Categories
Clinical Reflection

Working Miracles With Gravity

Before medical school, I worked as an assistant at the clinic of a physical therapist. Half of the physical therapist’s business was bread-and-butter physical therapy, but the other half was vestibular rehabilitation. The therapist specialized in diagnosing and treating balance and dizziness disorders of the inner ear. And guess what? Most of his patients were there as a last resort, because the doctors and their drugs weren’t working. They had fallen through the cracks, and the tragedy is that the most common cause for their dizziness is easily treatable, in 5 minutes, with only a table and some body positioning.

Benign paroxysmal positional vertigo, or BPPV, is caused by rogue calcium carbonate otoliths. These otoliths escape from the utricle of the inner ear and make their way into the semicircular canals (usually the posterior semicircular canal). These otoliths cause aberrant movement of the fluid in the semicircular canals with changes in head position, confusing the brain, which is getting mixed signals about the body’s orientation in space from the right and left semicircular canals. Predictably, the brain’s confusion manifests as vertigo, which  defines as “an illusion of self or environmental motion.”

Patients with BPPV suffer from sudden dizzy spells triggered by changes in head position, usually lasting 15-20 seconds. Movements like looking up, rolling over in bed, or getting up out of bed in the morning set the world spinning, often with an accompanying nausea. As you can imagine, these patients do everything they can to minimize their head motion. They move in a characteristically rigid fashion, keeping their heads as still as possible in order to avoid repeat attacks. Clearly, this is an extremely unpleasant condition; one that is experienced at least once by 2.4% of the population. The good news, however, is that it is easily treatable, as long as it is recognized.

A certain amount of diagnostic finesse is required to rule out central nervous system problems, but once the proper neurological exams have been performed, BPPV should be high on the differential for patients with the symptoms described above. The test for BPPV is called the Dix-Hallpike Maneuver, in which the practitioner provokes a dizzy spell by changing the patient’s head position and observing the eyes for nystagmus.

Once a diagnosis has been made, treatment consists of The Epley Maneuver, which is nothing more than a simple series of head and body positions designed to use gravity to reposition the rogue otoliths into the utricle where they can no longer confuse the brain by moving semicircular canal fluid inappropriately. When the patients I saw were cured of their vertigo so quickly, with such a simple technique, they wasted no time in hailing the physical therapist I worked for as a miracle worker. They had been miserable for months, and that’s all it took to fix it?? In these situations, the patients were always ecstatic. I couldn’t help but smile.

As we go into rotations, residency, and practice, I hope we will be able to catch these patients before they fall through the cracks. My purpose in writing this article is to get the word out , because it is so easily treatable without the use of expensive, ineffectual, toxic medications. All we have to do is recognize it when we see it. As an added benefit, maybe someone will call you a miracle worker one day.

References
http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo
Harrison’s Principles of Internal Medicine, 19th Edition, Chapter 28
http://www.neurology.org/content/70/22/2067.long

Featured Image:
Vertigo by Diana Mehrez

 

 

Categories
Literature

The Spouter-Inn: let’s see what’s inside

Photo courtesy of Tony Sun
Photo courtesy of Tony Sun

The third chapter of Moby Dick, “The Spouter-Inn,” is all about how to interpret new things. Ishmael, who settled on staying in the hotel called “The Spouter-Inn:–Peter Coffin,” tells readers about what he sees upon entering the hotel. Let us compare Ishmael to a medical student, first entering a new floor, say the neurology floor of a hospital. Ishmael and student are both faced with the task of making meaning from whatever presents itself. On that floor, the student wonders: who are the people sitting in the center of the floor? What is the meaning of the NPO signs next to some room entranceways? On entering Spouter-Inn, Ishmael wonders: what is this painting I see? What are the “monstrous clubs and spears” doing on the wall? I draw this comparison between Spouter-Inn and the neurology floor because I remember thinking about Ishmael’s first visit to that inn when I entered the neurology floor, where my physical diagnosis practice took place. I wasn’t sure what to expect, and there is not much to do for preparation. Like Ishmael, I just walked in and did my best to make sense of what I saw. If there was any “preparation” on my part, it was reading Moby Dick and knowing about the analogous situation of walking into a foreign Spouter-Inn.

For Ishmael, a painting hanging on the wall caught his attention, though he couldn’t make sense of what the painting was about. However descriptive he was about what he saw in the painting, he couldn’t give readers a definite sense of what the painting was. While you might see a painting at the Metropolitan Museum of Art and text your friend what you saw (Washington crossing the Delaware, or the like), Ishamel tells readers this:

A boggy, soggy, squitchy picture truly, enough to drive a nervous man distracted. Yet was there a sort of indefinite, half-attained, unimaginable sublimity about it that fairly froze you to it, till you involuntarily took an oath with yourself to find out what that marvellous painting meant. Ever and anon a bright, but, alas! deceptive idea would dart you through.–It’s the Black Sea in a midnight gale.–It’s the unnatural combat of the four primal elements.–It’s a blasted heath.–It’s a Hyperborean winter scene.–It’s the breaking-up of the ice-bound stream of Time…But stop; does it not bear a faint resemblance to a gigantic fish? even the great Leviathan himself?

