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Saturday, June 27, 2009

Patients: for a change...

I am happy to report that the long awaited feelings of gratification, satisfaction, and sweet fulfillment have come through during these two past weeks of hospital clerkship (the first two weeks in Med III). This is it. What I have been waiting for since I graduated from high school, and even a few years before that, if you will deem meaningful the idealism of a foolish teenager and his noble aspirations to save the world one patient at a time. This quest, this mission, now surely tarnished by disillusionment and eroded by its relentless and savage conflict with the grit of reality, this enthusiasm, and idealism, or what's left of them, is what I am trying to salvage at this time in my life and career. The fact is, I can proudly say that at last, at long last, I have the power to do something about it. I, your dedicated and enthusiastic medical student, now have enough to work with to impact people's lives, no matter how limited that impact may be. Flashback 3 weeks ago: I was just another student in a classroom counting the seconds before it was time to head back home or to the pub for a few drinks. Now, for a fast change, things are different. Let me tell you the story of a patient who made me realize that.

N. is a sweet old lady patient I was following up. She was one sick lady, with heart problems, kidney problems, and diabetes. One of the many, many long term complications of diabetes is peripheral vascular disease. simply put, this means that diabetics have problems in their blood circulation and as a result, there is impaired blood supply to the lower extremities. Impaired blood flow means impaired oxygenation, impaired eventual wound healing, and impaired immunity in the affected area. This is why you see 'informed' diabetics and think that they're anal about foot hygiene. It's simply because they've been informed that even the smallest abrasion or cut to the skin of their feet could result in devastatingly painful ulcerations and invasive infections that could ultimately warrant the amputation of a toe, or even the entire foot or leg in severe cases. What makes it worse is Diabetic Neuropathy, another complication of Diabetes that impairs sensation in the lower extremities, meaning that any wound, abrasion, or developing infection in a hidden area could go undiscovered for months, without the patient feeling so much as a tingle. Read more about The Diabetic Foot and Diabetic Foot Care.

N. had had diabetes for many years, and after an ulcer between her toes failed to heal and got infected, she lost her little toe, which was amputated to prevent the infection from spreading further up her leg with dire consequences. The first time I examined N., she immediately reminded me of my grandmother (Read); an exceedingly sweet, but obviously worried old lady, more open to suggestion than anyone could imagine. Even long years of fighting with chronic disease, life saving operations, and medications, along with a roughed up body both inside and out, had failed to embitter this inspiring character. The best of it all is that all she had to do was smile.

After this introduction it's time I got back to the point I was trying to make. People like N., with limited resources, bad or no insurance, are usually treated and let go as soon as possible. This is the sad reality of health care today, and is something that I'll be sure to write about when time and inspiration permit. The bottom line is that after a successful operation, N. was about to be sent home with her foot well on its way to a full recovery. Sadly, no one really took the time to sit down with N. for a few minutes and explain to her what steps needed to be taken to avoid another visit to the operating room. My group and I (Myself, M, and G.) felt that we could do it. Why not? It is now our duty to care for our patients, examine them, and help in their treatment and convalescence. Why would we not be responsible of raising some awareness and help them also by preventive measures? We went to N.'s room and gave her a talk with a few crucial instructions on how to care for her feet. And yes, this is the essence of what I've been rambling about for the past 3,000 words or so. We did that, and I like to think that we DID make a difference in N's life. Only time will tell, but things are looking up.

M. told me a similar story about one of her patients. She felt the same as I did, but the feeling is a bit new to us. It's something that, deep down, you know is right and that you are 100% sure that you're doing the right thing, but that still feels awkward, for some reason, and you're always worried that it's not your place. Well, I think it is. And I'm sure that if we don't do it, no one will. If we somehow lose this enthusiasm, this 'flame' that sadly has burned itself out in all but the newest blood in the health care system, we can be sure that no one, especially not the hardened veterans with their cynicism, will kindle it back to life. And it is the patients that will ultimately pay the price. Who else?

I said goodbye to N. with a few last minute instructions and reminders, and she told me how grateful she was, and the last words she said before I left will stay with me for a long time.

