It sure was nice not to know anything. Those days are long gone.

Before medical school-or even just last year-I didn’t know a thing about disease. What makes you sick, how you can die, how your body can fail on you. And now that I do, it’s a frightening knowledge.

With every new organ we study, I basically learn more ways that I can die. More things that can go wrong, more ways that I can get sick, more complications and symptoms I could have in the future. First with the heart, you can have a heart attack. Duh. But you can also have sudden death-your heart just stops . Or you could have a clot that you have no clue about go to your brain or your lungs or anywhere else and kill you. Then with the lungs, there’s a ton of really nasty diseases that end up in honeycomb lung . Or you can get a number of respiratory infections that’ll do you in. Then onto the kidneys. Plenty of ways those can just stop out of nowhere. And now with the GI, there’s cancer everywhere. (What’s worse, a significant number of these diseases are what medicine likes to call “idiopathic.” That basically means no one has a freaking clue what causes them.)

The funny thing is, for those first 23 years, my risks were always the same, my chance of developing any of these conditions never changed. It’s only that my understanding of them has changed. Hell, my risks have probably decreased now since childhood-I eat better, I get more exercise, I’m much more hygenic-but I still feel like all of them are just waiting to get me. Any inkling of a sore throat jump-starts the thought-process quite well: “Is it strep? If so, am I going to develop acute post-streptococcal glomerulonephritis and start peeing blood? Or maybe I’ll get post-strep endocarditis. Listen. Do you hear a murmur?” This is contrary to the fact that I get maybe one or two sore throats a year anymore, and before that I had so many so frequently as a child and young adult that I got my tonsils out.

There’s some good sides to this, of course-every classmate I talk to washes their hands much more frequently. And I think once I see how rare most of these conditions are, I’ll be less concerned that I’m going to develop Goodpasture’s any time soon.

It must be scary as hell to try to raise a child being a physician though–worrying about Wilms tumor and rotavirus and what have you.

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Peter Rost has an excellent Op-Ed in the NYT:

I have a confession to make. I am a drug company executive who believes we should legalize the reimportation of prescription drugs. I know that I have a different opinion from that of my employer on this matter, but to me, importation of drugs is about much more than money; it is about saving American lives.
According to a study by the Kaiser Family Foundation issued in 2000, 15 percent of uninsured children went without prescription medication in the previous year because of cost, 28 percent of uninsured adults went without prescription medication because of cost, and 87 percent of uninsured people with serious health problems reported trouble obtaining needed medication. We have 67 million Americans without insurance for drugs, according to the foundation. They pay cash – full price – and can’t always afford life-saving drugs. American drug prices are about 70 percent higher than in Canada and almost twice as high as in Europe…
Every day Americans die because they can’t afford life-saving drugs. Every day Americans die because Congress wants to protect the profits of giant drug corporations, half of the top 10 of which are French, British and Swiss conglomerates.
I have another confession to make. Americans are dying without the appropriate drugs because my industry and Congress are more concerned about protecting astronomical profits for conglomerates than they are about protecting the health of Americans.

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Diarrhea Quote of the Day, from a microbiology/infectious disease doc at Kaiser:

“Diarrhea can be hard to define. One good definition: stool that conforms to the shape of the container in which it’s placed… as long as the container’s not a big long cylinder.”

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Californians, hear me roar! Vote YES on Proposition 72 to support employer-mandate health insurance. It’s going to be a very tight race, we need all the support we can get. And Wal-Mart just dumped $500,000 more toward its opposition . It’s far from perfect, but it will get California closer to having health care for all. Some facts (from Health Access ):

