Artificially Extending Life

It seems most people have very mixed views on extending a person's life artificially with respirators, feeding tubes, and the like. My personal opinion is one of individual liberties, that each person has the right to determine his or her own fate, whether by dictating in a will to be on a respirator indefinitely or by ending life prematurely with assisted suicide. Personally, I want to live as long and healthily as possible. Of course, anyone seeking assisted suicide should first seek counseling and explore all options, but ultimately it should be their choice. Better for them to do it safely and with certainty while they are able, than attempt it and become handicapped for life, becoming even more miserable and unable to make a second attempt.

This topic was inspired by today's Dilbert, which was surprisingly funny with Scott Adam's take on extending life:

I understand that people object on moral (primarily religious) grounds, but I do not think other people should be able to prevent others from taking control of their own life or death. The Terry Schiavo and Karen Quinlin cases are the prime examples, where parents or spouses fight the state, doctors, or other family members for the right to prolong or end the person in question's life. I really feel for the doctors trapped in those situations, and hopefully if I face one of those cases the players will be relatively rational.

The Latest News

Well, I have my news from Western University - I'm on the alternate list. From what I have heard from students, a lot of people are taken off the alternate list. However, in the meantime, I need to find ways to beef up my application. I am going to submit a letter re-emphasizing my interest in the school, and hopefully I will be able to tell them I am doing insect research (still pending). I may be able to obtain another letter of recommendation, but it is not too likely. There should be some wait list movement around March 20th, because people will need to make their second deposit of 1,000 dollars by then, and one of the last interview day decisions is made on March 19th. I will make a separate post about wait list limbo after I have further researched my plan of action.

Now, I need to fax in my deposit for Touro-CA tomorrow, and wait until I receive my official alternate list offer in the mail. I hope I do not have to put down a deposit to stay on the alternate list. Luckily I have many contacts for information, advice, etc - a Pre-Med adviser, a current Western U student, and a doctor mock-interviewer with experience on admissions boards. I wish I didn't have to lose $2,000 but that's the way the cookie crumbles, as they say. At least I have been accepted to a California school in a familiar area.

Origins

It's always fun to discover the ancient roots behind modern medical practices, terminology, etc. Here is a passage from my cognitive science textbook Psychology of Behavior on the origin of the terms "Dura Mater" and "Pia Mater" to refer to two of the layers of the meninges:

A tenth-century Persian physician, Ali ibn Abbas, used the Arabic term al umm to refer to the meninges. The term literally means "mother" but was used to designate any swaddling material, because Arabic lacked a specific term for the word membrane. The tough outer one was called al umm al djafiya, and the soft inner one was called al umm al rigiga. When the writings of Ali ibn Abbas were translated into Latin during the eleventh century, the translator, who was probably not familiar with the structure of the meninges, made a literal translation of al umm. He referred to the membranes as the "hard mother" and the "pious mother" (pious in the sense of "delicate") rather than using a more appropriate Latin word.

People often forget the non-Western origins of many medical practices. Ancient India was famous for its medical skills, particularly cataract surgery. The Middle and Far East had many renowned medical practitioners and scholars. Many medical texts from the Islamic empires were translated to Latin and used up until the 17th and 18th centuries. In fact, medical knowledge in Europe was quite stagnant after Galen - it was practically heresy to question Galen's texts, and in the autopsy theaters the medical doctor would be on a pedestal, reciting from Galen, while a lowly barber would be dissecting a body below. Whenever anatomical differences occurred between an actual human body and Galen's descriptions and drawings, it was assumed that the body was deformed. Most of Galen's anatomical knowledge came from animal extrapolation, since human dissection had been taboo in Europe for the longest time. So, while the rest of the world was advancing and exploring medical knowledge, the "civilized" world held Galen's texts from ~200 CE as indisputable.

The End of Interviews

At long last, the application process is essentially over. My last interview was today at Western U. The day started off badly with nightmares of being late to the interview and getting a parking ticket...but after that the day went pretty smoothly. One of my interviewers had a real poker face too, and made it a bit tough to know whether I did well in the interview or not. I now know he is a department chairman for pathology, so I have a feeling he is one of the committee members... I didn't have any real stumping questions and they didn't grill me, so I think the pressure was just in not being able to read their reactions to me. At any rate, I really like Western U most of all the schools and hopefully I will matriculate there.

