Mexico Medical Student |

Um, I was trying to update Gallery, the program that powers the photos section on my site, because it wasn’t making thumbnails properly and I thought upgrading would fix it. As is typical, I tried doing the upgrade while doing 3 other things and something went royally wrong, giving back a PHP stack trace and the like. Did I make a backup? Of course I did! Did I make a complete backup including my database? Of course not!

So anyway, hopefully I’ll get it fixed. I shudder at the prospect of either spending the time to isolate the problem (now that my database is probably hosed from the aborted half-upgrade) or spending the time/bandwidth to re-upload all the photos. *sigh*

…at least here in Mexico.

November 12th is Dia de cartero, as seen by this scan of my telephone bill. Mexico apparently has a day for every working person it seems. It’s appropriate that the scan shows my Telmex bill, because after the weekend when we first moved here, we arrived at the phone company office bright and early at 9:00 AM only to find out no one was there (except for people paying their bills via the automated machine). I looked at the window and there was a sign posted that basically read, “Due to the holiday, our offices will be closed.” I thought, “Crap, my luck. What holiday?” As one of the people line answered for me, “Dia de la telefonista,” of course!!

(note the motorcycle–here in Mexico, motorcycles are used almost exclusively for timely delivery. You don’t need to follow any traffic laws whatsoever as your bike can zig-zag between cars in a traffic jam and/or you can simply drive 30 mph down a sidewalk, passing cars in traffic. Why then the mail is so slow is beyond me…)

Thank you to all our men and women in the armed services who are serving or who served our country in this way. You are doing a job I could never do in a hundred years for many reasons. Courage, patriotism, and self-sacrifice takes many forms, but today we honor yours and rightfully so.

My grandfather was a World War II veteran who passed away three years ago. My father-in-law is also a WWII veteran, and today I think of them.

Last week I got the “special” Classical Music edition of the iTunes Store new releases and it had as its featured artist Janine Jansen. I don’t normally pay attention to the looks of most classical artists, but this one is well, jaw-droppingly gorgeous. They’ve tried to make sex symbols of classical artists before; namely, the Eroica Trio were called “babes of classical music” for crying out loud, there’s such a desperation to tie sex appeal (or any appeal) of classical music/musicians to mainstream audiences, and that’s pretty desperate.

Just like in any professional field, one should be judged on merit. There have been too many Anna Kournikovas. Jansen is a serious talent. I bought the “Four Seasons” CD and it was awesome. The latest “style” for baroque instrumentation and interpretation is to basically beat period instruments within an inch of their life, pushing tempos, etc. Her ensemble doesn’t ignore this trend, but they don’t sacrifice lyricism either. They definitely had some fresh ideas. If you don’t have a good copy of Vivaldi’s “Four Seasons,” go to iTunes Music Store and check it out. Meanwhile, I’ll indulge my own fresh ideas…

So I earlier made an entry that touched upon patient respest for m.d., which indirectlly touches upon informed patients. I knew that that deserved follow up but several night calls defeated that intention.

Let me start this message with the extreme opposite of how the “new media, etc” had merely perpetuated the snake oil problem and possiblly made it worse.
I had a patient, L lung FULL of lung ca, metastatsis everywhere, had a spinal met that basically pararlysed him. Was so out of it, couldn’t even comprehend his med situation. So I tried to make the family make him Do not intubate/do not resuscitatate in the event of catastophic event. For days I tried, I will not go into the many details of those conversations. Then, one day, the family member showed me a book by Kevin trudeau http://www.cures-they-dont-want-you-to-know-about.com/. I had glanced at this book before while at barnes and noble, the biggest example of internet snake oil shiester dom you’ve ever seen. (HOnestly I encourage every MD to at least glance this book, as it is a BIG seller and will impact, statistically, every practice at least once and you HAVE to be prepared for it.) She says “you know, you should read this book, it says things that doctors don’t know and should be educated on”. IT WILL happen to you to. I politelly stated, i’ve read it, but declined to comment more.
I think sometimes we think that the proliferation of cheap misleading infor on the internet is harmless/ won’t really effect anyone besides their pocketbook, but believe me, this family was letting him wallow in pain BECAUSE this book/sister internet site states, and I am not exaggerating, you need to read this book, don’t trust doctors, they are undereducated on natural cures cause they get money from drug sales. he literally says, and I QUOTE: “I am qualified to comment on medicine because I am **NOT*** a doctor” There is REAL harm.
By the way, as a consequence, the patient almost died twice, is in the ICU now practically comatose when he is not in pain, and on life support. He is NOW DNR/DNI, but honestly it is too late for that. He will wallow for months/years now.
As you can tell I am still quite livid.
I have no problem with mdconsult type sites that know to edcuate patients to a certain degree but entrust the medical decisions to MD’s. Even then, we all get slightly annoyed when you do your best to meld thousand of review articles/research protocol into a decision for a patient, and when you are walking out they are whipping out their palm pilot/powerbook and when you walk back in they probe your knowledge to see why you didn’t use so and so antibiotic becase a NEJM articel suggested it was better for this bug in this state for this indication.It’s hard to explain that only AFTER four to five years in the field do you understand that there will always be a new article, so it is not a matter of blindly following this month’s jama, or you’d change every month.

