Today’s subject: pharmacology of diarrhea. Our lecturer, who has been quite funny in the past, could barely keep a straight face. It was, for lack of a better word, hysterical. Look, no matter how far we go in medicine, poop will still be funny. I may have to be a GI doc.

A few choice excerpts:
“For lack of a better word, it’s a… uh… large pressure head… causing explosive diarrhea.”
“My favorite laxatives, of course, are the bulk-forming agents.”
“…the disadvantage of saline laxatives is that they often produce explosive, watery bowel movements.”
“Emollients have a tendancy to leak past the anal sphincter and soil clothing.”
“Let’s just go with ‘excessive flow’. ”
“Dammit, next year I’m giving this lecture to a more junior faculty member.”

It’s my favorite holiday! Happy Thanksgiving everyone!

We had a review of gastrointestinal pathology today. At one point, our prof started listing off potential complications of a peptic ulcer. As he spouted off a list of medical terminology, I realized that I knew what he was saying.

I had a sudden flashback to a pizzeria in Perugia, during my time as an exchange student. I was the only American who knew Italian, and since the waiter spoke no English, I had to translate for everyone on the fly. In between ordering appetizers and main courses, I noticed that I wasn’t thinking about what the words meant. They just made sense to me. It was the first time that I realized I knew how to speak Italian.

That’s what this felt like, today- I was understanding Medicalese. It was kind of surreal. Don’t get me wrong- I’m definitely not claiming to be an expert in medical knowledge. What I do think is at some point over the past year and a half, my classmates and I have become somewhat familiar with the medical jargon. When I really stop to think about it, it’s amazing to think of how far we’ve come*.

*of course, it’s even more amazing to ponder how far we have yet to go. Since that’s somewhat depressing, though, we’ll focus on the positive.

I just want to point out that my friend and I (coincidentally George W. Bush’s cousin) camped out at Best Buy overnight on Saturday to get a Wii.

And it is awesome.

That is all. Feel free to come over and play sometime.

We had a very interesting talk from some Jehovah’s Witnesses today as part of a health competency lecture series. For anyone not acquainted with Jehovah’s Witnesses, they are best known to the medical community for their refusal of any form of blood transplants. They outlined the biblical basis for their belief today (IV blood transfusions are deemed equivalent to “eating blood”, which is expressely forbidden in their version of the Bible), as well as the nuts and bolts of how this particular belief interfaces with modern medicine.

Interestingly enough, the ban against blood transfusions doesn’t seem to be that big of a problem, in terms of treatment. I spent all afternoon researching it*, and while obviously more expensive, an entire cottage industry has sprung up around treating Witnesses with “Bloodless Medicine”. This has even led to the development of blood substitutes that, though currently in their infancy, may one day help with nationwide shortages of blood.

Most Witnesses carry around a card that identifies themselves as such, and expressly grants the physician legal immunity in the event of their death secondary to blood loss. This is kind of a nice touch; though I may not agree with what they believe, if giving them a transfusion breaks their pact with God, who am I to force it upon them? I know I’d still have problems letting a patient die, but at least it would be on their terms.

I do, however, find myself troubled by one major aspect of Witness-dom… and that is the issue of pediatric care. I don’t think that children should be subjected to the religious beliefs of their parents if it may cause them harm. Turns out this was established as legal precident in Prince v. Massachussetts (1944), in which a Jehovah’s Witness was found guilty of breaking child labor laws. She was accused of forcing her child to distribute church pamphlets door-to-door (what Witnesses are best known for outside of the medical community).

Now, I am not a huge proponent of the culture of life. I believe that abortion should be legal, and I don’t think that Terry Schaivo should have been kept “alive” even though half of her brain had atrophied to mush. But I strongly feel that if a child is brought in by ambulance to an ER after major trauma, they have a right to all the blood transfusions necessary to keep them alive – no matter what their parents believe.

Unfortunately, the Witnesses did not agree. They offered to take “all legal responsibility” for the death of the child, just as they do for themselves. That does not sit well with me. As far as I’m concerned, letting a kid die on the table when you could have helped them is murder… and damned** if I’m going to be a murderer because someone else thinks blood is a bad thing. Even if the law would be on my side if I let it happen.

Anyhow, I suppose this is all very intolerant of me. But I also know I couldn’t live with myself if that child’s death was on my hands.

*I do not have time for this!
**literally!

At a Surgery Club talk the lecturer showed a picture of a man with a cleaver stabbed though his chest, left of the sternum. When he asked which organs were potentially in the path of the knife, an undergrad piped up:

“Well, it couldn’t have hit the heart, because the heart is on the right side”.

Pharmacology scares me. Not because it’s a lot of information (which it is), because each class of drugs contain countless specific variations (which they do), or because our notes are crappy (which they are).

No, pharm scares me because what we have learned is that drugs are metabolized differently from person to person. More fat and the THC from marijuana sticks around longer (good luck with the drug test, porky!). Less liver and drugs build up in your system. There are even people who get no pain relief from codeine because they simply lack the enzyme needed to make it work.

My point is that right now I’m reading about digoxin. Digoxin (affectionately referred to as “dij” by clinicians) is used to treat heart failure, but has a very small therapeutic window. What this means is that it is very, very easy to overdose – unlike, say, on Tylenol, from which thousands of angsty teenagers have failed to die over the years. What scared me was a throwaway sentence in our notes “in women, digoxin therapy for heart failure is associated with increased risk of death from any cause”. I’ve added the italics for emphasis.

This makes me think that prescribing drugs will do more harm than good. Maybe I’ll go be an alternative doc and prescribe acupuncture for everything.

Haphazard \Hap”haz`ard\, n.

Now, I usually say hap-hazard. I’d be willing to bet all of the english speaking world does. But, as our prof pointed out today, Ha-phazard (i.e. hafazard) might actually be the correct pronounciation if you were to come across it for the first time. Everybody in my hood knows it’s phat with a ph.

I’ve been having trouble seeing lately. My vision is distinctly blurrier than it used to be and I can’t see things at a distance. I think this is because of studying.

I found this post languishing in my “drafts” folder, and figured it was close enough to being finished that I might as well just put it up. It’s several weeks late at this point.

I’ve heard stories from the class above us that our pharmacology class is horribly outdated. We routinely learn drugs that are outdated and pass over ones that are currently used.

All of a sudden, I realized that they were totally right. Why? Our prof just told us that his slides are available on a “carousel” in the library. Lets ignore, for a moment, the fact that he is lecturing us off a powerpoint (I think it’s possible he’s not even aware of that fact)*.

As he was talking about antihypertensive drugs, he started to cut broad swaths through drugs we needed to know, and drugs we did not need to know. Unfortunately, one of my classmates mentioned that she had seen two “don’t need to know” drugs on several patient’s charts just the other day.

This worries me. This worries me both for the boards (on everyone’s mind, by this point) and for 3rd year. Pharmacology is supposed to be a given: a patient tells me that they are on acetazolamide, and I need to know what it does. I think I’m stressing myself out. But when I think “doctor”, one of the things that immediately comes to mind is “someone who can prescribe medication”. How is that going to work if I don’t know what the drugs do?

*It has come to my attention that he may not, in fact, have been implying that his slides were available on a carousel. However, for the purposes of good storytelling**, my incorrect assumption shall stand.

**To claim that I’m a good storyteller, of course, would be a mistake. This statement, however, shall also stand. Hey, once it’s written, it becomes true, right?