Some other tidbits - they have a strong emphasis on medical Spanish, because of the veterinary school and Banfield on campus we get a lot of vet discounts (good for me since I have a kitty), the boards scores are impressive, there is a ton of clinical experience, and the campus is pretty nice. One of the other students there to interview surprised me a bit - he could not have looked more pissed off to be there. I do not know why he was acting the way he did, but his body language was almost flamboyant in its distaste for the school. He didn't speak to any of the other interviewees, he kept leaving the room during the current student Q&A, and I swear he was rolling his eyes during the OMM demonstration. Since he clearly couldn't hide how much he didn't want to go to Western U, I'm not worried about him getting my spot, haha. Also, the dean of admissions informed me, after the interview, that we are the last group to be receiving acceptance notices - after this point, they are interviewing people for the alternate list...but most of the people on the alternate list get into the school this year or next year at least.

Put Down Those iPods!

I always objected to the bud earpieces on a comfort level - I just could not get those little things in my ears comfortably. Looks like I dodged a bullet. Most people listen to those buds with the volume so loud I can hear them from a few feet away. In my youth, I always sprang for the huge DJ headsets, which felt like they made sound easier on the ear. I used to listen to music pretty loudly, despite my parents telling me I was killing my ears. Somehow, those warnings never felt very finite - I might have a slight buzzing in my ears after an hour or two of listening, but it always went away. Even though I have since stopped pounding the music into my ears, most of the damage is probably done - at least I never stuck those buds in my ears. I always thought those smoker's lung vs. healthy lung ads were particularly convincing, so perhaps these images will be convincing to a few (c/o my CogSci class):

The first image is pristine, healthy cochlear cilia, or in simple terms, "the hairs in your inner ear that interpret sound for your brain." The second image is cochlear cilia with mild-moderate damage, and the third image is cochlear cilia with a lot of damage. Unlike lungs, which take a long time to recover but do to a certain degree, damage to cochlear cilia is PERMANENT. I seriously expect half the people in my generation to have significant hearing loss by the time they are 40 years old on account of the mp3 player/bud headset craze. Do your ears a favor - if you want to listen to music for more than half of your lifespan, turn down the volume.

Dietary Supplements

To preface this entry, a new study came out disclaiming the medical benefits of taking multivitamins, adding to the message from the November studies disclaiming the benefits of Vitamin C and Vitamin E. I have never been a big fan of dietary supplements, in fact I wrote a paper explaining why the industry is so unregulated and able to make such fantastic health claims, but many people are self-medicating with vitamins, minerals, etc. This is one of my favorite clips summing up my view on the subject:

Yes, indeed, they really are no better than placebos. Unless a person has an actual vitamin deficiency, there is no real reason to take dietary supplements. You may think you are taking steps to prevent cancer by popping that Vitamin C every day, or that your memory will improve by downing Gingko Biloba, but the odds are good that you're just producing expensive urine. As a side note, make sure you're not also taking birth control pills, since Gingko Biloba affects liver enzyme activity and you may end up getting pregnant or extremely hormonal. I am very glad that these decade-long studies are finally coming to their conclusion and proving that there are no long-term health benefits to taking dietary supplements. Maybe the hubbub will die down by the time I am practicing, and I won't have to listen to a speech by a patient enlightened by Wikipedia about the benefits of taking Selenium or Echinacea each day.

Marburg Fever

With global travel, diseases uncommon in the developed world are increasingly being seen. I am fascinated by infectious diseases, one of my favorite movies being "Outbreak," so ID news tends to catch my attention. One that recently made headlines was Marburg hemorrhagic fever, contracted by a tourist in Uganda. He likely caught it when he visited a python cave and encountered fruit bats. The virus, a member of the filovirus family which includes Ebola, was only discovered in 1967 - ironically, it was transmitted by African green monkeys imported for research and to prepare polio vaccines. Check the CDC page for more details on the background and symptoms.

It's pretty scary to think how unprepared the medical field is for rare, contagious diseases from the third world. So many viral infections start out with flu-like symptoms that the person would not be treated or quarantined, and it would be easy to transmit the disease to other people. With an incubation period of 5-10 days, plenty of people could become infected.

With global warming, in addition to global travel, I'm confident we will begin seeing more tropical diseases, particularly those carried by insect vectors. The range of mosquitoes capable of transmitting Dengue has spread across the southern United States, the Hemipteran responsible for Chaga's disease may be able to spread north from Mexico, and West Nile Virus is already found across the country. Cases of Dengue fever have occurred endemically in Texas. It will be interesting to see how the geography of tropical diseases continues to evolve.

Second Acceptance!