Rule number one:
You learn everything you REALLY need to know, that’s striaightforward enough to just follow a book/article, in your first two years-three years in med school
The rest is GRAY (dark black sometimes), and really needs thinking because no one has addressed the unique need of THAT patient ever in ANY research.

Rule number two:
Different MD’s will do different things, and each will be uniquely correct, and each will be uniquely wrong. REmember this when each of your attending gives different advise on how to address so and so disease.

Therefore, you now have the unique problem of people having unlimited access to research articles that, yes they can read and understand, but don’t have any context to place it in. Not cause they are unintelligent, but because it’s not their professsion. In fact, the intelligence factor plays in a different way usually. usually it is high powered, well educated successful people that are the worst candidates. Why? Because they are so successful in one thing, so they figure they can figure out the rest of the world given time. hey, I’m the same way too. the same way that i used to think, when I met a mechanic/accoutant/lawyer/etc, that “hey, give me those books and some time, I could figure it out and save myself some cash. I’m smart and successful, aren’t I”

thus we have patient walking in, having read jama and saying “hey I can somewhat understand this!’
probe the doctor, see he doesn’t use the latest protocol they read about, and have this underlying doubt the whole time.

now don’t get me wrong, the mass education of patients is great, and the majority of self informed patient I met at baylor clinic (our private/self pay/rich folk clinic) is definatly for the betterment, and the mostly defer to their doc for real decisions. But there are negatives, and you too will feel them. Not in the community clinic/hospitals, but in your outpatient clinics for the well off, you have to be prepared.

Get a subscription to time/newsweek.

this has gotten too long….

I have been reading a lot of medical blogs for some time. I enjoy almost all of them, even if they are not in any field that I personally like or would chose to go into. Whether they are written by a Chief of Medicine, your neighborhood family physician, a nurse, or a tech, those that write about their work and patient experiences provide such vital information to those of us not quite “in the trenches.” At times, the experiences are banal, sometimes they are humorous, too many times they are tragic, but almost always they are enlightening. I read medical student blogs too, and certainly the more linked and “popular” ones have great stories to tell about their patient experiences or their growth as clinicians and people during their med school careers.

Why then do I have such an inferiority complex about writing? It’s something I love to do, but I tend to be too much of a perfectionist about it. I’ll start a post and take far too long to actually get it up on the page, wrangling over sentence structure or word choices. I don’t like posting about what I had for dinner–it sounds narcisistic, but my standard for posting is what either I think someone else would want to read, or even more narcisistic (!), what I think I would want to read later, looking back on that particular day. I guess I feel as a personal blog, it’s all good, but I wanted it to be a medical student’s journey that was different than most being in Mexico, educationally and culturally. Although I’m staying true to that (with understandable forays here and there), there’s just not that much to tell that doesn’t involve seemingly endless lectures about basic sciences, multiple-choice tests, and amatuerish fumbling trying to percuss an abdomen like it’s a ripe melon. Everything about my experiences screams “newbie” and I’m fine with that–it’s what I am. But I am impatient to do more, see more, and write more. I think my primary audience if there is one would be pre-meds, and that’s pretty darn scary! I’ll just write when and about what I can, and hope there is a readership that cares. Yes, I mostly write for myself and would still write even if no one was looking, but I wouldn’t care about how it looked, grammar, etc. if it was just a series of entries on my personal computer.

