Archive for Medicine

To be a Woman in Medicine

What is a woman’s role if she is not beautiful?  No one’s girlfriend/wife?  No one’s mother?

A good friend told me that woman often have less self-confidence than men and this is especially obvious in the field of medicine.  I’m working with a man who I consider to be the best family practice DO I have ever met.  There’s nothing to criticize in this experience except myself, so why do I do that?  Why can’t I just soak up the experience for what it is, learn what I can and forever have this magnificent example of an ideal osteopathic family practice?

Woman are natural nurturers.  Medicine is very paternalistic: either grow some balls or get out!  I receive so many compliments that I’m going to be a great doctor and all I can think to myself is that I can’t wait to pay of my loans so I can run away to a nunnery, a Buddhist nunnery of course.

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Residency, sights and authors, Oh my!!

It is confirmed.  I matched to do my residency in Neuromuscular Medicine (a euphemism for Osteopathic manipulation) in Southampton!!  I think I might take up surfing…

It has been raining for 4 days here in southern California and this afternoon the sun came out and I saw snow on the distant mountains.  As corny as this sounds, it was one of the most spectacular scenes I’ve ever seen!

I saw 2 authors in person this weekend.  One was Noah Levine, the founder of Dharma Punx, an American Buddhist Society that arose out of the punk rock era.  It is also the name of his first book.  I bought the book and hope to have it autographed before I leave LA, preferably after I read it!  Secondly, I saw Eric Pearl, DC who wrote “The Reconnection”.  I read this book about 2 years ago.  He was a good, grounded and funny speaker, even if I’m still a little skeptical…He presents some bizarre concepts.  I’m neither completely turned off by him nor am I jumping on his band wagon with both feet.  I need to do some experimenting.

The Zen of Surgery

Focused.  Workers sacrifice their bodies for a greater cause.  My favorite surgeons are cool, calm and collected.  They try to create the best possible environment in which to work and then accept and work with whatever circumstances present themselves.  It is really quite impressive, almost (gasp!) spiritual!!

Genetics vs. the Soul

I butted heads today with my psychiatry preceptor.  He believes that the future of medicine is “PharmacoGenomics” and I emphatically disagree.  I do agree that there are some interesting discoveries in the genetic world, but genes are not the end all be all in the disease process.  And then to but drugs and genes together is so repulsive that I feel nauseated.  It amazes me that there are people that believe you can control gene expression in humans.  Have you ever read some of the studies they’ve done on the genetic mice?  The mice have been so inbred and genetically manipulated to isolate a gene that they hardly resemble and living creature.  And then they want to transfer the information that get from these studies to humans?  No no.

I’ve started doing yoga on the screened in porch when I get home in the evening to take advantage of the beautiful weather.  My historical thinking is that yoga is good for stretching, but to get a full workout, I should go jogging.  Now I am wondering about the transformative properties of yoga.  The body awareness, physical exercise and meditation quality can lead to a tranquil state of mind.  With this mindset, one is less likely to over eat, have proper posture and feeling of general well-being, as opposed to overindulging after running 5 miles.  When my body wants to jog, I still will, but I’m not going to try to over do it.  I need to explore this yoga thing more…

Real?

For all my ranting about the medical community/school, etc, I wonder how my analytical side would have faired in a more rigorous environment, challenged to hone my skills and answer pimping questions.  Today I sat through almost 4 hours of touchy-feel-ly discussion between the residents (mostly the international medical graduates-IMGs) and the faculty of the Maine Darthmouth Family Medicine Residency.  The program has become known for its laid-back, open-minded program.  The IMGs were concerned that people were excited next year’s intern class had no IMGs, which turned into this huge discussion on ethnic diversity, benefits of IMGs and disadvantages, blah, blah, blah.  Some points were valid and interesting, but I was not interested in sob stories.  I feel like such a hard-ass.  I greatly admire the IMGs for coming to the US for their training despite being away from their home culture and familiarity, but why are they so upset if the patients can’t understand them or ask where they’re from?  I wonder what it would be like in a place that doesn’t allow this kind of belly-aching.  Where the goal is teaching/learning and patient care.  Would I feel just as alienated because of the lack of human relating or would I be more comfortable?

Last thought (has to include Osteopathy, right?): there was some discussion about the prejudice against DO’s and I was wondering if ANY of the DO’s or OMS’s feel discriminated against because they want to treat a patient (regardless of disease) with manipulation.  To be honest, I feel like my education has discriminated me against Osteopathy because we have to behave and think like medical students.  And yet one of UNECOM’s goals is innovation in health care.  Did they ever consider that returning to our roots would be an innovation at this point???  It kind of makes me laugh and cry and go insane, but I have to be careful because I’m on my psychiatry rotation and they might not let me go home!!!

It is completely ironic that I have to “get through” my education without getting the education I really want.  Although, maybe next year…maybe I’ll find people who treat all diseases with manipulation and can talk to me about the anatomy…maybe next year…

A surgeon’s perspective

It is so interesting to get different people’s opinions of me.  I was evaluated today by the surgeons I’ve been working with.  They labeled me as quiet, reserved, passive, even mousy.  They were concerned I would not make an impression on people where I rotate or do my residency.  This is interesting for 2 reasons: first, they are surgeons and by definition they have to fairly out-going and aggressive.  For goodness sake, they are cutting people up!!  Therefore, they don’t understand introverts.  I am an excellent listener, thoughtful and compassionate.  I wasn’t able to show them these qualities in the OR other than listening to people yak, in which case they don’t notice anyone is listening as long as no one else is talking!!  Plus, they didn’t see me in lectures where I regularly answer questions or ask questions of the instructor while most other students sit passively through the lectures.

