MD in training

Brand new US Family Medicine intern

[mdintraining]

Down dog yoga app is free for healthcare workers and students and teachers through 2020!

https://www.downdogapp.com/healthcare

https://www.downdogapp.com/schools

[mdintraining]

His Last Year

The window box outside was blooming with color that last spring

The air fresh and wet with a hint of rain

The sidewalks filled with people

Voices and birdsong filtered through his open window

Bittersweet reminders of the world outside his fortress

But the spring was gone from his step

A cold metal walker served as his faithful bodyguard, dictating where he could go, what he could do 

It was summer when he summoned her 

His beautiful princess 

Grown-up now with two princesses of her own

And a job in DC that kept her busy 

A life that no longer revolved around coming home from school and setting the table for dinner with Mom and Dad

But here she was, her oldest now the one to set the table for the family

He watched the blur of energy of his grand princesses

Building their own fortresses of pillows and couch cushions

Asking Granddad to move his feet off the ottoman 

They needed it for their little empire

Aware of his daughter’s quiet energy

Calling the doctor, arranging the appointments

Remembering the details he just couldn't keep anymore 

Arranging an aide to stay with him when she left with the girls to go back to school 

It was fall already when he fell 

His own leg betrayed him 

His faithful bodyguard skittering away across the floor, retreating like a coward 

His aide in the kitchen rallied to action by his call 

And so his fortress shrunk further 

They closed the windows and turned off the lights

Packed up some photographs and moved him away to a white room with a hospital bed and a roommate who snored 

He couldn't remember her number and he couldn't remember when she called 

And so he built up his defenses

Determined not to let his captors know about his princess hard at work in her important tower in the city 

And she built her own walls, bracing herself for the days when she'd visit and he didn’t know her 

As the days got shorter his days got shorter 

Sometimes she listened to him tell a story of his beautiful princess who was still a little girl and loved rapunzel and the color blue 

And sometimes she’d hear the story of two young princesses building a castle in his living room 

And sometimes she’d just sit with him and listen to his roommate snore as the snow fell outside

[mdintraining]

[npr]

When Ellen Buchanan Weiss’ son was about a year old, he broke out in a rash — little bumps that appeared to be hives. So Buchanan Weiss did what a lot of new parents do: She turned to the Internet to find images that matched the rash she was seeing on her little boy.

“I’m trying to figure out — would I be paranoid if I went to the doctor at this point? Is that a reasonable thing to do? So I started googling it,” says Buchanan Weiss, who lives with her family in Raleigh, N.C.

But her son has brown skin, and as she scrolled through the photos that came up, she couldn’t find any images of rashes that matched her little boy’s — there were none on people of color. Even when she looked at the usually reliable webpages of the Centers for Disease Control and Prevention, for example, or the Mayo Clinic’s, she faced the same problem.

“It became immediately clear to me,” she says, “that the vast majority of even common skin conditions are on white skin. You have to scroll down like 80 pictures to find a single one on brown skin.”

Lynn McKinley-Grant, a dermatology professor at Howard University and president of the Skin of Color Society, says that’s not just a problem with websites aimed at patients.

“Often in medical schools,” she says, “they have limited pictures of diseases in skin of people of color.” That means health professionals trained with these resources aren’t seeing the full picture, McKinley-Grant says. The diversity gap is embedded in medical training, and that should concern us all.

Medical school classes rely on a lot of pattern recognition — especially when it comes to dermatology, explains Art Papier, an associate professor of dermatology at the University of Rochester Medical Center, in New York. “You see picture after picture, to encode them into your brain,” he says.

Diagnostic Gaps: Skin Comes In Many Shades And So Do Rashes

Illustration: Kristen Uroda for NPR

[mdintraining]

“I’m a strong independent woman and I believe in equal pay for equal work and all that, but I’m gonna stand down on this one. I’m not ready to ‘be the change you wish to see in the world’ on this particular issue quite yet.”

— patient after I suggested that one option for dealing with razor bumps and ingrown hairs is to not shave her bikini line

[dxmedstudent]

If only having body hair wasnt seen as inherently disgusting.

The irony is that on lots of men you can’t even tell where leg or stomach hair end and pubic hair begins. Which is fine because there is nothing wrong with body hair, and as long as people are appropriately covered in settings where viewers haven’t signed up for the Full Monty, it’s OK.

But most of the time, we’re brought up with the attitude that God forbid a lady show any body hair, anywhere, even though her swimming clothes or underwear are much tinier. They just have to spend their time removing it all as often as possible. To wear their skimpier clothes without engendering disgust in others. I’m not even talking about pubes; people treat under arm hair or leg hair as it it’s practically sinful.

