Doctor, what next? The thoughts of a graduating medical student.

Education
June 16, 2015

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Two years ago, during my second year of medical school, my classmates and I sat in cramped auditorium chairs as our instructor presented us with a clinical scenario.

We were learning about arrhythmias, and our instructor flipped through slides of different ECG patterns, asking how we would respond to each. After several less concerning ones, the slide flashed ventricular fibrillation: an irregular …

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Doctor, what next? The thoughts of a graduating medical student.

The transition from medical student to teacher

Education
May 17, 2015

In just under two months, I will be making two big transitions as I begin life as a resident. The first and obvious change is from student to doctor. The second doesn’t get the same spotlight, but might be just as important: from student to teacher.

Residents play a vital role in medical student teaching. With medical training like an apprenticeship, it is the residents with whom third-year medical students often …

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The transition from medical student to teacher

Projection.  From an unlikely source.

Education
April 7, 2015

The patient was hacking sputum into a tissue when the resident and I entered his room.

“How long have you had that cough?”

“Oh this? As long as I can remember.”

“But it’s been worse lately?”

“Yeah.”

“Worse how?”

“More stuff coming out each time. See?”

He opens the tissue.

“How much sputum is there?”

“Sputum?”

“The stuff you cough up.”

“I don’t look that close.”

“More than two spoonfuls?”

“Oh yes. Definitely.”

“And the color?”

“White-ish.”

“Ever see any streaks of blood?”

“Never.”

“And how long have …

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Projection.  From an unlikely source.

Lessons from my first nasogastric tube

Education
February 23, 2015

I was glad she never asked if I had done this before.

My first nasogastric tube was placed on an elderly woman with chronic liver disease. As her illness worsened, it gradually turned her skin yellow, her abdomen swollen, and her mind foggy. One day, we realized that she was at too high a choking risk to swallow her medications herself. She would need a plastic tube to do it for …

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Lessons from my first nasogastric tube

3 amazing medical advances that haven’t caught on

Conditions
January 23, 2015

The life cycle of a medical advance usually goes something like this: from discovery at the research bench and replication of findings to translational research and clinical trials, to implementation. The bottleneck can be at any one of these stages, and often it is in the discovery one; we just haven’t yet found the thing that works.

But other times, we have — the intervention works, we have shown and confirmed …

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3 amazing medical advances that haven’t caught on

Breaking the vicious cycles in medicine

Education
January 5, 2015

He was known to the hospital as someone who would try to manipulate his caregivers. And I fell for it anyway.

Frequently admitted for pain crises associated with a chronic illness, he spent most of his hospital course avoiding eye contact with the team. So, too, were avoided answers that involved more than a few words. Providing care for him was business-like; we knew better than to expect pleasantries.

The day of …

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Breaking the vicious cycles in medicine

Sick or not sick? Handling the reality of inpatient medicine.

Education
November 28, 2014

“So, is this the sickest list you’ve ever had?” the resident asked me at 2 AM, after I finally finished checking off all my boxes for the night. I nodded. I agreed.

I was also shaking.

I had been covering nine patients that night. Almost none were stable. In the span of one shift, we called three rapid responses. One person went into cardiogenic shock right in front of me was transferred to …

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Sick or not sick? Handling the reality of inpatient medicine.

There’s movie psychiatry, and then there’s real psychiatry

Conditions
March 20, 2014

The page comes from the psychiatry intern on call. “There’s a situation with patient RB on the unit. Please advise.”

We gather in the hall outside the patient’s room. There are already three — no, four — security guards standing several feet away with their arms folded. Backup. Ready. Ready for what? We whisper in hushed tones as the intern explains what happened.

He was “acting out.” He was running through the …

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There’s movie psychiatry, and then there’s real psychiatry

When talking with patients, sometimes we skip steps

Education
November 21, 2013

“Ms. M,” the resident says, “I saw in your chart that the last time you had surgery you had a pulmonary embolism.” She nods with recognition: “I felt like I couldn’t breathe. It was really scary.” Then: “I sure don’t want that again.” The resident lifts up the covers and sees that the patient’s calves don compression boots. “Make sure you keep the boots on,” he says, pointing.

