Wednesday, June 18, 2008

Updates On My Appetite, Vibrating Veins, & Why Jesus Screws Up The Geriatric Depression Scale

This picture was the best of a photo shoot I took while salsa dancing in my hotel room this morning. I know, I'm lonely and pathetic. In it you can see my burnt face, my unmade bed, and my sweet white coat! Today was my first day in the clinic. It was a pretty perfect summary of how I feel about Puerto Rico so far. First of all, the clinic was in a MALL. So far I have been thoroughly dismayed by the Americanization of Puerto Rico. Of course I had expected it, but literally, it's more Americanized than Waterbury. I have never seen so many Burger Kings, Walgreens, and Subways concentrated in one area. I'm thinking it's because I have only spent time in the San Juan metropolitan area so far. Second of all, the first person I meet in the clinic is DRUG REP. For those of you who don't know how I feel about drug reps, perhaps I will upload my essay I wrote for the Brigham and Women's "Why Drug Marketing is Evil and Destroying the Very Fabric of Our Moral Conscience" essay contest. That may not have been the exact name of the contest. He brought Chili's (yes, baby back ribs Chili's) for everyone, but of course I refused to eat it, pleading an upset stomach. I actually wasn't that hungry anyway, despite my intense exercise routine this morning. After 6 hours, the doctor actually demanded that I go get something to eat, because she couldn't understand why I hadn't eaten anything all day. So I got this:
Hell yes, Puerto Rican food! Clockwise from the top is pastelón, which is like a sweet plantain and ground beef casserole, arroz y gandules, which is rice and pigeon peas, and some kind of delicious shredded chicken stew with potatoes and carrots. I WILL learn how to make these things. Sadly, my appetite still isn't back, so this meal is sitting in my fridge right now.

Anyway back to the clinic. I got to see a vibrating fistula. I had never even heard of this before, so I'll write a little bit about it. Basically, when someone is in kidney failure and needs to go on dialysis, doctors need direct access to their blood. Common methods of gaining access are through arteriovenous shunts or central venous access. But sometimes, a doctor decides to do something really cool and creates a fistula, which (in this context) is a direct connection between an artery and a vein. Eventually, the vein gets really big because of the high arterial pressure (looks like a snake under the patient's skin), and even more cool, the turbulence causes the fistula to literally vibrate. It was probably the weirdest thing I've ever felt, almost like little shocks going through my fingers. This guys humungo vein means a few things for him. First, his veins are easy to access and less likely to be damaged from all of the needle poking. Second, he has less of a risk of infection and clotting than he would have with either a central line or or shunt, meaning better outlook. Third, he will have pretty permanent access to his blood for hemodialysis, as opposed to the other options. Fourth, he gets to freak everyone out with his buzzing arm.

Okay, Jesus. Let me not go into a whole religious issue right here, let me just comment that it seems to me that sometimes Jesus and pals interfere with medicine. Like when 14 year olds die because they won't accept blood transfusions or when we trail behind the world in promising stem cell research because people claim to value frozen embryos as much as living children. Let me ask you this- if you could only save one thing from a burning building, a tray with 50 embryos or one 7 year old, which one would you choose? What about 50 embryos or your neighbor who's got mild Parkinson's? Not trying to be an instigator, but for Pete's sake, at least give yourselves some credibility and come up with an argument that makes sense.

Anyway, today I went with a medical assistant to give a Mini-Mental Status Exam and Geriatric Depression Inventory to an older woman. The mini-mental was the mini-mental, in my opinion a terrible screening exam that should be abolished. It's completely arbitrary and you could probably get a much better assessment by just talking to the patient and their family, especially for things like Alzheimer's. I suppose the clock drawing can be useful, but if you're suspecting a stroke, I would hope you would be digging a little deeper than the mini-mental. Plus, today I would have failed it, since I didn't know the date, the pueblo I was in, what floor we were on, or how to count back by 7s from 100. I'm sure someone will come out with a research study in the next 10 years proclaiming its uselessness. Obviously, I hate mini-mental. But what really got to me was the Depression Inventory. This woman cried during the entire depression screening, and if just thinking about your mood brings you to tears, you're probably not a ray of sunshine on most days. So why did this lady pass the screening and walk out of the clinic without medication or therapy? JESUS! Because she answered each question, I believe, the way that she thought she should, based on her piety. For example, despite the fact that she spoke for 10 minutes about how much she worried and couldn't sleep as a result, she responded to the "Do you frequently worry about the future?" question with, "One can't worry, because one needs to turn themselves over to the mercy or our Señor Jesucristo." She really said that. And to "Are you in good spirits most of the time?" Well DUH! She's filled with the HOLY SPIRIT! Of course those are good spirits! Nevermind she cries herself to sleep every night and has heart palpitations worrying about her husband's health! And it's totally healthy that she has isolated herself from all her friends and family so she can lock herself in her room for hours reciting the rosary! Those aren't signs of depression, just of one devout lady who is blazing her glory path straight to the pearly gates! She's fine!
Get real.

People, I implore you, if you're feeling blue, please answer depression inventories honestly, not the way that you think you should. You aren't saying Jesus is failing you if you get the mental health care you need and deserve. Doesn't he want you to be happy?
And doctors, please don't assume that just because someone is deeply involved in religious endeavors that they are happy. Because after all, believing that your life will finally be better in heaven is essentially the same as saying that your life will be better when you're dead.

Sorry that rant was so charged. Here's something to cool you off:

Quote of the day: "I just did something bad. I dipped American cheese into Tostito's Southwest Ranch Dip." -Scott


Laura said...

lol lol lol. you make me laugh. i suck at the MSE too, especially the backward 7s. I don't think anyone should have to be able to do that!
love your sad patient, i want to give her a hug and hide her rosary. this week a patient told me all about how her circulatory system flows back and forth to the planet venus, how she travels along that channel, and how she's trying to train her husband to be able to do it too. fabulous.
i love your life!!

Renee said...

Venus? That has to be one of the best I've ever heard. Once a lady told me that her mom died because “she have headaches every day, and this medicine, it make her heart explode and crack like egg. It leak everywhere…inside.” But Venus is better. I wonder if her husband ever figured out how to do it.

Manish said...

1. That's the difference between a doctor and question asking robot. It is a little something called clincal accumen. When things don't seem right you try a different approach. the minimental or the depression scale are not the end of the road.

2. I completely agree with your assessment of religion and the practice of medicine. Unfortunately for us God and religion are a part of 90% of human beings lives to a greater or lesser degree. (sigh!!) so we have to suck it up.

3. cheese and dip!! Scott is really missing you.

4. White people really aren't built for tropical sun unless the douse themselves in SPF 250 or something! please use that awful sunscreen stuff or you'll come back looking like a tempura!!

Renee said...

mmmm tempura...

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