Today I was notified that I have been accepted by the committee at TUCOM-CA! As great as the feeling was at TUCOM-NV, I really do want to stay in California. I need to have green around me and be close to the coast. If I do not get into Western U, I will be very happy to go to TUCOM-CA. Also, TUCOM-CA offers a joint DO/MPH program, which unfortunately Western U does not. I am definitely a lot less stressed having this knowledge. Another perk of the school is that the anatomy lab is on the second floor, full of light, instead of in the basement like a morgue...

Now I just need to do awesome at my interview at Western U on Thursday. I'll be staying at my boyfriend's family's place, so I won't need to pay for a place overnight. In the meantime, I get to go to work tonight from 3:00-9:30.

Extreme Measures

Bill Gates has just gone up a few notches in my book - I can forgive the sleazy early Microsoft tactics and the bugs in every Windows release. Anyone who unleashes mosquitoes to try to make people feel malaria is an urgent issue gets points for unconventionality and creativity.

Gates makes some important, obvious statements: "There is more money put into baldness drugs than into malaria," and "the market does not drive scientists, thinkers, or governments to do the right thing." The first point he makes is unfortunately just the tip of the iceberg - pharmaceutical companies will make as many expensive drugs as possible for people who can afford it. Rich white men afflicted with AIDS, cancer, hair loss, or erectile dysfunction will pay huge sums for treatment. AIDS cocktails and chemotherapy drugs are so unbelievably expensive and require so many doses, it seems obvious from a pharmaceutical company's perspective why it is more profitable than investing in curing malaria or tuberculosis, which are most prevalent outside the US. It is easy to criticize pharmaceutical companies...because they're so crooked and their business so engrossed in making money. Only in the US and New Zealand are prescription-only drugs advertised to the public, and our pharmaceutical companies are consistently at the top of the Forbes list with profit margins up to 10x as high as other companies. As for the second point, yes, the market does not drive companies or people to do the right thing. I disagree that it does not drive scientists or thinkers to do the right thing; rather, it drives the companies and money wielders away from scientists and thinkers who want to do the right, but unprofitable, things. Whether the businessmen of pharmaceutical companies will ever yield to their role of creating significant treatments and cures, only time will tell...

Teenage Breast Cancer

Today at work, I came across a teenage girl, about sixteen years old, getting tested for BRCA genes (Breast Cancer genes, 1 and 2). She told me that she had actually had a lump biopsied and it had come back positive for breast cancer, and that she had to insist on the biopsy for the physician to perform it. Teenage breast cancer has been likened to winning the lottery - a condition almost unheard of without strong genetic predisposition and other relatives with early onset breast cancer. I can understand from a statistical and biological standpoint why a physician would not order a biopsy of every lump in a girl with developing breasts, but at the same time I would hate to misdiagnose breast cancer simply because I played the odds.

When I shadowed a breast cancer physician, we did actually see a teenage girl, probably 14 or 15, come in with a lump and he did a biopsy on a lump in her breast. A that age when the breast is developing, it is common for a duct in the breast to become blocked and form a temporary cyst, or for a benign tumor, a fibroadenoma, to form. He suspected she had a fibroadenoma. For the guys out there who don't know what those would feel like, they resemble grapes in the breast, and they generally go away as a girl gets used to hormones and the breasts develop. If I were a guy learning about feminine health, I would probably be very surprised at how much happens. I may be biased, but I think female development is a lot more complicated than male development, on account of girls having breasts, a uterus, and ovaries to worry about, instead of a single, localized sperm-delivery system. Also girls seem to have more hormones to regulate the reproductive system, whereas men mainly have testosterone.

Not Just A Doctor's Visit

Working in a hospital laboratory, one can see the complexity behind a simple doctor's visit. There are many steps, and many points at which a critical error could be made. For example, say an elderly person comes in and has a suspected vitamin B-12 deficiency and a couple sores on the arm which resemble community acquired methicillin-resistant staphylococcus aureus (MRSA). So the doctor talks to the patient, swabs the wound to be cultured, suggests using multi-antibiotic ointment on the sores, and recommends eating supplements or food rich in B-12, while scheduling a follow-up appointment. At this point, the patient feels he has been treated and leaves the office, goes downstairs for a B-12 blood test and is feeling pretty good.

