Pick your battles

A few weeks ago (yes, I'm a bit behind on the blogaschedule), I attended the American Medical Student Association Region X conference. AMSA is a forum for med student activism, and the conference was titled "Advocacy into Action: Taking responsibility for the future of health care." While being really impressed with the passion and spirit that everyone -- speakers, participants, and organizers -- showed, I walked away a bit disoriented.

My problem was how to choose. The issues at hand were all pressing, important, and easy to get caught up in, especially after hours of impassioned speeches from people who dedicated large pieces of their lives to their issues. Global health, health disparities, health care reform, reproductive health rights, issues of race, gender and sexuality in medicine. These and more were addressed, with a plea to "get involved" behind every speech and presentation.

So how do you decide how much time to dedicate to activism, when learning to be a doctor is already so taxing? How do you pick what the best use of your time is? By the number of people you may be able to help? The profundity of your impact? Or maybe it's about you: you pick the issues you feel closest to; you're drawn by what has touched you in the past.

I care about change on a systemic level -- the idea of being an advocate for women in the developing world is one of the reasons I'm in medical school. But lately I've been feeling that focusing my efforts on people thousands of miles away is irresponsible, and will tear my attention into pieces. So I made a decision to get involved in advocacy around universal health care in the U.S. It's as pressing an issue as any, and only by speaking up will any change ever happen. Look for more posts on this in the future.

Let's be clear that I still haven't come to a conclusion on this. I still don't know how starting an activist career will affect my performance as a student, or overall sanity. And I don't want to ever stop pursuing international women's health issues. But getting involved in issues closer to home makes me feel like I'm serving my future patients, and taking responsibility for mistakes my own government has made, at the expense of its people. And it's exciting: we're planning a lobby day to take place next month. If you're a California voter who believes in expanding health care access, come join me.

The grass is always greener

In recent conversations with friends, I've told them how trapped I sometimes feel as a student.

I told one working friend that I need more balance in my life, that it seems that all I do is study; she wrote back and told me how she'd been wishing that she could just sit all day in coffeeshops and concentrate on learning. I told a friend in Mozambique how much I wished I were there. She quickly wrote back with a list of reasons she wishes she were here.

Why is it so hard for us to be happy?

Why Medicine Doesn't Make Sense, #1

How can someone design a drug without knowing how it works?

I keep running across descriptions of drugs that say "mechanism of action unknown". How does this happen? As I get deeper and deeper into the study of medicine, I am more and more amazed by how much what is practiced is a crapshoot.

Maybe medicine is more an art than a science.

On Death and Understanding

A few days ago, I found myself having a very hard time understanding how an infection can actually kill a person.

I asked this question, specifically about pneumonia, as my professor and I walked out of class. Part of the difficulty, I think, is that it's not a simple event. Intuitively, a massive invasion of foreign organisms doesn't seem like it can be a good thing. But to actually outline the steps until death -- pathophysiology, if you'd like to put a name to it -- is much more difficult. Which organs are most affected? What are the proximal causes that actually make these organs fail?

The professor explained that the inflammatory exudate floods the alveoli to such an extent that breathing becomes labored. But, I insisted, can't you just aspirate out the fluid? If we know what's happening to a person's lungs, can't we just fix it?

The answer, of course, is that it's not that easy, antibiotics aside (and antibiotic resistance is a whole other story). Once the inflammation response is at full strength, the influx of cells, cellular debris, and protein into the lungs results in a complete loss of lung architecture such that the normally air-filled lungs actually take on the consistency of the liver.

I still couldn't wrap my head around it. And it will probably be awhile before I do. Because really, it's not just an intellectual difficulty in understanding the process; it's also a psychological difficulty in really comprehending how a body that functions, sustains a living individual, can become one that is lifeless. Humans know what death is from a young age, and have some exposure to it; but really understanding how a person dies is something that comes much later, and much harder. This, I guess, is where the man is who loses a loved one and says, "one minute she was with me, and the next, she was gone."

I know I'll need to wrestle with it some more. And I probably won't really understand it until I have firsthand experience witnessing the end of a life. And maybe not even then.

Thrilling thought of the week: I love Mondays

You know you've found the right graduate program when you look forward to Mondays.

I love Mondays because those are the days when we're presented with a new case to read through and drive our learning (see a previous post for more on PBL). Mid-week, when we're plowing through test results, synthesizing information from biochemistry and physiology and clinical manifestations, and sifting through sources that contradict each other, things aren't as much fun.

