The Rumors Were True is a quality, quality site by Christopher R. Kinsella Jr. He started his first two years of medical school in the Caribbean, transferred to Drexel, and is now amidst a competitive residency."Like most people I tried to get into medicine in the states and was rejected for perfectly good reasons. Chief among them were:
1) immaturity
2) poor scholastic performance in spite of the tools to excel
3) horrible recommendations from teachers aware of points 1 and 2."
"I took two months to study for the USMLE Step 1, a test that covers the first two years of medical school, and while in Cambodia on my 6 week tour of Southeast Asia, I found out that I scored a 240/99 (the goal I set for myself). [Ed. note: this ~82 percentile!] While studying for this test, I began editing a review book (First Aid for the USMLE) just for fun and submitting my corrections and suggestions to the authors. They contacted me and asked for my CV, and now I am working for them and credited as an author on the 2008 Edition of the book. During this time, I applied for transfer to several medical schools in the US. Drexel University in Philadelphia invited me for an interview. What follows is the story of that interview and the outcome."Another excerpt from the entry Pancakes Every Morning:
Looking at it now, I’m tempted to start the passive bragging of impossible odds. “You have no idea how hard it is,” I’d say. “Medical school is like trying to take a drink from a fire hose,” I’d brag.
And that’s total bullshit....
Medical school is like trying to eat five pancakes every morning for breakfast.
You know you can do it. A Premed advisory committee endorsed you saying, “He has the stomach for it. He’s committed.” And you prove them all right. Every day you show up with your first-year optimism and your annoying hunger for learning and you clean that plate (just kidding, it’s adorable). But you begin to notice that those pancakes are slowing you down a little each day and the sugar highs and lows are screwing with your sleep. Smart person that you are, you decide to pass on the flapjacks one day. You think to yourself, “Self, I’m going to eat ten pancakes tomorrow so that I don’t have to eat any today.”
But it never stops. Turns out that “self” isn’t the most responsible lender, and before you know it there are 40 pancakes in front of you and your plate needs to be clean by tomorrow. So yeah, at this point it looks impossible. But really, it’s your fault.
In the future, as I like to imagine it, I’ll be in charge of all medical school admissions. The process will be six weeks long and will consist of nothing more than showing up each morning to eat five pancakes, at which point you can then go about whatever you were going to do that day. At the end of the five weeks a few jaded, newly diabetic hopefuls will come to my office and, mixed with both pride and resignation say, “I did it. I finished those goddamn pancakes.”
“Wow,” I’ll say. “That’s very impressive. You must be very proud, and your parents must be very proud. Just one more thing.” They’ll reflexively clutch their stomachs, shifting their girth from one hip onto the next and groan, “What’s that?”
“Regurgitate it.”
And with that, she asked if I had any questions. The night before, I had prepared six questions that sounded specific but were in fact broad and I figured this would cover me, but I ended up not using them. Instead, I asked about very practical things like, “Do Drexel students take advantage of international rotations?” I knew the answer to this, but asked anyway to bring up the fact that I understand the importance of being bilingual and have plans to do a rotation in Ecuador (with Aunt Lucy and Uncle Fred) and that I have already traveled and have stories to tell you that will kill some time and make you think that I am well-rounded and interesting.
I told her about Laos and how much I loved the people. I told her about filthy, filthy Cambodia and the Killing Fields. I told her about the motorcycle trip in Vietnam with Kelly’s heroics, our first stitches, and the pictures that I’d show her if only she’d accept me. The interview ended with her telling me that they would decide later that day (or possibly on Thursday) who would be accepted and that I would know either Thursday or Friday.
So the interview was split very much in two and while I handled myself as well as I could have in the first half, I think we both enjoyed the second half much more. After this, my day was over. I then went down to the bookstore, bought Drexel stationary, and wrote her the following letter.
"Dear Mrs. XXX,
As a writer, I depend on stories. There is something extra and hidden between the lines of a good story that would be harder to see if stated simply. You can imagine a much more interesting version of “he went to medical school,” for example. As an applicant, I notice when others have higher scores and I worry that someone might not see my stories tucked between my A’s and B’s. I wanted to thank you for inviting me to interview; it was my chance to show you some of the extra and hidden parts of my life that otherwise might have been missed on paper.
For Drexel, I hope to become a great story.
Sincerely, Me."