What the patient doesn't see is the many steps of labeling the culture tube and blood sample, tracking the sample on multiple packing lists, how long the blood sample is sitting around unspun and unaliquoted (B-12 is sensitive to light and temperature - must be put in a light-protected tube and frozen). Any one of these steps could lead to a wrong diagnosis - the B-12 could break down, the patient's medical record number could be typed in incorrectly when labels are printed, an incomplete order could result in the sample sitting around for a day or two, while aliquoting the tech could put the wrong label on the new light-resistant tube, etc. There are so many variables involved in laboratory science, it's a wonder that there are not more misdiagnoses. Maybe there are. Something has to be said for the work these people do - there is a huge volume of samples and patients to process in a given day compared to what doctors see, and they often put in extra hours or forego breaks to make sure everything is processed and sent out on time. However, most of these people, from couriers to lab assistants to receptionists, do not have more than a high school education, are overloaded with information about hospital protocol, and are constantly rushed, so mistakes inevitably happen.

After working in the lab, there are a few things I will take with me to medical school: always be courteous to hospital personnel, regardless of their position; take sensitive lab tests with unexpected results with a grain of salt - do a retest to be certain; make my instructions, particularly written instructions, as simple and clear as possible; always pick up my phone in case the lab or other department is calling for a clarification; and keep up-to-date on hospital protocols, in case test names/codes have changed or if certain tests can only be performed at specific locations.

How I Got Here

If any other pre-medical students or passerby are curious as to what activities and qualifications got me to this point, that is the purpose of this post. With that in mind, here is my combination of activities, with minor activities left out:

• 4 years member of pre-med student org, 1 year social chair, 2 years president - involved coordinating CPR training, volunteering in Mexico, guest speakers, etc.
• 1 quarter and a half of research (Autism)
• Certified phlebotomist, worked at Kaiser for 3 years
• 7 months shadowing D.O. physician
• Double major, Biochemistry and History
• GPA: Overall 3.4, BCPM 3.1; MCAT: 32R
  

I only write this for the record, or so I can refer people here later. In the meantime, I am anxiously waiting to hear from TUCOM-CA, and the interview at WesternU is next week! I have a good feeling about this!

As an afterthought, I had the pleasure of attending my history of ancient Egypt class tonight. We covered the relevant topic of ancient Egyptian medicine. Several interesting tidbits came up. For one, Egyptian physicians were exalted, of course, and even more specialized than medicine today - each physician specialized in a particular ailment (head trauma, stomach pain, broken legs, swollen throat, malaria, tuberculosis). Imagine going to the hospital and seeing the "influenza doctor" for treatment, or the "lower back rash" specialist. At that time, it was probably feasible - as they could not easily differentiate intestinal blockage, swollen appendix, or extreme diverticulitis - it would all fall under the jurisdiction of the "lower stomach pain" specialist. Today, there would need to be at least a thousand physicians in a single hospital to match the number of known individual diseases, symptoms, and conditions. As for their treatments, they used pills, liquid drops, liquid, food, and combinations. Some common effective treatments were castor (oil, fruit, root), prunes, and coriander for digestive problems. Fitting that many of the earliest treatments involved herbs or foods which affected the digestive tract, such as anti-diarrheals, laxatives, diuretics, anti-diuretics, and gas/bloating relievers.

Introductions Are in Order

Hello World. I've been around for about 22 years now, and the big dream has become reality - starting in August, I will begin the 4-year path to being a physician. As of now, I have one acceptance, am waiting to hear from another school, and have yet to interview at a third. Regardless of the latter two, I will be attending a school this August. The prospect is so exciting, and the experience available to only a handful of people each year, I feel it is my duty and privilege to document the years ahead of me - not only to remember for my sake the journey, but for anyone else who is, or has ever been interested, in pursuing medicine.

Now, my path will be slightly different from traditional, as I will be attending an osteopathic (D.O.) medical school instead of an allopathic (M.D.) medical school, but the basics are the same: nearly $200,000 dollars in debt, two years of classes, and two years of clinical rotations. I like to think D.O.s are super-M.D.s, since they learn essentially the same material as M.D.s yet also can perform OMM (osteopathic manipulative medicine). At any rate, I will fill in my background as the posts continue. As far as the basics, I will graduate from UCSD in March 2009 as a double major in Biochemistry/Cell Biology (B.S.) and History (B.A.). From there, I will attend one of the following schools: Touro-NV, Touro-CA, or Western U. I hear my decision from Touro-CA on February 6, and interview at Western U on February 12.

As far as this blog goes, I shall try to include medically-relevant information in every post, and keep discussion of my personal life, beyond life as a medical student, to a minimum. For oodles on my personal life and ramblings, see my Livejournal .