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Archive for August, 2005

Wednesday, August 17th 2005

Leaving Home

This is a tragic event. I have incredible admiration for Ariel Sharon. Here was a man who trumpeted Jewish settlement of Gaza early and life, and yet having seen the only way to peace he has risked his career and his reputation and suffered to watch settlers torn from their homes in order to give such a chance.

Israel has made a giant consolation. If the Palestinian Authority cannot control the militants now, then may Israel bomb them into oblivion and be done with them.

Wednesday, August 17th 2005

How A Person Becomes A Patient

I hope I never look at a person as a disease but it is far too easy. This is a pretty brutal and impolite situation.

Here’s how it happens, from the New York Times.

Wednesday, August 17th 2005

Five Minutes of Medical School

This is five minutes of medical school.

I’m sure the vast majority of undergraduate biochem majors have or will see this pathway during their college work, but to cover it in five minutes? It is merely the speed of medical school and the amount of information presented that makes it so difficult.

Tuesday, August 16th 2005

Designer Babies

Will parents be able to choose the sex and genes of their embryos before implantation in Britain?

The medical director of one of Texas’ most successful and largest infertility clinics came and talked to my class today in an ongoing clinical correlation set of lectures tied to gross anatomy. His clinic wouldn’t reveal or allow parents to choose the embryos to implant based on sex (except in the case of X linked diseases).

As well, if the parents didn’t take back their unused embryos, no embryo, no matter if PDG revealed chromosomal abnormalities, was destroyed. All of them were sent to long term cryogenic storage.

Monday, August 15th 2005

In The Past

The kid doubles over like he’s about to hurl and then comes rhythmically back up, extending his arms and leaning back; stretching his abs which he hasn’t willed to contract. He remembers back to the time he was ill. This is his only reminder of it, these cramps and contractions. The scar from his surgery is even hidden from his view as so he can simply pretend it isn’t there.

“You okay?”

The kid nods as his opponent puts the basketball down. Predictably, a few seconds into the mess and the muscles start to relax. The muscles give up in a wave, from top to bottom until his side doesn’t ache anymore and the breaths become easier. He picks the basketball up. Back to normal he can once again forget about those days in the hospital, years ago.

He was sick though. It began with a backache; low down a single side of his body and deep. The way he remembers it, the few times he thinks of it, is of days, perhaps a week, where at times the pain left him curling up in bed and others where it seemed a mild inconvenience. A fever comes several days later.

“You have the flu,” or something of the sort, his mother thinks.

There’s reason to think it. The night before he’s admitted to the hospital he goes out to the movies with friends. He can remember that. It’s a joke now. He gets home after dark and crawls into bed. At some point he begins to feel sick and then to vomit. It doesn’t stop though. At no point does the heaving relieve the wrenching of his stomach, as he might expect from past experiences. His parent’s are concerned as he wakes them up.

There’s reason to be now. When the sun finally rises and the private labs open, it’s off to get blood drawn.

“He’s dehydrated,” they say; an easy enough diagnosis. It is to the hospital with him. He’s resentful, a little. There was an unspoken expectation that his first hospital admittance would be at 60 for a hip replacement. Maybe the thoughts weren’t so specific in nature, but they were there. There’s little time for that. The fluids they put in him bring an incomparable, unbearable pain.

So bad he embarrassingly can’t stop himself from writhing or letting the tears come to his eyes. He doesn’t want to remember feeling cowardly and wimpy that night or how it helped a little when later in his hospital stay a fireman, turned nurse, told him his pleurisy was the worst pain he had ever experienced. He wishes he would tell that to all the people who saw him that first night.

The pneumonia found on the scans explains the effusion and later the culture reveals the bacteria is no super bug, bowing to antibiotics quickly. The doctor takes his time explaining this to him even fielding ridiculous questions (or at least the kid will imagine them as such later), like, despite the culture could the effusion be caused by something else, say, cancer? He can’t remember the doctor’s name despite this consideration.

The morphine helps, both before and after the diagnosis. More and more and more with the little push button until the next thing he knows the doctor is leaning over him asking him how many fingers he’s holding up, who the president is, what day it is.