• Prop 72 Sets Standards in Health Care: Large and mid-sized companies are required to pay for private health insurance for employees. Companies must pay at least 80% of premiums and can pay up to 100%. Private coverage must include prescription drug, major medical and preventive care. Small businesses are exempt.
• Safeguards Private Health Insurance: 19 million Californians currently get private health insurance from their employer. Under Prop 72, employers can keep the same coverage paying as much as 100% of premiums. Employees get the added security of knowing that employers cannot pay less than 80% of premiums and must maintain preventive care, prescription drug and major medical coverage.
• Extends Health Insurance to More Working Families Under Prop 72, another 1.3 million Californians – workers and their families – will be able to see their own doctor, rather than rely on emergency rooms and clinics. Prop 72 is an important step in making sure that everyone has access to affordable health care.
• Taxpayer and Business Protections: California taxpayers pay $4.6 billion annually to cover ER and other health care bills for the uninsured. By extending health insurance to 1.3 million Californians, Prop 72 will save tax dollars and help relieve the burden on emergency rooms. Businesses benefit from a healthier, more productive workforce. Small businesses are exempt (including 93% of all restaurants and retailers). Levels the playing field by taking away the unfair competitive advantage some large corporations have because they don’t provide insurance to their employees.
• California Families will Save Money: The average family in California already pays nearly $2500 annually in premiums (KFF/HRET California Employment Health Benefit Survey). Opponents of Prop 72 estimate that 72 will cost the average family up to $1,700 per year. Even by the opposition’s own estimates, Prop 72 will save money for the average family right now.

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Not a whole lot of interest in blogging right now–in the middle of GI and wanting to do a 1,000 things, and blogging’s 1,001. Although 2nd year is a pain in the ass, and information overload, I actually feel like I’m becoming a doctor. It’s kinda cool. I know some of the most common drugs, I know most of the organ systems. What a great feeling.

Try to beef up on my auscultation (stethescope) skills, which is proving quite challenging, but here’s a couple of excellent tutorials for any students out there reading: Blaufuss Multimedia’s Heart Sounds and The Auscultation Assistant .

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Farting-I mean, flatulence -is due to poor absorption of carbohydrates.

Beans contain raffinose and stachyose, tri- and quadrupe saccharides, and cannot be digested by humans. They get passed along through your large intestine, where your normal flora (bacteria living in your colon) feast on them. (They do this anaerobically, fermenting the carbs, so that’s where the gas comes from.)

This is clearly why I went to med school.

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We’re in GI right now, and I couldn’t be happier to learn today in lecture that “dumping” is a medical term .

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I’m not sure how my comments (“I don’t mean to be overly alarmist, as the plan is only that-initial planning-just in case Congress would ever authorize a second draft.”) were interpreted as “ sky-is-falling ,” or fearmongering for Kerry (did I ever mention Kerry or Bush?) , but apparently what I thought was cautionary concern turned into “Graham freaks out.”

In fact, I know perfectly well what military doctors do , as my father was a physician in the Air Force, and one of my other physician heroes was a medic in World War II. But I’m sorry, I don’t see this war as the same as World War II. There wouldn’t have been soldiers and Iraqis wounded (as well as tens of thousands killed, many collateral damage ) if we hadn’t have invaded Iraq.

I’m fully aware that the draft legislation failed with almost full support. But it’s more than just rumors on the internets .

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Some alert readers have recently made me aware of a frightening possibility in the future: a “skills draft” targetting Americans with certain skills, including medical training . I don’t mean to be overly alarmist, as the plan is only that–initial planning–just in case Congress would ever authorize a second draft. But the fact that it’s even being planned is a little frightening. (This draft would also include women–generally all citizens up to the age of 34.)

There’s more information at The Blatant Truth , including a PDF of a FOIA document that unearthed the information , and a great deal more at DailyKos . (And from what I’ve heard, “Don’t Ask, Don’t Tell” isn’t enforced for medical personnel.)

I would imagine a significant number of health care professionals–doctors, nurses, etc.–would fundamentally be opposed to being sent to war on ethical grounds: that whole concept of “killing people” and “causing harm” don’t really go too well with the Hippocratic Oath.

Update: Medpundit and Gruntdoc both say it’s all over-reaction. I’m sure it’s easy much easier to downplay the concerns of young polyglots, computer network engineers, and medical students when you’re over 35, and not at risk of being drafted. (And god forbid should bioterrorism occur, I hope we don’t turn so militarized that waves of physicians get drafted–add us to the Public Health Corps or the CDC, but not the Armed Services.)

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Sometimes even the AMA gets it right :

Dr. Andrew F. Calman of San Francisco, an ophthalmologist who pushed for the new policy adopted by the medical association, said: “I don’t think it’s a Democratic or a Republican issue. We have the support of doctors from different points on the political spectrum. We’re very concerned about patients’ access to affordable drugs. I have some glaucoma patients who need to take three or four different types of eye drops to avoid going blind, and each medication may cost $50 to $100 a month.”

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