I would have mailed it, but as I said, the decision was being made later that day. I left the envelope with her secretary and caught the train back.
| The Daily Show With Jon Stewart | Mon - Thurs 11p / 10c |
| Atul Gawande | |
Auto-appendectomy in the Antarctic: case report is an article on The BMJ (British Medical Journal) by Drs. Vladislav Rogozov and Neil Bermel. It describes the saga of Leonid Ivanovich Rogozov, who in 1961 while on expedition in Antarctica, performed a self-appendectomy. Exerpt:"One of the expedition’s members was the 27 year old Leningrad surgeon Leonid Ivanovich Rogozov. He had interrupted a promising scholarly career and left on the expedition shortly before he was due to defend his dissertation on new methods of operating on cancer of the oesophagus. In the Antarctic he was first and foremost the team’s doctor, although he also served as the meteorologist and the driver of their terrain vehicle.This article begs the question, is the writer Rogozov related to the story's surgeon Rogozov? I could google it, but I'm kind of feeling lazy.
After several weeks Rogozov fell ill. He noticed symptoms of weakness, malaise, nausea, and, later, pain in the upper part of his abdomen, which shifted to the right lower quadrant. His body temperature rose to 37.5°C.1 2 Rogozov wrote in his diary:
'It seems that I have appendicitis. I am keeping quiet about it, even smiling. Why frighten my friends? Who could be of help?'...
He chose a semi-reclining position, with his right hip slightly elevated and the lower half of the body elevated at an angle of 30°. Then he disinfected and dressed the operating area. He anticipated needing to use his sense of touch to guide him and thus decided to work without gloves.
In honor of today's Facebook flurry of bra-color status updates and the ongoing controversy, here is an article from the perspective of a patient: "What sustained me through the "treatments" is a purifying rage, a resolve, framed in the sleepless nights of chemotherapy, to see the last polluter, along with, say, the last smug health insurance operative, strangled with the last pink ribbon. Cancer or no cancer, I will not live that long of course. But I know this much right now for sure: I will not go into that last good night with a teddy bear tucked under my arm."
Memoir of a former abortion addict is an LA Times news story about Irene Vilar, now a mother of two, who wrote a memoir of about led her to have 15 pregnancies ended."She describes her abortions as part of a misguided quest to free herself from the burdens of a complicated and tragic family, then as part of an immensely dysfunctional dynamic with her first husband, a professor of Latin American literature whom she met at Syracuse University when she was 16 and he was 50.
'We could be a couple as long as I relinquished my desire for children,' she said of her husband, 'a disturbingly handsome man" who taught her that 'families are nests of suffering" and informed her that he preferred young women because they are "unformed . . . unfinished, with not too many wounds.' Children, he told her, were incompatible with freedom. (Her ex-husband, Pedro Cuperman, did not respond to an e-mailed request for comment.)
Again and again during their 11-year relationship, she rebelled: 'Forgetting' her birth control pills, she would get pregnant, feel the thrill of self-determination, then panic that she would lose her husband, seek an abortion and collapse in relief and despair.... 'I can completely understand the discomfort that some feminists feel,' said feminist author Robin Morgan, who wrote the book's foreword. 'There is a perfectly human tendency to say we can't afford ambiguity, we can't afford nuance. I am afraid it comes from years of being pummeled by the extreme, anti-choice right. The truth is that it's a complicated issue.' "
Also the medscape news alert tells me that, "The Senate Finance Committee today passed a massive healthcare reform bill — mostly along partisan lines — that would eventually reduce the ranks of the uninsured by more than half." Whee!
Edited for accurate links.
(From my iPod subscription)Homeopathy & Nutritionists vs Real Science! is a stand-up routine by Dara O'Briain about the public understanding of biological and health science.
Basically, teehee. Especially after my CAM class on homeopathy. For the uninitiated, that's a field whereupon people think that "like cures like." They make healing potions by diluting something to or beyond avogadro's number... and shake the hell out of the bottle (calling it "succussion"). Then they call that an elixir and sell it to you.
The routine is precious.
(From Boing Boing)
Beautiful Cervix Project is a website that features pictures of different cervices. There is one that shows the same cervix every day for a whole month. Other images include a post-menopausal cervix, an IUD cervix, and a pregnant cervix. If you're not ready to see pictures of such things, wander away now. 
Why are we so fat? is a New Yorker article by Elizabeth Kolbert. She talks about the global fat epidemic, as evinced in the National Health and Nutrition Examination Surveys, by the Centers for Disease Control and Prevention."The World Health Organization has come up with more than three dozen actions that governments could take to encourage better eating and fitness; these include imposing a 'fat tax' on caloric snacks, improving health education, regulating food and beverage advertising, limiting the foods available in public facilities, and insuring access to sidewalks and bike paths."
Click through for the article, which has actual paragraphs and makes more sense. (Having been edited by a proper editor, and all.)
