Image: Dr. Vanessa
Grubbs and Robert Phillips at their wedding in August 2005. (Courtesy of
When she was a primary care doctor in Oakland, Calif., Vanessa Grubbs fell in love with a man who had been living with kidney disease
since he was a teenager.
Their relationship brought Grubbs face to face with the
dilemmas of kidney transplantation — and the racial biases she found to be
embedded in the way donated kidneys are allocated. Robert Phillips, who
eventually became her husband, had waited years for a transplant, and Grubbs ended
up donating one of her own kidneys to him. And along the way she found a new
calling as a nephrologist — a kidney doctor.
She shares her story in a new memoir called Hundreds of Interlaced Fingers: A Kidney
Doctor’s Search for the Perfect Match.
it's interesting to hear about the health challenges in other countries; I was particularly intrigued by the fact that the US has too many specialists. Here, in Ireland, we have way under the amount of specialist consultants required for our population in pretty much every field. I think the numbers for GPs (general practitioners- equivalent of family doctor) is low-ish too, but not nearly as low because the training is so much shorter and the lifestyle is better.
Yeah the problem here is that the lifestyle is better for specialists than primary care docs. Specialists often work shorter hours, see less patients, do less paperwork, and make tons more money than primary care docs. So our system is skewed to favor specialties, especially procedures-based ones, which pay higher.
Queer Self-Presentation and Burlesque Auto-Sexuality in Yuri Plisetsky’s “Welcome to the Madness”
PHEW! It’s finally ready for ya!
Thanks to everyone for patiently waiting. I was overwhelmed with the response to my teaser post about this meta. I’m sorry it took so long to finish… I had to write the academic version for class, then rewrite it to be tumblr-appropriate (I’m still not sure that it is, constructive criticism is welcome!)
I’m hoping that this will contribute to the ongoing conversation about underage characters in fandom, and am looking forward to your asks. I’m a little nervous to be tossing my hat into the Otayuri discourse, but I hope I won’t catch too much hate.
I took out footnotes but included the bibliography at the end. If you have any questions about specific references, send me an ask or DM :)
Hey humans! Aunt Scripty here. This post is a submission by Brittany, whose Tumblr handle I surprisingly don’t know. This post came through the Submissions Box. If you’re interested, I encourage people to submit articles to appear on the blog! [though it may behoove us both if you message me first, as I have a few posts in-progress and I don’t want us to duplicate efforts]
Anyway, give Brittany some props! This is an awesome post, and I’m CRAZY thankful she wrote in! And now, Brittany, take it away!
Disclaimer: This applies to the American medical system only, and may be biased by the author’s experiences. Also note that this is the process for becoming an MD, not a DO (both MDs and DOs are fully licensed physicians, but DOs have a stronger focus on the musculoskeletal system and their schooling is slightly different).
Disclaimer Part 2: I swear, this was SUPPOSED to be a brief post. Oops.
The quick and dirty:
—4 years of undergrad
—4 years of medical school, 2 in the classroom and 2 clinical
—3-5 years of residency depending on what they specialize in. Can be longer if they add subspecialties or fellowships.
The in-depth description:
Getting in (Premed student)
Acceptance to medical school is hard enough to start with. There’s an estimate that 75% of applicants are qualified, but only 50% get in. Your character doesn’t need to major in biology or pre-med, but there are pre-requisites: two semesters each of biology, chemistry, organic chemistry, calculus, and physics, plus a couple biology electives, and I think psych and statistics have been added on since I graduated, but don’t quote me on that. That’s pretty much 2/3 of a science major right there, so you can see why a lot of people just end up with that. During spring of junior year, they’ll take a giant standardized test called the MCAT that covers all of those topics and is notoriously difficult.
Along with the classroom work, they’ll have to get clinical experience—most commonly volunteering, shadowing, or working as a medical scribe, but you can get creative—and usually do a little research of some kind. Med school is hard and being a doctor is harder; they want to know that you’ve got an idea of what you’re getting into. If your character does all that right, they interview with medical schools during the fall of senior year, and hopefully get accepted!
