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Emergency Medicine, Medical Education, Patient Care, SMS Unplugged

Role reversal: How I went from med student to ED patient in under two minutes

Role reversal: How I went from med student to ED patient in under two minutes

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

emergency sign - smallAs part of the second-year clinical skills course, each member of my class is required to complete two 8-hour Emergency Department (ED) shifts. I had my first ED shift last week, and when I walked in, I introduced myself as a second-year medical student who needed to practice IV placements, EKGs, and any other procedures that happened to come my way. Three hours later, when I walked out of the ED, staff knew me not as a medical student, but as a recently discharged patient, grasping paperwork with my official diagnosis: “syncope and collapse.”

It was 30 minutes into my ED shift, while I was watching a pelvic exam (ironic, given my post a couple weeks ago), when I began to feel a little dizzy. I’ve fainted twice before – once in high school after getting my blood drawn, and once when watching a C-section at a clinic in India – so I recognized the signs: feeling a little hot, starting to see black dots, slightly swaying. I tried to fight off the sensation by breathing slowly, but I could tell it wasn’t working. At the earliest possible opportunity, I turned to the attending in the room, saying, “Is it okay if I leave? I’m feeling lightheaded.”

I barely waited to hear her response before I bolted out of the room and found the closest stool to sit on. Bad call. The stool had no back to it, and next thing I knew, I was on the ground. When I opened my eyes, there were at least five  nurses around me, one whom matter-of-factly said, “Honey, you just became a patient.” Another nurse quietly slipped my hospital badge off my jacket, returning two minutes later with a medical bracelet that she fastened around my wrist.

My memory of those early moments is a little shaky, but I do remember saying over and over again, “I’m so sorry, I’m so sorry.” I felt awful that I had come to the ED to learn from the patients, physicians, and staff – without being a burden – but had ended up being another patient for whom they had to provide care. The nurses and attendings immediately normalized the situation, telling me repeatedly that this is a common occurrence in the ED and that many of them had had this happen to them as well. Their assurances made me feel so much better.

The efficiency of the events that followed totally impressed me. The nurse helping me to the bed did the fastest history on me I’ve ever heard, all while hooking me up to a BP cuff and a pulse oximeter. Did I have allergies? (Nope.) Did I  have diabetes? (Nope.) When was the last time I ate? (That morning). Any other medical conditions that I’m being treated for? (Nope.) Any family history of cardiac conditions? (Nope.)

The attending who was with me when I initially felt lightheaded came in at that point and asked, “Has this happened to you before?” and when I told her about the C-section, joked, “ObGyn probably isn’t your favorite thing, huh?” She then laid out the plan for what would happen next: an EKG, a glucose stick, and a blood test, to check for cardiac abnormalities, low blood sugar, and anemia, respectively. Within 30 minutes, all three of these had been done, and I even got a bonus ultrasound thrown in by someone who was practicing recognizing cardiac pathology (not that I had any). Noticing my scrubs and med student badge, this person took the time to show me each ultrasound image, pointing out the various heart chambers, valves, and the location where my IVC entered my right atrium.

By 2 PM, my tests were all back, everything was normal, and I was able to laugh about the entire situation: Somehow, I had come into the ED hoping to practice blood draws and EKGs but came out having them done to me instead. Just another day in the life of a med student.

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by zoomar

 

Behavioral Science, Global Health, Neuroscience, Stanford News

Stanford Rhodes Scholar heading to Oxford to study ways “the brain can go awry”

Stanford Rhodes Scholar heading to Oxford to study ways "the brain can go awry"

10515175_10152524157302002_5878205180193467577_o-001Undergraduate Emily Witt is one of two Stanford students selected to receive the prestigious Rhodes Scholarship to study abroad at Oxford next year; an announcement was made late last month.

Witt is a human biology major with a concentration in neuropathology, and she’s minoring in psychology. Her research experience thus far spans neuroscience, psychology, autoimmune pathology, and health in the developing world; and she says she’s interested in studying “any way that the brain or the nervous system can go awry.”

Witt, who plans to attend medical school after her scholarship tenure, works in the lab of  neurologist Lawrence Steinman, MD, PhD, which seeks to understand the pathogenesis of autoimmune diseases, particularly multiple sclerosis. She’s using the lab to conduct research for her honors thesis, which focuses on the mechanisms of vitamin D in multiple sclerosis. She’s also involved with the Center for Interdisciplinary Brain Sciences Research and has participated in various studies related to autism and social cognition.

After hearing about this honor, I reached out to Witt with some questions about her work and her future plans:

How did you become interested in this field?

I’m interested in MS for two reasons. On a personal level, I have seen the devastating impact of the disease first-hand as my uncle has the progressive form of MS. Watching his condition worsen, and seeing the impact it has had on his life and the life of my aunt and cousins, inspired me to research this horrible disorder.

On an intellectual level, I’m fascinated by the interaction between the immune system and the brain. I believe it’s an incredibly important area of research as the immune system is a contributing factor to numerous neurological diseases, from multiple sclerosis and autism to depression.

What makes Oxford a particularly appealing place for you to study? Who or what do you hope to work with there?