I have a large list of sites I regularly read and want to share, but I just haven’t had time to do the site organizations I’ve been wanting. I use Drupal because I had grand ideas of splitting content for music/arts, medicine, and life in general with separate link contexts, feeds, etc. but now that I see that’s way too much than I have time for, I probably would be better off going back to WordPress or hell, just Blogger. But that would involve yet another migration, which takes its own time.

Boy this was rambling. I promised myself before I sat down to write (in the library betwen classes) that I would do minimal editing and just get posts out there, grammar and spellings be damned. Must….fight…edit…. But honestly, I have anatomy lab in 10 minutes, so that’s a good enough motivation to just hit “submit.” Until next time….. –ec

The Kansas board of education voted 6-4 (all who voted ‘yes’ were Republicans, but not all Rebublicans voted ‘yes’) to uphold mythology over science. In support of Intelligent Design [sic], Kansas students will be subjected to religion in science class. One insidious problem is that ID on paper looks innocent, perhaps even more educationally inclusive by saying there are problems with some Darwinian concepts and that not all is explained by his theories. Fine. It goes a step further–and this is the main problem–that there must have been intervention of a higher power for things to have turned out so complex yet so functional.

Please tell me how this is different than just a mere few hundred years ago when people had no idea what made the rain fall, so it was a rain god. Don’t know what makes the sun rise in the east and set in the west? 500 years ago it was God Almighty, 2500 years ago it was Apollo and his Sun Chariot with the new shiny Dorian rims. I have no problem introducing the concept of God or Allah or Quetzoquatl into the classroom, just make it history, philosophy, social anthropology–ANYTHING but science!! I understand different areas of the country have different social “norms,” and they need to be respected, honestly, but there has to be a line drawn. Gravity is the same everywhere; F=ma in any school district. Evolution is not a law, but it upholds orders of magnitude more scientific rigor than mystic speculation about a higher power. I can look at a flower and ponder the existance of God in making such beauty and diversity, but I can’t even test it, study it or challenge it.

The scariest quote in a CNN article is the following:

The challenged concepts cited include the basic Darwinian theory that all life had a common origin and the theory that natural chemical processes created the building blocks of life.
In addition, the board rewrote the definition of science, so that it is no longer limited to the search for natural explanations of phenomena.

So if God says, “Star, stay!” (I promise on a stack of ID textbooks that this is a true quote/story from a cousin that went to Oral Roberts University for a year), then Kepler’s laws and other physical phenomena are immediately thrown out the window. I repsect someone’s right to beleive that, as outlandish as it seems to me, but again, what everyone seems to forget is that this is science, not mythology or philosophy. The biggest fear isn’t that the schools are required to introduce the possibility of God into the classroom as science, but that there are no limits as to how far it can go, no limits to the length of time, energy, or money spent in such curriculum. Sure they still have to teach Darwinian theory, but what’s going to stop them from spending a day or two on it then moving on to the “real” story and spend three times as long on Genesis? The last time I checked, Moses wasn’t subject to peer review.

What kills me is that the only people pushing ID are Republicans, most of whom are Chrisitan fundamentalists. These are the same people that foam at the mouth with the idea of homosexuality, calling it immoral, derived from Satan. Let me tell you something that you can easily see for yourself by watching TLC or the Discovery channel: nature is beautiful and complex, yes, but she is also a cruel, vengeful bitch. Praying mantis females bite the heads off of their male partners during the act of copulation, their death throes finishing the act of fertilization. Male lions recently overtaking a pride will actively kill the cubs of previous male lion’s offspring while the lioness watches, obviously wating to fight to the death but realizing there is no chance she can win; better to live and procreate more (the basic drive of all life) than waste it in a moment of futile honor. Don’t even get me started on the “design” involved in human suffering, with congenital illnesses, etc.

But guess what else? Most higher mammals routinely engage in homosexual acts. Bonobo monkeys regularly masturbate, engage in oral sex, and sodomize each other just for pleasure…obviously there is no procreative purpose in any of these. So when a monkey is blowing another monkey or a dog down the street takes it in the ass from another, bigger dog just for fun, I have to ask, where are the Intelligent Design proponents looking for God in these places? Perhaps the dog spent too much time watching Hollywood filth that turned him gay because it wasn’t natural and a lifestyle choice…yeah, that’s it.