Year 1 (MS1)
Your first year is classroom based. You get daily lectures on very complicated medical topics, with relatively little patient interaction this year. Schools will include more practical classes as well, including a cadaver dissection, pathology (where you train to look at cells and understand what a healthy vs. diseased one looks like; some schools are old school and have people still work with slides and microscopes, others like mine do it virtually), and standardized patient encounters (where they hire actors to come in and work with us so we can practice histories and physical exams and basically get a baseline on things like “what does a normal lung sounds like?”).
Patient interaction varies from school to school, but generally is pretty low. You can shadow a certain specialty you’re interested in, volunteer in free clinics, join different clubs/interest groups, or do various electives that will focus on teaching certain aspects of patient care (nutrition, medical Spanish, global health, etc.), but you have to go look for them. If I hadn’t done any of that, I would have seen maybe… two patients a month? Most students will branch out with those other opportunities, though.
Year 2 (MS2)
Similar to MS1 in that you’re still on classroom duty, still not seeing many patients. Typically you learn more sensitive physical exams this year (urological, gynecologic, breast, etc.), and you’re finished with the cadaver dissection, but things are otherwise the same. At the end of your character’s MS2 year, they’ll take their first board exam, called STEP 1. You can take it one time only unless you fail. Low scores or a fail are really frowned on, and can limit the specialty your character goes into, so you can imagine the pressure.
Year 3 (MS3)
Yay! Your character’s now ready to be let loose on the clinic/hospital!
Boo! This year kicks. your. ass.
This year is all about making your character feel like an idiot putting what your character’s been studying for two years into action. The schedule is broken up into rotations, which are periods of 4-8 weeks where students focus on a specific specialty each time. These courses are: pediatrics, family medicine, psychiatry, ob/gyn, neurology (usually), emergency (sometimes), surgery, and internal medicine. Difficulty varies by rotation, with surgery and ob/gyn being the worst (12 hour days with only one day off a week, max; surgery adds in occasional 24 hour shifts too, just to spice things up). Occasionally you’ll land on a nice one, like psychiatry, with 10 hour days and free weekends.
On a more day-to-day level, third years are usually part of a small medical team that cares for a set of patients. The team consists of an attending (fully licensed physician), residents (physicians who are training in their particular specialty), and medical students (MS3s and MS4s both). MS3s will usually get a small subset of hospital patients they care for every day—take their histories, do their physical exams, list what you think they have, and suggest treatments/tests—but because you’re not licensed, you basically take all that to the attending/resident who hears you out and then says ‘yea’ or ‘nay.’ As the year progresses, hopefully you hear more ‘yeas’ and fewer ‘nays.’
At the end of this year/the beginning of 4th year, there’s another board exam called STEP 2. Half is your typical multiple choice test, with a numeric score—much like STEP 1—while half is a pass/fail practical where you work with standardized patients.
Year 4 (MS4)
Hopefully by now your character has figured out what they want to specialize in. I can go over specialties in another post if anyone’s curious, but the biggest ones are basically the same as the ones listed as core rotations during the MS3 year. There’s a giant application/interview process that takes up the lion’s share of the summer/fall/winter for interviews with residency. At the end of the process, everyone ranks the residencies they interviewed with from most to least favorite, and at the same time the residencies rank their interviewees from most to least. The whole thing goes into a giant computer algorithm to give as many people as possible as high a choice as possible, and then on the same day of the year, at the same time, MS4s across the country take a deep breath and open envelopes saying where they ‘matched.’
In addition, with those pesky core rotations out of the way, the character has time to take electives that may or may not be applicable to their future specialty—me, I’m going for emergency medicine, so I’m doing several rotations in EM as well as EMS, but I’m also doing a two week course forensics because it sounds awesome.
Otherwise, 4th year is widely known as the ‘take a breath’ year. People get married or have babies during this time, travel, and generally start to act like human beings again. There’s space in your schedule that’s off—it’s generally intended for interviews or studying for STEP 2 if you’re taking it late, but people will use it for anything.
Not going to give too much detail about it, seeing as how your character is technically a doctor at this point, but residency is basically 3-5 years where your character trains in a specialty—yes, they’re physicians, but they don’t know everything about their particular field and need trained. You’re in this weird limbo between student and employee; you make a salary (although a very low one considering the number of hours) and can prescribe medication, perform procedures, etc., but an attending is responsible for you, you still attend a weekly lecture, and you can’t practice independently. To give you an idea of how hard these years are, they recently had to limit things like “don’t make residents work more than 36 hours in a row,” and “don’t put the doctor who graduated med school a month ago in charge of an entire floor of ICU patients for a night with no backup.” Incredibly, some of the old-school attendings think said changes are a bad idea and will produce doctors who are “weak.”
