Where does the medical interest come from?

I got a new reader (Hi C and welcome!) and she asked me a good question: why the medical interest.

I always wanted to be a doctor. My grandfather was a surgeon, family physician and ob-gyn. In his 90s, his hands were so precise that he would walk with a cup full of coffee from the kitchen to his room without spilling a drop. At 80 years old, he was doing a spinal taps, one of them right when a big earthquake happened. He was very respected and everybody was wishing that someone will follow his steps. I would have liked it, but when time came, the status of health care in Romania was pretty bad and doctors were not seen as having a bright future (he he, talk about the American healthcare being in bad shape...). On top of that the admission exam was extremely difficult and i never thought I would ever make it. Right now, I think I had good chances anyway, but at that time my self esteem was very low and no one around me told me otherwise.

Life seemed to take me farther away from medicine, until I got hit with preeclampsia. After the initial shock with this not well understood disease, I got every book I could find on the subject and some of the books were medical textbooks. I found the Preeclampsia Foundation and a group of people that were just as nuts about finding answers and learning more (even if that meant housewives reading medical textbooks).

I learned and understood a lot in those years: I learned how little is known about pregnancy, I learned that doctors are not Gods, I learned that we need to take responsibilities and to accept a degree of risk. After the initial: "you doctors are all idiots" phase, I learned to respect doctors and medical professionals and I tried as hard as possible to communicate effectively and help them help me. It was a long road with lots of bumps, but I ended up feeling very comfortable with the doctors I sticked around and I feel I have a good grip on navigating through the health system.

After my second pregnancy, when it looked like preeclampsia was out of sight for a while or maybe forever, I attacked the anxiety with a new set of health care system challenges: finding the right therapist, deciding on meds vs. therapy or both, etc.

While working on the anxiety, I realized that I had the freedom to have dreams and that no matter how unlikely these dreams are, I can still have them. There is no shame in dreaming. I found Paul Levy. Paul is not a doctor, but he does a great job being the CEO of a large hospital... so maybe my dream is not that impossible either. Add to that that I am working in a field (IT, database software development) that is needed like air in healthcare today, and the dream seems just around the corner.

Grand Rounds

For those of you interested in medical-related writings, be sure to check the Grand Rounds - the best of the medical blogosphere. Each week it is hosted by another blogger.

As a personal challenge, I submitted one of my posts this week and it was accepted. Check the rest of it

http://blog.vitummedicinus.com/2007/07/official-grand-rounds-volume-3-number.html

Many thanks to Vitum Medicinus for including me.

6 months update

There are 6 months since I started this blog and 1 year of therapy (no anxiety-related medication) and I see major improvements.

Anxiety is still here, but it has no steam. It really is like a roller coaster ride: gets me up or down quickly, a bit dizzy and nauseated at times, but 5 minutes later (or an hour... or a day), the ride stops and things are fine again. I am still shy around new people, avoiding to make phone calls, not sleeping when something good or bad happens, etc. but it lasts only one night, or a finite amount of time, I know exactly what it is, and I have the luxury of rationing through it. Whenever I get too angry, overly upset or too happy, I just question what caused this and I talk myself through being rational about it.

I am even more thrilled with my physical health. Everyday I am amazed at how well I am doing. Last year I used to have high blood pressure (mild, but still, without medication it would get into 130/100). I now take no medication and my blood pressure is around 115/75. I get spikes into the 80s when I am anxious or excited (like posting comments on other people's blogs ;o) ).

My recent diagnosis with ulcerative colitis has been an immense relief for me. Yes, it is a chronic disease, but it is manageable. I didn't feel really well for a very long time, and I always thought it was the anxiety that was causing it. Isolating the real problem made me me feel better (with medication) and relax about the anxiety messing up my life.

So I am very much OK with where I am... I did very well, I got very far. What is the miracle? What did I do? I did therapy, exercise regularly (aerobics for 45 minutes 3-5 times a week and yoga 2-3 times a week) and blogged. I also read a lot (LOL - I knew I was doing better when I put all my psych books back on the shelf and swore that I will not read another one for another year at least).

I hope that over the next couple of weeks I will be able to describe how each of these was beneficial for me, but all in all, I just attacked the anxiety with as many weapons as I could (other than medication) and I eventually won. I guess that how everything can be resolved in life.

Are you ready to use props?

When you are very fresh in a yoga class, you are usually told that you can use blocks and straps to help you through the poses. Unfortunately, when really new to it, there's no way you could do that without help: you try so hard to do some of the stuff, that you can't even breathe and much less scoot around for your block. If you go out of the pose, you feel that you would never go back in again. As you gain more experience and strength, you are able to breathe, move easier and figure where you need some help, and get your blocks and straps to help.

By reading medblogs, I found out that the new year just started for medical interns and residents and likely they are in completely new and scary roles and can't hardly manage to go through the day. Therefore I completely understand the poor resident that I am going to trash in the rest of this post.

OK, here's the story:

I'm going for my appointment to find out the results of the colonoscopy. I was very happy to finally get to talk to a gastroenterologist so I could put into perspective all the various complaints that I had during my life.

