If It Quacks Like a Quack...

The New York Times profiles Andrew Wakefield, the discredited British physician whose paper attempting to link the MMR vaccine to autism was retracted last year, and whose medical license has been revoked. Meanwhile, the number of needless childhood deaths from completely preventable diseases like measles continues to increase among the unvaccinated.

Big Time

Just discovered that Second Shift has made it to Ambulance Driver's Blogroll O'Doom. AD is one of my favorite reads, and I've taken to occasionally listening to his podcasts on my long runs. To any new readers that happen this way, thanks for stopping by!

Give Blood

Middle-aged male, history of chronic EtOH abuse, arrived via EMS for an uncontrolled upper GI bleed. Quickly intubated to protect his airway, he was hypotensive to the 50s. Piles of used blood bags formed at the base of the rapid infuser as the medical team attempted a transfusion to stabilize his pressure. With blood oozing out of his nose and mouth as fast as it could be given, he remained hypotensive, with periodic bouts of arrhythmia, for an extended period. Finally stabilized long enough to be brought upstairs, we learned less than an hour later that he coded and died.

Without donated blood products, this patient would never have even made it out of the ER. Donated blood isn't a cure-all, but it does help save lives every day.

Only 8% of eligible Americas donate blood. If you're able, please be a hero and consider donating blood.

I Whip My Brain Back and Forth

Dear High School Student,

Welcome to the anatomy lab demonstration. Your extreme enthusiasm for real cadaver parts will make you a great sociopath and/or physician healer.

I regret to inform you, however, that you are not Roger Daltrey, and that spinal cord does not lead to a microphone. Kindly refrain from swinging it as such.

Thank you for your consideration.

Sincerely,

Second Shift

Lessons Learned

Well, med school sure did get busy there for a while. I wish I could claim that I spent the last month and a half elucidating the intricacies of Chédiak-Higashi Syndrome or memorizing the effects of each and every cytokine, but the truth is that even if I had, those nuggets of knowledge would already be forgotten.

As always, the most memorable lessons come straight out of the ER.

Like, when you flee the bank with the bundles of cash you just stole, resist the temptation to stuff the bills down the front of your pants.

When those explosive dye packs go off, they're going to damage some pretty valuable real estate.

It's Not a Toomah. At all.

After endless hours studying human pathology, it's not uncommon for medical students to become convinced they suffer from a rare disease or two... or eight. During a psych block, for example, the incidence of obsessive compulsive disorder self-diagnosis among my first year class shot up astronomically.

With much of this week's schedule devoted to discussing brain tumors, I feel a bit of prophylactic cautionary advice is in order. See, in learning how to make a diagnosis, we're taught to remember Occam's razor - that, in general, the simplest explanation is most likely. In other words, that dropped pen or sudden muscle jerk in lecture probably results from dozing during class and not a cerebellar lesion.

Moral of the story: you probably don't have a brain tumor. And if Occam isn't a funny enough last name for you, take it from this guy...

The Bionic Man

Spend any amount of time in an anatomy lab and you'll quickly discover that the crisp, bright colors of a Netter's atlas are nowhere to be found in an actual cadaver.

Which means if you happen upon oddly vivd pink gums while bisecting the head, they're probably dentures. Shiny silver prongs poking within a great vessel? That would be an IVC filter. And no, that bright yellow tube left in the urethra is not another fascial plane, but a foley catheter left for you to find.

All these surprises laid in wait deep within our cadaver. Other highlight from our class included a pacemaker and an artificial hip.

Still, I doubt anything will ever top the handicap parking permit I once encountered buried in a patient's skin folds...

Playing Doctor

I'm just going to take a quick listen to your Beatles collection, sir...

Stethoscope headphones via Geekologie.

Valentine's Day

Ah medical school, where the most physical contact I'll experience on Valentine's Day involves practicing the cranial nerve exam...

Whatchu talkin' about [Circle of] Willis?!

"Note: do NOT decapitate the cadaver" - Anatomy dissector guide.

Easier said than done, actually, when you consider that the last several weeks have involved sawing through the skull to peel out the brain, disarticulating the skull from the spinal cord to expose the back of the larynx, removing the skin to visualize the muscles of facial expression, sawing again to bisect the face, and removing an eye from its socket.

This of course is in addition to previously removing all the organs, sawing the thorax apart from the lower body, bisecting the pelvis, and more recently, slicing the brain into tiny pieces.

Barbaric? A bit. Tiring, frustrating, tedious and serial killer-esque? At times. But our now completed gross anatomy course was also a pretty phenomenal experience - humbling, challenging, rewarding and (literally) eye-opening.

I can't say that I'll miss the smell of formaldehyde, but I remain incredibly grateful to the women and men who donated their bodies to further our education.

To them and their families: Thank You.

Homeopathic ER

In case I don't pass this mega neuro block that has dominated the past month, I suppose I could always try working here...

