Thursday, August 2, 2007

Blog Rounds 1: Learning to Drool on Command

Glad to see there are still people reading this blog. We all had to take a little break after boards and to finish the end of our second year. Much, much more on that from my POV still to come, stay tuned for a month or two and you'll get the good stuff.

So I read a lot of other blogs, probably way too many. The good ones often leave me thinking about far more than I end up writing in comments, but us three Type B girls often get into good conversations about why these posts appeal to/disgust/inspire/amuse us. I've decided to do some posting on here about why it is that certain posts hit a nerve, and call these posts "Blog Rounds."

I caught this post tonight. It's over on a not uber-popular (read: Michelle Au..yeah you know who I'm talking about) but BEAUTIFULLY written blog, Nobody wears a white coat anymore... The writer is a resident at a hospital in Indiana (my home state!). She is amazingly clear and insightful about what is happening around her, I highly recommend it.

She was writing the other day about a patient of hers that she had just diagnosed with amyloidosis, and despite everyone saying what a "nice" woman this was, the unfairness that she will most likely die soon of this horrible disease.

Here's the excerpt that moved me the most out of all this, bold and italics added for emphasis:

"A has systemic AL-type amyloidosis. It's a horrible disease in which a particular line of cells in the bone marrow is overproduced, yielding an excess of a particular protein, which then simply silts out into the spaces between cells. The only good thing about this disease is that when you stain amyloid with Congo Red and light it up with a polarized microscope, it glows a bright shade of green and looks very pretty. The prognosis is poor, the progression is relentless, and most people who have it die within the year."

The post is much deeper and longer than this. But I think I've just figured out what it is that hit me so hard about it. We're taught in the first two years of med school how to make quick associations that lead us to develop differentials. Any med student entering their third year in the States will quickly, in true Pavlovian nature, shout out "Apple green with Congo Red stain!" if you so much as mutter the phrase amyloidosis anywhere near them. (Go ahead, try it sometime, I dare you. Even if they don't shout it, I can guarantee you that a picture somewhat like the one posted here popped into their minds.)

What is difficult for so many of us to deal with during these first two years, though, is that these aren't just diseases we're dealing with, they're PEOPLE with diseases. These people have lives. They have families. They have hopes and dreams. We came into med school saying that we were here to help PEOPLE, not learn how to knee-jerk diagnose a disease. But that knee-jerk association is necessary to even begin to be able to help them.

Somewhere between the beginning of med school and now, we've, I've, forgotten at times that the people are what matter. It isn't that I think they don't matter, but it's hard to not get caught up in the tornado of memorizing facts and spitting them back out that med school can be.

I'm glad to see it put into perspective that sometime down the line, a few years from the constant onslaught of Scantron tests and lab practicals, this information still came back to her in residency. But it was somehow separate and a tangent to what actually mattered, the patient.

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