Remembering Ishmael’s struggle to make sense out of that painting, I felt a comfort of familiarity, the best feeling I think that someone can feel when thrust in a new situation. It’s OK that Ishmael couldn’t make sense of the painting he saw on the wall, just as it’s OK that I didn’t know what to make sense of the labels telling me: NPO, or D5 0.45 NS. It’s no big deal to look those acronyms up on my smartphone, or just simply ask someone, the latter of what was done in Ishmael’s time: “based upon the aggregated opinions of many aged persons with whom I conversed upon the subject. The picture represents a Cape-Horner in a great hurricane.” This comfort of familiarity I mentioned earlier arises not necessarily from previously seeing the acronyms “NPO” and “D5 0.45 NS,” though seeing them before certainly does add to familiarity–no, this comfort comes from knowing that it’s not uncommon for someone, someone even as smart as Ishmael, to see something and be entirely uncertain what it is and to have several guesses as to its meaning.

Featured Image:
Silver Bank Outtakes by Christopher Michel

Categories
MSPress Announcements

Announcing: The Free Clinic Research Collective

On behalf of the entire MSPress Team, I am very proud to announce a call for papers for the newest MSPress publication, The Free Clinic Research Collective (FCRC). The FCRC is currently accepting: original research, brief communications, narrative/reflection essays, and viewpoint articles.  Since the FCRC’s official online debut in February 2015, we have received enthusiastic responses from medical students across the nation.  We are still reviewing and accepting submissions, so please do not hesitate to contact me, Elizabeth C. Lee, the FCRC Associate Editor, at freeclinic@themspress.org with any questions!

As we have received numerous inquiries about the FCRC, I thought it would be helpful to write a blog post to provide further information about this new publication.  Here are some FAQs that I have received:

#1 What is The Free Clinic Research Collective (FCRC)?
The FCRC is a new peer-reviewed, open-access publication from The MSPress that aims to establish a national collective of student-run free clinics.  Almost every medical school in the U.S. has at least one student-run free clinic, and yet there is currently a paucity of literature about these clinics.  With the launch of the FCRC, our goal is to improve the distribution and accessibility of information relating to student-run free clinics by creating a centralized publication hub for easy information retrieval.  Additionally, the FCRC encourages medical students to share their experiences in working with underserved populations in interprofessional settings at their schools’ student-run free clinics.

#2 What types of submissions are accepted by the FCRC? 
The FCRC accepts the following: research articles, brief communications, narrative/reflection essays, and viewpoint articles.  (NB: In the future, we will also be accepting correspondences. More on this in #3 below!)  As we are firmly committed to embracing all medical student original work, please contact freeclinic@themspress.org if your work does not “fit” into any of the above categories, and we would be happy to work with you to help get your work published!

#3 Why should I submit my work to the FCRC?
Thank you for asking!  Here are 5 reasons:

  1. Get your research published in a peer-reviewed journal.  (Tip: If you’ve already given an oral presentation or made a research poster on a topic related to student-run free clinics but have not yet published your findings, then simply translate your work into a research article format, and send it to us!)
  2. You are/have been a student leader at your school’s student-run free clinic, and you have insight into your clinic’s organization, management, services, and limitations.  Sharing this information by writing a brief communication would help your peers across the nation improve efficiency in their own home clinics, leading to better patient care.
  3. You have a particularly exciting or memorable patient encounter or experience at your school’s free clinic, and you would like to share your experience with your peers by writing a narrative/reflection essay.
  4. You have an opinion about the role of student-run free clinics in addressing issues, such as: health disparities, access to quality care, primary care physician shortage, medical education, etc.  If you have an opinion on a topic involving student-run free clinics, then write a viewpoint article!
  5. You enjoy the art of debate.  (Not a joke!)  If so, then write a correspondence article!  This is one particularly unique aspect of the FCRC, which is not just a simple one-way information portal.  Through correspondence articles, the FCRC encourages intercommunication between authors and readers by establishing an open dialogue.  The correspondence article gives readers the opportunity to comment on any previously published article in the FCRC.  If your correspondence is accepted for publication, then a copy will be sent to the author of the original article, allowing for the opportunity of a brief reply.

At the MSPress, we have a highly dedicated team of editors and peer reviewers, and we ensure that each submission undergoes a blind peer review process and receives full consideration for publication.  I have deep confidence in the launch of our new publication, The Free Clinic Research Collective, and am proud to launch this wonderful platform for the benefit of medical students across the nation to exchange ideas and share their research findings regarding student-run free clinics.

Again, please do not hesitate to contact me, Elizabeth C. Lee (FCRC Associate Editor), at freeclinic@themspress.org with any questions. Thank you for your hard work out in the clinic, and we look forward to reading your submissions!

