Medical Mullings

[lauratheexplorrerr]

Today for the first time I made quinoa porridge for breakfast! I boiled 1/2 cup of quinoa in 1/2 cup almond milk and then let it summer until it was soft and fluffy. To serve I added 3tbsp coconut milk, some coconut sugar, cinnamon, nutmeg and a spoon of@mayversfood dark chocolate super spread.

[medicalmullings]

Patient Four: The Dying

The Medical Assessment

A 32-year-old man presents with squamous cell carcinoma of his right groin with unknown primary cancer. Various medical work-up, including colonoscopy, The tumor has metastasized and the patient has undergone extensive oncology and radiation therapy. Six months after diagnosis, patient began to experience bilateral groin drainage and suffered a femoral artery rupture during an emergency room visit. Cardiovascular intervention was unsuccessful. Current admission is secondary to septic shock. Patient was seen in the ER with low blood pressure, high white blood cell count, and rapid heart rate that reached 160 bpm. Patient was stabilized and taken to the operating room for exploration of his bilateral groins, at which time it was found that the carcinoma had invaded the nerves, muscles, tendons, and blood vessels of the area. The leg was separated at the right leg and right hip joint to prevent a recurring arterial rupture.

The Social Assessment

The tale outlined in chapter four of Eric Manheimer’s “Twelve Stories” is the story of Octavio Salcedo, an illegal immigrant from Mexico now living in New York accompanied by his wife. An undocumented immigrant, Salcedo lacked the ability to make money to provide for his family in Mexico, prompting his travel into the United States. It is learned early on that Salcedo is indeed circling the drain and his last wish is to return to Mexico, despite his unstable condition. His wife, Liliana, asserts that Octavio has not seen his family, parents or children, in six years and has never in fact met his two youngest sons. Liliana notes that she paid off several coyotes to have herself smuggled into the U.S. as her husband’s condition deteriorated rapidly. Both Octavio and Liliana elaborate on the difficulty of getting Octavio between work and doctors appointments, a struggle ending in Octavio being laid off. Manheimer appears impressed by this story and wants to provide for Octavio’s final wish. He sets up plans to have Octavio safely transported back to his hometown in Mexico to live out his last several weeks in the arms of those who love him. Manheimer accompanies Octavio and transfers him personally to the accepting physician in Octavio’s hometown, knowing that his death is imminent.

The boundaries between doctor-patient relationships are blurred, at best. To keep one’s distance in the face of suffering ignores the primal “protect the herd” instinct that runs through our mammalian blood, and yet we celebrate such a feat as “professional”. Manheimer shows no shame in his closeness to his patients, often doing personal favors in their honor to provide them with the best level of care possible. Manheimer’s actions throughout this chapter elaborate on the idea of palliative care and elevate the roles of the physician as not merely a healer, but also a provider. It is clear from Manheimer’s chapter that he does not believe physicians play a passive role in curing diseases but are responsible for curing the patient with the disease in whatever manner is possible. To care for others is the primary job of a physician.

Religious texts are doused in verses advising individuals to care for others. Within the Biblical narrative, the first coming of Christ presented experience after experience that illustrated the role of Christians in providing for others. This is not a role isolated to the healthcare profession, but rather, a role that extends into the veins of the human race and requires that we not turn a blind eye on suffering. Octavio’s struggle was not coping with death, but reconciling his desire to return home. Philippians 2 is clear,

“Let each of you look not only to his own interests, but also to the interests of others.” (Philippians 2:4, ESV)

The interests of others are not isolated to physical comfort, but extend into the realm of mental and emotional health. It is not enough to merely assert friendship with an individual. Loving and caring for one another requires a difficult sense of personal involvement, no matter the emotional/mental toll it make take on you. Thus, the struggle of another human being is the struggle of oneself. To  “love thy neighbor” is to aid in the comfort of one’s neighbor, no matter the cost. Manheimer’s actions in chapter four emulate the Christian role in caring for others and establishes the role of a physician as an individual of faith – faith in the hope humanity provides through caring for others.