Secondly, the OR was an extremely intimidating place for me, so I naturally shut down until I became comfortable and understood my position.  Once I became comfortable, I didn’t have many questions because surgery became rather boring to me.  Once patients are scheduled for surgery, or yet, as soon as they are referred to a surgeon, the course of action is fairly straight forward.  I asked a few questions that I thought were intelligent, but I didn’t ask the questions like, “Do you think OMT instead of surgery could help facilitate the healing of this [fill in the blank]?”  “Should we do soft issue OMT to the thoracic and lumbar paraspinal muscles to help this patient regain bowel function?”  “How about suboccipital release for all the patients who are intubated?”  What’s really ironic is that Inland Hospital is the only Osteopathic hospital left in Maine, but you’d never know this by the way it is run…

Medicine…

I was reminded after my last post that allopathic medicine has quite a bit to offer patients.  I do believe that, especially in the case of emergency situations.  Today I saw a woman prepared to be air lifted to Bangor from Waterville because she had a rupture thoracic aortic aneurysm with right hemothorax.  It was an intense experience and I was the official glove provider.  🙂  My emphasis on this blog is in regards to all that allopathic medicine cannot do or does not understand: assisting the body heal a diabetic foot ulcer by stimulating circulation or alleviating an asthma attack by putting your hands on the patient’s ribs.  Natural, common sense approaches to patient care.  I’m learning about fluid management, electrolyte disturbances, surgical patient perioperative care, which is useful.  The constant question in the back of my mind is how many of these procedures are actually preventable given appropriate Osteopathic management?  Breast biopsies, cyst/abscess removals, I even wonder about appendectomies.  The key word here is WONDER.  Until I get significant experience, I plan to practice as expected.  My constant curiosity, analytical ability and faith in the body to heal itself given the right circumstances will continue to gnaw at the back of my mind.

Yoga and Brits

One of the general surgeons I work for is one of the nicest people I know.  He is so gracious and polite, even to the obnoxious nurse that everyone else ignores.  He recently moved to the States from Britain and that may partially explain his congeniality, but he speaks of some of the surgeons in England who are complete asses, as one would expect from a surgeon.  He makes me feel guilty for being judgmental/critical.  Unfortunately this a is a part of who I am and although I know it is not something to be proud of, it is what has helped me in my pursuit of various scientific degrees.  However, I see the healing effect that this surgeon has on the patients, nurses, students and other doctors and it is humbling.

I started reading a book dissecting the different types of yogas.  The yoga we are most familiar with is Hatha yoga, where people use exercise to separate soul from mind/matter and connect with the greater Oversoul.  However, all forms of yoga are various ways to attain this goal and they just use different means to get there.  I’ll write more as I learn more.  I’m learning a lot of new vocabulary, so the information is not sticking as well as I would like, hence I will write interesting tidbits as they come up.

M*A*S*H*

Yesterday I watched adhesionolysis and a segmental small bowel resection in a woman receiving chemo for carcinoma in her mouth.  During the operation I constantly marveled at the beauty of the bowel with its mesentery and its ability to return to function after being man-handled.  I felt a twinge of guilt knowing I should give this woman OMT after the surgery to help normalize function, but knew that I wouldn’t.  Then I felt it should be standard practice since the hospital IS an Osteopathic Hospital, although no one would know it by looking at it.  Finally, my thoughts strolled over to my favorite medical TV show, M*A*S*H*, where they are constantly doing abdominal surgery on wounded soldiers.  In one episode Hawk Eye is temporarily blinded and walks around camp exploring his other senses.  At one point he helps a colleague find a nick in the bowel of a patient simply by smell.

I enjoy M*A*S*H* because it is as much a political show about the Vietnam War as it is about medicine, which keeps the episodes varied and interesting without having to add too much soap opera drama.  I have a lot of respect for the doctors who constantly let everyone know they don’t want to be there.  However, since they are there, they do their job helping the wounded recover, all the while dreaming about home and other creature comforts.  They are fulfilling a duty and it strikes me as honorable despite the dishonor of the war.

I admire my classmates who signed up for the military.  I am too selfish to sign myself up for such duty. In a way, my classmates who signed up for the military, although they are making a sacrifice, are using the military to help pay their expenses, so they are not completely selfless either.  Meanwhile, we’re all studying hard, looking for the “best” residency, trying to please our attendings and for what?  The become the “best” doctors?  Earn the most money?  Be satisfied with life?  Sometimes, I think it is all a bunch of bollocks and I want to scream.  Sometimes, I believe we can help people.  Mostly, I wish I had a cause to work for besides my own well-being.

Relative Futility

Social work, psychology, physical therapy, speech therapy, occupational therapy and even medical therapy.  All these specialties get together to analyze children in their development when it is abnormal.  Today I saw an 18 month old newly diagnosed with Autism.  It amazes me that 1) there are definitive developmental skills (eye contact, social engagement, talking) when not present can draw attention and be labeled as abnormal, 2) there are interventions that people can provide to facilitate proper development of otherwise developmentally delayed children.  These workers put a lot of energy into evaluation of the patient, educating the parents and writing reports.  What troubles me is the amount of paperwork and number of people required for this.  I guess it is out of necessity for quantifiable data and proper documentation for insurance companies to pay.  It just seems ridiculously lengthy, burdensome and distressing.  Sometimes I feel like we go through all this effort because it makes us as care-givers better that we’re actually trying to do something.  I suppose there have been studies to indicate that some interventions help better than nothing.  Still, it amazes me that SO MUCH effort goes into these kids who have difficulties.

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