Consult the Free Clinic Research Collective Author Guidelines

Categories
Disability Issues Lifestyle Opinion

Hearing Voices

“In examining disease, we gain wisdom about anatomy and physiology and biology. In examining the person with disease, we gain wisdom about life.”
― Oliver Sacks

Hallucinations are a window into the mind. They illustrate the complexity of the human mind and the pathways that can lead us astray. Art has explored the idea of madness over the centuries, translating paranoia into tragedies, delusions into dramas. It is only in the 20th century that hallucinations have been described as a sign of illness. In the past, hearing voices used to be linked with saintliness and spiritual enlightenment: a path towards God. Hallucinations are also heavy with cultural meanings: we can look back at Moses and the burning bush or Buddha beneath the Bo tree. Different cultures prescribe meaning to different senses: Protestants emphasise hearing while Catholics emphasise vision. Perhaps most interestingly, West Africans partake in kinesthesis; Westerners distrust unusual sensory experiences and label them as pathological.

The term auditory verbal hallucination refers to hearing a voice in the absence of an external stimulus. Auditory hallucinations are more common within the general population than many of us may think, especially in times of stress: up to 70% of people have been found to hear the voice of their dead relative during bereavement. Most of the people who report auditory hallucinations within population studies do not report any distress or impairment; they are able to live happily alongside these voices within their heads. Some people find that their voices can give them guidance through difficult times, while others see them as a companion or a best friend. After all, we do not consider it abnormal for a child to report that they have an imaginary friend. This relationship between the person and their voice is incredibly complex – as complex as any other relationship we may encounter, and we must tread softly when we deal with such intimacy.

Hearing Voices as a Disease
Hearing voices is not the same as having a sore throat. Hearing a voice can have a deep significant meaning to the person in a way that a sore throat cannot. So what makes the voice pathological?

Western Society sees hallucinations as pathognomonic of a serious mental health disorder. Serious psychotic disorders are however recognized across all cultures with a similar pattern of symptoms. Hallucinations that are linked with serious psychotic disorders are described as ‘pathoplastic’ – that is, they are shaped by local meanings. Behind the response to voices is the attitude of society. The society we grow up in has a lot to say about the meaning of these voices: Mexican-American relatives are more likely to display tolerance and sympathy for a relative hearing voices compared to Euro-American families, who are more likely to display criticism and hostility. If you grow up in a society where you are taught that hearing voices is wrong, this will affect your relationship with them. Imagine if you were a child hearing voices, and you turned to your parents to support and found they were even more afraid of the voices than you. Would you see your voices as an enemy, or a friend?

People experience the mind and its underlying symptoms differently depending on where they grow up. Prof Luhrmann found that US patients self-identify as schizophrenic, using the diagnosis to describe their condition through textbook definitions. They accept the medical diagnosis and are even able to recite the medical criteria – for them, the meaning of the voice is “to be crazy.” In general, the American sample did not treat their voices as a person and many of their voices were filled with violence. On the other hand, in Accra people described voices as a spiritual attack. Half of patients reported hearing only positive voices. Even when hearing negative voices, individuals also described good voices telling them to ignore these negative influences. Some people in Accra even said these voices kept them alive. In India, hearing voices is viewed differently yet again. Many of the doctors don’t mention a diagnosis and families don’t ask. None of the patient’s believed they had a devastating illness, and thus compared to the West, most of them expected to get better. Does this suggest that people suffering from hallucinations in the developed world have a better quality of life?

It has been suggested that within the Euro-American culture, an individual who is unable to distinguish between reality and imagination is labelled as pathological, while in many non-Western societies such rigidities do not exist. But this labelling goes beyond cultures; it transcends time. Mitchell and Vierkan compared hallucinations in an East Texas hospital both in the 1930s and then in the 1980s. They found that command hallucinations of the 1930s were found to be more religious, such as “lean on the Lord,” while those of the 1980s were more destructive, such as “kill yourself.” Perhaps such changes reflect the hostile environment we have created for our patients, and thus leads onto the questions: are we treating our patients with a dignified and open manner? Do we treat them as fellow individuals?

If you do not envision schizophrenia as a life sentence, you increase the chance that patients will be able to discover their own resilience.
– Prof Luhrmannn

Hearing Voices as a part of Life
In 1987 psychiatrist Marius Romme appeared on Dutch television with his patient Patsy Hague, a voice hearer, to publicise his new approach to voice hearing – that attributing meaning to one’s voices changed the way one responded to them. Four hundred and fifty people responded to this television appearance, reporting that they heard voices. More than half of the people who responded had never sought professional help: they lived happily with their voices. From this stemmed the world’s first Hearing Voices Congress held in Holland that year, and from this then grew the Hearing Voices Movement.

