culture · health policy · infectious disease · narrative medicine · New York

The Normal Heart

Friday night, I went to see The Normal Heart, a revival of a 1985 play about the early days of AIDS. (Starring Lee Pace! And Jim Parsons! More on them later.) It was quite shocking to us, for whom HIV/AIDS has become … well, not a commonplace, but a fairly straightforward chronic disease. I was on the infectious diseases service last January, and it was one of the most difficult months of my life, but we knew was wrong with these patients. We knew it down to the molecular level. We had drugs to extend their lives. We couldn’t cure them, not quite yet, but we could do something. 

And so forgive my naivete, but it was a shock to step back nearly 30 years (the play is set 1981-1984) and see a time when that wasn’t possible. The Normal Heart is basically a rant against the people that twiddled their collective thumbs while young men died. It’s happened before, and it will happen again. It’s probably happening now, and I just don’t see it because of the New York bubble. The title comes from a poem by WH Auden, which you should all go read because it’s Auden, nuff said.

The didacticism and emotional manipulation did get a little heavy-handed at times, but there was enough nuance to just save it. The relationship between Ned and his conservative brother Ben, for instance — love, uncertainty, and depth. The City government and the NIH bear the brunt of Ned/Larry Kramer’s diatribe, probably fairly, but they do come across as straw men. I guess it’s easy to attack institutions, but I would have preferred to see the people within those institutions.

And fantastic acting all around. Lee Pace as a jerk (though hints of backstory suggest non-jerkish behavior)! And Jim Parsons — holy crap. He had very few lines, but he just commands the stage in this understated and powerful way. Everyone was amazing, but he was just on point.

I was thoroughly impressed and should probably read And the Band Played On at some point. Why don’t we talk about this stuff in medical school?

health policy · infectious disease · news · pediatrics

Vaccine Hoax

According to the NY Times, there’s a new report discrediting the Wakefield study.  Andrew Wakefield’s unethical science — including undisclosed financial gain and altered data — is one of the worst medical moments of the modern era, right up there with Tuskegee.

I once reported on an anti-vax rally for a summer internship, and it was one of the saddest moments of my medical education.  Hundreds of parents swarming around Capitol Hill, listening to Jenny McCarthy and Jim Carrey blather on about medicogovernmental conspiracy.  Oh no!  We actually want to prevent diseases that kill more than three-quarters of the world’s children! (Fun fact: Did you know that measles kills more children under age 5 than HIV/AIDS?)

Once, a long time ago, when I was in India, I saw a man crouching by the tourist gate of the Mughal fort we had just visited.  Then I looked again and saw that he wasn’t crouching at all.  His right leg was withered away, a crumpled bit of skin lying uselessly at his side.  Polio.  It seems like something so far away, so ancient. Until suddenly you see it and smell it and then somehow it’s not so far away at all.

classes · exams · infectious disease · MS-2

Just a little bit crazy

I have spent entirely too long studying and I think I may be going out of my mind.  A friend of mine came by my table in the library to ask if I wanted to discuss practice questions.  I stared at him for about ten seconds and then started laughing so hard I began crying.

I don’t know anything about infectious diseases, but I’ll be very glad in twelve hours when this exam is over.

infectious disease · MS-2

Survival

Man.  That pharm exam was brutal.  I came home and slept for several hours, then went to an Internal Medicine/Infectious Diseases dinner, which was pretty amazing.  When it comes to the medicine/surgery divide, I definitely find myself leaning toward medicine (but yeah ok, keeping an open mind for third year). I am just fascinated by the understanding of disease processes, especially how one pathogen can cause a systemic illness involving, say, kidney failure AND pulmonary involvement AND anemia AND AND AND. Once you know what’s going on, it all makes sense. As for Infectious Disease, it’s kind of awesome.  It’s a very open field, in terms of career placement: academic, private practice, international, all of the above.  Also our course in infectious disease is particularly well-run, so that may play into my current love for the field.

(By the way, don’t read too much into my thoughts on different branches of medicine.  At this point, with little clinical exposure, they mostly stem from having had a good lecture.  It’s one of those “Every month I am going to be a different kind of doc” situations.)

I am really looking forward to third year.  As terrifying as it can sometimes seem, I actually find that I learn things a lot better from patients than from lectures.  I’m glad we’re not a PBL-only school, because I would find it hard to extrapolate Grand Truths directly from case presentations, but what makes medicine so much more appealing than, say, grad school is that the stuff I’m learning is directly applicable to someone’s life.  Which, you know, is a lot of responsibility, but it also is probably the best motivator.

And whooosh! off I go to the hospital to learn HIV and opportunistic infection!  from a patient!  exclamation!