31 March 2009

Parenting and Doctoring

Why it is bad to have a parent who is a doctor (Saturday noonish)...
ThePinkThing: I don't feel good.
NeuronDoc: What's wrong?
TPT: I'm tired.
ND: That's because you woke up at 6 am.
TPT: And my leg fell asleep.
ND: Is it still asleep?
TPT: No.
ND: Then it's okay.
TPT: I think I have a fever.
ND (after checking forehead temp): No, you don't have a fever.
TPT: My stomach hurts.
ND: I think you just don't like your lunch and don't want to eat it. That's fine. If you don't eat your eggs, I won't give you something else instead.
TPT (grumpy): Fine.

Why it is good to have a parent who is a doctor (this morning)...
TPT: Mommy, I can't sleep.
ND (pries eye open, notices that it is 5 am): What's wrong?
TPT: I can't breathe out of one nostril.
ND: Why don't you cuddle with me for a bit?
TPT: Okay.
(climbs into bed. lots of shifting around. and snorting. and elbows. now 5:20 am)
ND: How is it now?
TPT: Still stuffy. I can't sleep.
ND: Would you like to go downstairs and watch TV?
TPT (sits up): Yes! (leaves before ND can change mind)

Why it is bad to be a parent and a doctor (around noon today)...
**ring, ring**
Neurondoc: Hello?
Female Voice: Hello. This is School Nurse. ThePinkThing is here. There isn't an emergency, but she has a temperature of 100.6. She told her teacher that her head hurts.
ND (having visions of meningitis, encephalitis and other awful things): Okay, I'll come right over and pick her up.
SN: She'll be lying down in the Health Room.

**ring, ring**
TheHusband: Hello?
ND: PinkThing alert.
TH: What's up?
ND: The school nurse called to say she has a fever, so I will go down and pick her up.
TH: I can get her. My job for the afternoon was canceled.
ND (somewhat untrusting): Okay. But call me if there is anything really wrong.
TH (correctly reading ND's thoughts and rolling eyes): Fine, I will.

Why it is good to have a husband who is not a doctor...
1 hour later...
**ring, ring**
ND (looks at caller ID -->TH): Well?
TH: She's fine. She's sleeping.
ND (a bit freaked): Sleeping? Was she lethargic, somnolent, confused? Did she say anything about her head hurting? Or a stiff neck?
TH (definitely eye rolling): No. She was lying down in the nurse's office, popped right up, and came over to me. She said she was tired, so we came home.
ND: Are you sure she wasn't lethargic?
TH (slightly annoyed): Yes. She got up at 5 am, remember? Stop it.
ND: But she could have meningitis.
TH: (sigh)
ND: Well, she could. I'm going to come home now.
TH: Fine, but I don't think you have to.
ND: But I'm worried.
TH: (sigh)
ND: Fine, I won't come home. But I'll be pissed at you if something bad happens.

90 minutes later
**ring, ring**
ND (looks at caller ID and cuts off coworker who is talking): Is she okay?
TPT: Hi Mommy!
ND (in a much happier voice): Hi love, how are you feeling?
TPT: Better, Mommy. Daddy and I are watching the Three Stooges on youtube.
ND: You definitely are feeling better...

29 March 2009

Diagnose and Adios...

Random person: What kind of doctor are you?
Neurondoc: I am a neurologist.
RP: What is a neurologist? Are you a brain surgeon?
Me: Umm, no, I don't get my hands dirty and I don't perform surgery.
RP: You're not a brain surgeon?
Me (slightly annoyed): No.
RP: So what does a neurologist do, if they can't do surgery?
Me: I treat patients with neurological diseases.
RP: Ah.... How?
Me (grrrr): With medications and therapies and sometimes referrals for surgery.

That is a not uncommon exchange between me and some random curious person, regarding my medical specialty. Unfortunately, many medical students and physicians exhibit a similar attitude, which is characterized as "diagnose and adios". There are many neurological diseases and disorders that do not have treatments, so many medical professionals consider it a frutiless specialty -- we can diagnose the patients, but we can't do a thing for them. It is a highly annoying attitude that pervades medicine in general. When I decided to go into neurology during my 3rd year of med school, I got one of several reactions ("Why?" "Yuck!" "Better you than me." "Diagnose and adios..." "You can't do anything for the patient, why do you want to go into neurology?" etc). Sort of like Bones McCoy's attitude to 20th century medicine in Start Trek IV, but even more annoying.