The Hearing Voices Movement states that hearing voices is part of human variation. It rejects the pathologising of auditory hallucinations and emphasizes empowerment of the individual. The Movement combats the stereotype of the “all-powerful psychiatrist” by giving more control to the voice-hearer and viewing the hallucinations not as a disease but as a key part of their identity. Eleanor Longden, a lady diagnosed with Schizophrenia is one example of how such a movement can have a significant impact on a person’s life. Below she describes how her meeting with the psychiatrist, Pat Bracken, became a turning point:

“[he] didn’t use this terrible, mechanistic, clinical language but just couched everything in normal language and normal experience”

Her story illustrates the road from “schizophrenic” to “voice-hearer” – from the clinical language of disease to the everyday language of emotions and experience. The stories of those diagnosed with schizophrenia can often be seen as disordered and incoherent, lacking any meaning. They are seen as having a defect. They are not entitled to a story. Hearing Voices Groups across the UK give people the opportunity to come together and share such stories in an open and trusting environment. The narrative contexts are the foundation blocks upon which these voices grow. It has been suggested that the inability to share stories about the self is part of the origins of psychopathology. We as healthcare professionals need to emphasize the point that hearing voices does not always lead to a life-long sentence of medication and institutionalization, as described eloquently by Eleanor Longden below:

If someone is reporting that they do not want their voices to stop then we must not automatically jump to the conclusion of poor insight. When the voices are distressing it is important to develop coping strategies that address this distress rather than the symptoms themselves. The problem is not the voice but the relationship one has with them. The goal of the Hearing Voices Network is for people to learn how to deal with their voices as one would deal with annoying roommates: with respect.

It has been argued that in Western medicine, doctors focus too much on a person hearing voices and not on what they say. Thus, anti-psychotics are seen as the answer with the devastating side effects described as a sacrifice for bringing someone back to the ‘norm.’ In order to understand the voices heard by our patients, we must first improve our knowledge of the cultural and social environments in which our patients reside and the practices and beliefs that our patients hold dear. If a clinician cannot take into account the cultural context of his or her patient, they cannot respond appropriately to their distress. And if a clinician is unable to respond appropriately to their patient’s distress, how can they ever hope to alleviate it?

“People with thought disorders do not keep a list of famous and successful people who share their problem. They can’t, because there is no such list. Comparatively few schizophrenics lead happy and productive lives; those who do aren’t in any hurry to tell the world about themselves.”
– Elyn Saks

 

References
1. Woods, A. et al. Interdisciplinary Approaches to the Phenomenology of Auditory Verbal Hallucinations. Schizophrenia Bulletin. 40:S246-S254
2. Laroi, F. et al. Culture and Hallucinations: Overview and Future Directions.Schizophrenia Bulletin. 40:S213-S220
3. Luhrmann, T.M. 2011. Hallucinations and Sensory Ovverides. Annual Review of Anthropology. 40:71-85
4. Woods, A. 2013. The voice-hearer. Journal of Mental Health. 22:263-270
5. Vaughan, S., Fowler, D. 2004. The distress experienced by voice hearers is associated with the perceived relationship between the voice hearer and the voice. British Journal of Clinical Psychology. 43:143-153
6. Ritsher, J.B., Lucksted, A., Otilingam, P.G., Grajales, M. 2004. Hearing Voices: Explanations and Implications. Psychiatric Rehabilitation Journal.27:219-227

Featured image:
Sound Waves: Loud Volume by Tess Watson

Categories
Humour Lifestyle

Study Strategies: The Good, The Bad, and The Ugly

The Tortoise
The tortoise is in it for the long haul. He studies for a fixed amount of time, every day. He has a routine. He never has to worry about cramming or catching up, because he’s always on top of things. The med school years for him are simple years; he studies and refrains from indulgence. Indulgence is too time consuming, and throws him off his rhythm. “If I party on Friday night,” he says, “then how will I get up at 6:30 to study on Saturday?”

The Hare
The hare is usually a social butterfly. So much energy, and so productive . . . in spurts. But the hare also enjoys taking time for herself. She takes evenings or maybe even whole days off studying. If she didn’t do this, she would fall victim to the dreaded burnout. At least that’s what she tells herself. Although she is often behind, her ability to catch up is second to none. Many of us have probably heard the adage that it’s impossible to cram in medical school. Well, not for the hare. Cramming for the hare just starts a few days earlier than it did in college. It really is impossible to cram for a neuro test the day before the test, but it is possible to pull 3 consecutive 20-hour cram days and still do well. As for long-term retention, who knows? Only boards will tell.

The Moocher
The moocher is lazy. He keeps to himself most weeks. He does not make study guides or contribute to anyone else’s learning. If at all possible, he will not show up to lecture. When a test is not looming, he can be found in his underwear at home, drinking beer and cruising the interwebs. Then, when a test looms near, he breaks free from his filthy cocoon of lethargy and can be seen on campus and social media snatching up all the condensed study guides everyone else in the class has made in the previous weeks. The moocher usually does okay on the tests, but one wonders how he will perform during rotations and residency when he does not have such helpful resources on hand.

The Memorizer
The memorizer is the queen of facts. Her ability to absorb large tables of seemingly random bits of information is unparalleled. While some may struggle to recall even the names of different medications, the memorizer will calmly recite all of the generic drug names, all of the brand names, how to spell them, how each of them is metabolized, their side effects, and which are contraindicated under what circumstances. She can do this after only going over the material once. Her classmates are in awe of her. Truly she is blessed.

The Reader
The reader… reads! Truly he is a rarity in our times. While he abhors the brute memorization of random facts, he loves to read textbooks. Bringing together a large body of knowledge into a logical system is what the reader enjoys most. He is a systematic learner who loves finding out how the little details fit into the bigger picture. The reader also must have strong shoulders, for textbooks are not known for being lightweight.