What do boots …

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When talking with patients, sometimes we skip steps

Had I met her anywhere but the hospital, I would have helped her

Education
October 16, 2013

Had I met her anywhere but the hospital, I would have gone to her side. I would have asked her what was wrong. I would have offered to help.

She was 99-years-old and about to undergo surgery. Pre-operative holding is generally a busy place. Patients lie in gurneys, spending some last moments with loved ones and fielding questions from various players of the surgical team as they come to the bedside. No, …

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Had I met her anywhere but the hospital, I would have helped her

You may not remember me, but you changed me

Education
August 7, 2013

You may not remember me, but when I asked how you were, you said, “alive.”

A few weeks earlier you were afraid of going under anesthesia and not waking up. They said you’d do great; that this was routine; that we’d see you again soon. Then you coded on the table. I’ve never met someone who was grateful for life the way you expressed to me that day.

You may not remember …

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You may not remember me, but you changed me

The process of studying changed the way I think about medicine

Education
May 15, 2013

I’ll start with this: it’s great to be back.

I’ve been on hiatus from blogging for the past few months because of the exam I took last week: the medical boards, or Step 1, an eight hour test that covers all of the first two years of medical school to prepare us for the hospital wards. To give you an idea of what it entails, most second-year medical students use a …

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The process of studying changed the way I think about medicine

Countertransference is a reality that must be grappled with

Education
January 29, 2013

“Sometimes, how you feel at the end of an interview can be clinically revealing,” my preceptor says. “How does this patient make you feel?”

***

“Mr. M?” I ask gently, knocking on the hospital room door. “May I come in?”

“Hello? Hello?”

I enter at what I think is an invitation to me, but see that 79-year-old Mr. M is speaking into the phone instead.

“I’m sorry, I can come back…” I start to say. …

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Countertransference is a reality that must be grappled with

Is it justifiable to judge a paper by its author or funding source?

Education
January 13, 2013

Doctors use different standards to judge scientific research depending on who funded it. They judge research funded by industry as less rigorous, have less confidence in the results, and are less likely to prescribe new drugs than when the funding source is either the NIH or unknown – even when the apparent quality of the research is the same.

Those were the results of a study published by Harvard …

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Is it justifiable to judge a paper by its author or funding source?

Medical eponyms and their connection with Nazi crimes

Education
December 17, 2012

In 1977, a group of doctors began a campaign to change the name of an inflammatory arthritis after discovering it was named after a Nazi doctor who planned and performed gruesome forced human experimentation that killed thousands. In one of these experiments, for example, Hans Conrad Julius Reiter inoculated Buchenwald concentration camp inmates with the microbe causing typhus, resulting in the deaths of over 250 people. The …

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Medical eponyms and their connection with Nazi crimes

The functional and professional necessity of detachment

Education
July 5, 2012

There’s an intersection in Boston outside one of my favorite places to eat. At the corner of two bustling streets is a white bike, chained in place, surrounded by flowers. In loving memory.

***

One evening earlier this month, I was riding the ‘T,’ Boston’s streetcar system, when our train suddenly stopped.

There were the usual sights and sounds of delayed passengers: people fiddled with cell phones, glanced at watches, tapped feet impatiently. …

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The functional and professional necessity of detachment

Care about people as people, not just as hosts of disease

Education
December 7, 2011

I never thought I would call cancer “cool.”

It was the last day of anatomy lab. Finally, we had dissected through everything: starting with the back, moving through arms and legs, hands and feet, chest cavity with lungs and heart, abdominal cavity with gastrointestinal organs, pelvis, and ending with head and neck.

Looking at our cadaver was disorienting. There were insides where outsides should be. Organs completely removed. The head literally sawed …

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Care about people as people, not just as hosts of disease