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His Last Year
The window box outside was blooming with color that last spring
The air fresh and wet with a hint of rain
The sidewalks filled with people
Voices and birdsong filtered through his open window
Bittersweet reminders of the world outside his fortress
But the spring was gone from his step
A cold metal walker served as his faithful bodyguard, dictating where he could go, what he could do
It was summer when he summoned her
His beautiful princess
Grown-up now with two princesses of her own
And a job in DC that kept her busy
A life that no longer revolved around coming home from school and setting the table for dinner with Mom and Dad
But here she was, her oldest now the one to set the table for the family
He watched the blur of energy of his grand princesses
Building their own fortresses of pillows and couch cushions
Asking Granddad to move his feet off the ottoman
They needed it for their little empire
Aware of his daughter’s quiet energy
Calling the doctor, arranging the appointments
Remembering the details he just couldn't keep anymore
Arranging an aide to stay with him when she left with the girls to go back to school
It was fall already when he fell
His own leg betrayed him
His faithful bodyguard skittering away across the floor, retreating like a coward
His aide in the kitchen rallied to action by his call
And so his fortress shrunk further
They closed the windows and turned off the lights
Packed up some photographs and moved him away to a white room with a hospital bed and a roommate who snored
He couldn't remember her number and he couldn't remember when she called
And so he built up his defenses
Determined not to let his captors know about his princess hard at work in her important tower in the city
And she built her own walls, bracing herself for the days when she'd visit and he didn’t know her
As the days got shorter his days got shorter
Sometimes she listened to him tell a story of his beautiful princess who was still a little girl and loved rapunzel and the color blue
And sometimes she’d hear the story of two young princesses building a castle in his living room
And sometimes she’d just sit with him and listen to his roommate snore as the snow fell outside
When Ellen Buchanan Weiss’ son was about a year old, he broke out in a rash — little bumps that appeared to be hives. So Buchanan Weiss did what a lot of new parents do: She turned to the Internet to find images that matched the rash she was seeing on her little boy.
“I’m trying to figure out — would I be paranoid if I went to the doctor at this point? Is that a reasonable thing to do? So I started googling it,” says Buchanan Weiss, who lives with her family in Raleigh, N.C.
But her son has brown skin, and as she scrolled through the photos that came up, she couldn’t find any images of rashes that matched her little boy’s — there were none on people of color. Even when she looked at the usually reliable webpages of the Centers for Disease Control and Prevention, for example, or the Mayo Clinic’s, she faced the same problem.
“It became immediately clear to me,” she says, “that the vast majority of even common skin conditions are on white skin. You have to scroll down like 80 pictures to find a single one on brown skin.”
Lynn McKinley-Grant, a dermatology professor at Howard University and president of the Skin of Color Society, says that’s not just a problem with websites aimed at patients.
“Often in medical schools,” she says, “they have limited pictures of diseases in skin of people of color.” That means health professionals trained with these resources aren’t seeing the full picture, McKinley-Grant says. The diversity gap is embedded in medical training, and that should concern us all.
Medical school classes rely on a lot of pattern recognition — especially when it comes to dermatology, explains Art Papier, an associate professor of dermatology at the University of Rochester Medical Center, in New York. “You see picture after picture, to encode them into your brain,” he says.
Illustration: Kristen Uroda for NPR
Source: NPR
“I’m a strong independent woman and I believe in equal pay for equal work and all that, but I’m gonna stand down on this one. I’m not ready to ‘be the change you wish to see in the world’ on this particular issue quite yet.”
— patient after I suggested that one option for dealing with razor bumps and ingrown hairs is to not shave her bikini line
If only having body hair wasnt seen as inherently disgusting.
The irony is that on lots of men you can’t even tell where leg or stomach hair end and pubic hair begins. Which is fine because there is nothing wrong with body hair, and as long as people are appropriately covered in settings where viewers haven’t signed up for the Full Monty, it’s OK.
But most of the time, we’re brought up with the attitude that God forbid a lady show any body hair, anywhere, even though her swimming clothes or underwear are much tinier. They just have to spend their time removing it all as often as possible. To wear their skimpier clothes without engendering disgust in others. I’m not even talking about pubes; people treat under arm hair or leg hair as it it’s practically sinful.
^^^ my thoughts expressed much better than I could say them!
I'm a strong independent woman and I believe in equal pay for equal work and all that, but I'm gonna stand down on this one. I'm not ready to 'be the change you wish to see in the world' on this particular issue quite yet.
patient after I suggested that one option for dealing with razor bumps and ingrown hairs is to not shave her bikini line
Vancouver Daily World, British Columbia, June 27, 1921
not sure if this is real but love it regardless
The Woman Who Could Not Live With Her Faulty Heart
Margaret Atwood
I do not mean the symbol of love, a candy shape to decorate cakes with, the heart that is supposed to belong or break;
I mean this lump of muscle that contracts like a flayed biceps, purple-blue, with its skin of suet, its skin of gristle, this isolate, this caved hermit, unshelled turtle, this one lungful of blood, no happy plateful.
All hearts float in their own deep oceans of no light, wetblack and glimmering, their four mouths gulping like fish. Hearts are said to pound: this is to be expected, the heart’s regular struggle against being drowned.
But most hearts say, I want, I want, I want, I want. My heart is more duplicitous, though to twin as I once thought. It says, I want, I don’t want, I want, and then a pause. It forces me to listen,
and at night it is the infra-red third eye that remains open while the other two are sleeping but refuses to say what it has seen.
It is a constant pestering in my ears, a caught moth, limping drum, a child’s fist beating itself against the bedsprings: I want, I don’t want. How can one live with such a heart?
