Voice of Reason

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Every time I read or see a well thought out piece on end-of-life decisions, it makes me want to go into palliative care medicine. Yes, I am a trauma/critical care junkie--but I also love the holistic approach and paradigm shift that palliative care provides. They are my yin/yang areas of love and interest in medicine. The ability to reach out and pull someone back from the brink---or the skill and wisdom to let go and let be when that is what a patient wants.

I think that Atul Gawande is an excellent writer and though he is a surgeon (i.e. from the specialty that probably gets slammed the most in the media with regard to these issues) he has an amazing grasp of these dichotomies.

I have droned on about end-of-life issues on this blog before, I know, but his article on the matter is a work of art as far as I am concerned. If you haven't already read it, you should. And then you should make your friends read it. And your parents. And your siblings.

I will now step off my well worn tiny soapbox. 

"Aha!" Moment

I went for a run this afternoon with Prof. Goljan and listened to the part 1 of the cardiac lectures. 
He was talking about aortic aneurysms and aortic dissections and so of course my mind wandered off, recalling the most traumatic ambulance nurse escort I've ever done (outcome aside).

Dr. Goljan mentioned one of the salient features of aortic dissection: the midscapular back pain. This was the complaint which alerted me to the aortic dissection pathology in my 'mild chest pain' patient that day in the emergency department.

In passing Goljan said, "of course the pain is different than cardiac pain because the aorta is retro-peritoneal so it radiates into the back not down the arm".

OF COURSE!

In anatomy we have had to go through cardiac pain, and referred pain a million times, and the dermatomes, the arm, the jaw, blah, blah blah...and then other times we've talked about abdominal structures, retro-peritoneal verses intra-peritoneal, etc. etc. and the aorta being a retro-peritoneal structure.

But I never really thought about the connection with aortic dissection and the pain pattern!

(I know this has probably been dead obvious to all of you nursing/medical people reading this, but it just clicked in for me today).

AHA!

I have known for so long: mid-scapular back pain =  red flag = do bilat leg/arm BP's = ?dissection.

But it wasn't until today that I understood why that was the case.

Ok medical school, we've officially kissed and made up this week. I (heart) you again.

Experimenting

In an effort to wean myself off music (no earphones allowed during relay race in June) I have decided to try running to the not-so-dulcet tones of Edward Goljan's pathology lectures.

I think it is safe to say that most medical students know about Lord Goljan or G Pac as he is lovingly referred to on his FB fan site. You could say he wrote the book on pathology, because he did. THE BEST book on it IMHO: Rapid Review Pathology.

I usually need some heavy beats to get me up the hill outside campus gates but tonight I had [insert hard American G.I accent here]:

"look at that...what IS that...NUTMEG...does that look anything like a NUTMEG LIVER?? NO!! I don't know who decided that NUTMEG liver looked like NUTMEG. Must have been someone with CATARACTS...someone with corticosteroid use induced CATARACTS...did you know that corticosteroids can cause CATARACTS?? Not glaucoma. Anyway..."

But, it worked! Ok my pace was slower than usual, because he's good but he's no black eyed pea. I was surprised though at how having my brain engaged actually let me forget my usual, "I hate running, ow, ow, ow, remember to smile" mantra. I have been feeling guilty lately about taking time out to exercise what with my study and review for school plus study and review for USMLE schedule. But now--huzzah! I can cram and run at the same time! I do realise that maybe it is a bad thing to combine recreation with studying so I am still keeping up my yoga in a Goljan-free zone.

Path domination here I come!!