I get to do the vital signs part quickly and I am planted in an exam room. I wait there until about 1 hour after my appointment was scheduled. A resident and a medical student eventually come in. The resident states his name and starts asking me about my symptoms. Asks me to sit on the table and does an exam. I politely and slightly joking ask him what the results of the colonoscopy are. He pompously tells me that the doctor is going to talk to me about my results and the treatment and starts writing in the chart. I am amused and amazed at how little interest he has in me as a person. For this guy, I am just a set of interesting bowels... if even interesting (maybe GI is not his desired specialty and he just wants this over with).

The med student figured the awkwardness of the situation. She introduces herself. She asks me what other symptoms I had. I say a few things and then get frustrated with the resident's incapacity to treat me as a person. I stop talking. The med student asks me if this was my first colonoscopy. I answer yes. (what a great prop she handed the resident - first colonoscopy... she must have questions, right) The resident keeps ignoring us both. I am a bit frustrated, but things are still OK as I know that I will eventually see the doctor.

After another 15 minutes, the doctor and the rest of the guys come in. The doctor is quite young, but he looked bright and cute when he did the colonoscopy. He's telling me that I indeed have ulcerative colitis, and explains the treatment. I ask how long will the treatment take: he says he has no idea, it's a wait and see. He hurries toward the door. As all three of them almost head out, the med student asks if I had any questions. My frustration bursts out, and the doctor figures that something is wrong with this picture. He sends the resident and med student away and insists that I ask my questions. I get to ask my questions and understand a bit more about my condition. I am relieved and happy. I stopped being a set of bowels.

I am told that most patients are very happy with this kind of treatment.. as long as they have their prescription and their pain can go away. When I complain about the delay, I get apologies and I am told that's because he takes time with his patients. I had to laugh out loud at this one. Come on guys, do you still expect us to believe that? It's just bad management, not all that wonderful quality time that you give to your patients.

Many thanks to the med student that saved the day and I hope the poor resident will be able to get the props soon as he gets used to his new role. As for the young doctor, what are we turning these guys into? All in all, I think it was a learning experience for all of us.

My anxiety: I got very frustrated and I had my moment of emotional immaturity: I insisted that I leave upset and that I don't want to talk. Fortunately, I got over it and after taking a few breaths, I could concentrate on my questions. The whole experience was so emotionally intense for me that I cried as I got into the car, but I was OK with this and the whole event. I could have been more mature, but I don't feel that I needed to. I am happy with myself. I still have social anxiety, but I am not viewing it as a disaster, just living with it. I guess I got to the point where I can use props if I need to :)

We are not broken TV sets and you are not TV repairmen

I was planning to write a mini-series dedicated to computers and IT in general, but I just had another (rich in anxiety) healthcare experience and I neeeeeed to talk about it.

As I see it, having colitis is pretty straightforward for doctors these days in US. You have the symptoms, they have the luxury of seeing what's going on with a colonoscopy, they figure what's up. They give you ASA first, if it doesn't work, they give you steroids and so on. Just like fixing a TV: the image is flickering, so you get a flashlight, open the back cover, peek inside, find a burned something, replace it, still doesn't work, you go up the stream until you find something broken and the TV now works.

Just that we are not TVs, we are humans. And even though you have tons of pressures with administration, too many patients, too little time, and who knows what else I'm pretty sure you didn't go to medical school to find out how to peek in assholes and write prescriptions. I bet you went there to help people in need, and to have human contact. So where in the process did you lose this? Why did you become insensitive machines?

I realized today why would someone like to do Gastro/Enterology. I think you have the opportunity to offer more relief and be in more intimate human contact than almost any other specialty. Even more than gynecology, pretty much at the same level as obstetrics.

I don't know details about all the gastric/intestinal diseases, but in our culture, we put so much emotional content in our digestive system... think of all the bathroom jokes, of the big laughs on burps and farts. So, here you have someone that is scared enough to come see a doctor, after a lot of embarrassment at work or in public places, after avoiding to be too far away from a clean toilet because the bathroom becomes a very common place. Oh the growling stomach and the rushed trips to the bathroom, and the horror of checking what's coming out and the daily cramps.

Maybe you indeed do not need to know all the details of our symptoms, because you have your solutions, but we need to finally tell someone and there's a big trust that we put in you. Yes, we too are embarrassed to talk about our bloody poops and our smelly farts, but you are the only ones we can talk to about it; when we are finally ready to talk about this, please listen to us and try to empathise. And maybe, if you do listen carefully, you will eventually be able to tell us more than you tell us these days, one day you will be able to make connections between all that ails us and can suggest ways to prevent it in the future without drugs.

I ended up being listened to and I asked my questions and I got a few answers. And all is well if it ends well.

I will comment on the other aspects of my adventure in later posts, but, if you are a doctor, other medical professional or a medical professional to be, please always remember: we are not broken TVs, and you are not just repairmen.

More along the same lines in a post from new blog I added to my to read list: Surgeonsblog. Check it out:

http://surgeonsblog.blogspot.com/2007/06/shoefoot-other.html

And another one :)

http://www.memag.com/memag/article/articleDetail.jsp?id=438103&ref=25