February 1971
A junior in high school living and learning at a boarding school in Austin, she enjoyed the occasional free weekend in Houston with her sister, her husband and their two young daughters.This trip started out like all the others. A happy reunion with family, a different routine, freedom from tasteless school cafeteria food. She remembers eating Fulshear sausage dripping in barbeque sauce, maybe too much but it tasted so good. A freshly made bed waited upstairs. If her real home was thousands of miles beyond, this had to be second best.
No one would have expected that she'd not make it back to school for class on Tuesday. No one would have predicted she'd get sick enough to be popped in the hospital with a nasogastric tube and IV fluids to decompress a hugely distended stomach and guts which simply quit working for over a week. No one would have expected she'd be out for the better part of the trimester, leaving the hospital to recover in Aruba and then back to school in late March.
I know that what happened to me was iatrogenic. When all that rich food and a possible overlay of irritable bowel syndrome or norovirus infection gave me the belly gripes, I was able to get a Saturday appointment with my sister's internist. I remember getting an injection which would "relax your belly" which was apparently in knots. In retrospect, this was not a good move on his part.
I don't blame the doctor. The problem is my unique and unpredictable patho-physiology, an unusual, amplified reaction to a medication designed to relax the gut and offer relief of symptoms. In my case, the drug paralyzed my entire GI tract. I know very well that patients don't come to us with an instruction manual about which drugs may have a paradoxical, harmful reaction in their system.
I put together my theory about a drug causing my gut woes and hospitalization only after having a similar experience years later, during my thrid trimester of pregnancy with Laura. I self medicated my abdominal discomfort and bloating with an anti-motility drug and paid the price. A drug that should have helped me backfired so badly that I wound up in the hospital for three days until my insides started working again. Paralysis.
I used to think that the term iatrogenic meant that the doctor made a mistake in the care of his or her patient. Not so. Iatrogenesis plagues all physicians. We deal with human physiology which presents without an accurate road map. We do the best we can. I doubt any of us intends to cause harm.
Sunday, January 13, 2013
How it Began
"Acute viral gastroenteritis with paralytic ileus" was the diagnosis on the medical records from March 1971 when I left Methodist Hospital in Houston at the age of 16. After my last post about "seminal events" this was my own version of a a life changing experience which brought my professional passion into focus. I moved from an interest in biology to a determination that a career as a physician was the goal.
I have some very clear memories of this ten day hospital stay and some that have faded over the years. I'll be returning to this story to explore in more detail how and why the experience catalyzed the dream. There were also facets of the experience that were so vintage 1970's that I laugh in retrospect.
I've always identified this event as the start of my journey. The reasons for the infatuation (remember this was the mind of a 16 year old) had more to do with charisma and fantasy than a sudden commitment to a life of service in the care of the ill. My doctor was young and attractive. The comings and goings of the hospital staff as they tended to my every need, the blood tests and xrays, and the delirium of the illness crystallized into a vision of myself as the one in my doctor's shoes, directing the show and witnessing the miracle as health returned to my patients. Overly dramatic? I think not.
Weeks after my discharge from the hospital, home in Aruba recovering and eating everything in sight to re-gain the lost weight of a ten day stint with minimal caloric intake, I told my parents, "I want to be a doctor".
I have some very clear memories of this ten day hospital stay and some that have faded over the years. I'll be returning to this story to explore in more detail how and why the experience catalyzed the dream. There were also facets of the experience that were so vintage 1970's that I laugh in retrospect.
I've always identified this event as the start of my journey. The reasons for the infatuation (remember this was the mind of a 16 year old) had more to do with charisma and fantasy than a sudden commitment to a life of service in the care of the ill. My doctor was young and attractive. The comings and goings of the hospital staff as they tended to my every need, the blood tests and xrays, and the delirium of the illness crystallized into a vision of myself as the one in my doctor's shoes, directing the show and witnessing the miracle as health returned to my patients. Overly dramatic? I think not.
Weeks after my discharge from the hospital, home in Aruba recovering and eating everything in sight to re-gain the lost weight of a ten day stint with minimal caloric intake, I told my parents, "I want to be a doctor".
The Seminal Event
From Miriam Webster on line:
Definition of SEMINAL
— sem·i·nal·ly adverb
Examples of SEMINAL
- Kandel was awarded the Nobel Prize in medicine in 2000 for his seminal observation that it was in the action of the synapses between cells that memory existed, not in the cells themselves, and that a molecule called cyclic AMP was what allowed cells to retain memory over the long term. —Michael Greenberg, New York Review of Books
Origin of SEMINAL
Middle English, from Latin seminalis, from semin-, semen seed
First Known Use: 14th century
Seminal. What a strange word I thought never having heard it used in a context other than related to SEMEN. That is, until the Chief would pronounce with great fanfare that a certain discovery, break-through, or insight into an area of Medicine was "seminal". By context I figured out that anytime he used the word it was listen-up time, a pearl of medical history and worthy of knowing because almost certainly he would ask about whatever he was describing again. We'd be expected to know the exact nature of the seminal event in question. He was doggedly determined to extend to us more than the raw facts. We needed to know the history and origins.