“I’m waiting for the trick question,” the kid says. They know he’s alright with that. He doesn’t ponder what it must have been like for his mother, sitting there in the room, as he starts imaging and rambling about three legged animals, or so he’s told that’s what he spoke of. Instead he’s absorbed in the thought, that he was so cowardly in dealing with the pain that he drove himself into a morphine induced hallucination. It does make for a good story however, later in life. His experience with drugs.

They send him home eventually, waiting for the effusion to go away by itself. Trips to the hospital show it merely dries up into a fibrous solid. Yes, there’s some trouble breathing, but let it be, he thinks, it’s better than the solution.

When he wakes up in the ICU after the surgery he’s vindicated. Like with that first night in the hospital, when he remembers, he remembers the pain. It hurts when they can’t get the material out with a scope and have to cut and spread your ribs at your side. He remembers being able to feel himself pee out the catheter, despite the epidural.

Nowadays he can say, “It wasn’t that bad, it could’ve been worse.” He even talks about how, if he was going to have to get a scar, he wishes they had made it longer, cooler. Those around him know it was tough though. They watched him from his bedside. They remember better than he does.

Slow steps around the hospital as he starts to walk a day or two after the surgery. He tries not to be a wimp for this part of it. And then, it’s home, and changing your own bandages, and having to sit on a stool while taking a shower as standing for long periods is still difficult.

It’s as if as soon as he’s home he starts to forget. It was another life when those doctors took care of him, when those friends came and visited him in the hospital. As the incision heals and scars so does that part of his brain holding those memories.

He thinks about Christmases and family trips and that time on his high school basketball team when he hit those free throws to beat St. Anthony’s but he can’t even remember the year he went into the hospital. Was it 1999 or 2001? All major events but not all equal

Maybe they did their job to perfection then. Everyone who cared for him, that is. He’s normal, he’s healthy, and except for that scar he can’t even see in the mirror, the entire trip may have been made up. A vivid dream, that’s how hazy some of the memories are.

If he stopped he might feel ungrateful for trying to forget his experience. After all, those healthcare providers did an awful good job on him, he might suppose, and yet he can’t remember a thank you or even their names.

He might excuse himself with, “They wouldn’t even remember me.”

Maybe that’s not important. It might have been a big enough thank you the day he walked out the door.

Monday, August 15th 2005


…can buy happiness, as presented at the American Sociological Association annual meeting.

Saturday, August 13th 2005


Sometimes it is hard to separate your own personal experience with studies and facts. Accutane was a wonder drug for me, I loved it, it was simply put amazing. However, the FDA is imposing new restrictions on the drug for fear of neurological changes in users (and birth defects in pregnant women who take it).

Friday, August 12th 2005

HIV Treatments

A UT – Southwestern (hooray) ID researcher, of some renown, has led a study that offers a very very promising new treatment for HIV/AIDS patients. It’s making its way through the news sources very quickly.

Friday, August 12th 2005


The Veteran Affairs health system is going to review every case of diagnosed PTSD between 1999 and 2004 to see if the veterans should truly be receiving disability benefits.

I’m skeptical of many psychiatric diagnosis that can appear with wide ranging symptoms and require a subjective diagnosis above and beyond say what an ID doctor must make. However, this is clearly a witch hunt for the VA to save a few million dollars at the expensive of this country’s veterans — otherwise they’d be looking at veteran’s applications whose PTSD disability claims were denied as well, in hopes of finding those that should be receiving benefits but aren’t.

Tuesday, August 9th 2005

The Drug War

Make no mistake. I hate John Tierney. However, despite my less than libertarian views on stifling immigration and opposition to abortion, most of my social views fall along the party line. Among them is my belief in the legalization of illicit drugs, which Tierney has written a column about in the NY Times.

It’s not only the right thing to do in terms of restoring rights but also the pragmatic solution to a problem, the use of illicit drugs, which has grown only worse since the declaration of the ‘war’ on drugs.

H/T to DB’s Med Rants, who comments on the article here.