Belle of the Hospital

Internal medicine doc charting her life away

[belleofthehospital]

20 days until rank lists due....

I’ve been feeling very conflicted. I LOVE my top choice program. Ideal location, rigorous training, friendly residents. After that, it’s murky.

I interviewed at a fantastic, prestigious program but it’s in a new city. New city isn’t too far, but it does mean moving alone to a city where I have no friends or family. If this were 5 months ago, I’d easily make it my second choice. But 5 months ago I met someone. Even though it’s kinda new, I think he could be “the one”. If I stay in my #1 city, I can see us moving in together, getting married, doing the whole shebang. Now 3 years isn’t an awful amount of time to be separated, he might move down to new city eventually, and we discussed how we wouldn’t break up over this. BUT I’m hesitant to put this stress on our relationship and risk our future. I love medicine but I want a life outside it too.

My alternative is making my second choice a less prestigious program located significantly closer to my ideal city. I like the program, but it is very tough and much lower in the rankings. I think I could be happy and fellowship match is good (but worse compared to #1 program and the prestigious program), but I’m scared I’m throwing away everything I’ve worked for. If my relationship were to end, I think I would regret not ranking the more prestigious program. I don’t think it’ll end but I just don’t know.

If I match my #1, there’s no issues. Too bad my #1 is a fantastic program everyone wants. I just don’t know what to do.

[belleofthehospital]

So funny to read this back and remember the angst. So lucky I didn’t have to compromise - got the top program I wanted, married the boy, and we’re going to start a family :)

[zooophagous]

I know I sound like your mom but you kids need to stop fucking vaping

[joshgrobanscock]

1) Vaping is confirmed to cause cancer. Vaping coats the lungs with toxic substances, such as heavy metals and benzene, which are known to cause cancer

2) Many vapes contain diacetyl, which, when inhaled causes popcorn lung, or scarring of the lung

3) Ultrafine particles, when being inhaled, can be lodged in the trachea (not good!)

4) Ultrafine particles can also constrict the arteries in the lungs potentially causing A HEART ATTACK

5) Vaping is relatively new. Not much studies have been done in comparison to tobacco. Plus, the vaping companies are powerful people. There is a large chance that they are purposely downplaying and even burying any evidence that vaping is harmful - just like the tobacco companies before them. They do not care about you, or your health, or the truth. They only care for money

[letsoulswander]

Also STOP VAPING INDOORS AROUND OTHER PEOPLE. Holy shit, if you're gonna wreck your lungs at least give me the option not to wreck mine.

[cephalopodvictorious]

It’s such an issue that the MTA had to run a campaign about it

[yeahokayillreblogthat]

yeah okay ill reblog that

[belleofthehospital]

One day you’re an intern and the next you’re a PGY-4 chief resident teaching interns. Life comes at you fast!

[ley-med]

Medicine is great because when I think I finally start to understand something it turns out I don't

[ley-med]

Medicine is great because when I think I finally start to understand something it turns out I don't

[quilavastudy]

When I’m a consultant, I hereby swear I won’t be the type who treats medical students like shit. Or as if they don’t exist.

[dxmedstudent]

I pledge my allegiance to this cause. You have my Stethoscope.

[belleofthehospital]

I promise to make eye contact with them and ask their names and answer any questions.

[cyclist-of-guilt]

why I feel this on molecular level

[biolegend]

It’s over. Killer T-Cell has the high ground.

[dohnjorians]

[belleofthehospital]

151 days of residency left!!!

[liesmyth]

Everything I know about Prince Harry’s memoir has been against my will, but if I had to see this so do all of you

[liesmyth]

It’s been hours but I still can’t get “who the fook is Faulkner” out of my head. It’s this what expensive education gets you

I checked btw. it’s true

[nimmieamee]

Everyone keeps posting about his penis but one of the funniest details I have heard so far is from the Vox review telling us that Harry was “charmingly overwhelmed by Megan’s literary sophistication when she references Eat, Pray, Love, a book Harry informs us he has never heard of.”

[appalachiananarchist]

I just want to be a really, really good doctor who helps a lot of people, but I also am pretty sure I am quite stupid most of the time. This is the war raging eternally in my life. 

[mednerds]

New generation of cancer-preventing vaccines could wipe out tumors before they form

By Jocelyn Kaiser (Science). doi: 10.1126/science.abq3411.

When Dave Dubin learned at age 29 that he had colon cancer, it wasnt a big surprise. His grandfather and father had both survived the disease. “It was almost the Dubin way, and we just went on,” Dubin says. He had surgery and chemotherapy, but his cancer came back 10 years later. Genetic testing finally found an explanation for his family’s trials: a mutation in a DNA repair gene that lets genetic errors pile up in dividing cells. The disease, Lynch syndrome, comes with up to a 70% lifetime risk of cancer.