One of his favorite seminal events was the discovery by Banting and Best. that lack of insulin was the cause of diabetes and replacement of same could restore blood sugar to normal. The link is worth reading since Best was skipped over in the awarding of the Nobel Prize for this amazing research. As pupils of the Chief, we heard the story many times.
As I write this, I'm taking a jaundiced look at the term "seminal" to describe such pivotal discoveries. Why are they not just a well insights of "ovarian force"? Back in the day, I never gave it a moment's thought.
Seminal. What a strange word I thought never having heard it used in a context other than related to SEMEN. That is, until the Chief would pronounce with great fanfare that a certain discovery, break-through, or insight into an area of Medicine was "seminal". By context I figured out that anytime he used the word it was listen-up time, a pearl of medical history and worthy of knowing because almost certainly he would ask about whatever he was describing again. We'd be expected to know the exact nature of the seminal event in question. He was doggedly determined to extend to us more than the raw facts. We needed to know the history and origins.
One of his favorite seminal events was the discovery by Banting and Best. that lack of insulin was the cause of diabetes and replacement of same could restore blood sugar to normal. The link is worth reading since Best was skipped over in the awarding of the Nobel Prize for this amazing research. As pupils of the Chief, we heard the story many times.
As I write this, I'm taking a jaundiced look at the term "seminal" to describe such pivotal discoveries. Why are they not just a well insights of "ovarian force"? Back in the day, I never gave it a moment's thought.
Monday, January 7, 2013
Let's Try Again in 2013
OK, so this blog has been dormant for nine months; the time it takes to make a baby. So, maybe the way to look at this is that I've been doing something else that takes just as long and am ready to start anew.
Today I read an interesting comment on a Nephrology blog. The subspecialty of Neprhology is the least popular of all the subspecialties of Internal Medicine at this time. I am not surprised by this statistic although the hypothetical reasons don't make sense to me.
Difficult and challenging classwork during medical school on fluid, electrolytes, acid-base disturbances and the study of glomerulonephritis is cited as the major reason why young physicians in training don't select Nephrology for their professional life. Hmmmm.
I remember sitting in renal physiology lectures in UTMSH back in the late seventies and being totally confused because of two things:
1. the poor quality of the teaching in general, and
2. a particularly horrid clinician who delivered the "real world" of Nephrology lectures. He ruled the classroom with a "Gestapo-like" approach. In his opinion, we students were appalling unprepared, dumb, and hopeless. I was terrified that Dr. N would call on me as he was wont to do; so terrified that I'd often leave class so as to avoid even the smallest chance of ridicule. He was a horse's ass (hole).
And yet, although I understood little of renal physiology, a spark of interest remained and bloomed much later when under the watchful and supportive influence of mentors in the field. This made all the difference for me.
The reason I attribute to the decline in interest in this field we call Nephrology in the "modern era" is what students witness as the nitty gritty real, everyday practice of the Nephrologist.. The work is hard; labor intensive and never ending. Furthermore, when kidneys don't work, the whole body suffers head to toe. Ultimately nothing works well aside from the liver which for some reason hangs on to a relative immunity unless....unless, we're talking about a particularly thorny problem of hepato-renal diseases and then, absolutely NOTHING in the body works well or at all.
We patch things up the best we can. We do as little or as much as we can, depending on the day and time and the end result is usually the same. The diseases often benefit from benign neglect, a term that I've learned to embrace the further along I am on this doctoring path. If you simply leave things along, resist the notion that doctoring requires action, many times things improve on their own.
We cure little, hopelessly little. We stand by and watch ravages of disease march along at variable pace. And for this we come to work every day and do the very best we can.
It takes a certain person to consider that this field gives back enough to balance the feelings of helplessness in the midst of a super storm.
Today I read an interesting comment on a Nephrology blog. The subspecialty of Neprhology is the least popular of all the subspecialties of Internal Medicine at this time. I am not surprised by this statistic although the hypothetical reasons don't make sense to me.
Difficult and challenging classwork during medical school on fluid, electrolytes, acid-base disturbances and the study of glomerulonephritis is cited as the major reason why young physicians in training don't select Nephrology for their professional life. Hmmmm.
I remember sitting in renal physiology lectures in UTMSH back in the late seventies and being totally confused because of two things:
1. the poor quality of the teaching in general, and
2. a particularly horrid clinician who delivered the "real world" of Nephrology lectures. He ruled the classroom with a "Gestapo-like" approach. In his opinion, we students were appalling unprepared, dumb, and hopeless. I was terrified that Dr. N would call on me as he was wont to do; so terrified that I'd often leave class so as to avoid even the smallest chance of ridicule. He was a horse's ass (hole).
And yet, although I understood little of renal physiology, a spark of interest remained and bloomed much later when under the watchful and supportive influence of mentors in the field. This made all the difference for me.
