. All in all, this seemed to me to be a strongly positive doctor-patient interaction. All that's missing is the sticker.

The patient's impression of the doctor was that he was extraordinarily dismissive of the condition, and that he totally ignored the patient's intractable (though never verbalized) belief that the lump was a cancerous tumor. Furthermore, he never said how long the hemorrhoids would last and wouldn't prescribe any medication to make them go away.

What didn't came up during this visit, was that the patient was a recently-outed, gay man. He was coming to grips with his sexuality in the context of a) his new, autonomous life at college and b) his traditional upbringing in a religious, military family. His concerns about the lump on his butt didn't just come from hypochondria; he was terrified that he was being punished for his lifestyle and that this condition would make him less attractive to men.

The patient vehemently believes that it was the doctor's fault that a discussion of these concerns never took place. Maybe it was, I really don't know. I'm not retelling this story to investigate that question. All I want to do is point out that, although his impression of the interaction was drastically different than my own, the patient is probably not crazy. And that terrifies me.

I probably would have treated a frightened college freshman the same way that doctor did, because that's how I'd want to be treated. If I thought I had cancer, and I saw a trained physician who was absolutely certain that I had only a benign condition that would resolve itself with time, I would WANT him or her to tell me exactly that. It would freak me out more if the doctor dwelled on any possible diagnoses that were clearly not appropriate. And if I could clear this condition up without taking any drugs, all the better. Though I might be exhibiting some self-preservation here, I'd like to think that this position is also not crazy.

So we have two, ostensibly sane people considering the same professional interaction. One of these people is entirely satisfied that there's nothing wrong (absence of stickers notwithstanding), and the other is so wildly offended, that he has spent thirty years of his life railing against this doctor to audiences across the country. Is this just the nature of a profession driven by interpersonal relationships? Is there some way that a physician can account for all of the disparate personal needs, histories, and characteristics that walk through the door? Am I doomed to have any patient who doesn't think like I do leave my office in a fury telling people I'm a jerk?

Sometimes the science class is much easier.