"Ra7 a3mel metel ma eltelle ya 7akim!"(I will do exactly what you told me to, Doctor!) - said a proud and emotional N. ...

Sunday, June 21, 2009

And So It Begins...

One week into Med III and I've been wondering how it would be possible to sum up a whole week in one post. And not just any week. The first Med III week,the first week in med school remotely resembling anything that even comes close to being a physician.
Well in fact, sometimes when I think about it I feel that I haven't done anything quite so significant yet. But at other times, I also feel that every small step, be it the patient you so much as greet in the hallway, or the first EKG you set up, or every Once-In-A-Lifetime Choledochal Cyst (1 case per 2,000,000 Live Births in the U.S) Roux en Y Hepatico-Jejunostomy (Yeah never mind... Just something fancy ) you witness in the OR is now a decent step forward, a landmark, a mini checkpoint, if you will, along the way to becoming a fully developed physician. It's really hard to describe, but what I can say is that it's a whole new world, that's for sure, and there is absolutely no way of comparing it to the previous two years of classes and bookworm-ism so I'm not even going to try.

Getting ready for tomorrow, the 8th day into Med III and the General Surgery rotation we incidentally started out with, and already, I'm (and when I say "I" I mean "we") already feeling more familiar with the system. There's a certain satisfaction to it, to becoming one of the microscopic cogs on one of the tiny wheels in the at-best marginally well-oiled, Willy-Wonka-esque machine that is our hospital. We meet with and examine patients, write admission notes, follow up on patients after their operations, write progress notes, and suggest management plans that will be a new point of reference in the patient's chart. And the new in it all, I mean besides the contact and all, is that it feels useful. What I'm doing with what I've learned and what I'm learning is actually being used by my peers and superiors, to benefit someone in the end. I think that's the best way of describing what it feels like. In one word: just grandiose. And it's only when you realize just how much more there is to learn, how much more there is to accomplish, that your head starts spinning and you let it spin back down to earth and get on with what you're doing.

I just paused for a second, and thought about all the stuff I want to write here. There is no way this could all fit into one post. So if somehow I've managed to grasp your attention and interest, come back soon for more...

Sunday, June 14, 2009

Our Humble Beginnings... Who Are We?

It is a the end of this one-month vacation that I realize that we are at a new checkpoint. For those of you who remember, I was rambling about time and how we seem to be pissing it away by the years and decades without even wondering where it went. But today, I stand before you a changed man *grin*. Changed by the beneficial effects of that exquisitely inculpating farniente month that just seemed to rain down from the heavens. And is difference a beauty or what?

Here, we're contemplating the onset of a new, 2-year era, a new setting and a new context in our lives, as we peer through that door, ajar, on the threshold between books + exams on the one hand, and the patients + associated responsibilities + real medical practice on the other. On Monday, tomorrow, we begin our 2 clinical years, as well as the beginning of the second half -and end- of our medical training.
It is at this opportune time that I started thinking back 2 years ago. When Le and La Colleague were nothing but strangers to one another, and I thought I'd catch us up on how it started... For simplicity, I will be Le Colleague, and La colleague will be the "She".

Some time around the end of August, 2007, the first day of med school for 83 students from AUB, adding 2 from universities abroad. She was one of these two. The first time I laid eyes on her, I knew that our love story had begun. REALLY??? Wait it's that glass of whiskey talking. Let me rephrase. Hmm... let's see. She was hanging out with the wrong crowd -as wrong as it gets if you ask me-, she dressed funny but I've never told her, hair looked funny but I've never told her... -need I say more?- we were casually introduced, and I looked away and made no note of it, just another med student in the sea...
The next few days didn't get any better, as we had our first meaningful encounter at the Saab Medical Library. If memory serves right, someone was on the phone *cough* and another someone was all pissy and "please can you keep it down?" with a serious frown and "woe is me" (La Colleague 2007). It was all downhill until we had one crucial conversation at main gate during that skipped class (what was it again?); that conversation was to prove a landmark, a milestone without which no further contact would have been made. That made me realize back then: hmmm... we may be on to something there...