Also, you thought your character was done with standardized tests? You sweet summer child. STEP 3 has to be finished before you can complete residency, and is usually done during intern year. The good side of this is, you’re in a residency now, so as long as you pass, no one cares about the score.
—This is a sample timeline, following your ‘traditional’ student. It’s becoming more and more common for people to take a couple of years off after undergrad and apply for medical school after that. If you want a chance for your character to gain some non-medical life experience (travel, other skill sets, becoming a parent, etc.), this is a good chance for them to do it!
—I’ve been asked by a writer I know in RL how young someone could potentially become a doctor. I think she wanted to put in a prodigy kind of person. The problem with that is that medical schools don’t just look for smarts, they look for maturity—imagine having someone who looks like they can’t drink yet tell you you’ve got a terminal disease, and you can see why. That said, there are a couple of accelerated programs, where I’ve seen people graduate undergrad a year early and go straight into medical school, or where they condense medical school into three whirlwind years because the person’s on track for a specific primary care residency. So if most people graduate medical school at age 26-27, you could have someone out at 25 or maybe 24, but probably no younger. And remember, they’ll still need residency training from there.
—Not gonna lie, medical school is incredibly difficult. That said, I think the best students/doctors are the ones who maintain an outside interest or two, so don’t feel like your character can only have medical skills (*cough*Grey'sAnatomy*cough*) . Give them a few side interests to maintain their spirit.
—I can give more detail about any and all of these if anyone asks; these are supposed to help you understand what your character has had to go through to be a doctor, not be a full detail spiel. I can also do ‘day in the lifes’ if someone’s writing a med student character and wants an accurate description, but let’s be real: most people want to write the master, not the pupil.
Summary: AU. Reader is given the task of running a
popular love advice internet show when her coworker is fired. Her
cynical attitude toward love makes her offer some harsh advice, and more
than a few hearts are caught in the aftermath. Will hers be one of them?
Pairing: Bucky Barnes x reader
Word Count: 4,190 (sorry)
language, mentions of injury, mentions of trauma, some confrontations, Sam being precious, reader self-reflection, mentions of threats, creepy emails
A/N: Guess who’s back…back again…Reader decides to take control of her life and do what she thinks is best. I really liked this part. That’s probably why I went a little crazy.
Hey Wayfaring! I wanted to ask, how come doctors earn so much money if healthcare is so cheap? It is like this where I live, not sure about the US but it mustn't be that different right? I'm just curious. Greetings from the Netherlands
I don’t know how the healthcare system in the Netherlands works AT ALL, but let’s get one thing straight about the US: healthcare is NOT cheap here.
We believe the lie that we have the best healthcare in the world. Our rates of obesity, premature birth, maternal/fetal mortality, and life expectancy all point to the fact that we are way behind other developed nations.
College and graduate medical education in the US is more expensive than anywhere else in the world.
Salaries are high because costs are high, but cost of education is rapidly rising and wages are not keeping up.
Physicians in the US have one of the best paying jobs in the country.
Only about 20% of the money spent on healthcare in the US goes toward physician salaries
We have way more specialists than we need and we have way less primary care doctors than we need.
We have approximately 2.5 doctors per 1000 people in this country, which is way under what we need. Numbers for nurses are similarly low.
Healthcare in the US is treated as a business rather than a service. Thus patients are seen as customers and healthcare is becoming more about patient satisfaction rather than delivering quality care.
Doctors’ salaries are often based on how many patients they see or how many procedures they do.
Though doctors do make a lot of money, remember that they also pay a ton out of that salary in taxes, student loan payments, professional fees, and licensing requirements.
Doctors work hours unlike most other careers and are not paid on the basis of their time. Most other jobs have limited hours and lengths of shifts, whereas doctors routinely work 60-80+ hours a week (yes, even past residency).
Reimbursement for services is a very complicated system in the US. It’s based on how complex the care is that’s being given, and procedures are valued higher than chronic illness management. Doctors/hospitals can theoretically charge whatever they want for their services, but how much money they actually get is based on what the insurance companies and Medicaid and Medicare are willing to pay.