Long ago I gave up singing to it, it will never be satisfied or lulled. One night I will say to it: Heart, be still, and it will.
~From Selected Poems II (1976-1986) by Margaret Atwood, 1987.
Dear specialists...
Dear specialists, If you are going to tell my primary patients to make changes to their meds (especially meds that aren't specifically related to your specialty) it would be really helpful if you included some thought process or evidence in your note so that I know what you're thinking about. Otherwise I have to tactfully tell my patients that I have know idea why you said that and I would like them to resume their meds as before. For example, if you are a neurologist who my patient is seeing for a recent subdural hematoma (which thank goodness is getting better), why are you telling him to decrease his miralax (which he takes for significant constipation with a history of stool impaction) to once a week? Sincerely, Perplexed PMD
burn·out
/ˈbərnˌout/
noun
1. the reduction of a fuel or substance to nothing through use or combustion
The dictionary definition really hits home on this one.
I’m pretty sure I’m not the only one who has trouble remembering developmental milestones. I put these together, but can’t take credit for any of the photography. Hope someone finds them helpful!
Boy and I get married in 17 days. Yikes!
@Anti-vaxxers: Don’t treat autistic people like their existence is worse than a pandemic
Boy is out of the country on an away elective and I miss him a lot but at the same time, sometimes it’s just really nice to come home, pour myself a glass of wine and clean the kitchen and not have to talk to anyone.
Breathe
Breathe in, breathe out. Of course, for him, it’s a bag-mask forcing the air into his lungs. It’s us doing chest compressions that’s moving his blood through his veins, taking on the job of his heart. It’s quite a job we have, when at times our task is literally to be a heart.
Breathe in, breathe out. You’re going to be ok, I say. It’s ok, take a deep breath. I see the anxiety in her eyes. We both know, at least in the back of our minds, that it’s not going to be ok. There’s more fluid than air in her lungs, her kidneys are failing, her body unable to keep up.
Breathe in, breathe out. She’s four years old and sitting on my lap. “Can I listen to my heart too?” she asks. She’s perfect, tiny, sweet. Mom is worried about what the teachers say. Autism? Shy? She’s too quiet at school.
Breathe in, breathe out. I lay with my head on my fiance’s chest. Listening to him breathe, so inexplicably quick to fall asleep.
Real convo that just went down between me and the ED doc:
"Hi this is MDintraining with Family Medicine calling for signout on [new admission]"
ED doc "You want the nurse."
Me: "Sorry?"
Him: "You're the nurse so you need to talk directly to the nurse for signout"
Me: "... No, I'm the admitting physician, I need to talk to you."
Him: "oh. You sounded like a nurse."
What a butt head.
Self reblog because I am so fed up with insurance and lack thereof interfering with my patients' care.
I want to be the kind of doctor who can go home at night and sleep well knowing that I've done well by my patients, gone the extra mile to ensure they get the best care. But I also want to be the kind of doctor who can GO HOME and SLEEP. And there are only 24 hours in a day.
Discussing the art of balance during biopsychosocial round this morning.
oncelerfucker69-deactivated2019
I mean. Yes ??
What is the downside to everyone being able to eat…how many layers of ideology are you on
captainmdphd
What in the ever-loving-fuck is wrong with people? I don’t understand. I can’t wrap my mind around being so big of an over-privledged blow hard that I thought some people just genuinely don’t deserve food. What. The. Fuck.
Anonymous asked:
How difficult is it to get an ID fellowship? For your fellowship, is it more consult based, clinic based, or a pretty good split? I loved my ID rotation. My attending did his clinic in the morning while the resident and I rounded on all the patients in the hospital and then we all rounded together in the afternoon and I really liked that setup.
Hi anon!
Right now, ID fellowship is not considered highly competitive in the US. As an ID fellow in the US, I can only speak to the US, so if you are not from the US, take what I say with a grain of salt.
The reasons are few but deep rooted which cause ID to be not wildly competitive in the US (and this is in the US. I hear in Canada that ID is very competitive, and certain European countries consider ID very competitive). One: the US pays for procedures and interventions because those are tasks or services you can bill for. How do you bill for someone’s thoughts? Experiences? Ideas? Second, American medicine and the healthcare industry also do not value the prevention driven practices ID often espouses. Only in the past several years have ID docs been able to demonstrate with statistics and large scale studies that our recommendations save hospitals money and save lives. Third, infectious diseases often champions vulnerable populations: we care for those who have gotten endocarditis, Hep C, or Hep B from their opioid use disorder, HIV stigma and with it homophobia remain unfortunately rampant. The elderly who may be neglected and get terrible pneumonias, urinary tract infections. Refugees and immigrants from TB endemic countries. This isn’t comprehensive but these are patients who can feel rejected by the general population and in turn, institutions do not prioritize them, and thereby us.
But what people don’t know is that it’s a job that opens doors to so many types of jobs, clinical, research, admin, education, etc. It’s enriching and rewarding. And honestly if a person went into medicine to make money…go into business instead. Medicine doesn’t make capital M money for the most of us. It’s also a career that people are passionate about. After years of being in a malignant residency where I was just a cog in a broken machine, I feel like I make a difference now. I can educate medicine residents to relieve the stigma of starting methadone or suboxone for patients struggling with opioid use disorder and have gotten endocarditis. I can relieve stress and fear by starting patients on antiretroviral therapy for HIV.
I believe ID will see a resurgence in my lifetime. The need for our specialty is rising and I know we can find our place in the changing healthcare landscape. Don’t know how. But get in on it now and shape the future of this profession!
I cannot put into words how much I value and depend on my ID colleagues. Keep doing what you do, you amazing humans!