The High Yielder
The high yielder is focused first and foremost on the next exam. Perhaps it is a flaw, or maybe just an efficient allocation of her resources, but the only thing she cares about is information likely to be on the next test. She might be heard on campus saying something resembling the following: “Did the professor say that’s going to be on the test? No? Then I’m punting it. I’ll learn it later for boards if I have to.”

The Recluse
The recluse is only seen on mandatory days. Nobody really knows what he does. The only thing known for certain is that he does not go to class or social events. He doesn’t have a Facebook, and certainly shuns the company of others when he is forced to be on campus. The recluse may either be an actual loner, who would much rather be alone than in a group, or he may just be an older, married father of 3 who spends his time with family and studying at home. Either way, whenever he shows up, everybody turns and whispers to each other “Who IS that? Is he in our class?”

The Deity
The deity is revered by all. She is at the top of the class. Her study methods are mysterious. She somehow gets top scores on tests, actively participates in multiple clubs, is on student government, volunteers regularly at free clinics, and conducts research. She has a strong presence at social events and on social media. All of the students and professors adore her. Many have tried to discover her secret, but it remains a mystery. The current hypothesis is that she only sleeps 3 hours per night.

Featured image:
Studying in Starbucks by Nicola Sapiens De Mitri

Categories
Literature

The carpet-bag: what to bring with me?

In the first chapter of Moby Dick, “Loomings,” Ishmael gives his reasoning for going on a sailing journey. He is anxious, irritable, and needs to find an escape from his current life, symbolized by the land, so he plans on going to sea as a sailor. In my previous post, I likened his narrative in the first chapter, redolent of the famous Shakespearean monologues, to an exchange between a patient and a physician. I noted that understanding Ishmael’s narrative is analogous to understanding a patient’s story. In chapter two, “The Carpet-Bag,” Ishmael prepares for his sailing journey and leaves Manhattan island, but he faces a problem:

Quitting the good city of old Manhatto, I duly arrived in New Bedford. It was a Saturday night in December. Much was I disappointed upon learning that the little packet for   Nantucket had already sailed, and that no way of reaching that place would offer, till the following Monday (Ch. II)

Ishmael realizes he must look for a hotel to spend the cold December weekend. He surveys the area and finds several hotels: The Sword-Fish, The Crossed Harpoons, and The Trap. Finally, he stumbles upon one that seems reasonable, at least by its name:

Moving on, I at last came to a dim sort of light not far from the docks, and heard a forlorn creaking in the air; and looking up, saw a swinging sign over the door with a white painting upon it, faintly representing tall straight jet of misty spray, and these words underneath- “The Spouter Inn:- Peter Coffin.”Coffin?- Spouter?- Rather ominous in that particular connexion, thought I. But it is a common name in Nantucket, they say, and I  suppose this Peter here is an emigrant from there (Ch. II).

Here, Ishmael’s response to something seemingly as simple as the name of a hotel illustrates an important point—that the perception of language shapes how one feels about what one’s exposed to in life. This is a vital issue in science and medicine, one that deserves more attention in medical education. A few weeks ago, Dr. Mary Simmerling of Cornell University gave a lecture to first year medical students about the ethical, social, and economic issues surrounding kidney transplantation, and in her lecture, she talked about “how much language matters.”

As someone trained in philosophy, I’m very attuned to how the choices we make about words have a huge impact… And I think it’s so true when talking to patients. When I was in graduate school, we called what we now call ‘deceased donors,’ ’cadaveric donors’. So, who wants an organ from a cadaver, and who wants an organ from a deceased donor? Right? So, every word counts. And, it’s really important that we are careful in how we talk about things and describe them because it makes a big difference in how people think about things and how receptive they are, and how willing they are to do things. For example, ‘harvesting’ versus ‘recovering’ an organ—all these things that you might not think really make a difference… The way we talk about things has a huge impact on how the public thinks about them, how we think about things, and most importantly, about how the patients that you care for are going to understand and think about what you’re saying to them.

I’ll take Dr. Simmerling’s point one step further with a personal example. I recently participated in a small group discussion about taking a complete patient history, and the question came up of whether or not to ask about religious identification as part of the social history. I noted that asking about this issue is relevant but can be difficult to bring up in conversation. But there are ways to ease into this conversation. For example, asking patients what support groups they turn to in times of trouble is a better way to start this topic than asking directly about what religion they identify with. How can physicians be more conscientious about how they present information and ask questions? There are two ways, and the first is simply keeping this issue in mind while speaking to patients, students, or colleagues. The second way is to read more, and particularly imaginative literature and poetry, because such works are written in ways that require readers to be attuned to how language is used. Moby Dick gives readers a poem and play clothed in what appears to be a novel, but it really is an enormous prose-poem, and the dialogue between characters very much resembles interactions in Shakespeare’s plays. Reading Moby Dick is great practice for physicians and very much deserves to be alongside Bates’ Guide in a student’s carpet-bag.

