April 2006 Archives

The second of the two important topics from the Ophthamology lecture series, continued.

Salient point #2: There is a medication used for treatment of macular degeneration that is made from shark cartilage. I repeat. Shark cartilage.

Squalamine is an anti-angiogenic drug: it suppresses the development of new blood vessels (angiogenesis). It is used to prevent the growth of vessels that can bleed behind the retina, leading to age-related macular degeneraion, and often blindness. It was developed from the cartilage of the dofish shark Squalus acanthus, a creature whose entire skeleton is composed solely of cartilage (as shark skeletons are wont to be). The thought is that this chemical will also be able to suppresses the formation of new blood vessels in tumors as well, and may therefore be useful in the battle against cancer. So just picture a fierce yet benevolent shark with a laser attached to his head, swimming around zapping tumors and tiny blood vessels and saving the lives of its land-dwelling brethren. It is truly beautiful.

What I don't understand is how someone can deliver a lecture in which the phrase "shark cartilage" is uttered, and not include it in the power point presentation. Not including a picture of a giant shark on the slide (and I will accept one without a laser) is a clear indication that you do not understand the the art of the lecture, nor the mind of the stimulus-deprived student. Nay, you have demonstrated an inherent lack of comprehension of the essense of the human psyche. Put a picture of a shark on the effing slide if you want people to remember anything you say. I am probably the only person who remembers this incredibly crucial piece of information, because I clearly documented in my notes "made from SHARK CARTILAGE" with a cirlce around it and a couple of arrows.

In the quest to correct the situation - to reunite this concept with the shark picture that was destined to be its companion - I turned to Google images. And found what may be the most awesome image ever created by a human being since the dawn of time. Behold.

Oh my god. The goat? What???

I will be slightly embarassed if this turns out to be a scene from Austin Powers. But only slightly.

I just got done with the "continuity curriculum" - a week-long series of lectures between rotations that cover subjects that most of us would not otherwise be exposed to in medical school. The topics for this week included Ophthamology, the study of the human eye.

While there was much relevant information presented, I walked away with the two most important points from the entire week, which will be described below:

Salient point #1: There is a video-based vision magnification system for patients with low vision called "The Jordy." Its name is inspired by the character Geordi LaForge on Star Trek: The Next Generation, and is a head-mounted camera and display system, based on a Low Vision Enhancement System (LVES) that was initially developed at NASA. This camera on your forehead records images and transmits them with maginfication to dual screens, positioned in front of your eyes in the form of glasses. And boy, does it look cool.

When this fact was announced in class, in passing, my friend turned to me and said that she didn't get it. What's Jordy? she said. And I tried to explain that Geordi LaForge was chief engineer on the U.S.S Enterprise, and as he was born without formative matter in his eyes he required a special high-tech prosthetic V.I.S.O.R to transmit visual input directly to his brain, allowing him to see. This was met by a blank stare. You know, LeVar Burton? Nothing. Am I that nerdy? Everyone knows who Geordi is, right?

Salient point #2 will be related in a separate entry, as it deserves its own space.

After a long hiatus, my life has regained a sense of connectedness. And if you think I am being poetic and symbolic, I am not. For the past 5 weeks I have basically been without computer access, and this has left me with a strange sense of isolation and dependence and subacute unease. I was helped through it by the generosity of friends, and the understanding of neglected email contacts.

Now, hopefully, my computer will no longer be effing me, and I can regain my position next to the outlet at the Wireless Internet Coffee Shop, so ubiquitous in NW PDX.

I just finished my rotation in Family Medicine. At a clinic without internet access. If you can believe that. Apart from this glaring fault, I had a very good time, learning tons about musculoskeletal complaints, sports injuries, testosterone deficiency, and the common cold. Family medicine docs are my hero, in a way. I could not do what they do. Seeing patient after patient all day long, every day, getting to know them year after year, treating the common, diagnosing the uncommon, attempting to ease the suffering associated with chronic medical problems, trying in vein to convince people to get off their asses and lose weight, managing the teetering slope of diabetic blood sugar control . This is one of the most important jobs. But it doesn't hold enough excitement for me, unfortunately. The times when I was truly engrossed in patient care issues in the clinic was when there was an active decision to be made. A decision that would have serious consequences. Usually these decisions centered around when to send people to the hospital. The little kid with crackles in his right lung, the feverish woman with an advancing rash... this is when I temporarily ceased to feel the weighty pull of the clock slowly dragging me through the day.

I like the challenge associated with making these decisions. But I am not yet good at making them. How many times has my preceptor asked me "what would you do next?" If we even make it past the blank stare portion of my response, what follows is often "I would do nothing," or "I think this is probably viral and I would not give antibiotics," or something that attempts to imply that I have given it a great deal of thought in the preceding 7.5 seconds. And many times the response to my treatment plan starts out with "actually..." or "well...," Which usually translates as "the correct answer is the exact opposite of what you just said, but nice try."

One of my fondest recent memories (please note the sarcasm dripping thickly off of the word "fondest") was the Observed Clinical Skills Exam, which, against all logic, is referred to by the incorrect abbreviation "OSCE". Whoever said that medical students were behelden to the laws of grammar and pronunciation was sorely mistaken. Anyhow, this is a 4 hour test of sorts that consists of filmed interactions with patient actors. You are given a task such as Explain to the patient the results of her abnormal pap smear or Convince the patient to stop smoking or Tell the girl with meningitis that you need to stick a needle into her spinal canal. On the Read a very long and complicated medical history in 30 seconds and then perform an abdominal exam Station, I found myself telling the patient, who had just been seen by 10 other medical students, that I thought he had acute pancreatitis and I wanted to get a CT scan of his belly and possibly admit him to the hospital. This, I was soon to discover, might have been a wee bit of overkill. Everyone else had apparently diagnosed some form of simple gastritis and started with a trial of proton pump inhibitors. The grader said "you are the first person today who has even mentioned pancreatitis." Ok. Hmm.

But maybe my way of thinking about things is good. Maybe that means that I have a good framework for making such decisions. I just need to learn how to make them correctly. I hope that class is offered 4th year.