The brain absolutely fascinates me, nerves to a lesser degree. The brain is the organ that all other organs exist to support and live to serve. The heart pumps blood to the brain -- percent blood flow from heart to brain is 15-20%. The lungs oxygenate blood to provide the brain with oxygen, and the brain uses about 20% of total resting oxygen.* The gut absorbs nutrients so that the brain gets fed. The liver and kidney clean the blood of toxins and other crap, so that the brain remains healthy and isn't poisoned in situ. The eyes provide visual information for the brain to process; the ears allow for auditory recording. The legs move the body around so that the brain has new things to experience or to avoid dangerous situations. I am "brain-o-centric", okay?

However, I do have to agree that neurology is fraught with progressive, degenerative and untreatable conditions: e.g., Huntington's Disease, Alzheimer's diease, Lou Gehrig's Disease (ALS), Muscular Dystrophy, traumatic brain injury, spinal cord injury. Even the "treatable" ones are not usually curable: Multiple Sclerosis, Stroke, Parkinson's Disease, Epilepsy. So why am I a neurologist? As I said, the brain is totally cool and interesting. Knowledge in medicine is ever-expanding, and we are learning more and more about the underlying workings of the brain, spinal cord and nerves, and also about the diseases that affect the nervous system.

Perhaps, Pinky and the Brain express their love of the nervous system better than I ever could...

Fun website for silly brain and other nervous system facts is Brain Facts and Figures

* Kandel et al., Principles of Neural Science, New York: McGraw Hill, 2000 (<--- look a footnote!)

27 March 2009


Just a quickie post to show a totally cool picture that warms my science-y heart. Here is a picture of the ash cloud from Mt. Redoubt taken from a geostationary satellite that is over Asia. That is freaking enormous!

Photo courtesy of the National Weather Service, processed by the Cooperative Institute for Meteorological Satellite Studies at the University of Wisconsin-Madison. Picture Date: March 26, 2009 17:30:00 UTC. Downloaded from http://www.avo.alaska.edu/image.php?id=17104

Bite me, Bobby Jindal. (I know, I know, that's a gratuitous snark, but I couldn't help myself.)

Introducing the cats...

Today being Friday, I thought that I would introduce the cats. We have two, a male and a female.

We got the female first, although she is a little younger and certainly not the alpha-cat. She is a mildly feral, rather retarded, striped tabby cat. Her name is Muxa. Muxa? you say, in a very puzzled voice?. What the heck does that mean? "Muktzah" is a Hebrew word that basically means things that you shouldn't futz with on Shabbat, if you are observant. We are not, but it was a nice-sounding word, and we figured that nobody else in the world has a cat named Muxa.

The other cat is Ajax, who is sort-of Muxa's brother. He is a weird combination of scaredy cat and pet-me-slut. He has a "Pet-Me Meter" that frequently has a hole in it and requires lots of petting to fill up. I call him a "morning suit kitty" instead of a tuxedo kitty, because he is gray and white. He has no idea that his name is Ajax (named for the Greek warrior, not the foaming cleanser), but probably thinks it is Fluffy. He also has about 9 other names, but he responds to none of them.

If Ajax had his choice, he would live in a studio apartment (or perhaps a one-bedroom) with TheHusband, because I and ThePinkThing basically spend our time getting between him and his Master...

26 March 2009

Words of wisdom from me to me

Check the weather in the morning, otherwise you will send ThePinkThing to school in a fleece jacket when it is pouring rain and cold out. Kid is just fine with that. You -- not so much.

Do not ignore VEIP (vehicle emissions check) warning notice. Cops won't.

Do not kid yourself that you will be able to withstand the temptation of your favorite chocolate, if it is in the house. You won't!

If the job, deal, bargain, buy, etc seems to good to be true, it is. Really!

Don't ask TheHusband to do something too early in the morning. Chances are high that he will forget.

Adequate sleep is a great thing. (In other words, go to bed at a reasonable hour, you idiot! The internet will still be there in the morning.)

Hug the Husband -- you never know what might happen.

If ThePinkThing wants to wear a lime green/aqua/white striped shirt with pink/mint green/orange/yellow striped/flowered leggings (and pink/white flowered socks), don't object. The ensuing argument isn't worth it, and any pictures taken can be used for blackmail in 10 years.