So today’s challenge is to create a safety plan or a self care plan.
So a self care plan would be something like this: When I am feeling depressed/anxious/ other emotion that is hard to deal with, I will…
-Listen to soothing music
-Lay in bed and cuddle with my dog
-Talk to my best friend
A self care plan is aimed towards people who are suicidal or have been suicidal in the past. I haven’t ever had many suicidal thoughts, so my example might not be at all accurate to what you have experienced.
Part 1: Warning signs that a crisis might be developing (thoughts, moods, behaviors, images, situations)
-Thinking about suicide
-Planning ways to commit suicide
-High levels of depression
-Talking to others who are suicidal
Part 2: Internal coping strategies– things I can do to take my mind off my problems without having to contact another person (relaxation technique, physical activity).
-These would be things yoy could do for self care
-Listening to music
-Taking a bath
Part 3: People and social settings that provide distractions
-Best friend (phone #)
-Other friends (#’s)
Part 4: People I can ask for help.
Part 5: Professionals and agencies I can ask for help
-Primary care doctor
-Therapist or psychiatrist
-National suicide hotline (US): 1-800-273-8255
-911 if you are actively worried you will commit suicide
Part 6: Making the environment safe
-Lock up firearms
-Lock up prescription drugs
-Move knives/ other danger items for you into a shared space
-If possible, ask people you share the space with to keep an eye out for you.
Again, I haven’t experienced suicidal thoughts, so my examples likely won’t line up with yours.
I know this isn’t my standard thing. I try to keep from doing too much mental health stuff, because I know not everyone is here for that. I, however, think mental health is extremely important and I will talk about it aaaalllllll day long.
One thing: If you are currently in therapy and are feeling suicidal, you may want to bring up a safety plan with your therapist before just doing it on your own.
I hope you all have a WONDERFUL day. If anyone wants to share one of there plans, you can submit it! Also, if you want to message it to me I can look, at it privately if you want to do that.
Have a wonderful day, lovelies!!
The Senate healthcare bill just dropped and it’s an appalling disaster.
If this bill passes it will:
Completely defund Planned Parenthood.Planned Parenthood is an essential health care provider. Not only is Planned Parenthood the primary source of health care for many patients, but it also provides health care primarily to low-income people and communities. Planned Parenthood doesn’t just help with birth control and unwanted pregnancies. Only a small fraction of Planned Parenthood’s work is with abortions. They also help millions of Americans with cancer screenings and procedures, and preventative HPV and other STD shots, and other types of birth control.
Hurt people with disabilities and pre-existing conditions. Because of the waiver authority in place in the bill, states have the option to limit coverage given to people with pre-existing conditions. Not only that, but the bill makes huge cuts in Medicaid, worse than even the House bill that preceded it. Insurers in certain states will be able to change their plans and how much they charge people with disabilities or pre-existing conditions, which will make millions lose coverage they need.
Take away mental health services and coverage. If this bill passes, Medicaid will no longer be required to cover any mental health after 2019. This includes counseling and psychiatric services and medicine.
Give tax breaks and money to corporations and the wealthy. The bill repeals all ACA taxes on corporations and the wealthy that help pay for insurance subsidies.
IF YOU HAVE A REPUBLICAN SENATOR IN YOUR STATE, PLEASE CALL THEM UP 1-866-665-4470 OR SEND THEM A LETTER OR EMAIL. LET THEM KNOW YOU WON’T STAND FOR THIS AND YOU’LL MAKE SURE THEY WON’T BE RE-ELECTED COME MIDTERMS.
GIVE THEM HELL.
(IF YOU LIVE IN A STATE WITH A DEMOCRAT SENATOR CALL THEM TOO. LET THEM KNOW THEY CAN’T LET THIS PASS.)
Black history month day 28: American astronaut Mae Jemison.
Mae Carol Jemison was born on October 17, 1956 in Decatur, Alabama. When she was three years old, her family moved to Chicago, Illinois for better employment and education opportunities. Jemison was always interested in science and dreamed of going to space from a young age. Once when she was little a splinter infected her thumb. Her teacher mother turned it into a learning experience and she ended up doing a whole project about pus.