Friday's Food For Thought

Typically sage wound care advice from The Onion's health desk: pick at it.

"If it doesn't smell like cheese, don't worry: You just need to pick at it some more. "

"Remember, the two best doctors in the world are right there at the end of your hand: your thumb and your index finger. So get in there and pick it!"

I'll try recommending that next time I'm in the ER.

A Friendly Reminder from the ER

As much of the country begins cleaning up from the snowstorm, just remember: hands and snowblowers don't mix.

Update: Shoveling can be pretty dangerous, too, says the American Journal of Emergency Medicine.

Open Wide

Popular imagination aside, in my years spent working in the emergency department, foreign body removals just really weren't that common. Of course there were occasional instances where objects found themselves in unlikely places -- "Sir, either we wait for the laxative to help the golf ball out, or I'm afraid you'll need surgery" -- but they really weren't a frequent occurrence.

I can also dispel any rumors of a "hall of fame" of removed objects... you'll find no drawer of lightbulbs or Coke bottles in the Big City ED. You will, however, find a very impressive collection of foreign bodies detailed in a new book about a pioneering endoscopist. Profiled in the NYT, Swallow tells the story of a turn of the century physician who removed (and kept) everything from keys to miniature binoculars from inside his patients.

Makes the pen I once saw fished out of a patient's throat seem not nearly as impressive.

Art Imitates Life

Stolen via facebook from a friend of mine, a cartoon guide to becoming a doctor. Very funny, and from what I've experienced so far, scarily accurate.

Just One More Question

In addition to our love of distinctive coats, Lt. Columbo and I share something else in common: we're always asking one more question. As a first year medical student, I practice taking a history and physical on patients in the emergency department. It's a great learning experience and a needed counterbalance to the hours spent in the library, but it requires some patience from the patients.

A typical ED patient will be likely be asked a similar set of questions by a triage nurse, their actual nurse, a resident, maybe a 3rd or 4th year medical student, and the attending. At the end of a long and uncomfortable visit, plucky Second Shift, MS-I might not be exactly what the doctor ordered.

Which is why my mentor and I always ask the patient's permission before I take their time, explaining that this opportunity is a valuable part of my education. If the patient looks too sick, or would rather not be bothered, we thank them for their time and move on. A few are annoyed at the interruption, some respond only with terse replies, but the overwhelming majority generously give of their time and eagerly participate.

While reconnecting with family over the holidays, one older cousin asked if I had begun interviewing patients yet. He angrily recounted how a medical student once asked him about symptoms that he never had, accusing the student of being lazy and not taking the time to actually read his chart. I tried to explain things from the med student perspective, but whether the student was actually lazy or just conducting a review of symptoms, we'll never know.

So, to anyone who has ever endured a barrage of seemingly random questions from a neophyte medical student: Thank You. It may be a bit of a hassle, but you really are helping us become better doctors.

Friday's Food For Thought

Identifying structures in the murky, monochromatic mess of an MRI of the brain is just one of the many challenges of our recently begun neuro block. (Memorizing hundreds of new anatomical terms would be another.)

While a career in neurology is almost certainly not in the cards, I have looked at enough scans to recognize that the above image is not -- despite its slight resemblance -- a human brain.

It is, however, an MRI of a bell pepper.

Thanks to a friend who trolls the internet to find awesome sites like these, I have been procrastinating lately by spending time on the "Inside Insides" blog, which features MRI scans of food (check out CT scans of a chicken McNugget here).

And now, back memorizing those cranial nerves...

Hmm, You Should Ask a Doctor

Typically when I gather with my family around the holidays, everyone enjoys retelling the same embarrassing stories of yesteryear. That time when I vomited out of a moving vehicle. The trip where I ripped my baby brother's stuffed animal out of his hands because I was scarred of the baggage claim at the airport. And who can forget the day when wee little Second Shift got so excited at Discovery Zone, he found himself in need of a dry pair of scrub pants? Ah yes, the memories.

This year, however, was the damnedest thing. Rather than the 20th recounting of how I very nearly burned the house down with a birthday candle, family members were instead seeking my expert medical advice. Now, they warned us that this would happen when we received our white coats, but I thought if anyone could see through that charade, it would be the same folks who remember me from my too-fat-to-wear-a-turtleneck-because-it-would-strangle-me days. I was wrong.

"I've had a pain in my back, but today it moved to the front, why is that?" "Can I take medicine X with medicine Y?" "You're the doctor, why do I sometimes wake up with a stuffy nose and sometimes not?" "Hey cuz, can you write prescriptions yet?"

Folks, if it doesn't involve one of the enzymes of glycolysis that I've long since forgotten, you're out of luck. Predictably, the only one not to get caught up in the collective madness was Uncle Jerk. As my father pushed him to seek my advice on his treatment options, Uncle Jerk replied that unless I had taken out a few hundred prostates in my first few months of med school, he'd stick with the real doctors.

Glad we're on the same page for once, Uncle Jerk.