[mdintraining]

^^^ my thoughts expressed much better than I could say them!

[mdintraining]

I'm a strong independent woman and I believe in equal pay for equal work and all that, but I'm gonna stand down on this one. I'm not ready to 'be the change you wish to see in the world' on this particular issue quite yet.

patient after I suggested that one option for dealing with razor bumps and ingrown hairs is to not shave her bikini line

[yesterdaysprint]

Vancouver Daily World, British Columbia, June 27, 1921

[mdintraining]

not sure if this is real but love it regardless

[mdintraining]

The Woman Who Could Not Live With Her Faulty Heart

Margaret Atwood

I do not mean the symbol of love, a candy shape to decorate cakes with, the heart that is supposed to belong or break;

I mean this lump of muscle that contracts like a flayed biceps, purple-blue, with its skin of suet, its skin of gristle, this isolate, this caved hermit, unshelled turtle, this one lungful of blood, no happy plateful.

All hearts float in their own deep oceans of no light, wetblack and glimmering, their four mouths gulping like fish. Hearts are said to pound: this is to be expected, the heart’s regular struggle against being drowned.

But most hearts say, I want, I want, I want, I want. My heart is more duplicitous, though to twin as I once thought. It says, I want, I don’t want, I want, and then a pause. It forces me to listen,

and at night it is the infra-red third eye that remains open while the other two are sleeping but refuses to say what it has seen.

It is a constant pestering in my ears, a caught moth, limping drum, a child’s fist beating itself against the bedsprings: I want, I don’t want. How can one live with such a heart?

Long ago I gave up singing to it, it will never be satisfied or lulled. One night I will say to it: Heart, be still, and it will.

~From Selected Poems II (1976-1986) by Margaret Atwood, 1987.

[mdintraining]

Dear specialists...

Dear specialists, If you are going to tell my primary patients to make changes to their meds (especially meds that aren't specifically related to your specialty) it would be really helpful if you included some thought process or evidence in your note so that I know what you're thinking about. Otherwise I have to tactfully tell my patients that I have know idea why you said that and I would like them to resume their meds as before. For example, if you are a neurologist who my patient is seeing for a recent subdural hematoma (which thank goodness is getting better), why are you telling him to decrease his miralax (which he takes for significant constipation with a history of stool impaction) to once a week? Sincerely, Perplexed PMD

[mdintraining]

burn·out

/ˈbərnˌout/

noun

1. the reduction of a fuel or substance to nothing through use or combustion

The dictionary definition really hits home on this one.

[mdintraining]

I’m pretty sure I’m not the only one who has trouble remembering developmental milestones. I put these together, but can’t take credit for any of the photography. Hope someone finds them helpful!

[mdintraining]

Boy and I get married in 17 days. Yikes!

[brightlotusmoon]

[anti-capitalistlesbianwitch]

@Anti-vaxxers: Don’t treat autistic people like their existence is worse than a pandemic

[mdintraining]

Boy is out of the country on an away elective and I miss him a lot but at the same time, sometimes it’s just really nice to come home, pour myself a glass of wine and clean the kitchen and not have to talk to anyone.

[mdintraining]

Breathe

Breathe in, breathe out. Of course, for him, it’s a bag-mask forcing the air into his lungs. It’s us doing chest compressions that’s moving his blood through his veins, taking on the job of his heart. It’s quite a job we have, when at times our task is literally to be a heart.

Breathe in, breathe out. You’re going to be ok, I say. It’s ok, take a deep breath. I see the anxiety in her eyes. We both know, at least in the back of our minds, that it’s not going to be ok. There’s more fluid than air in her lungs, her kidneys are failing, her body unable to keep up.

Breathe in, breathe out. She’s four years old and sitting on my lap. “Can I listen to my heart too?” she asks. She’s perfect, tiny, sweet. Mom is worried about what the teachers say. Autism? Shy? She’s too quiet at school.

Breathe in, breathe out. I lay with my head on my fiance’s chest. Listening to him breathe, so inexplicably quick to fall asleep.

[mdintraining]

Real convo that just went down between me and the ED doc:

"Hi this is MDintraining with Family Medicine calling for signout on [new admission]"

ED doc "You want the nurse."

Me: "Sorry?"

Him: "You're the nurse so you need to talk directly to the nurse for signout"

Me: "... No, I'm the admitting physician, I need to talk to you."

Him: "oh. You sounded like a nurse."

What a butt head.

[mdintraining]

This. 

http://christopherkeelty.com/breaking-bad-outside-us/

[mdintraining]

Self reblog because I am so fed up with insurance and lack thereof interfering with my patients' care.