Speaking of Hollywood, I wonder what movie will be made years from now about today akin to Inherit the Wind? History sure does like to repeat itself.

Saturday night I went out with a couple of friends from class. We went to a really nice bar called the Bali Bar which is owned by a company that clearly caters to Americans and upper-middle class locals (one of the other bars is called “Wall Street,” so even the names can be in English). I hadn’t been to any bar/club in forever (the closest I get is usually a God-honest pub, which hasn’t been all that long), so I was interested to see how it would go.

It was a great time, definitely worth doing more often. There are two downsides, however. The first is probably universal to all clubs, and that’s the noise. The music was never painfully loud, but from 9:30 to 12:30 it was a gradual crescendo from being able to hold a decent conversation over the music to nearly hemorrhaging my larynx from screaming and using broken sign language to ask, “Do you think we should go somewhere else?” The music mix was also interesting, ranging from unknown Latin artists (good ones), to 50-Cent (talentless thug) and Snoop Dog (good anytime).

The second problem is the cigarette smoke. I haven’t smoked in a long time, but I’m not one of those militant ex-smokers who feels the need to crusade at the faintest whiff of tobacco (as an aside, one year I bought the entirety of my Christmas gifts from saved Camel cash in college). However, I don’t want to smell smoke when I eat, and I really can’t stand that stale ashtray smell of old smoke or a spent cigarette–it’s disgusting. The smell on your clothes after a night on the town will almost always approach that, but it’s usually tolerable. The reek after a night out in Mexico is beyond description. Take the cheapest of the cheap American cigarettes, and that’s a frickin’ Havana Puro compared to the rotten cabbage leaves they use for the cheap tobacco here. Prisoners at San Quentin would spit these things out, they’re so awful (I know, I tried some of them way long ago). At this point, coming home with just Marlboro on me would be a blessing.

Actually a blessing was the foresight for me to stop after the free drink and 4 tequila shots. I was so needing a night out, I could have done quite a bit more and stayed out a lot longer, but prudence (or old age, you pick) kept me from going nuts and allowed me to salvage some of yesterday to get some studying and errands in.

I guess if there’s a point at all to this post, it’s to remember that it’s not where you go or what you do, it’s with whom. And even more importantly, it’s the fact you go out at all, even if it’s by yourself. I need to be reminded and prodded to fight my own inertia to get out and have fun sometimes, even though I never regret it afterwards.

As I write this, I feel quite the little girly man. You see, I had to get a whole battery of immunizations to prepare for public clinic work (not that it’s a bad idea being in Mexico anyway) later this month. I had been procrastinating all semester, so there’s no way to pull any records from the States to see if I need a full DT injection or just a booster. Does it really matter? No–it’s a stick all the same, and quite frankly the pain and hassle of getting some of these records from ages ago would have been a herculean time-consuming task in and of itself (not to mention cost, since proving I had chicken pox by serological titer costs 3x more than the vaccination).

So I want into the Vaccination Shack on Friday and said, “Hit me!” indicating, from the given menu, all of the following which are mandatory (for now; there are more starting our 3rd year at the hospital):

• Hepatitis B, Hepatitis A
• Measels, Mumps, Rubella (MMR)
• Diptheria, Tetanus (DT)
• Chickenpox
• Meningococcus
• Pneumococcus

I think it was four sticks, but that wasn’t any big deal; you hardly feel these things as anything other than a tiny nuisance. I knew I might have a small reaction, perhaps some redness, but I was concerned more about an immune reaction. As the day and night progressed, nothing happened. However, early this morning I woke up and thought I needed a sling for my arm it was so stiff, with a bright red, diffuse rash spreading radially from the injection site on my upper arm. There was never any fever, thankfully. It just seems silly … I knew I might feel bad the next day but not 2 days later, and certainly not from the SHOTS … jeez! Could I be any more pathetic? I guess so, since I’m telling everyone about it.

Note to self: get these done earlier, and don’t get 7 at a time.

I’ve been away for a bit because after the biochem exam this week, I kinda went into hiding, half studying way-too-behind genetics and half hibernating in general. Inertia has won over many times not posting but I promised myself I’d catch up later this weekend, so I will. I’m definitely at that almost-end-of-semester-but-not-quite lull that seems to have me just going through the motions every day. The reality of finals in a few weeks will definitely jog me out of it. I’m going to go out with some friends later tonight, so that should help.