Dubin, 55, gets annual colonoscopies, endoscopies, and imaging scans, which caught a third cancer, in his kidney. His eldest son, Zach Dubin, 26, inherited the DNA repair mutation and also regularly gets checked for cancer. “It’s no fun. Nobody enjoys it,” Dave Dubin says—not the 2-day colonoscopy prep and procedure, nor the worrying about possible tumors. The disease also turned him into an activist. He and his family in Haworth, New Jersey, launched a nonprofit, AliveAndKickn, to promote research and awareness of Lynch syndrome, which affects an estimated 1.1 million people in the United States.

“There is a lot of anxiety in this patient population,” says oncologist and geneticist Eduardo Vilar-Sanchez of the MD Anderson Cancer Center. “It is a big psychological burden.” In hopes of easing that strain, Vilar-Sanchez will soon lead a clinical trial of a vaccine to prevent or at least delay Lynch-related cancers. If it works, Dave Dubin says, “it could be huge.”

Vaccines to prevent certain types of cancer already exist. They target viruses: hepatitis B virus, which can trigger liver cancer, and human papillomavirus, which causes cervical and some other cancers. But most cancers are not caused by viruses. The Lynch vaccine trial will be one of the first clinical tests of a vaccine to prevent nonviral cancers.

The idea is to deliver into the body bits of proteins, or antigens, from cancer cells to stimulate the immune system to attack any incipient tumors. The concept isn’t new, and it has faced skepticism. A decade ago, a Nature editorial dismissed a prominent breast cancer advocacy group’s goal of developing a preventive vaccine by 2020 as “misguided,” in part because of the genetic complexity of tumors. The editorial called the goal an “objective that science cannot yet deliver.” But now, a few teams—including one funded by the same advocacy group, the National Breast Cancer Coalition (NBCC)—are poised to test preventive vaccines, in some cases in healthy people at high genetic risk for breast and other cancers. Their efforts have been propelled by new insights into the genetic changes in early cancers, along with the recognition that because even nascent tumors can suppress the immune system, the vaccines should work best in healthy people who have never had cancer.

Keep reading

[belleofthehospital]

Oh man, found my way back after a few years. I’m a PGY-3!! I’ll be a chief resident in Internal Medicine next year!!! I’ll be applying to oncology fellowship next cycle. I look back at my posts from before I disappeared of tumblr and I see so much fear and burn-out and confusion. I’m now getting married in a month, I feel somewhat comfortable in my job, and I love where I’m at professionally. What a wild, terrifying, emotional journey. Working on night shifts with interns this week and will remember to be a little extra compassionate - especially to the ones who seem confident on the outside but are shaking a little inside.

[ahagisborn]

was just Remembering how you’d be out with a friend and you’d each order a different cocktail and you’d ask “what’d you get?” and they’d read the description off the menu and you’d be like “ooh that sounds good” and then they’d say “try it!” and then you’d have a lil sip of their drink and they’d have a lil sip of your drink and you’d decide which one was best and you wouldn’t give each other a life-threatening respiratory infection

[doc-resilient]

[janedoemd]

ECG: quick and dirty

I’ve had countless sessions and lectures on ECGs. I don’t know how many websites I have bookmarked, or how many times my eyes glazed over reading Dubin. I’m also terrible at cardiology. I was on my way to accepting my fate of being horrible at ECGs forever, until I had a life changing session on ECGs taught by a great ER doc. I want to post it here because it was probably the most useful thing I learned in med school, and it will stick with me for the rest of my career. 

WHEN LOOKING AT ECGs FOR THE FIRST TIME:

1. One ECG is never enough. Always get old ones for comparison. If none available, do another one. Because. One ECG is never enough. 

2. RATE. Look at the number on top of the printed ECG. It’s stupid not to use that number. Yes, you should know the rule, 300-150-100-75-60-50. People say you shouldn’t trust the machine because… well, it’s a machine, and it can make mistakes. This is true. I don’t like to look at their “diagnosis” until I have gone through it myself. But the rate is just a number. Plus you should be able to eyeball it and be able to tell if it’s tachy, brady, etc. If the machine is telling you it’s 200 and if it looks tachy, then it’s probably the right number. 

3. RHYTHM. Is there a p-wave for every QRS and a QRS for every p-wave? Is the p-wave upright in lead II and down in aVR? Good. Done. BOOM. It’s sinus rhythm. ***if you cannot clearly see the p-waves then you cannot call sinus. move on.