[medicalmullings]

Patient Three: The Healer

The third chapter of Erik Manheimer’s “Twelve Stories” presents an entirely new problem to the table – the mental suffering of the patient, and, more specifically, the suffering of a patient’s identity. Manheimer elaborates the story of a patient who, following his diagnosis of throat cancer, finds himself laying on a cold metal table awaiting chemotherapy. Manheimer’s story is revealing in many terms as the patient is revealed to be Manheimer himself. The chapter focuses namely on the mental and social ramifications of the disease rather than the physical manifestations. Manheimer notes repeatedly that his identity and the disease are not – cannot – be the same entities. It begins with his name, scrawled on a nearby chalkboard present in the chemotherapy room, which he asserts was “mine and only mine” (60). Manheimer furthers his assessment by revealing that he in fact split his personality “neatly in half” in the hopes of retaining his identity (62). The attempt to maintain his identity throughout the disease proves to be a difficult feat as Manheimer misses his grandson’s birth prior to his first day of chemotherapy. The disease begins to take a toll on Manheimer but is resolved with remission of the cancer. The chapter concludes with his grandson’s birthday, a day which Manheimer may not have seen without the treatment.

Though he is surrounded by those he loves most, Manheimer asserts his fear regarding his diagnosis, a fear that resonates throughout the walls of every known hospital – the fear of not merely death, but loss of the “self”. To cease to exist physically transcends human understanding but to cease to be an independent individual remains an unfathomable concept. The idea of identity is so engrained in the human psyche that it verges on the realm of obsession. But the question comes to mind, how do we define our identity? Many would argue that it is a concept only definable by the individual, not something that may be dominated by a Merriam-Webster scholar. And yet, we remain oblivious most of our lives to who we are as multifaceted individuals. For Manheimer, his identity remains that of a physician and a family man. This is why his early depart the evening of his grandson’s birth was an emotional burden. Manheimer’s leave to sleep the evening of his grandson’s birth prior to his first chemotherapy round served to promote the idea that the disease was in fact taking over. Such is the conflict with all human beings, continuously thrown into the reconciliation of the external environment with the internal environment.

The Christian community is largely mute of the role of identity in the religion. However, the faith is full of quotes suggesting how one is to identify themselves as a Christian. John 15:5 serves to summarize the view in a concise manner,

“I am the vine; you are the branches. Whoever abides in me and I in him, he it is that bears much fruit, for apart from me you can do nothing.” (John 15:5, NIV)

Thus, it is clear that Christians are to identify themselves as a fragment of the body of Christ rather than an individual collection of various hobbies and habits. And yet, this identity still remains threatened in cases of adversity, including disease. Illness creeps on the certainty of our minds, threatening the very thing we believe we are and bringing to question our strength, physically, emotionally, and mentally. It is impossible to not be prone to self-doubt and to question the very beliefs we use to guide our lives, but it is precisely in cases of suffering that we are to hold onto such beliefs with greater force than we ever have. Manheimer found faith through his family, maintaining his connection throughout his battle. In the end, Manheimer came out a survivor, not merely from the cancer, but also from his own self-doubts. A similar method should be met no matter the suffering. Christianity suggests we maintain faith in God through suffering. Each event is an opportunity at self-discovery, an ability to become closer to God. To find our identity requires complete faith in ourselves and in a higher power. It is through suffering that our identity truly emerges.  

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Patient Two: The Runaway

Remember that little project I said I was about to embark on? The one that focused on analyzing Eric Manheimer's "Twelve Patients: Life and Death at Bellevue Hospital"? Well, I still hold interest in the analysis and will present today what has been by far my favorite chapter (out of the meager five I have read). The chapter is titled "Tanishsa" and holds the place as chapter two in Manheimer's book.

The Medical Assessment

Sixteen year old female presents with extensive past medical history of psychiatric concerns. She provides that she walked here from her current foster home but does not provide further information. Patient is noted to have multiple episodes of severe aggressive behavior beginning at age seven, with the first episode involving a physical attack on another foster care child. She states that she is amnesic to many events occurring during the episodes. Patient admits to suicidal ideation for "a while" and states that she has a plan for suicide but will not vocalize the specifics of the plan.

The Social Assessment

Manheimer immediately paints a picture of a sixteen year old runaway, the kind of individual many deter away from. Tanisha, the patient, is discovered to have an extensive history of sexual abuse within her foster homes. Manheimer elaborates that Tanisha has had twelve foster care placements since she was taken as a ward of the state when she was only six months old. Alone and fearful, Tanisha has seemingly taken to one principle, that is, don't trust anyone. So, it is no surprise that Manheimer's attempts at understanding Tanisha are met with coldness. Through patience, however, Manheimer reaches Tanisha via her hidden talent -- art. 