While Jemison’s parents were always very supportive of her scientific interests, her teachers were not. Jemison once recalled: “In kindergarten, my teacher asked me what I wanted to be when I grew up, and I told her a scientist. She said, ‘Don’t you mean a nurse?’ Now, there’s nothing wrong with being a nurse, but that’s not what I wanted to be.”
Jemison went to Stanford University when she was just 16 and graduated with a B.S. in chemical engineering. She received her doctor of medicine degree at Cornell Medical College in 1981. During medical school she traveled to Cuba, Kenya and Thailand, to provide primary medical care to people living there.
Jemison first applied for the space program in 1983 after the flight of Sally Ride. The program was delayed after the space shuttle Challenger disaster in 1986, but she was accepted into the program after reapplying in 1987, one of 15 applicants out of 2000. One of her biggest inspirations for pursuing the space program was African-American actress Nichelle Nichols, better known as Lieutenant Uhura from Star Trek. Later Jemison would go on to guest star in an episode of Star Trek: The Next Generation, becoming the only actual astronaut to appear on the show.
As a lover of dance, Jemison took a poster from the Alvin Ailey American Dance Theater along with her on the flight saying: “Many people do not see a connection between science and dance, but I consider them both to be expressions of the boundless creativity that people have to share with one another. She also took some small art objects from West African countries to symbolize that space belongs to all nations, and a picture of African-American pilot Bessie Coleman.
Jemison is now 60 years old and currently serving as the principle of the 100 Year Starship organization.
I sincerely hope you have enjoyed going on this educational journey with me this month, exploring 28 inspiring figures in black history. It was a lot of fun for me to do research for this project and I learned quite a few things along the way. I really tried to get at least some figures who are less commonly discussed during Black history month. There is a lot of information I didn’t get to cover, so I would strongly encourage you to read up on everybody I’ve mentioned this month because they have some very interesting stories to tell!
At least, my mother was convinced I was going to be a boy when she was
pregnant with me. She claimed that I “carried” like a boy, but since I’m
the youngest, and I have an older sister, it is reasonable to assume
that my mother was simply suffering from a massive case of wishful
thinking. Whatever the reasons, my parents were so convinced I was going
to be a boy they had even decided on a boy name for me—Daniel Thomas.
But I’m a girl.
My parents, always a frugal , figured, why throw out a perfectly good
name just because the gender’s wrong? They put a handy “le” on the end
of Daniel, and I’m rather glad they did. I like my name, or at least I
realize it could have been much worse. They could have been planning on
calling me Ralph or something. Not much you can do with Ralph.
So I am Danielle.My middle name ended up being Victoria- Named after a
Soap Opera Character my mom fancied. I was born to two folks in
Edmonton, Alberta. I’m a completely mixed personality of a neurotic
introvert and a psychotic extrovert. I am a makeup, and fashion
enthusiast as well as studying to be a Primary Care Paramedic. Overall
I’m a complicated person in the most simple of ways. I love anything
unique even if it defines the term boring.I love living, failing,
learning and getting up to figure everything out one step at a time. I’d
like to have a pen pal because I’d like to see what it’s like for an
individual of my age in another country. How does our way of life differ
from each other from where we grew up and how we grew up.
I’m going to be honest with you guys, even though this will certainly make me look weak. There’s a reason most people’s social media exhibits a distortion of their reality. We get to pick and choose what aspects of our identities is seen. To protect myself, I leave the bad out.
Being silent isn’t going to help anyone out. I’m going to break out of my safe little world I’ve created on here, and tell you a little about the reality of things lately. Well actually five months ago. Someone said “I’m so happy you’re sharing your mental health journey,” and I was embarrassed to admit that I’d already deleted it, hiding any sign of weakness.
For the past 22 years of my life, I’ve been lucky my mental health didn’t impinge on my ability to achieve my ridiculous standards I’d set for myself. In fact, I saw a therapist for the first time in my life, and she immediately saw that I had created some sort of performance based esteem. No matter what I added to my resume, no matter how well I performed at soccer, the piano, molecular biology… nothing actually made me feel accomplished. When I graduated with my bachelors in cellular and molecular biology, I literally didn’t get even a jolt of feeling good about myself.