4. AXIS. Again, look at the number at the top of the page. If it’s between 0 and +90, then it’s normal axis. If the number isn’t provided, or if your preceptor doesn’t believe in the convenience of machines/technology, look at the QRS complex of lead I and lead II. 

up in lead I, up in lead II: normal axis

up in lead I, down in lead II: left axis deviation (most common causes are left anterior hemi block and left ventricular hypertrophy)

down in lead I, up in lead II: right axis deviation (most common causes are right ventricular hypertrophy…PE)

5. did someone say HYPERTROPHY?

look at V1

is the R wave tall? (greater than 7mm?) right ventricular hypertrophy.

is the S wave tall? (greater than 11mm?) left ventricular hypertrophy.

  6. P-waves

look at lead II

is it wide? left atrial enlargement.

is it tall? right atrial enlargement.

7. PR interval

should be between 0.12 sec and 0.2 sec (3-5 small boxes). I used to always get this interval and QRS complex (less than 0.12 sec) mixed up. Think: atria depolarizing + shit getting to ventricles is gonna take longer than ventricles depolarizing. [2 things happening] versus [1 thing happening]. [0.12 sec-0.2 sec] versus [<0.12 sec].

long PR interval means there’s some sort of block at the AV node. 

1st deg block. PR interval is long. everything else is normal. cool. 

2nd deg block

type I: PR interval progressively gets long. eventually a dropped QRS.

type II: PR interval is constant, but randomly dropped QRS. 

3rd deg block “complete block”

there is no association between P waves and QRS. they run separately. **QRS does NOT have to be wide. Just look for P wave/QRS complex disassociation. I sometimes get this and 2nd deg type II mixed up. The only difference I try to remember is that PR interval is constant in 2nd deg type II, but is variable in 3rd deg. 

8. QRS complex

narrow or wide? 

narrow: good. signal coming from somewhere above ventricles. 

wide: think BBB (bundle branch block)

LOOK AT V1 ONLY.

if the last deflection of QRS is DOWN, then it’s a left BBB

if the last deflection of QRS is UP, then it’s a right BBB. super easy. no more of this bunny ears crap. 

9. ST segment

always look from J point, and compare with the isoelectric line of T-P segment (NOT PR interval). 

elevated/depressed… STEMI… duh. indicates ACUTE ischemic changes. 

look for reciprocal changes of the heart. if ST elevation in lateral leads, could see ST depression in the septal leads. PAILS:

posterior up, anterior down

anterior up, inferior down

inferior up, lateral down

lateral up, septal down.  

LBBB can look like STEMI. How to tell?

disconcordant changes is normal. (QRS and STEMI on opposite sides of the isoelectric line.)

concordant changes is abnormal. 

massive discordance is abnormal. (STEMI is greater than 5mm)

this isn’t that important. Moving on. 

Inferior STEMI. Could right ventricle be involved? 

DO NOT GIVE NITRO DO NOT GIVE NITRO DO NOT GIVE NITRO.

order a 15 lead

is STE in lead III > lead II? likely RV involvement

INFERIOR MI? 15 LEAD NO NITRO

INFERIOR MI? 15 LEAD NO NITRO

INFERIOR MI? 15 LEAD NO NITRO

10. T waves

is it inverted? indicates recent ischemic changes. 

11. Q waves

is it significant? indicates old ischemic changes. will likely be present if followed rule number 1 of reading ECGs. (1 ECG is never enough= look at old ECGs). 

I literally go through this list of 11 points in my head when I’m reading an ECG, regardless of whether or not I have an atrial flutter jumping at my face or if I see a massive anterolateral STEMI. Obviously I needed background knowledge on ECGs and the physiology of the heart before constructing this list, but this basic checklist has been very, very useful to me so far. It might look lengthy, but it doesn’t take a lot of time at all- a patient is not likely going to have all these issues with their heart. 

  Anyway. I still don’t love ECGs, but it feels pretty wonderful to be able to be able to evaluate it in a systematic manner, and get the theory behind interpreting the scribbles of an ECG reading. I don’t get these moments as much as I would like to, but it’s that crosspoint where my classroom learning actually meets real-life applications that gives me happy brain-gasms for days. I love knowing things and more importantly, knowing why.

[priorisn7-deactivated20180719]

This is Medblr gold. Reblogging for anyone staring down the barrel at 1 July.

[cranquis]

I learned a lot here.

[medicalmiracle]

can never reblog this enough. working in a COVID field hospital now and the lifepack ecg is literally the only diagnostic tool i have besides my physical exam. GOLD IS NOT ENOUGH.