The Seminal Event

 From Miriam Webster on line:

Definition of SEMINAL

1: of, relating to, or consisting of seed or semen

2: containing or contributing the seeds of later development : creative, original <a seminal book>

— sem·i·nal·ly adverb

Examples of SEMINAL

1. 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.

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.

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.

"He Went to Chicago...."

During medical school and residency, slang phrases for death were inevitable, especially amongst the surgical trainees  Thinking back, I'm wondering if a certain wild and crazy resident from Argentina named Mario K might not have invented his own terminology for the act of passing on into the great unknown. I first heard the phrase come out of his mouth and then from others who worked with him. After leaving Texas and my training roots, I never heard this expression again. A Google search for synonyms for  the verb "to die" spews forth all manner of  crude expressions as well as the more generally accepted phrases that one might hear from a funeral director....like "departed", "passed away", or "left us".

Mario referred to the act of dying as "going to Chicago". I remember coming in for rounds one morning as an eager, yet terrified third year medical student and hearing him (as senior surgical resident) say of someone who had died during the night, "He went to Chicago".  I recalled thinking this an odd blend of disrespectful, weird, and funny, a not uncommon situation in Medicine when stress-busting humor commonly borders on the edge of decency, if not beyond. Medical types typically limit our not-so-professional-speak to times when we're in the company of others of like mind or those who wouldn't take offense. Discretion is key.

Yet, "going to Chicago" isn't really an offensive term for dying. The only question I had then, and still do is what happens if someone dies in Chicago?

also published at Ahead of the Wave

When Your Child is Ill

My parents owned hundreds of books, belonged to several book-of-the month clubs, and considered books worthy of display in one's home; much like art. The only books hidden away were written by Mr. Alfred Kinsey. But, never fear; I found them anyway as a naive but curious twelve year old, stashed in the back of the guestroom closet. I read fast, furiously, and frequently, always careful to put the books back in their not-so-childproof hiding place. In retrospect, those books taught me things no one else bothered to educate me about.

But I digress, wildly off topic.

If there was something or someone that started me on the path, it would definitely be the innocent looking book entitled: When Your Child is Ill by Samuel Karelitz, M.D. This hardcover book-of-the month selection from 1958 found  a prominent spot among the books in our living-room bookshelf. I don't think Mom read the book but I certainly did. Voraciously.

The introductory remarks in this book includes the following passage....
"When Your Child is Ill is a book for intelligent mothers. It is not a substitute for the doctor: it tells her when she needs him (love that); and it helps to answer the questions parents often ask themselves before and after the doctor's visit. Dr. Karelitz's object in writing for parents so fully and frankly is not to alarm but to inform and how to treat her sick child herself, but rather to tell her what symptoms to look for and which are danger signals.  This book, so full of facts, will also be of use to nurses, school matrons (huh?) and social workers--in fact to any person who may have to deal with sick children."


This book simultaneously scared me to death and pulled me back into its pages with a kind of warped fascination. I was a healthy kid but succumbed to the usual: measles, chickenpox, and croup-like upper respiratory illnesses. Whenever I was sick enough to stay home from school, I'd pull this book off the shelf and devour the pages that discussed whatever symptoms were most prominent in the moment. The problem was (and to this day); whatever complication there might be from any relatively benign illness......I figured I'd get. Meningitis, encephalitis, rabies, liver failure.....and on it went.

Mom eventually confiscated this book from me. "You get too upset when you read this.", she'd say. I'd beg her let me read just a bit more. If the book disappeared, it was never well hidden. I'd always find the book and read voraciously about all manner of horrid thing that might happen.

Did this book fuel a budding interest in things medical?  I believe so. When my parents moved from Aruba back to Texas and were packing up their belongings, I spied this book and felt a peculiar bond. Mom told me to take it, jokingly. I was just finishing up my first year of medical school at the time and had come to Aruba for a last visit home.  That was 35 years ago, 1977.

I never see this book, which resides in the back on my closet with other old books, that I don't stop and remember a very young, impressionable girl.