'Sit! Stay! Snuggle!' is a story from the Wall Street Journal about a new sort of service dog--one for the psychologically afflicted. It's very interesting."NEW YORK -- Like any other golden retriever seeking a treat, Tuesday nudged his owner's hand with his snout one recent morning and waited expectantly.
Luis Carlos Montalvan got up from a chair in his small Brooklyn apartment and walked to the kitchen. Tuesday followed close behind, eyes fixed on a white cabinet. The retriever sat alertly as Mr. Montalvan, an Iraq war veteran with severe post-traumatic stress disorder, reached for a vial of pills, lined a half-dozen on the table and took them one by one.
The dog had gotten what he wanted: When the last pill was swallowed, he got up and followed his master out of the kitchen, tail wagging.
Tuesday is a so-called psychiatric-service dog, a new generation of animals trained to help people whose suffering is not physical, but emotional. They are, effectively, Seeing Eye dogs for the mind....
Tuesday, now 3 years old, listens to the daily alarm on Mr. Montalvan's wristwatch, his cue to make sure he takes his pills. Wearing the red harness of a work dog, he accompanies Mr. Montalvan to Dunkin' Donuts and the movie theater, to Veterans Administration group counseling sessions in Manhattan, and to Columbia University, where Mr. Montalvan is studying journalism and communication.
At Mr. Montalvan's apartment -- decorated with his Purple Heart and Bronze Star certificates, and pictures and paintings of Tuesday -- they sleep in the same wooden sleigh bed.
On a recent afternoon, Mr. Montalvan and Tuesday walked to a nearby subway station. The platform was crowded. Mr. Montalvan began to look agitated. Tuesday, who had been lying at his feet, jumped up and stood between his master and the nearest cluster of people, creating a buffer. Mr. Montalvan's breathing noticeably stabilized.
The train approached. Mr. Montalvan bent down to tie his Army combat boots, scratched Tuesday behind the ears, and they made their way aboard."
The Cost Conundrum is a New Yorker piece by Dr. Atul Gawande published at the beginning of this month. It's a good article. The piece, which has been covered on Fresh Air this week, has purportedly become mandatory reading for White House staffers. In it, Dr. Gawande discusses the peculiarities of our health care system, contrasting areas with high cost, poor-quality health care (such McAllen, TX) versus areas that have low cost, high quality care (Mayo, Grand Junction). The difference is in part cultural, and in part that there is someone at the helm working toward that goal. What's interesting about the article is that so far, the debate has largely been about single-payer insurance versus multiple, private versus government--but Atul states these arguments are neglecting the most important point--we need a contractor, a person actively working to lower costs while increasing quality:
"Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.The way I read this article, Atul seems to be asking for a Health Care Czar, a contractor in charge of lowering costs, increasing quality, and managing the totality of health care for the country:This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here’s how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen."
...
"Dramatic improvements and savings will take at least a decade. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone—because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world."
"As America struggles to extend health-care coverage while curbing health-care costs, we face a decision that is more important than whether we have a public-insurance option, more important than whether we will have a single-payer system in the long run or a mixture of public and private insurance, as we do now. The decision is whether we are going to reward the leaders who are trying to build a new generation of Mayos and Grand Junctions. If we don’t, McAllen won’t be an outlier. It will be our future."
PS: I like that little nod to Malcolm Gladwell at the end. And that diaeresis over the ö in coordination tickles me... it's just New Yorker whimsical.
PPS: Kottke points to a follow-up from Atul's address to the University of Chicago, Pritzker School of Medicine.
MPL is a song by three University of Illinois College of Medicine students: Alex Cantrell, Jon Paul Youakim, and Christian Nuñez, set to the tune of Howie Day's "Collide". The song chronicles their experiences as first-year students (M1's). It is named after the Minimum Passing Level (MPL), meaning the minimum grade a student must achieve to pass a test or class. Most M1 medical school classes are graded pass/no pass/outstanding. MPL is usually between 60% to 73%. Recurrent themes include having no time, barely making it through the year, and accidentally signing up for med school. The song was performed at a variety show/fundraiser after a series of soul-crushing exams.
Lyrics as performed:
The dawn is breaking(From Christian)
A light shining through
I've been dissecting...
So-I-just dont have a clue
Yeah
This guy I'm carving
Been here for so long
Why am I starving in this place?
That sounds so wrong
M-1 is way too hard sometimes
Knowing I'm always out of time
Think I'm going out of my mind
I somehow find
I get M-P-L
Labs every evening
So much used latex
Can't think of seeing
all-of-that without the sex
What a smokin' class
So many hot girls
Some love could be worth makin'
Too bad that most are taken.