Art to Manheimer is "the amygdala speaking truth to power" (43). Manheimer notes that it is through art that emotions are expressed, bringing up the art of Martin Ramirez and Henry Darger, whose unconventional methods towards their artwork proved to be hits within the art world. Manheimer comes across Tanisha's artwork and fosters her talent, thus creating a connection with Tanisha. Tanisha proceeds to share information about one foster home she lived in that she seemed to value. The foster parents, however, were long deceased and now what was left was mere memories of a happier time. Manheimer successfully attempts to track down the descendants of the foster parents and contacts the matriarch, Lila, who, after months of deliberation, agrees to take in Tanisha permanently.  Throughout this chapter, it is evident that Manheimer is continuing the idea of advocating for the patients on a social scale rather than simply a medical scale. Tanisha, a lost and confused teenager, has known happiness only once and was robbed of it simply because of the way the foster home system works. Children like Tanisha lack advocates or stable homes, factors that have been linked to increased criminal activity. Manheimer presents this story of tragedy and triumph to illustrate the role a physician may play in advocating for patients. However, this role is not limited towards the profession, but rather, should be a moralistic goal for all individuals. Human beings are meant to tend for one another, not to promote or instigate harm, emotionally or physically, towards another man or woman. While the medical world observes patients like Tanisha often on a vulnerable level, all human beings have an innate responsibility to acknowledge that there is more to an individual than simply his or her past. 

[medicalmullings]

Patient One: The Criminal

If you haven't heard of the Bellevue Hospital, I must admit, I'd be surprised. I mean, heck, Microsoft Word acknowledges Bellevue as a word and it is constantly changing my name to "Jacks". The hospital characterizes New York's First Avenue, and, in it's 278 years (1736, before 'Merica was 'Merica and medicine was, well, helpful) of existence, it has seen both the social and medical development of America. From the first maternity ward to the first ambulances to everywhere in between, Bellevue is a cornerstone in the foundation of modern medicine. So it comes to no surprise that Bellevue is the location of Eric Manheimer's assessment of the medical system today. 

       Bellevue…the site of the next American Horror Story season. 

Eric Manheim, MD., uses his experience as a practicing physician and medical director at Bellevue Hospital to make an imperative point about social misgivings in society. Just as Bellevue was a witness to the nation's most important social reformations, so medicine is a witness to the impact of societal ills. Manheim presents twelve medical case studies to provide us with a first degree view of how medicine and society correlate.

I have decided to take on a small project involving Manheim's book Twelve Patients: Life an Death at Bellevue Hospital. During this project, I will evaluate multiple patient stories from both the objective medical side  and the more subjective, emotional patient stories behind them.

The Medical Assessment

A 59-year-old hispanic male presents with four largely swollen lymph nodes. The areas are not painful and the patient is able to tolerate PO secretions and food. Upon exam, it is noted that the lymph nodes are hard. The patient is frail and appears older than stated age. Patient has a past medical history of throat cancer is currently undergoing aggressive radiation therapy for treatment. Patient is currently incarcerated from Riker's Island State Penitentiary. 

Prognosis: Poor

The Social Assessment

In evaluating the medical assessment, it should be noted that there is not a single mention of his past history. I don't mean past medical history, but rather, the patient's history -- where he has been, where he is, where he is going. 

The patient is Juan Guerra, an inmate at Riker's Island, the largest penitentiary system in the country and located adjacent to New York. Born in New York City to Dominican parents, Guerra reached maturity at the cusp of Vietnam, prompting his draft into the military. Twenty-one years old and sent into a foreign country wrought with violence, Guerra, one among many, became addicted to heroin

Despite his attempts to come clean, Guerra was arrested many times secondary to drug possession. His wife and son remained faithful to his side, despite his minor drug offenses. Guerra was incarcerated after an officer caught him walking his dog off a leash. Under New York's Three Strike Law, and in the face of a history of "criminal activity", Guerra was sentenced to prison. It was during that incarceration that he found out he had cancer. 

Recoiling from his own cancer treatment, Manheim empathetically comes to know and understand Guerra. It is unjustified that Guerra, a petty criminal, will be forced to spend his remaining time in prison. Fairness, to Manheim, is not subjecting Guerra to the same treatment as a murderer or rapist. With Guerra's poor prognosis and the frivolent nature of his "crimes", Manheim pushes for compassionate release. 

In the legal system, compassionate release permits early release under special situations, such as terminal illness. Prisoners in the United States may request such a release to the warden in extenuating circumstances. However, Guerra's compassionate release, like many of such requests, remained stalled for quite some time. Eventually, Guerra was released and it is presumed that he died soon after.

