fellowship

Can Scientists (Not) Be Activists?

I just went to a talk titled this, given by a leading climate change scientist and activist. I was hoping for some practical advice from his 20+ years advocating for alternative energy sources and reducing dependence on fossil fuels (which is not only bad for the environment, but also bad for human health).

Unfortunately, what I got was a rambling lecture on how young people need to rise up and do something. Didn’t say what. Didn’t say how. But something. Then he showed more pics of himself age 4 on the family farm in Iowa.

I don’t know if I even count as a “young person” any more (it’s all relative, right? but seriously, when did they start admitting children into medical school?), but I can tell you that my generation, or at least my bubble of my generation, has the passion. We have the science. What we lack is the generational knowledge of the folks who pushed for the Clean Air Act of 1970 and the Clean Water Act of 1972. Unfortunately, it appears that generation is committed to blaming us for perceived apathy, while withholding the practical knowledge they acquired in pushing forward the most important pieces of environmental legislation since the creation of the National Park System.

So anyway, can scientists not be activists? I don’t know, because to me, being one is being both. See you all at the March for Science next week!

fellowship

Measly

One of the first patients I met in medical school was a 10-year-old boy with SSPE, a not-so-rare and always-fatal complication of measles infection. He was blind, deaf, severely encephalopathic, and spastic. It was a peds GI clinic, so I guess he had some GI issues too, but the thing I remember most about him was his father lifting him out of his wheelchair and carrying him across the room to the exam table. His head flopped as Dad laid him down; he had scissoring clonus at both legs.

 

He was the first neurologically devastated person I’d met, and it was shocking. I was pretty naive, I guess — I was a first-year medical student, 22 years old, still wet behind the ears. In the decade since, I’ve taken care of a lot of people in various stages of coma, but that kid stands out to me. That kid, more than anything else — more than the science, even — convinced me that vaccines were essential.

 

So when I heard that SSPE is on the rise (previously thought to be 1:10k cases, but with vaccination rates falling, appears to be more like 1:600) and that Europe is facing a massive measles outbreak that’s left 17 children dead in Romania alone, I’m struggling a bit with the appropriate response. Yes, sympathy for the families of those kids — no parent should ever, ever have to bury their child. But I can’t quite silence the little part of me that wants to say, “What did you think was going to happen? You withhold a lifesaving preventative measure from your child; therefore they die. Do you make sure your kid wears their seatbelt? Brush their teeth? So why don’t you vaccinate?”

I’m a big believer in the patient’s right to bodily autonomy, but I think we’ve lost sight of the fact that the patient here is the child. I can’t think of anything that strips your bodily autonomy faster than complications of a vaccine-preventable disease.

[Please, no anti-vax arguments in the comments. I’ve heard them. They are wrong. And if there is a God, there will be a special circle of Hell for Andrew bloody Wakefield, who is directly and personally responsible for this current iteration of the anti-vaxxers. Preferably involving torture by the souls of the children he has killed.]
culture · fellowship

Physician suicide

This week, the New England Journal published two articles on physician well-being, or the rather, the lack thereof. One, Kathryn, is the story of a fourth-year medical student who jumped out of her apartment window last August. The other, Breaking the Stigma, is about how the culture of medicine is one of ritual shaming, particularly when it comes to mental illness. [I think both are open access, but please let me know if they are paywalled.]

Tragic stories, both of them, and sadly common. There were no suicides in my medical school, but there was at least one almost. I’m glad that there is growing awareness — at least among medical educators, hopefully among the wider public too — of how severely we are failing each other. When one in ten medical students contemplate suicide, we are failing each other; we are failing our future.

fellowship

Sunday rant

“Can I ask you a personal question?”

hate when people say this. Because you know what’s coming — a socially inappropriate, irrelevant question about your age, your income, your marital status, your ethnicity, or your personal appearance — and the question-asker knows this, and is basically asking your permission to be let off the hook for their rudeness.

It’s also a question without a free choice, because either you say “yes” (and validate the inappropriate follow-up question) or you say “no” (and then YOU become the impolite one.)

So there’s a weird awkward pause while you try to figure out how to respond, and then you finally give up and say “…sure” because it seems easier, and then you have to deal with several layers of increasingly inappropriate follow-up questions.

Next time someone asks me “Can I ask you a personal question?” I’m just going to say, “Only if I can ask you one too.”

fellowship

Know thy audience

PATIENT
What’s dystonia?

RESIDENT WORKING WITH ME
It’s the sustained co-contraction of agonist/antagonist muscles.

PATIENT

[I found out later that the reason he was so far behind with the previous patient was that when the patient asked “What causes Parkinson disease?” he drew the direct and indirect pathways. For a demented patient with a 10th grade education.]

Greater than 50% of this visit was spent in counseling and coordination of care.

fellowship

Bad Leadership

I’m not sure I know how to be a great leader, but I can tell you how to be a terrible one:

When your state has declared a disaster emergency for snow, you should tell your subordinates that they better come to work tomorrow for their routine clinic patients (who may or may not show up), and declare that you’re going to be home playing in the snow with your kids. And when your staff expresses doubts about the feasibility of making it to work in 2 feet of snow and 60 mph winds, tell them they are not team players.

And then leave an hour early, to get a head start on those snowmen.

[Bonus points for blaming a staff member for poor documentation in a note that was written more than two years before she started working there.]

fellowship

Get off my lawn!

Led a small group of first year med students through a couple of clinical cases; first one was sudden onset headache in a young man. We talked about how to generate a differential diagnosis, thinking about what’s urgent and what’s most likely.

One of the students goes, “What about epidural hematoma?”

“Good thought,” I say, writing it on the whiteboard. “What do you think about the fact that the patient’s talking to you and lucid?”

Blank stares.

“OK, so epidural hematomas can have a lucid interval, where the person might look and sound ok until the hematoma hits a threshold size and they decompensate quickly.”

Click-click as they type away (I would rather have said *scribbles* but kids these days with their laptops and snazzy equipment, they wouldn’t know a pen if it hit them in the face.) They seem disengaged; how can I make this relevant for them? Diseases mean very little unless you know, or know of, someone who has it.

“You know, like Natasha Richardson.”

Blanker stares. Finally, one of the students goes, “Who?”

*sigh* “She was skiing and fell, and when the paramedics got there she sent them away, then she went back to her hotel room and died.”

Later on, during a case of parkinsonism, I mention post-encephalitic parkinsonism, Awakenings and Oliver Sacks — no recognition. And when we were talking about dementia with Lewy bodies, I tell them, that’s what Robin Williams had, and they are like “huh?” So I decided not to tell them that Dudley Moore had PSP, because I don’t want to have to explain who Dudley Moore was.

Then after class, I submitted my application for an AARP card, because clearly I’m an old lady now.