The Test-To-End-All-Tests was okay–I passed. So that’s good news.

In less-good news, I had vaso-vagal reaction yesterday while seeing a patient with our preceptor yesterday. (Another classmate had one as well.) A vaso-vagal reaction is basically a drop in blood pressure in response to emotional stimuli–usually visual or olfactory, according to my preceptor.

It was the weirdest thing. We were seeing a patient with a large surgical wound on the side of his neck; it was a long incision, and had two drainage tubes coming out of it as well. We were in the patient’s room for no more than 8 minutes, but out of nowhere, in the last minute we were there, I started to feel intensely nauseous. My first thought was that some noxious gas was being bumped into the room. Another classmate had already stepped back and sat down because she was feeling a little light-headed. We left the room and I continued to feel really naseous, like I was gonna barf everywhere. Then a couple minutes later I felt a little light-headed, so I sat down in the middle of the hallway. Lost all my color. After a few minutes rest, we walked down to the cafeteria and our preceptor (Dr. Gesundheit, is that not the coolest name ever) bought us cookies and fruit.

Came back home and took a nice nap and felt better after that. It was an especially strange experience because I’d thought I’d already seen far worse–open heart surgery, heart transplants… but for some reason this did it for me.

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Welp, that was relatively painless. It’s a new look and a new name. Gross Anatomy was so last year, so I figured I’d find something a little more applicable to medicine in general. Seeing how I love awful puns (I was considering making my domain name talknerdytome.com), I figured Over My Med Body would be perfect.

A couple administrative notes:

• I’ve majorly updated my blogroll –if you’re missing from it, then you’re not on my RSS feedreader either. Please leave a comment so I can add you! (And please update your blogroll with my new name and URL.)
• There are now two RSS feeds: one with the full text of this site and another for the Goodies links on the right side.
• If anything’s broken, please let me know .
• I’m now using WordPress to manage the entire site, and loving it. Highly recommended.
• Yes, you can still access The Facemaker . God that’s a scary picture that pops up.

Enjoy, and welcome back!

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We’re making ch-ch-changes here at Grahamazon (and by “we”, I mean “I”). Launching in a few days is a new site-wide design, new weblog software , and even a new weblog name. Gross Anatomy just seemed too 1st year, and probably frightened away any potential readers that didn’t want to see dissection pictures.

Please, pardon the dust, it should be gone soon.

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Grand Rounds has begun! Nick came up with the idea to try to extend the medical weblogosphere to the rest of the world, so medical bloggers have submitted some of their best recent posts– go read !

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Maybe it’s just the homosexual in me, but any time I read or say “toxic,” as in “Doxorubicin is cardiotoxic ” or “Tetracyclines are phototoxic ,” that damn song starts playing in my head.

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My classmate Mike sent out this Exploding Dog cartoon as symbolic of our test struggles. We’re all relying on the fact that “they can’t fail all of us” and “70 new drugs in a week is simply ridiculous.”

All the cancer stuff — cancer types, cancer drugs — is so depressing. Yana summed it up the best:

bq. First year of med school they would’ve brought in a patient to talk about having cancer, experiencing cancer, how to talk to a patient about cancer… this year they just tell you “Small cell / oat cell carcinoma, 5 year survival: 0 percent. Next cancer…”

Here’s to drinking heavily tomorrow evening!

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African sleeping sickness is, pretty much, deadly. You get bit by a tsetse fly , you get a protozoa inside you, and if left untreated, you die. Eflornithine was discovered in the 1990’s–it’s nicknamed “the resurrection drug” for its ability to basically cure comatose people infected with African sleeping sickness. When the disease gets really bad, it enters your brain and spinal cord; eflornithine can also enter the brain and spinal cord however, and kill the protozoa making the patient sick. The other major treatment for severe sleeping sickness is called melarsoprol , but it’s much more toxic and much more dangerous; it carries with it a 4-12% risk of killing the patient.