No girl for me
No S-T-Ds
No girl for me
(Yeah, I'm still free)
Signed up to shadow
Doctors think I'm smart
Until I saw the patient in the nude
I had to barf!
What the hell is that?
I've never seen that!
I'm not touching that!
(I didn't sign up for THAT!)
Even if I survive this time
I'll graduate without a dime
Think I'm going out of my mind
I somehow find
I get M-P-L
Els taught Physio
My brain stenoses
But he assured me...
[Fake South African accent] "It-can't-get harder than this"
Immuno-micro
So many gross pathogens
I know that I shouldn't for-
-get to wash my hands!
Even if I survive this time
I'll graduate without a dime
Think I'm going out of my mind
I somehow find
I get M-P-L
Can't stop to
Procrastinate
I'm so behind
M-1 is way too hard sometimes
Knowing I'm always out of time
Out of the doubt that fills my mind
I somehow find
We will all survive
The Health-Care Crisis Hits Home is a Time article by Karen Tumulty. Karen has written extensively about health care, but recently, the problem has struck very close to home: her brother Pat was diagnosed with kidney failure.
"For six years — since losing the last job he had that provided medical coverage — Pat had been faithfully paying premiums to Assurant Health, buying a series of six-month medical policies, one after the other, always hoping he would soon find a job that would include health coverage...Kidney failure would seem to be one of those disastrous 'unexpected illnesses' that Pat thought he was insuring himself against. But apparently he was wrong. When my mother, panicked, called to tell me that the insurance company was refusing to pay Pat's claims, I told her not to worry; bureaucratic mix-up, I assumed. I said I'd take care of it, bringing to bear my 15 years of experience covering health policy, sitting through endless congressional hearings on the subject and even moderating a presidential candidates' forum on the issue.
Confident of my abilities to sort this out or at least find the right person to fix the problem, I made some calls to the company. I got nowhere. That's when I realized that the national crisis I'd written so much about had just hit home."...
Pat represents the shadow problem facing an additional 25 million people who spend more than 10% of their income on out-of-pocket medical costs. They are the underinsured, who may be all the more vulnerable because, until a health catastrophe hits, they're often blind to the danger they're in. In a 2005 Harvard University study of more than 1,700 bankruptcies across the country, researchers found that medical problems were behind half of them — and three-quarters of those bankrupt people actually had health insurance.
...
Pat's decision to save some money by buying short-term insurance was a big mistake, says Karen Pollitz, project director of Georgetown University's Health Policy Institute and a leading expert on the individual-insurance market. 'These short-term policies are a joke,' she says. 'Nobody should ever buy them. It is false security that is being sold. It's junk.'
...
While Pat had been continuously covered since 2002 by the same company, Assurant Health, each successive policy treated him as a brand-new customer. In looking back over Pat's medical records, the company noticed test results from December, eight months earlier. Though Pat's doctors didn't determine the precise cause of the problem until the following July, his kidney disease was nonetheless judged a 'pre-existing condition' — meaning his insurance wouldn't cover it, since he was now under a different six-month policy from the one he had when he got those first tests.
...
There was at least one thing we didn't have to worry about, Haile assured me. Pat's kidney doctor, Peter Smolens, would keep treating him even if he couldn't pay. Smolens, a thin, soft-spoken man, later told me that about 10% of his patients have inadequate insurance or none at all. He has agonized with some as they struggled with hard choices, like whether to have a hospital biopsy or pay their mortgage. As a physician, he said, 'you just see them. You know you're not going to get paid.'
...
A paradox of medical costs is that people who can least afford them — the uninsured — end up being charged the most. Insurance companies, with large numbers of customers, have the financial muscle to negotiate low rates from health-care providers; individuals do not. Whereas insured patients would have been charged about $900 by the hospital that performed Pat's biopsy (and pay only a small fraction of that out of their own pocket), Pat's bill was $7,756. For lab work — and there was a lot of it — he was being charged as much as six times the price an insurance company would pay. One pathology lab's bill alone was $3,290.
...
Pat's kidney function, which was 48% when Smolens first saw him last summer, has fallen to between 35% and 40%. And there are now outward, obvious signs of Pat's illness: he is lethargic, his eyes are puffy, and his lower legs and ankles are swollen to twice their normal size.