Featured Image:
Moby Dick by Mal Jones

Categories
Lifestyle Public Health Reflection

Giving Blood

When my cousin mentioned that she wanted to give blood, I was happy because she voiced a wish of my own. I had wanted to donate blood for years, but I never met the eligibility criteria: either I didn’t weigh enough or I was anaemic. I had been fully eligible for over a year, but I kept postponing my donation for no reason other than the fear of facing the unknown alone. Having found another person to share the experience with, I was finally brave enough to follow through and donate.

I am a medical student, an aspiring Emergency Medicine specialist, an advocate of blood and organ donation, and I am fully eligible to give blood. Who better to donate than me? How can I expect other people, who are less aware of the need for blood products or the process of blood giving, to volunteer for this seemingly unpleasant act, without serving as an example?

Let me tell you, it was not a big deal. The whole experience was actually quite different from what I expected. I expected to be in pain, to feel dizzy and to have to spend a whole day preparing and recovering from giving blood. Here is what actually happened:

After a usual day of classes and a light lunch, we walked to the Croatian Institute for Transfusion Medicine, nervous but excited. We were met by very friendly staff, who responded to my nervous humour with witty jokes. I have to give them credit, because they made a big difference in my first experience. While they joked and kept the mood light, they were professional and reassuring.

The nurse who welcomed me didn’t believe I weighed enough, but a quick consult with the scale proved him wrong. After a quick check of my haemoglobin level and a small routine examination, I was given a questionnaire to fill out about my medical history, medication use, lifestyle and traveling.

It was encouraging to see that quite a few donation beds were taken. A few people seemed to be regular donators, as they chatted between themselves and with the staff, looking completely at ease. While waiting for a donation bed to clear, the staff chatted with me about medical university workload and our health system. After a very short wait, I was shown to a donation bed and got comfortable in a head-and-feet-up position. My cousin couldn’t give blood herself as she was anaemic, so she kept me company. I have to admit my eyes did widen at the sight of the 16 gauge needle, but a nurse inserted it in my cubital vein quickly, and I can’t say that it hurt.

I squeezed my stress ball to keep the blood flowing, had sips of water, and chatted with my cousin and the staff. As I watched the red fluid flowing from my vein to the bag, I didn’t feel faint, as I expected. I did have a weird sensation I can’t describe, which was probably psychological, but there wasn’t pain, sweating, dizziness or any other symptom I expected I would have due to my low blood pressure. It didn’t last more than five minutes, which is a lot quicker than I thought it would be. Even though I felt completely fine, I was advised to stay on the bed for a few more minutes just to rest.

After a friendly goodbye from the staff, and a present of a pen that looks like a syringe, I was shown to the cafeteria where I got a drink, a warm meal and a doughnut. I left the site feeling happy knowing my blood will help someone else, and elated with the enjoyableness of the experience.

For the rest of the day, I made sure to keep hydrated and have healthy meals, but otherwise I went about my usual business: I walked my dog, studied and went to the gym (exercise isn’t recommended straight after giving blood, but I was careful not to strain myself).

I realise that giving blood isn’t the first thing to pop into your mind when you imagine a perfect day, but it’s a quick and easy thing to do. It doesn’t take a lot of time and effort on your part, but it can make a big difference in someone’s life.
Find out more about donating blood, eligibility criteria, and how to get ready for a donation, with special notes for first time donors.

A few facts from the American Red Cross:

  • Every two seconds someone in the U.S. needs blood.
  • More than 41,000 blood donations are needed every day.
  • Although an estimated 38% of the U.S. population is eligible to donate, less than 10% actually do each year.

Give blood, save lives.

Featured Image:
Blood Donation Appointment in Calendar/Journal by Oliver Symens

Categories
General

Neurology and Us: What Are Our Minds?

Conceptual side profile of a human face, with see through illustration of the brain.

As medical students, we have to take many classes. Some of them are relatively easy, and some of them are hard. One class notorious for being very difficult is neurology. Despite this, though, I find neurology to be one of the most fascinating subjects we study. Think about it: everything we call “us” arises somehow out of vast networks of interconnected neurons. It is mind-blowing to even begin to contemplate the complexity of the neuronal machinery responsible for such tasks as creating our thoughts, emotions, personalities, etc. etc.

For millennia, philosophers have been attempting to accurately describe what it is to be human without the aid of neuroscience. Only recently has neuroscience been added into the mix of this speculation; the first notable contribution of neuroscience to theories of mind appeared in 1949 as Donald Hebb’s book The Organization of Behavior. For the first time in a major publication, a neuroscientist postulated that it was possible for the purely physical processes of neuronal circuitry to explain psychological phenomena like states of mind and learning. Before the advent of neuroscience, learning was considered a psychological phenomenon, and any attempt to explain it in detail had no recourse to neurophysiology. Now, learning is taught in medical school curricula as at least partially due to changes in both presynaptic and postsynaptic neuron adaptations (changes in neurotransmitter release rate in the presynaptic neuron and long term potentiation in the postsynaptic neuron). This represents a paradigm shift in the way we think about ourselves. Is learning the only psychological phenomenon explainable by changes in neurotransmitter release and altered receptor densities? Are all aspects of our minds the result of nothing but extremely complex neuronal circuitry?

