And wash your hands too

I am so so so so so so so so so so so excited about the upcoming movie "Carriers." So excited.

Basically Avian flu kills everyone in the world (especially Germans) and then they all turn into zombies who join together to try to infect (eat? scare? it's unclear what motivates zombies) the only four survivors, who are of course 20-something attractive Americans with an SUV who make the sage decision to drive across the country to an abandoned motel where they'll be oh-so-"safe".

(On a side note, why are all horror-movie viruses zombie viruses? Isn't bleeding out your ears and dying scary enough?)

Now I luuuurve horror movies, especially with a pseudo-medical component, and double triple especially if that element is a communicable disease. (Giant poisonous mutated animal will also do).

But what's funny about this trailer is that it is nearly indistinguishable from the training video I just had to watch on controlling infectious diseases. I mean, holding the mask to your face instead of firmly securing it with both elastic straps? Classic rookie mistake. (In my training video, the girl who forgot to wear her mask got TB. You don't want to know what happened to the intern who recapped a needle).

Anyway, here's the trailer. . . enjoy:



Note the menacing histology slides flashed at the beginning. . . microbes are scary!

the tragic downside to graduation

I asked for my usual student discount at yoga this morning ($12 instead of $20!) and then realized mid-sentence that, oh no, I am no longer a student.

I don't imagine too many places offer doctor discounts.

Alas.

A change is going to come

As of today I:

-am an official, real live, MD

As of today I will no longer:

-drive past spray painted camels on my way to work (they're painted orange so cars can see them)
-be force fed endless cups of turkish coffee during morning report
-be greeted by my attendings with a kiss on each cheek
-have to clarify with my patients if their wife is a first or second cousin (or a first or second wife for that matter)
-have a majority of patient conversations translated from Arabic to Russian to Hebrew to English (or some variation thereof) and back
-be able to pretend I don't understand when attendings make uncomfortable comments about how my srubs fit
-be the cute chick with an accent
-live in a country where drive-through doesn't exist
-live in a town where 90% of restaurants daringly offer sandwiches, salads, quiches, pastas, pizzas, steak, fish, sushi, asian noodles, and hummus on a single menu
-be a medical student ever again


But I will try to continue:

-seeing each patient as an unkown, without prejudice or preconceptions
-to treat the patient in the way they would like to be treated, not the way I decide is best for them
-remembering that even someone who looks just like me comes with their own personal culture that I must try to discover, understand, and respect

Taking a two week moving vacation and then the new adventure begins. . .

Overheard in the trauma bay. . . oops, I mean dermatology clinic

My mistake.

Student (after noticing that the doctor examines all patients extremely intimately and without gloves, including three cases in a row of crabs):

"How do you avoid contracting contagious conditions, like pubic lice?"

Dr. derm (100% serious): "Well, I mostly try to avoid sleeping with my patients."

I see our translator comes with a side of agenda. . .

Today our fascinating and varied array of patients included 7 cases of warts, 10 psoriasis outbreaks, three dry skin emergencies, 2 cases of acne, and one 27 year old male who is starting to go bald. About half of these were signed in as "urgent."

Luckily there are always a few cross cultural occurrences to help keep me interested. Watching the doctor contend with the veritable parade of languages, religions, and cultural norms that walk through the door on a given day is far more educational than the actual medical content.

A completely typical day may include several Bedouin patients, several secular Israelis, a few orthodox Jews, a handful of recent immigrants from Russia, Romania, Ethiopia, and West Africa, and one or two European tourists. It's dizzying.

A few select moments from today:

1. The clinic is very sensitive to modesty/privacy issues. All the doors are locked during patient visits and there is an additional screen or curtain in the corner so that the religious and Bedouin patients don't have to remove their clothes out in the open. Today, we got to experience ultimate (like award winning) modesty. An orthodox Jewish woman in an ankle length skirt came in with a psoriasis eruption on her heel and insisted on going behind the modesty screen while removing. . . her sock. Not even removing, just rolling it down over her heel.

I'm with her, no good can come of women wantonly exposing their ankles.

2. We've seen multiple Bedouin women over the past few days with severe dry skin. Today, the doctor explained to us that a few of the desert tribes have a tradition of bathing for a few hours a few times a day. Sure enough, when I asked a patient today how long she usually showers for, she answered, "the normal, two or three hours."

3. The doctor was speaking to a twentysomething secular looking woman through a Greek translator. He was considering accutane for her acne (which can harm a fetus) so he needed to know if she was sexually active and if there was any chance she might get pregnant. He asked the translator to ask her if she was at any risk of getting pregnant. Without asking the patient, the translator immediately replied "no." The doctor repeated the question and asked the translator to please ask the patient. The translator refused, "It's not relevent, doctor. She's not married."

(A friend of mine had the exact same experience with her doctor. He was thinking of prescribing her an antibiotic that is harmful in pregnancy and asked her only "are you married or engaged?" before prescribing the drug).

4. A young Bedouin woman with severe warts on her hand came in to have the warts burned off. Her hands were hurting her after the procedure so the doctor asked her father if there was anyone who could help her around the house so that she wouldn't have to cook or wash dishes that evening. Her father responded "no, there is no one to help her. She has only five brothers at home."

(One of my classmates, a secular Arab-Israeli, stepped in and tried convince the father to make one of the brothers help out around the house, at least for that evening. The girl, who hadn't understood the (Hebrew) conversation up to that point, nearly fell off her chair laughing at the the thought of one of the men helping out with the housework. She honestly couldn't fathom.)

5. The camels are grazing!! There are camels strewn literally all over the city. And herds of sheep with sheperds following them on donkeys. It's like Israel is trying to be extra extra middle eastern for my last few weeks here.

Overheard in dermatology

A classmate: Ugh- this whole specialty makes me want to gouge my eyes out with a punch biopsy.


It is a rather anti-climactic way to end medical school. Nine days of fungus ridden toenails, age spots (excuse me, solar lentigo) thinning hair, and EMERGENCY!!!!!!!!!!!!!! pimples.

70% of the patients on the list had made an "urgent" appointment this morning. 100% of the patients had the least urgent medical conditions humanly possible. . . (in the vein of: "I've had this bump on my chin for seven years, it really bothers me!" Or: "My hands feel dry!! And they're peeling!!! Sometimes they itch!!!!!!!!!! What's happening to me??!!")



The highlight of the day for sure are the magical-derm-gnome consults. This guy is the dermatologist of the region. He's been practicing for about three of my lifetimes and is technically retired but hangs around the clinic to help out with tough cases (read: cases in which the doctor actually has to examine the patient and/or think). So every time our doctor encountered a patient who required him to move from the chair or :gasp: perform a physical exam, instead he would lift the phone and call a consult.

Within minutes and without a word, preceded by a giant magnifying glass, in trots this tiny squat little man, white hair flying in every direction (see above but without the hat). He silently examines the patient from head to toe with the magnifying glass glued to his eye and his face about 1/2 an inch from the patient's ulcerating rash. After thoroughly inspecting every inch of exposed skin (usually paying special attention to the armpits) while mumbling to himself, he proclaims his diagnosis in a thick Romanian accent, nods authoritatively, pushes up his glasses, and leaves, still nodding and mumbling, with the magnifying glass at the ready.

::I totally want one::

The doctor then of course prescribes steroid cream and a moisturizer (which is what he would have done regardless) and the patient goes on their way.