So we’ve got a pretty good drug for treating this serious, fatal disease, and it has few side effects (sore throat). However, it’s surprisingly expensive to make, and since the countries with sleeping sickness are primarily poor, developing nations, drug manufacturers stopped making the drug. No big deal. Sleeping sickness only affects 500,000 people annually. Hi, sarcasm.

In 2001, Aventis, the patent-holder, donated $12.5 million to provide 60,000 doses , and an oral form of the drug is being developed.

Lucky for those dying Africans, eflornithine has a new market: slowing the growth of unwanted facial hair. Personally, I find it disgusting that we went 6 years without a better drug with less side effects (and mortalities) because it wasn’t profitable ($12.5m is pennies for Aventis). But I find it absolutely disgraceful that the unwanted facial hair drug, Vaniqa, advertises using what appears to be a tsetse fly on a woman’s face , as well as other bugs. The quote on the homepage sums it up nicely:

bq. What a burden that has been lifted from my life! I feel so free now to be who I really am. I’m not at all self-conscious with people.

Is this how far we’ve come? The burden of facial hair is more important to us than totally preventable deaths in Africa? We have the means, but not the will to do it.

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Alan Schussman has been writing some really great stuff on medical sociology , and making me feel a bit better about myself in the process. I’m not the only one experiencing such frustrations with medical education.

In something of a meta emotional analysis, why is it that I can read that other people have felt the same why I have, and instantly feel relieved? Because my feelings are validated? Because it helps me believe that I’m “normal?” There’s a psych question for you.

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I originally started this weblog as a way to give myself some perspective about medicine. To help me step outside the box, and try to look back in. But it’s getting tougher–and I don’t know how effective I am at it anymore. I feel like I’m already deep within the trenches of medicine; I exist solely to memorize drugs and bugs and get excited about situs inversus . I don’t feel like an outsider looking in anymore. If I was, I’m sure I’d be seeing more glaring examples of medical school changing me, but anymore, it just seems so normal.

And I’ve lost my compassion somewhere along the way, too. I know when I get to see patients, it’ll come back, but taking a sip from the firehose of information has pushed anything but the bare essentials to the side. I don’t like it. I don’t like that my compassion and my ability to put myself in a patient’s shoes isn’t a bare essential. I guess I always kind of assumed it was so intrinsic to myself as a person that it would never be pushed aside. Reality check. Ouch.

It’s mostly because the drug or the bug is removed from context. We memorize syndromes the bugs cause, or we memorize toxicities of drugs that we’ll administer, but it’s totally removed from a patient’s experience of the former or the latter. We don’t see a patient in pain or discomfort; we don’t see them feeling awful, or confused, or delerious because of a medicine. They’re just ideas or concepts. Words on a page. The things I can best remember are tied to friends–one friend who took Cipro or another who took a tetracycline–I can recall those the best. So maybe there’s hope yet.

I just have to hope that this temporary lapse in perspective and compassion will subside with time, and that I’ll go back to higher, more rational and caring brain functions once this is over. But on the other hand I wonder, if I can’t do it now, when *am* I going to do it?

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Studying esthesioneuroblastoma tonight, and I started to wonder, how do you explain smell to someone? If an alien came down to Earth, how would you explain it to them?

Sure, it’s chemicals in the air that you can interpret as… a smell. But smell just seems more subtle. Sounds, sights, touch, they’re more explicit and obvious. If someone lacks a sense of smell, how would you explain it to them in a way that made sense? I’m totally stumped, in one of those interesting philosophical conundrums that only happens late at night as your brain is frantically trying to keep you from studying.

And that made me think, if we had another sense, what would that even *be* like? Senses are just our bodies interpreting our environments–photons of light, air vibrations making sound, touch being neurons firing in response to being pushed a bit… So say we could detect some other kind of external stimulus. Say, radiation for example. How would we experience it? I feel like my imagination is limited by my very experience of the world. I keep wanting to ask myself, “Would it be a color, or warm, or pain?” But it wouldn’t have to be any of those. It could be like… geez, I don’t even know. How cool.

(Okay, yes, fine, I admit it. I’m back on coffee.)

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