Proponents of a theory termed eliminative materialism believe all of the commonly held beliefs about our minds will soon be replaced by neurophysiological explanations at the level of neuron circuitry. As the Stanford Encyclopedia of Philosophy puts it in the entry on the philosophy of neuroscience:

“Eliminative materialism (EM) is the conjunction of two claims. First, our common sense ‘belief-desire’ conception of mental events and processes, our ‘folk psychology,’ is a false and misleading account of the causes of human behavior. Second, like other false conceptual frameworks from both folk theory and the history of science, it will be replaced by, rather than smoothly reduced or incorporated into, a future neuroscience. . . according to EM, continuing development in neuroscience will reveal that there are no such things as beliefs and desires as characterized by common sense.”

Will eliminative materialism turn out to be the correct account of our behavior? Who knows? The debate rages on. Neuroscience continues to uncover more physical processes underlying the way we experience the world, but competing theories claim the irreducibility of our experiences to mere materialistic phenomena. Even if I could, for example, fully explain the state of your nervous system down to the smallest detail after you learned of the passing of your loved one, does that mean I really know what you’re feeling? Does a specific brain state actually equate to an emotion as we experience it as conscious beings? I don’t know, that’s above my pay grade, but it’s fun to think about, isn’t it?

Source: Stanford Encyclopedia of Philosophy

Featured image:
object. by Evan

Categories
Disability Issues General Lifestyle

Deafness as a culture

“Try not to associate bodily defect with mental, my good friend, except for a solid reason”
– Charles Dickens, David Copperfield

What is the first thought that pops into your head when you think of the word deaf? Do you think of a disability? An inability to function in society? Do you think of loss? Of a deficiency in one of the most vital senses? Or do you think of group of people with similar values and beliefs, brought together through their experiences?

The medical model sees deafness as a disability, an impairment that needs to be fixed. A disability is defined in the Oxford Dictionary as a physical or mental condition that limits a person’s movements, senses or activities. In this sense, one could agree that deafness is considered a disability. However, deafness comes in two forms: deafness, indicating disability, and Deafness, indicating a culture.

Culture is defined as the ideas, customs, and social behaviors of a particular people or society. Deafness can therefore be viewed as a disability or an altered human experience. Deaf culture can include beliefs, behaviours, traditions, history, and values of the community. Deaf culture is an ethnocentric culture, based more upon sign language and relationships rather than a common native land – it is a global culture. Deaf Culture sees itself as a language minority than a disability.

 

Values and Beliefs

A culture tends to have its own beliefs and customs that are shared by its members, and deaf culture is no different. Deaf social protocol is based upon maintaining good visibility with others in the environment (Deaf Culture 2014).

Some examples of social customs within this culture include:

  • Rules of etiquette for getting attention and politely negotiating a signed environment
  • Keeping one another informed of what is going on in one’s environment – for example, letting someone know that one is going to the bathroom (in the hearing environment this is often not needed)

 

Arts and Literature

As with other cultures, deaf culture is rich in history and art. Storytelling also makes up a big part of the culture. Clayton Valli was an American deaf linguist who created works in ASL performed through handshape, movement and facial expression. One of his pieces of work, called Dandelion can be found here.

There is also a National Theatre of the Deaf in the USA that involves productions using ASL and spoken word. Their mission statement is to educate the public and open their eyes and ears to deaf culture (National Theatre of the Deaf 2014).

Media is a vital component in getting ones message heard, and many artistic groups throughout the world have increased awareness of deaf culture, helping to stem ignorance and begin a conversation about the experience of being deaf. Movies and TV programs also need to start promoting deafness not as a pathological condition but as a way of life, helping to banish this perception of disease and impairment.

 

Cochlear Implant Controversy

Cochlear implants are electronic devices that can be surgically implanted in patients who are deaf due to sensory hair cell damage. They can provide hearing in order to increase understanding of speech, and it is estimated that 324,000 people worldwide have received them as of 2012 (NIDCD 2013).
Although this may seem like an incredible treatment for those who have difficulty hearing, it also gives the suggestion that deafness is a condition that needs to be fixed. Some deaf people are not so much against the cochlear implant, than what it represents: a lack of respect for their culture. Indeed, some people have gone so far as to describe these devices as a means of cultural genocide.

It can be argued that deafness, as a cultural identity, should be encouraged to thrive and be supported in today’s diverse society. Others believe that every child should be given an equal chance in life. Through cochlear implants one will have opened the door to greater opportunities, such as better chances of finding employment, integrating with the community at large, and achieving a greater level of success. But why should a deviation from the norm result in fewer opportunities in the first place? Shouldn’t we be dealing with this inequality rather than trying to cover it?

Doctors may see a deaf child as missing something vital, being impaired and therefore not able to function in society. The word impairment implies fault; imagine the implications this can have on a child who is told they need to be fixed. Children should feel proud of who they are, not ashamed of what they were born with. What kind of impact would such thoughts have on their self-esteem? We all know how isolating it can feel to be different during childhood; why should we push these children further away from society?

