Science 2.0

Damn you wikipedia!
I tried to remember what the name of the social networking researchers was called, only to find out there are several competitors that look interesting. ResearchGate was the one I was looking for, but then I found Academia.edu, epernicus, and then SciSpace.com. Now instead of happily signing up for ResearchGate, I want to look into each of these but don't have the time. So I will likely forget about it for another few months and repeat the same process. Unless I can remember this blogpost...
Add these to my neglected accounts on Medpedia and LinkedIn, as well as that whole inspiration exchange thing AMSA has, and we're getting into serious social networking overload here.
Ok back to facebook.

The Unconventionalists

Nature (the journal) is running a theme this week on the future of the PhD. Some interesting convos going on in the comments over there, and I even found another cool book to read from it.
One blog post at the nature network stuck with me though. This scientist-in-training reflected on her unconventional aspirations and how others would react:

In the cover of my unspoken reality, I dared to be disappointed with my top 5 academic institution, where to entertain creative ideas of a non-traditional career in the sciences was to be exiled from the class of 'serious' scientists. A lullaby for a weaker child of chemistry. Enjoy your dreams of a lesser biology. She couldn't make it in the big leagues, they'd say. So I hide my dreams of translating science, colorful pages lost in a library of dull covers with obscure, impossible-to-pronounce titles. Surface Plasmon Resonance Series - Nanotechnology-based Sensors. Professor, here is my secret: such a library of science begs translation for the curious non-scientists. Thrilling stories of scientific discoveries that will make our fellow non-scientists as curious as we. Put me in coach. The only thing I know better than science, is the art and draw of language.

As someone with a non-traditional trajectory in medicine, I can hear her picturing others thinking "what are you doing here"... and have had others tell me the same thing. It can be frustrating at times, but I love her "Professor, here is my secret" line, it really captures how I feel when people ask my planned specialty or wonder how what I have planned with medicine...and why I persist on reading fiction in the middle of the semester. And then I run across quotes like these and feel a little bit better about it:

I cannot serve as an example for younger scientists to follow. What I teach cannot be learned. I have never been a '100 percent scientist.' My reading has always been shamefully nonprofessional. I do not own an attaché case, and therefore cannot carry it home at night, full of journals and papers to read. I like long vacations, and a catalogue of my activities in general would be a scandal in the ears of the apostles of cost-effectiveness. I do not play the recorder, nor do I like to attend NATO workshops on a Greek island or a Sicilian mountain top; this shows that I am not even a molecular biologist. In fact, the list of what I have not got makes up the American Dream. Readers, if any, will conclude rightly that the Gradus ad Parnassum will have to be learned at somebody else's feet.
-Erwin Chargaff
Heraclitean Fire: Sketches from a Life before Nature

Islands

Awesome article about how Central Park is an ecological island, human-made in almost every sense, but the laws of nature operate - resulting in an entirely unique species of dwarf centipede,Nannarrup Hoffmani.

Made me think how Hospitals can also be ecological islands, on the microbial scale.

Oh there was also exams this past week. Went well overall. Have some experimental results to share regarding the 10,000 question method for step 1. Apparently, doing just questions for pathophysiology review gave me the same score as doing straight reading/revision type review, but was much more fun to do questions! Not sure what this means for board prep yet though....more later.

Celiac without the Celiac

Exam week here. Pathophysiology was yesterday, lots of confusing questions about GI and Heme, like patients with celiac that had Iron and B12 deficiency (...??) and nonanisopoikilocytosis (seriously?) but otherwise a doable exam. I did several hundred questions and started to get a sense of how different QBanks have different styles. Exammaster makes it too easy by putting things that have nothing to do with each other for answer options and many first order questions, though they have good explanations. Kaplan QBook does a better job of making the choices more difficult, but still remains pretty straightforward. UWorld is the most dificult, but you're always clear about what they want - just you don't know the answer most of the time.

SGU's style consists of descriptions of conditions associated with the disease you just diagnosed and then about a paragraph full of distractions. So out of a 1/2 page vignette, probably 2 key words that are actually relevant. Anyway, in honor of nonanisopoikilocytosis, here is a link to a neat story about when you can have Celiac without having Celiac.

Patients Lie

icu has 4 beds for all of Grenada

4 icu beds for 100,000 people

Grenada only has 4 monitors for the patients in the ICU

no one else on the wards has a bp/hr/rr monitor

there is no beep beep beep in any other part of the hospital

i didn't notice this until this week, the 7th time i went.