24 March 2009

The Toe Story

Medical school is a combination of book-learnin', apprenticeship, hazing, and trial-by-fire. Therefore, it is the source of some great stories. Probably my favorite med school story is the "Toe Story". Not the Tooth Fairy or Toy Story, but the Toe Story. I haven't written it down, so I am not sure if it will work verbally as opposed to vocally.

This story takes place during my 4th year of med school, when I was doing an elective rotation during the fall -- Infectious Diseases. I adored that rotation, to the point that I strongly considered bagging neurology and applying for a medical residency so as to be able to do a fellowship in ID. It was mostly because of the attending physician on the service that month. I will call her Dr. C. She was amazing. She was 10 years older than I and 8 freaking months pregnant and could walk faster and for longer than I could. She knew an enormous amount about medicine, ID, and how to take care of sick-as-shit patients. I didn't want to grow up and be like Dr. C, I wanted to grow up and be Dr. C.

Anyway, on any given day, we would round on established patients in the morning, then be assigned new patients that we would have to see prior to rounds in the early afternoon. That day I was given a patient with possible osteomyelitis to evaluate. Osteomyelitis is infection (or inflammation) of the bone. She was a 50-something year-old woman with juvenile-onset diabetes, who has a non-healing wound on her foot that wasn't responding as well to the wound care as the docs had expected. So I was instructed to evaluate her for the possibility of osteomyelitis, which would most likely require her to have her foot amputated.

I went in and introduced myself to her. "Hi Mrs. X, my name is Neuron Doc. I am a student doctor working with the Infectious Diseases service. Your primary doc asked us to come take a look at your foot."

"Sure, dearie, come one in and take a look," she replied. "You know that I can't see you". I had read her chart prior to coming in, so I knew that she was blind from diabetic retinopathy and had pretty severe neuropathy of her hands and feet.

I went over and did the usual poking and prodding, listened to her heart lungs and belly with my stethoscope ("flea collar" in MedSpeak), etc. Then I went to the end of the bed to look at her foot. It was wrapped up all nice in a big white gauze bandage. I kinda felt bad about messing up the dressing, fully well aware that her nurse was going to be pissed about that. But I carefully unwrapped all the gauze and very daintily removed the pads. It was pretty gross. There was an open wound on the top of the foot, sort of at the base of the two toes just adjacent to the big toe (2nd and 3rd toes). The 2nd toe was almost black, and the 3rd toe was a darkish purple. “Eeuuuw,” I thought. I gingerly reached out and touched the 2nd toe. "Does this hurt?" I started to ask, as I moved the toe up a little. But then the toe came off in my hand. Literally. I was holding this woman's toe.

The look on my face must have been something to behold, but she was blind and couldn't see. And she was basically numb from the knees down, so she couldn't feel. "No, dearie, I can't feel a thing on my feet. Good thing, because my foot should hurt like the devil." But I was still holding her toe as she said this. There was no blood. Just a little slot where the toe should be. And it was in my (gloved, thank goodness) hand. I thought "oh fuck, now what do I do?" Then I very carefully, put the toe back in that little slot, wrapped the foot back up in clean bandages. And left. Quickly.

I went straight to Dr. C's office, hoping she would be there. She was. I knocked and went in. As soon as I got into her office, she could tell something was up and asked if anything was wrong. I lost it and started to cry. I wailed out my story. And she tried. She really tried to hold it in, but she couldn't. She burst out laughing. She asked me if I wanted to go back and finish that consult, or if I wanted to hop to it and see a different patient in time for rounds. Needless to say, I saw a different patient (a nice simple hospital-acquired, multi-drug-resistant pneumonia). When we met for the pre-rounds discussion, Dr. C couldn't resist and told the team the story. In hindsight, it really was hilarious.

The woman's toe had basically auto-amputated due to severe peripheral vascular disease, and that – combined with the poorly healing wound and underlying osteomyelitis – did require a below-the-knee amputation. Which went well. I always wondered what the woman thought when I ran out of her room and am ever grateful she couldn't see the look on my face, when I pulled her toe off. And I never became an Infectious Diseases doc...

23 March 2009

The Big Bang?

So I figure that I should start my blog off with a bang. A big Bang! And the Big Bang seemed quite appropriate.

Credit: NASA/GSFC/Dana Bery


See you tomorrow!