Cochlear implants are seen as being oppressive: an illustration of our overreliance on the biomedical model. Instead of seeing a child as impaired, it would be more helpful to see the child as having a different natural language. We live in an age where we preach about acceptance and diversity. Shouldn’t we be embracing the deaf culture instead of annihilating it?

What does this mean about the future? If we find the cure for deafness tomorrow, does that eradicate an entire culture? Will there be people out there who will refuse to accept the cure for their child? And what implications will that have on the medical profession – can we accept this refusal? After all, every child deserves the best start in life. Where do we stand between respecting ones beliefs and doing the best for our patient?

 

Diversity

It has been suggested that deafness can be an isolating experience; you are part of a minority, cut off from the rest of the world. One could also argue that there are plenty of cultural minorities out there; despite English becoming more and more vital in our multicultural environment, there are many minor cultures out there who do not have English as their native tongue and are therefore cut off from a large part of civilization. Does that stop them from being a culture?

Diversity is a good thing: it is what makes society grow. It is needed for creativity, for quenching ignorance and progressing as a race. What is considered normal in this day and age? Having an illness gives you a new identity, a new way of looking at the world and translating your surroundings. What is considered illness to one person is considered normal to another. By embracing the different views on deafness, we embrace the diversity of mankind and what it has to offer.

 

References
Deaf Culture. 2014. Comparative chart: deaf and ethnic cultures [Accessed: 17thDecember 2014]
Deaf Cultural Centre. Arts & Culture [Accessed: 17th December 2014]
Jones, M.A. 2002. Deafness as Culture: A Psychosocial Perspective. Disability Studies Quarterly. 22:51-60
National Theatre of the Deaf. 2014. About the National Theatre of the Deaf [Accessed: 17th December 2014]

Featured image:
DEAF project #5 by Dario-Jacopo Lagana’

Categories
Clinical Reflection

Chronic Fatigue Syndrome

The year was 2011 and I was an undergraduate student at Weber State University in Ogden, Utah. I was on the premed track and looking for doctors to shadow and research to participate in. I was also working part time at a physical therapy clinic and one day I started a conversation with one of the patients. After hearing a little about my interests and career goals, she became enthusiastic about introducing me to her doctor who was conducting research on chronic fatigue syndrome.   I had never heard of the syndrome, but I was eager to take on any new medical experience and jumped at the opportunity. One week later I found myself at the clinic of Dr. Lucinda Bateman in Salt Lake City.

After meeting with Dr. Bateman and discussing chronic fatigue syndrome, I followed her throughout her day and sat in on several appointments. Because chronic fatigue syndrome is a relatively unknown condition, Dr. Bateman and her patients were strong advocates of educating as many people as possible about the condition, including me.

Many of the patients shared their stories with me. One woman I remember vividly: she was quite thin with short cropped hair and wore a smart business suit and trendy glasses. The immediate impression I had when I saw her was that she was someone who got things done. Her story was heartbreaking. I listened as she described her life before chronic fatigue syndrome and how she was a “go, go, go” person. She worked full time, ran long distance races, and was active in every sense of the word. Then, one day, she could not get out of bed. Her muscles ached intensely despite the fact that she had not exercised the day before. She was debilitated by an intense fatigue she could not overcome. These symptoms lasted for days before she scheduled an appointment with her primary care doctor. All the tests came back negative and she was prescribed bed rest, which did not resolve any of the fatigue or pain.

I could tell as she was recounting her story that she was trying not to become emotional. She was still experiencing the fatigue and recalling the activities she used to enjoy was difficult for her. I felt I could begin to understand some of what she was going through, because I could remember how cripplingly fatigued I had been when I had contracted infectious mononucleosis as a teenager.   I could not imagine having to deal with that kind of fatigue for months or years on end.

After shadowing Dr. Bateman, I went on to finish my undergraduate degree and was accepted into medical school. I heard nothing of chronic fatigue syndrome for years. In February, 2015 I was surprised to see that NPR had published an article on the syndrome. The article was written to cover a new report published by the Institute of Medicine. The report legitimizes chronic fatigue syndrome (known as myalgic encephalomyelitis in Europe), establishes  new diagnostic criteria  , encourages more research into pathophysiology and treatment, and recommends that the name of the disease be changed to Systemic Exertion Intolerance Disease (SEID).

According to the report, “between 836,000 and 2.5 million Americans suffer from myalgic encephalitis/chronic fatigue syndrome,” and the hallmark of the disease is “a substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities, that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest.”

As we go through medical school and enter practice, I think it is a good idea to be on the lookout for these patients. I highly recommend reading the report for educational purposes, especially since, according to the report, less than one-third of medical schools educate their students about chronic fatigue syndrome and fewer than half of medical texts mention it. The disease is poorly understood, but increased awareness and future research may help fill in our knowledge gaps and assist in finding effective treatments for those who suffer from chronic fatigue syndrome.

Read the NPR article: “Panel Says Chronic Fatigue Syndrome Is A Disease, And Renames It”

Read the Institute of Medicine report “Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness”

Featured Image:
cfs by Jem Yoshioka