...the average cost of dialysis treatments in this country is $60,000 per year plus. There's another paradox: if Pat gets sick enough to need dialysis, as he well may, the Federal Government will pick up those staggering costs under the Medicare program for end-stage renal disease. But until that point is reached — and the goal is to keep him from getting there — his options are limited. Now that he is sick, it would be nearly impossible for him to purchase another insurance policy on the individual market. Since he lives independently and holds a job, it would be difficult for him to qualify for Social Security disability benefits.
...my brother would have to wait 12 months to join with a pre- existing condition, under the state's 'adverse selection' regulations that seek to prevent uninsured people from joining the pool only after they get sick.
...
As this country prepares to engage in its first serious debate over comprehensive health-care reform in 15 years, there are two leading approaches to covering the 45 million uninsured and reining in costs. One, which President Barack Obama is putting forward, would force more employers to offer coverage to their workers, with subsidies and other incentives to make it more affordable. The other, advocated by Republicans (including Senator John McCain in the recent presidential campaign), would take away some of the tax advantages that come with getting coverage at work and thereby put many Americans who are now covered by their employers into the marketplace on their own. The idea is that they would be the ones best equipped to decide which plan suits their individual needs.
...
Pat's experience suggests it is difficult for an individual to make such judgments. And the existing market for these kinds of policies leaves a lot to be desired. A 2006 Commonwealth Fund study found that only 1 in 10 people who shopped for insurance in the individual market ended up buying a policy. Most of the others couldn't find the coverage they needed at a price they could afford.
The individual health-care consumer has very little power or information. Still, it turns out that there are ways to fight back. As I was reporting my brother's story, I discovered something about Pat's former insurance company: last May, insurance regulators in Connecticut imposed a record $2.1 million in penalties on two Assurant subsidiaries for allegedly engaging unfairly in a practice called postclaims underwriting — combing through short-term policyholders' medical records to find pretexts to deny their claims or rescind their policies. In one case, a woman whose non-Hodgkin's lymphoma was diagnosed in 2005 was denied coverage because she had told her doctor on a previous visit that she was feeling tired. Assurant agreed to pay the fine but admitted no wrongdoing.
So I contacted the Texas Department of Insurance, identifying myself as both the sister of an aggrieved policyholder and a journalist. Officials there suggested that Pat file a complaint against the company. Each year the department receives as many as 11,000 complaints and manages to get $12 million to $13 million back for consumers, Audrey Selden, the department's consumer-protection chief, told me. 'It is important to complain.'
And it's easy too. It took Pat and me less than 10 minutes to fill out the complaint form over the Internet. That was Jan. 14, 2009. On Feb. 9, we had an answer: Assurant maintained that it had done nothing wrong and that Pat should never have relied on short-term coverage over a long period. But given 'the extraordinary circumstances involved,' the company agreed to pay his claims from last year, when the policy was still in force. (Pat canceled it on Aug. 22, 2008.) Those extraordinary circumstances, I assume, included the fact that the state insurance department was sniffing around."
There is a very interesting audio story on the same topic by WHYY's Fresh Air. Enjoy!
(From Fresh Air )
PS: Happy birthday to my dad on St. Paddy's Day.
But Can You Hear THIS? is an article on Noise Addicts."Here is a list of tones that go from 8Hz all the way up to 22,000Hz. It’s fairly common for people who are over 25 years of age to not be able to hear above 15Hz, so this will help you find out where your high frequency hearing cuts off."
Tono tono is a video about Broca's aphasia patient. Broca's aphasia is caused by damage (like stroke or trauma) to or developmental issues in anterior regions of the brain around the third convolution of the left frontal lobe.
Broca's aphasics have good comprehension but difficulty saying what they want to say. Speech is slow, labored, and telegraphic, prepositions and conjunctions are lost, and words are slurred. Broca's aphasia is usually accompanied by agraphia (the inability to express thoughts in writing.) They are usually aware of being unable to speak. :(
Access to Life is a moving photo-essay about AIDS and retroviral medication in 9 developing countries, shot by eight Magnum Photographers (Magnum is a photographic cooperative)."In the early 1990s, when antiretroviral drugs became available, AIDS was transformed from a certain death sentence to a manageable, chronic disease–but only for some. The expense of the drugs and their distribution prevented 95 percent of those living with HIV from getting access to them. International outrage that millions were dying because of economic disparity helped reduce drug prices, and also helped to create the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002. Through the Global Fund and the U.S. President’s Emergency Program for AIDS Relief, the world began to invest in a massive roll out of antiretroviral treatment in more than 100 developing countries.
Doctors and health care workers around the world have adapted complicated procedures to settings where people often could not access even the most basic care. Already, millions of lives that otherwise might have been lost are being saved. Equally important, providing treatment is becoming a central part of the efforts to prevent further spread of the disease.