Manheim's telling of this story illuminates several points about society that all revolve around one idea -- that every human being is the same. Under such a pretense, every patient is the same -- a diagnosis and a treatment. If we follow in these footsteps, it is easy to turn a blind eye to the suffering of the world at the cost of losing our humanity. 

Society is not the cluster of action, but rather, the sum of individual actions. All prisoners are not of equal sins, just as all patients do not share similar stories. The role of a physician is not to further these stereotypes with apathetic medical care but to reverse the effects that society has placed on individual patients. A patient's story must be told in fullness to gather every ounce of information. Physicians should not quarantine themselves in apathy, but instead extrapolate kindness. Few other professions allot the chance to impact many lives at such intimate and vulnerable moments. To be a physician is to be a healer -- of body, mind, and soul.

[medicalmullings]

I'm starting to think everybody is failing at this adult thing. 

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"30 minutes of sleep or 30 minutes of tumblr. Then it's back to work."

- me to myself.

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can we talk about the fact that delusional parasitosis is a real thing and that i am more afraid of contracting it than a real parasite?

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I've been 21 for a week now.

And the entirety of the week has been spent at the library studying, at the hospital working, at the house getting drunk and not looking at my bank account.  NOBODY TOLD ME IT WAS GOING TO BE THIS HARD.

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when i finally get a chance to sit down at work only to have the doctor call me to another room immediately

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studying biochem, like a boss

and it be the glucose business again (how do you keep coming up silly?) so, expect a vast amount of blogs in the next five days about diseases related to glucose being a 'tard and messing up. also, I will be staying in my university town all of Thanksgiving to work. so, you, know, expect drunk-I'm-so-effing-lonely-there's-no-one-here blogs about that. and expect them not to make sense because, well, I'll be drunk.

[nevvzealand-deactivated20130227]

one time when i was younger i had some of that no tears shampoo and i wanted to see if it was legit so when i was in the shower i squirted it into my eye...

[medicalmullings]

https://www.youtube.com/watch?v=NHzYEN1lS2Q

[medicalmullings]

Same anon who asked about Grey's Anatomy~ Ah, that's cool! I love the show and wanted to know if it's anything like real life. Are the people there anything like Grey's? Minus the hot neurosurgeon haha. Like, are they all competitive and frenemies and stuff?

I have been utterly terrible with this blog lately, excuse my absence and my neglectfulness with the answering of the questions :(Anyway, we actually do have a hot neurosurgeon. And a hot orthopaedist. And a hot paediatrician. But we also have some old married ones so, there it is. In my experience, ER medicine does not at all operate like Grey's Anatomy. I say this because ER medicine (at least where I work) is not competitive work at all. You have your chest pain, abdominal pain, and vaginal bleeding and no doctor will whip out a sword to take those patients. Surgery, on the other hand, is cutting edge (insert pun). It is a constant battle between new operations and rare cases. This isn't to say that ER medicine isn't fun and exciting, it's just a bit more passive than surgery, at least where I work. It should be noted that I do not work in a trauma hospital. We see traumas, but the majority of our patient's are the psychiatric patients and the hypochondriacs. I have, however, seen admitting doctors argue about who should take on a patient (as in, neither of them wanted them).

In summary, I really don't have the experience to tell you whether or not ED's really are competitive or not. I can, however, tell you that they are quite the adventure. (:

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FIRST DAY OF CLASSES. I AM SO EXCITED. ...not.

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Question that is probably really annoying but hey I'm gonna ask anyway - Is your life anything like that of the characters of Grey's Anatomy? I've always wondered what med school is like, although I never want to experience it myself haha. Just pondering~

Haha, it's not annoying! But I'm not in med school just yet. I do, however, work closely with doctors at a hospital and I can tell you that I've seen several medical cases similar to those on Grey's Anatomy. But, no, there are no cute doctors that are unmarried neurosurgeons at my hospital D:

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Guys, I left all my finals notes at the hospital. And now they are gone.

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Welp.

Yesterday could have been much better. I had the 7pm-4am shift and ended up sitting in a corner of the nurse's station studying for my impending final and sorting through the 25 patients in the waiting room and the 23 in the ER itself. I just wanted some sleep after I got off, but I ended up staying awake until 6 which means I slept in this morning and my study schedule has been thrown off majorly. Aaaaaand this is my life today. Expect few blog posts until tomorrow. :)