Now what led me to see a therapist for the first time in my life? I’m really not sure what the trigger was, but a few months after me and Ashley broke up, I started to get heart palpitations, my heart rate was consistently in the 130’s, shortness of breath, and this sharp chest pain. I thought I was stressed about my new job. But then days passed and I couldn’t get a break, I could not relax. People said, what’s on your mind, what’s wrong, Rach? I literally said there’s nothing on my damn mind. Nothing. I can’t point to something I “need to talk about, to get off my chest.” I just physiologically felt this way, and psychologically couldn’t find a cause. I eliminated caffeine from my diet. Stopped and did meditative breathing techniques. Exercised. Nothing helped. I am so lucky, so loved, so privileged, my life has been like a dream, and yet I was still completely shaken.
Regardless of the trigger, I recognized I was losing control, feeling like I was losing my mind, and, scared I might lose my job, I made a desperate attempt to stop this terrifying feeling. My only relief from the pain and heart palpitations was when I was asleep, and I was beginning to wish to be asleep more than be alive. The only time I felt any peace was when I was sleeping. But I got help. My primary care doctor saw me with only 24 hours notice, prescribed me an SSRI, selective serotonin reuptake inhibitor, a type of antidepressant that can treat anxiety, and Xanax for the acute instances of panic. It was plain as day to her that I had anxiety. She took care of me. I didn’t know it could be so debilitating.
I come from a blue collar, working class family that doesn’t really talk about feelings. They weren’t much help. But after battling the acute moments, and the SSRI kicking in after three weeks, my baseline returned to normal, and I felt myself again. I’m still not sure of the trigger. My insurance is terrible and didn’t cover therapy, and I was running out of money, especially with the medications not authorized, and 10x the price other people would spend.
There was this one day where I was sitting listening to live music, on a date, good pie in front of me, hot chocolate. And my heart rate suddenly jumped to 160 and stayed that way for five hours. And I couldn’t enjoy the food. I couldn’t embrace the music. My body was in fight or flight mode for no apparent reason. And I was so horrified. I didn’t tell her. I just silently took it, let it beat me down. Counting down the minutes until I could escape, collapse into bed, sleep and get a minutes peace. Anxiety truly is debilitating, but I fought back, and I couldn’t do it alone. My primary care doctor saved my ass. I’m still on the SSRI, though I want to be off of it.
The bottom line: you aren’t alone. Even some of the strongest of us have been broken down. We all have our own battles. No one is perfect, and there’s nothing wrong with getting a helping hand.
What kind of character (archetype/skill set) would be a good companion for an apocalypse medic? In my story it's less "a BOOM Apocalypse" and more of a gradual deterioration so the medic has been working in sub-prime conditions for a while but has only just now met the companion. Thank you ❤️
I’m going to suggest a few options for post-apoc healer backgrounds, and you pick what works for you :)
First, any doc who’s worked in austere environments is going to be a prime candidate. That is: anywhere there’s been a disaster, or anyone who’s worked with MSF / Doctors Without Borders / etc. In modern times, those who responded to the Haiti quakes, the Ebola outbreak in Africa, the horrendous typhoons in Japan, or any of a number of disaster relief efforts.
Second off is going to be a primary care doc working in a poor neighborhood.
Third is going to be a family practice nurse practitioner. NPs are rockstars!
Fourth is going to be any paramedic, but especially one who’s worked in low-income areas. Medics are used to doing a great deal with very little resources, and are used to treating patients outside the safety of the clinic or hospital.
Fifth is going to be an herbal botanist. (What? Yes. Plants may never go out of style, but the complex manufacturing required to make most medications will.)
Just remember that it takes a village to treat a patient: the doc to diagnose and prescribe, the pharmacist to fill the prescription, the truck driver to bring the meds to the pharmacy, the whole drug manufacturing world to make the meds…
I would also take a good hard look at some books on austere medicine if I were you.
“I used to think that was the gold standard,” she said afterward. “Transgender patients could just go [to these clinics] and get everything they need. I think it’s wonderful in theory, but … it lets everyone else off the hook. It makes it this special ‘other’ thing that you have to go to a special center for.”
Transgender care should be primary care, she thinks. It should require no special center, and unless a procedure is needed, no specialists.
“Any doctor should be able to do this,” she said.
Yes! When people email me asking what type of specialized physician they need to see to get hormones, they’re surprised when I answer: your regular doctor can do that.