The reason I attribute to the decline in interest in this field we call Nephrology in the "modern era" is what students witness as the nitty gritty real, everyday practice of the Nephrologist.. The work is hard; labor intensive and never ending. Furthermore, when kidneys don't work, the whole body suffers head to toe. Ultimately nothing works well aside from the liver which for some reason hangs on to a relative immunity unless....unless, we're talking about a particularly thorny problem of hepato-renal diseases and then, absolutely NOTHING in the body works well or at all.
We patch things up the best we can. We do as little or as much as we can, depending on the day and time and the end result is usually the same. The diseases often benefit from benign neglect, a term that I've learned to embrace the further along I am on this doctoring path. If you simply leave things along, resist the notion that doctoring requires action, many times things improve on their own.
We cure little, hopelessly little. We stand by and watch ravages of disease march along at variable pace. And for this we come to work every day and do the very best we can.
It takes a certain person to consider that this field gives back enough to balance the feelings of helplessness in the midst of a super storm.
Sunday, April 8, 2012
Isolation
"The patient is in isolation".....and I groan loudly inside.
This has been going on for 30 years in my professional life. Never any easier or any less aggravating; this need to take off my white coat, find a hook to hold it, don a flimsy yellow gown, put on gloves, and maybe a face mask (depending on whether we're talking respiratory isolation in addition). Then, I go into the patient's room all decked out, find family at the bedside who may or may not be in compliance with the warning sign of the door, and do my work. Then, in reverse, I peel off the costume and pitch all in the trash, wash my hands, and put on my white coat.
Back in the day this might happen once a day and sometimes only every few days depending on the mix of patients on service. Now, up to a third or more of the patients seen in the hospital have the "IN ISOLATION" sign on their hospital room door. Damn it, I think. And then, I feel guilty for cursing the need for all the hoopla.
I suppose it's possible to prove scientifically that what we do to prepare for our interactions with
those in isolation actually pays off in terms of preventing transmission of disease to other patients and to prevent ourselves, the presumed healthy, from becoming colonized with bad "beasties". In fact, I feel quite certain that this data exists. I just do what I'm told, cringing with the thought of reprimand if I'm caught out of compliance with the dreaded yellow paper gown.
Microbes are invisible. Yet, they are powerful and in some cases, deadly. It makes great sense to take precaution in hospitals where the risk of cross contamination between patients is so real. I get it. Truly, I do.
But, that doesn't mean I can't despise the process inside and curse and moan in silence for the plague of methicillin resistant staphylococcus aureus (also known as MRSA) which may have once been present in said patient but is years past but forever a "scarlett letter" around their neck. Or, the patient affected by clostridium dificil or multi-resistant enteroccocus, and on and on it goes. "Possible influenza" might be the cause for "in isolation and even though I've been immunized and am at low risk of transmission of disease....my hands and white coat, the humors that surround me, may represent the difference between safety for patients and palpable risk.
Sigh. I wax mournfully about this annoyance because I can. It takes up so much precious time. If I had a nickel for every yellow gown I've put on, I'd be a rich lady.
But, I'm compliant with orders. Compliant because it's the right thing to do; even if no one is looking.
This has been going on for 30 years in my professional life. Never any easier or any less aggravating; this need to take off my white coat, find a hook to hold it, don a flimsy yellow gown, put on gloves, and maybe a face mask (depending on whether we're talking respiratory isolation in addition). Then, I go into the patient's room all decked out, find family at the bedside who may or may not be in compliance with the warning sign of the door, and do my work. Then, in reverse, I peel off the costume and pitch all in the trash, wash my hands, and put on my white coat.
Back in the day this might happen once a day and sometimes only every few days depending on the mix of patients on service. Now, up to a third or more of the patients seen in the hospital have the "IN ISOLATION" sign on their hospital room door. Damn it, I think. And then, I feel guilty for cursing the need for all the hoopla.
I suppose it's possible to prove scientifically that what we do to prepare for our interactions with
those in isolation actually pays off in terms of preventing transmission of disease to other patients and to prevent ourselves, the presumed healthy, from becoming colonized with bad "beasties". In fact, I feel quite certain that this data exists. I just do what I'm told, cringing with the thought of reprimand if I'm caught out of compliance with the dreaded yellow paper gown. Microbes are invisible. Yet, they are powerful and in some cases, deadly. It makes great sense to take precaution in hospitals where the risk of cross contamination between patients is so real. I get it. Truly, I do.
But, that doesn't mean I can't despise the process inside and curse and moan in silence for the plague of methicillin resistant staphylococcus aureus (also known as MRSA) which may have once been present in said patient but is years past but forever a "scarlett letter" around their neck. Or, the patient affected by clostridium dificil or multi-resistant enteroccocus, and on and on it goes. "Possible influenza" might be the cause for "in isolation and even though I've been immunized and am at low risk of transmission of disease....my hands and white coat, the humors that surround me, may represent the difference between safety for patients and palpable risk.
Sigh. I wax mournfully about this annoyance because I can. It takes up so much precious time. If I had a nickel for every yellow gown I've put on, I'd be a rich lady.
But, I'm compliant with orders. Compliant because it's the right thing to do; even if no one is looking.
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