But Mondays, the sky's the limit. Everything that seems like it might fit -- a disease read about long ago, something someone's cousin once had, anything that sounds mysterious and interesting -- makes it up on the white board. Our new patient has abdominal cramps? Well maybe it's appendicitis. Maybe an STI. We should take her sexual history. How about abuse? Let's figure out her social situation. An exotic infectious disease? Let's get her travel history. Something related to a chronic condition -- does she have diabetes? Let's examine her, and maybe give her a pregnancy test

It's an exercise in medicine, but in the part of medicine that requires lateral thinking. Really, it's an exercise in stretching your mind to the limits of logic, and sometimes past that, just to make sure nothing's missed. With eight people in the room, ideas fly like ping-pong balls. The excitement rises as we exhaust all the possibilities we can think of and flip the page for more clues on our patient's problem. Eventually, most of our list will be crossed out as we learn more about the problem and its characteristics. But for a few minutes on Monday, anything is possible.

AMSA needs to work on its grammar

I just sent an email to my congresswoman thanking her for voting yes on SCHIP and continuing support for the bill as it goes back to congress after Bush's veto. And of course you should do the same because this bill will expand coverage to children who otherwise would be uninsured, helping more people in this country achieve a higher standard of health. To me, it's that simple; if you feel differently, please do tell.

But for heaven's sake, don't cut-and-paste what AMSA has written as a letter template:
"As a physician-in-training, your support of the SCHIP reauthorization bill was greatly appreciated...."

What? That means that "your support" is a physician-in-training! People, this is basic stuff. Maybe you should lay off the physiology, or even the health advocacy, for a bit and review English grammar. Maybe it doesn't really matter. But it seems to me that if you want your voice heard, you should at least make sure you're speaking correctly.

Blog of Events That Occurred During JMP Late Night Lit Review

I can't take credit for this....

9/26-9/27/07

11:09 – David has Coca-Cola poisoning. Will has decided to watch family guy and eat Top Dawg. Andie seems to be progressing nicely now that she has a picture of Barry Bonds in front of her. I am very . . . very . . . . upset about this lit review.

11:10 – David is laughing at me. Looks like I’ll be the only one to be contributing to this blog.

11:24 – I saw David put his head in his hands.

11:25 – Will is living in a state of ignorant bliss, still watching Family Guy without an inkling of consequences.

11:26 – David hit his funny bone – it wasn’t very funny. Group seems to be turning on Andie – she has too many resources.

11:28 – David: “I have no idea how to do this. What am I doing.” Will tells Matt that he is spending more time on the blog than on the lit review.

11:41 – Matt considers buying another cup of coffee for the second time in a half hour.

11:48 – Guy Micco shows up and said, “This is sick.” He asks us what we are doing here. We ask him the same. e gives us figs.

11:49 – Discussion of the movie “The Ring.”

11:54 – Discussion of getting McDonald’s breakfast in a few hours. Good discussion.
MIDNIGHT
12:11 – Will is asleep on the couch. Will thinks he’s better than us – he is wrong.

12:20 – Will has reverted to referring to himself in the third person like Bob Dole.

12:33 – Andie denies just hitting her funny bone.

12:34 – Realizations all around about how hepatitis, a disease of the liver, is aptly prefaced with the prefix “hepat”.

12:46 – Fantasies about large fans being installed in the Fun Room commence.

1:05 – Will is missing.

1:11 – Will is still missing. David states time, followed by Matt making a rule that there is no more mentioning of time.

1:14 – Will is back.

1:55 – Group decides to address the problem of the Fun Room having a hell-like temperature by putting the fan in front of the open refrigerator temporarily.

1:56 – David is hungry, and proceeds to have moral dilemma over whether or not to steal yogurt from the Fun Room fridge. He ends up taking it.

1:59 – Discussion of erections – strangely not awkward.

2:37 – Jason is discussed as character in a martial arts movie – he would be a wise and uniting influence.

2:39 – We discuss the highlights of JMPers zoning out; focus on Nicole.

3:06 – Matt loses it – lashes out at Will.

3:07 – Will loses it – barricades himself with pieces of paper.

3:08 – Nicole loses it – yells “I can’t take it!” bangs her hands on the table, and then makes an odd screeching noise.

3:25 – Group discovers levers on left side of chair – great fun!

3:36 – Another unjustified lashing against Will. Matt feels bad, but will not tell Will. Will retaliates by threatening to shave half of Matt’s head.

4:38 – Discussion topic: is the word “sequalae” in vogue? If so, why?

4:51 – Nicole is taking a nap on the couch.

4:59 – David is done.

5:09 – Will is taking a nap on the couch.

5:28 – Will is up.

5:52 – Matt leaves.