Here's to you...

Keeping the story short, we sure have come a long way since then, La Colleague became La Friend, and perhaps La Baby Sister (although there's nothing baby about her, so don't get me wrong on this) and now as we look ahead for even better times, I can't imagine how everything would have turned out if she hadn't been so interesting to talk to on that fateful day at the gate. Ups, downs, crazy days, relaxed times, easy sailing and rough seas, we've seen it all, and I don't see why anything would change.
I don't know about you, but it's just sinking in right now; the day before the beginning, before we start getting the feel of real medicine, and I couldn't be more excited if I tried. So here's to another 2-year batch of heaven and hell, and many many more to come.

Sunday, June 7, 2009

Elections, Lebanon, What do we really need?

For many months now, but mostly in the few days leading up to today, election day, we've all heard and seen countless ads, slogans, rebuttals, petty claims of corruption and some of the best and worst publicity we'd ever seen. I've hung out with people from all parties, listened to them discuss the elections, and what the other clan was up to. What they meant with this or that phrase, and what the hell they were thinking. Then I realized the disparity between what was at stake, and the level at which the discussions, verbal clashes, and even thinking were taking place. In fact, there was a distinct lack of mention of Lebanon in all these discussions. What the future held, what the REAL plans were for this country of ours that we're losing piece by piece. Instead, everyone was ecstatic when their clan rebutted the other clan's allegedly failed or misplaced ad. Everyone couldn't stop laughing and smiling when they heard their chief's distinct horn pattern. Keep in mind, that in arguing about the ads, and from a truly objective standpoint, both were right and wrong at the same time, but let's not go into that right now, because I think the arguments given by these people are too stupid to be a part of this post.

This brings me to the point I'd like to make. A point I and very few around me have been trying to get through. Also, I've been meaning to write about this here, but I have to admit that my lack of a respectable knowledge of politics has prevented it. I've often wanted to discuss and critique many key points that would come up on the news here and there, things my friends and I have talked about, but I never got around to it, because I never thought I'd be able to do it with enough substance. All I know is that the country's still being led by the same political leaders, thieves, murderers, and warlords that made it the shit hole that it is today. All I know is that their devoted followers are so goddamn blind that all they care about is how catchy their new slogan is or how humiliating that new advert is to the other clan. All I know is that this country is losing its youth, losing all its intellectual resources, and all I know, me, and my limited and stupid brain, is that there must be a reason behind this. There must be something that's being done that's preventing improvement, and leaving our problems like an open wound on an arm, gathering all kinds of infections, dirt, and parasites, to the point where amputation becomes the only viable option. All I know, is that very few people, if any, -and I am most definitely NOT a part of this few- can rightfully claim to have even the slightest idea on how to heal our country.

I came across something the other day that would do all this much better than I'd ever be able to. B. (My Marmite Guy) pointed out a video to me, a compilation of opinions and rants, denunciations and regrets expressed by a few prominent Lebanese personalities.
I will only post the trailer here, but please visit the link below and watch the whole thing. This is NOT some loser video with nothing but complaints and rants. It is a documentary and it starts and ends on a positive note, emphasizing hope rather than despair. I watched all three parts and each shook me to my core.

For the love of Lebanon, for the love of our future, please wake up.


Thursday, June 4, 2009

Adultery... Punishable by Death?

"At least eight women and one man are reported to have been sentenced to death by stoning in Iran.The group, convicted of adultery and sex offences, could be executed at any time, lawyers defending them say."

See the BBC article.

I heard about this on the drive to Beirut this morning. Not much was said, and I barely caught it on the radio so I wasn't sure what I had heard.
Now I'm reading about it and the more I read the more disgusted I am. I find it so difficult to believe that in the 21st century, we still hear about these sorts of things. Here are a few things I came across here and there while trying to satisfy my curiosity.

Monday, June 1, 2009

Air France: Missing plane probably crashed into Atlantic

Read more here.
Thoughts with families of victims.

Wondering how people deal with such horrific news about loved ones. Among the victims, reportedly, are 5 Lebanese passengers. 

Awful news.