Great to see a Hospice Blog out there; I’ve considered going into hospice work myself. [via public health press via rangelmd ]

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This could, of course, be total coincidence, but this morning was the first time in a long time that I started seeing advertisements for Merck’s Zocor, a cholesterol-lowering drug. ( Merck is the maker of Vioxx, and may have known as early as 1996 that Vioxx was associated with an increased risk of stroke or heart attack. Vioxx was taken off the market very recently.)

The really tacky part is that Merck (via Zocor) has a new patient brochure called Your Heart Matters . You can download it from their zocor.com website. Apparently, the heart matters if you’re taking Zocor, but not if you took Vioxx.

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Call me crazy, but are we giving people the wrong idea when marijuana dealers are getting longer sentences than murderers ?

The judge who sentenced him, Paul G. Cassell of the United States District Court here, said that he pronounced the sentence “reluctantly” but that his hands were tied by a mandatory-minimum law that required the imposition of 55 years on Weldon H. Angelos because he had a gun during at least two of the drug transactions.

Judge Cassell said that sentencing Mr. Angelos to prison until he is 70 years old was “unjust, cruel and even irrational,” but that the law that forced him to do so had not proved to be unconstitutional and thus had to stand. The sentence was all the more ironic, he said, because only two hours earlier he had been legally able to impose a sentence of 22 years on a man convicted of aggravated second-degree murder for beating an elderly woman to death with a log. That crime, he argued, was far more serious.

Mr. Angelos’s wife, Zandrah, who sat in court with the couple’s two boys, aged 5 and 7, began crying. “He might as well have killed someone,” she said bitterly, wiping her eyes, referring to her husband. “He should have done worse than he did if he was going to get 55 years.”

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I was just randomly listening to some Ella Fitzgerald, and realized that she says “dyspeptic” in her song, Bewitched .

Ella, you are even cooler than I thought you were already.

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We’ve been on endocrinology for a week now, and it’s really quite a light load so far. (I have just jinxed myself.) It’s really strange. I have… free time.

It really feels like I’m not doing something I should be, like I’m missing something. But I don’t think so. It’s such a weird feeling, it’s been such a long time since I’ve just been able to breathe. Take a walk. Exercise.

It’s quite nice.

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A Stanford physician at the student health center used code 5150 to send a student to Stanford’s psychiatric ward for 3 days, according to The Stanford Daily . There’s obviously two sides to the story, but I would assume the student must have done something to seriously concern the physician. Still, it doesn’t sound like the student’s stay was a pleasant one.

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I used to always be on top of things. I lost that somewhere along the way. Anyway, Grand Rounds 7 is up .

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Dr. Charles has a nice writeup of his experience with a transsexual patient, and I really respect him for trying to be sensitive and respectful. (When’s Stanford gonna start showing gay pr0n?) He did the right thing; above all, listen to your patient. And it’s okay to be ignorant (I don’t think doctors do it enough). The point is to have the willingness and interest to learn.

Just two notes: some people prefer transgender to transsexual, it just depends on the person. And a drag queen is not the same thing as a transgender person.

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A bunch of great stuff in today’s NYT, but two pieces hit home:

Living for Today, Locked in a Paralyzed Body is about Lou Gherig’s disease patients, euthanasia, and those that choose to live with a respirator. One doc featured in the article has an excellent quote: “Happiness is reality divided by expectations.”

The Flu Hunters is the cover story in the Sunday magazine, all about avian bird flu, pandemics, and how experts are worried we’re biding our time until the avian bird flu in Asia gains human-to-human infectious ability, and “SARS will look like a vacation.” There’s a nice primer on influenza about halfway down into the article, and the picture at the top of the article is worth a click itself. (And it mentions Promed-Mail , a site that updates frequently with infectious disease reports.)

The Spanish flu of 1918, the largest pandemic (pandemic is an infection across the entire world) of the 20th century, killed between 20 and 50 million people worldwide, and 500,000 in the US alone. It was the only year, since 1900, that the US population actually shrunk .

I <3 Huckabees teaches us the same lesson: we’re all connected. But in the world of infectious disease, that’s a bad thing. My health can affect you, and your health can affect me. If you don’t support health care for all for any other reason, support it for your own self-interest. If someone doesn’t have health insurance, they’re less likely to go to a doctor or the ER, and more likely to hope the illness will just go away. And in the case of a flu pandemic in the US, that’s time we can’t afford to waste.

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Note : do not read this whilst eating, thinking about eating, or just having eaten.

This was, by far, the most disgusting week of medical school, and Monday may just be the most disgusting day of my life. I’m not ready to proclaim this until I’ve been through the hell that is residency, but it’s gotta be top 5 at least.

Monday we started off with our intestinal tapeworms and nematodes (roundworms/helminths) GI lecture. This included whipworm , which causes, OHMYFREAKINGGOD, rectal prolapse (don’t click that!). We also learned about all the other fun ones, including ascaris (I wouldn’t click that one either), which can lay 200,000 eggs every day inside your stomach.

So that’s always a pleasant talk, I’m sure. Next, since I’m an anatomy TA, and we’re starting the pelvis, we have to pre-dissect the bodies for the students. This involves separating the abdomen from the pelvis and legs, and then hemi-section–separating each egg, by cutting down the middle. Along with vessels and nerves and muscles, you have to tie off the large intestine and cut it, so you can separate the top from the bottom. When you die, unfortunately your poop doesn’t magically disappear. It says right in the body. And, say, if you’ve never done this whole “hemi-secting” thing before, and you and your friend are sawing through a hip bone, you might just accidentally saw through a bit of bowel.

Yes, Monday not only did I see prolapsed rectums, but I got to clean a ton of shit out of a dead person’s rectum. This was, by far, the most traumatizing thing in medical school. We hit the bowel in two places, so we had to basically remove all the feces from the body and throw it away. No, they do not pay us enough.

And then, to wrap things up, for our GI test on Monday, I was studying Hirschsprung’s disease . This keeps you from pooping, because some of your nerve cells don’t make it down all the way to the end of your intestines, so feces can build up. I also learned, according to a review book, that the poop can build up so much… that you poop out your mouth. There’s a South Park episode where this happens, but it’s just that much grosser that it actually does.

And yes, I’m paying $50,000 a year for this wonderful life.

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