Dr. g was our instructor for the day

Cuban doc, came to Grenada because his dad is a surgeon here

you do school in Cuba for free, but you owe the govt 6 years of social service

then you can go wherever you want if you pass their test

came to Grenada 2 years ago knowing no english.

There were 3 patients in the ICU

one was the girl we had seen previously in peds, with muscular dystrophy

she was alert but in need of monitoring

the other was an older man with a subarachnoid hemorrhage, apparently unconscious

and another was a middle aged lady also with a cranial hemorrhage

before we saw the tube put in, we were to examine the man with a subarachnoid hemorrhage

as usual, no one in my group is quite awake, yet i am fully caffeinated by this point

so i take the lead to examine

one of the guys in my group says we cannot touch the patients in ICU because

his friend was there before and they weren't allowed

so i am puzzled as to how we can examine this patient without doing anything

i ask Dr. g - he says yes you can examine

so we try to communicate, he does not seem response

he makes some unintelligible muttering sounds

another fellow student suggest we do the Glasgow coma scale to assess this patient

the GCS is the scale used to asses and monitor levels of consciousness

you have 3 sections and get points for each section

conscious awake aware = 15 points

you asses visual stimuli response, verbal stimuli response and touch/pain stimuli response

if you are in a coma and completely nonresponsive, or even if you are dead

you still get 3 points for showing up

So we decide to do the GCS scale

he does not seem responsive to verbal stimuli - we ask him to blink if he hears us

it is just random, and he mutters

he gets 2 points for verbal

after some observation we decided his eyes don't really open to our voice

we think 1 point maybe

however, we need to test his response to painful stimuli

so i decide to poke the patient, but not hard

he moves his arm a bit when i touch

V says no, you really can't assess that

and that that is not a response to your stimuli because you didn't get his consent/understanding

i say we don't need that, but how are we supposed to assess this?

i am told by my colleagues that we don't need to really do it

its just a textbook thing

i say that is absurd, aren't we supposed to be monitoring this every hour?

what do you guys suggest?

they are nonresponsive

Dr. g then brings us over to see a nasogastric tube put in the middle aged lady

they needed to sedate her.

After, we go outside the ward

Dr. g asks us if we have any questions

i remember to always ask a question, i read this somewhere about rotations

so i ask how are we supposed to do the GCS scale and how important is it that we really do it?

Dr. g says

instead of answering

i will tell you a story:

I was given a page to examine a patient with coma

comes in, boy, 10yo, has IV line on each arm, fluids

given oxygen nasal, given nasogastric tube.

i examined the patient - respiration is normal, rr 20 bpm, hr 80bpm, bp 120/76

airway sounds normal, so does heart

something is not right he thinks, intuitively

i does his reflexes - none

i pinched the patient, no response to pain, no response to stimuli.

i calls the nurse over and say

"nurse this patient is dead, he died 5 minutes ago" shocked looks and gasps

"bring me the tools so that i may perform the autopsy"

suddenly the boy cries "no no, i am alive!"

Reboot and Open Access

My guilty spiral of not posting, and then having things to post but not enough mental energy/time, seemed to be stalled in a perpetual procrastination spiral, but then I ran across a fellow med student blogger - Lex MD - and realized that I don't need to write paragraphs of detail about, well, studying without internet (it really works - thank you silly campus Bradford security restrictions!) in order to keep things going here - or at my other neglected blog with Global Pulse Journal (though I have been keeping up with the twitter account). So even with Step 1 slowly creeping towards me, I hope to have a little more of a social-net presence.

Speaking of journals, I've been loosely following the Open Access debate going on in the scientific journal community. It seems that one of the journals I published at supports the DC Principles for Free Access to Science, purporting to be a middle way between traditional publishers and open access advocates like the Public Library of Science and the NIH. An interesting debate - any thoughts out there in blog land about this?

MS2

Med school is about not giving up on things.

Med school is about understanding how much time you have and what is possible to do.

Med school is about scheduling.

Med school is about finding time for things that you care about, like your neglected blog, even when you've got a long to do list.

Med school is about stepping back the week before exams and remembering why you have been sitting for 14 hours straight trying to download this book into your brain.

Med school is about understanding work and your duty to get things done, even when you're exhausted.

Med school is about learning how much we know of the human body, and how much (more) we have to learn.

Med school is about understanding what Oscar Romero meant when he said ""We cannot do everything, and there is a sense of liberation in realizing that. This enables us to do something, and to do it very well. It may be incomplete, but it is a beginning, a step along the way."