Since starting my clinical rotations, I've begun to appreciate much more the level of human suffering that normal, everyday people are experiencing. Not third-world-starvation suffering (although there is that, too, in areas of this city) but the kind you might not ever know about unless you were that person's family, friend, or doctor.
Consider these patients (identifying details changed of course):
A 70-year-old man who buried his 45-year-old daughter yesterday after nursing her through a horrible battle with lung cancer.
An elderly woman who told me that "being alive is hell on earth" (over a dozen suicide attempts in the last 5 years).
A kid barely out of his teens with terminal cancer. He told me he would be relieved to die since his life had been so full of suffering from his illness.
The teenager who lost her two sisters, her unborn child and ultimately the womb that carried him in a horrible car accident. (That case had all the surgery attendings in tears at rounds that afternoon.)
It makes me feel like an ungrateful whiner, and rightly so, when I catch myself complaining about the price of gas or someone choosing to pay by the method of the check in the grocery line in front of me (props to anyone who caught the reference there! MK I'm looking at you).
Monday, September 29, 2008
Saturday, September 27, 2008
Genital Infections: Everyone's Favorite Blog Topic
I started this year off with Surgery as my opening rotation, and now I'm in Family Medicine. Very different ballgame. On Surgery, it was hernia, appendicitis, cholecystitis, lather, rinse, repeat. This week on Family Med it was chlamydia, balanitis, and yeast infections.
Not all genital infections or ailments are sexually transmitted. Balanitis, bacterial vaginosis, and yeast infections can occur in people who have never had sex (by any definition of the word). On the other hand, it is pretty much impossible for anyone to get syphilis, chlamydia, or gonorrhea without having had sexual contact with an infected partner. Incidentally, you can get infections not only in the genitals but also in the throat or rectum from any of these lovely organisms :) I wonder if all the kids wearing "chastity rings" know about that...
This week in clinic I saw two patients with concerns about STDs. The more interesting of the two was a middle-aged man arriving with symptoms suggestive of gonorrhea. He had been treated the previous year for the same infection. His boyfriend was also treated; he had passed it to my patient. My patient was visibly dismayed as I asked him about his symptoms. "I know what I have; I've had it before. Let me ask you this: is it possible that last year the antibiotics didn't work and I just now am getting sick again? I mean, that's possible, right?" His eyes were searching mine and begging for me to tell him that yes, it is possible, and no, your boyfriend's not cheating on you with the bus-boy at his restaurant. I hemmed and hawed a bit, trying to buy time while my mind scrambled for some explanation other than the obvious one that would explain this man's having gonorrhea for the second time in 6 months. I quickly concocted a reasonable-sounding explanation. "Well, sir, it's possible if you and your partner did not take your antibiotics at exactly the same time last year, and you were still sexually active with each other, you could have re-infected each other during that time period." I didn't know then that my reasoning was actually scientifically valid, but it certainly seemed logical to me at the time. (Please know that I always have an M.D. who comes into the room at the end of the visit to discuss diagnosis and treatment with the patient and also answer any of the questions the patient has.)
At any rate, my patient was tremendously relieved. I cautioned him to go home and have a long talk with his partner about the issue, and also to send his partner in for treatment since he was probably also infected.
That day I was a little bit Sex Talk with Sue, a little bit Dr. Phil (who I hate; I'm not linking to his website to give him more traffic. I'm sure everyone know who he is).
The CDC has an excellent section on their website about STDs. Check it out if you're feeling nervous.
Not all genital infections or ailments are sexually transmitted. Balanitis, bacterial vaginosis, and yeast infections can occur in people who have never had sex (by any definition of the word). On the other hand, it is pretty much impossible for anyone to get syphilis, chlamydia, or gonorrhea without having had sexual contact with an infected partner. Incidentally, you can get infections not only in the genitals but also in the throat or rectum from any of these lovely organisms :) I wonder if all the kids wearing "chastity rings" know about that...
This week in clinic I saw two patients with concerns about STDs. The more interesting of the two was a middle-aged man arriving with symptoms suggestive of gonorrhea. He had been treated the previous year for the same infection. His boyfriend was also treated; he had passed it to my patient. My patient was visibly dismayed as I asked him about his symptoms. "I know what I have; I've had it before. Let me ask you this: is it possible that last year the antibiotics didn't work and I just now am getting sick again? I mean, that's possible, right?" His eyes were searching mine and begging for me to tell him that yes, it is possible, and no, your boyfriend's not cheating on you with the bus-boy at his restaurant. I hemmed and hawed a bit, trying to buy time while my mind scrambled for some explanation other than the obvious one that would explain this man's having gonorrhea for the second time in 6 months. I quickly concocted a reasonable-sounding explanation. "Well, sir, it's possible if you and your partner did not take your antibiotics at exactly the same time last year, and you were still sexually active with each other, you could have re-infected each other during that time period." I didn't know then that my reasoning was actually scientifically valid, but it certainly seemed logical to me at the time. (Please know that I always have an M.D. who comes into the room at the end of the visit to discuss diagnosis and treatment with the patient and also answer any of the questions the patient has.)
At any rate, my patient was tremendously relieved. I cautioned him to go home and have a long talk with his partner about the issue, and also to send his partner in for treatment since he was probably also infected.
That day I was a little bit Sex Talk with Sue, a little bit Dr. Phil (who I hate; I'm not linking to his website to give him more traffic. I'm sure everyone know who he is).
The CDC has an excellent section on their website about STDs. Check it out if you're feeling nervous.
Welcome!
I'm not sure who I'm welcoming, since if I tell anyone about this blog it will probably be only my parents and sisters who read it!
I'm Liz, a third-year medical student (class of 2010). I'm working/learning in the clinics and wards of Urban Hospital of Urban University. If you don't recognize that name, it's because I made it up. Blogging about medical issues and real patients, even when identities and identifying details are changed or omitted, is tricky territory. The last thing I need is for some whistle-blowing classmate with an ax to grind to report me to the Urban Authorities.
Anyway, I plan on posting at least weekly and hopefully a bit more often than that. Topics will include interesting patient cases (for the most part) and my opinions on various bioethicalmedicolegalfinancialpersonal issues. That should cover it.
Please note my Patient Privacy disclaimer on the right sidebar! If you somehow think you've identified yourself or your ailments in a post on my blog, please leave a comment with your concerns, but I can guarantee that it will be a coincidence.
I'm Liz, a third-year medical student (class of 2010). I'm working/learning in the clinics and wards of Urban Hospital of Urban University. If you don't recognize that name, it's because I made it up. Blogging about medical issues and real patients, even when identities and identifying details are changed or omitted, is tricky territory. The last thing I need is for some whistle-blowing classmate with an ax to grind to report me to the Urban Authorities.
Anyway, I plan on posting at least weekly and hopefully a bit more often than that. Topics will include interesting patient cases (for the most part) and my opinions on various bioethicalmedicolegalfinancialpersonal issues. That should cover it.
Please note my Patient Privacy disclaimer on the right sidebar! If you somehow think you've identified yourself or your ailments in a post on my blog, please leave a comment with your concerns, but I can guarantee that it will be a coincidence.
Subscribe to:
Posts (Atom)