I’m interested in working with two neuroscientists who are experimental psychologists; they’re actually bridging the gap between experimental psychology and neuroscience, which are the two degrees I’m hoping to pursue while at Oxford. One is Elaine Fox, who researches cognitive biases, and the other is Catherine Harmer, [who studies the] pharmacological aspects of depression and how they affect cognitive biases, particularly with respect to depression and anxiety.

Are you interested in contextual understandings of disease or degeneration – its social roots? How does interdisciplinary work fit into your imagining of what you’re doing and would like to do?

That’s what my primary motivation going forward is: kind of connecting what I see in everyday life and how neurological [diseases] manifest and what I understand about them biologically. So what I’m really interested in is combining a fundamental understanding of psychology with clinical applications of neuroscience… Because I do think that… there’s still a wide gap between studying the brain on a molecular and cellular level, and studying it on a behavioral level.

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Cancer

How I’ve survived survivor’s guilt

How I've survived survivor’s guilt

We’ve partnered with Inspire, a company that builds and manages online support communities for patients and caregivers, to launch a patient-focused series here on Scope. Once a month, patients affected by serious and often rare diseases share their unique stories; this month’s column comes from Hope Aguilar.

When I was in my second month of treatment for late-stage ovarian cancer I read a friend’s post on Facebook about her friend passing away from cancer after just six weeks of being diagnosed. I was so sad about this news and about the fact that I had made it past six weeks and she hadn’t. Then when I was a few months out from finishing chemotherapy and back to teaching in Saudi Arabia, I found out that the woman who helped me when I was just starting treatment had passed from her five-year battle with ovarian cancer. I was again saddened, but even more so than before. This woman was just fifty years old and had a husband and children – she had so much life ahead of her. And that’s when survivor’s guilt first truly hit me.

I didn’t know that “survivor’s guilt” was the name of what I was feeling. I just knew that a part of me was torn. Torn between being so very grateful that I had made it (even though it hadn’t been very long) and anguished over knowing that I still here and this woman wasn’t. I did my best to not let the guilt bring me down too much: I kept moving forward, living each day to the fullest, and staying positive through all the post-chemotherapy problems I had. But every once in awhile I would get that feeling of sorrow from the guilt that I survived and that so many others didn’t. I would read article after article about men, women, and/or children who lost their battle, and I would start to ask “why?” even more. Why them and not me?

I had no significant other in my life. I had no children who needed me. “So, why am I still here?” is what I would ask and think about. If I thought too long about it I would start to cry, and as I cried I would call out to God and ask Him why. The answer that I believe God gave me was that that even though I didn’t have a significant other and children, I had people who loved me and needed me in their lives. And I still had some purpose here on Earth.

Did survivor’s guilt go away? No, and I don’t think it ever will – not completely. That said, something feels different each time that guilt pops up now. I don’t dwell on it. I remember those who love me. I think about all the ovarian-cancer awareness advocating I have done and will continue to do. I share my story in the hopes that other women will listen to their bodies thereby getting them to go to the doctor sooner rather than later. I share my story in the hopes that other survivors will share their stories too. Because when more people share their stories, more awareness will take place. And awareness is knowledge and knowledge is power.

For me, the way to survive survivor’s guilt is to live a life of purpose. To do more with giving back. And to remember that survivor’s guilt can rule you or you can rule it.  I’ve chosen to rule it. I know it will come and it will go, but it doesn’t have to stay. Not unless I let it. And I don’t, I won’t.

Hope Aguilar is a teacher of the English language in Saudi Arabia, and the author of  the book “HOPE through Cancer.” The native Texan is also a veteran of the U.S. Navy and Army. She loves to advocate for ovarian cancer awareness, travel, write, jog, and spend time with friends and family.

Cancer, Clinical Trials, Events, Stanford News, Women's Health

Country music stars thank Under One Umbrella for supporting Stanford Women’s Cancer Center

Country music stars thank Under One Umbrella for supporting Stanford Women's Cancer Center

7856258414_163d347129_zCombatting cancer isn’t cheap. It takes an innovative team with access to top equipment and support. A team that can provide compassionate care while developing new therapies and scouring through detailed data to uncover unknown aspects of the disease.

At the Stanford’s Women’s Cancer Center, that’s where the Under One Umbrella movement comes in. Now in its sixth year, this group has raised more than $23 million for projects benefitting women with cancer. That money pays for leading doctors and researchers, drug and clinical trials, improved facilities, new treatments, tools and more.

“Your generosity is palpable,” Mark Pegram, MD, director of the Stanford Breast Cancer Oncology Program, told the several hundred donors who gathered at Sharon Heights Golf & Country Club in Palo Alto for the group’s annual luncheon earlier this week. Researchers are making molecular “portraits” of breast cancer to determine which patients would benefit from chemotherapy, he said. They’re testing a treatment that “packs all the punch of chemo, but with no chemo side effects.”

Due to a gift from Sonoma County winery Chateau St. Jean, all of the proceeds from the luncheon were used to support the programs, according to Lisa Schatz, former chair of the steering committee.

During the event, organizers screened a video tribute to Gwen Yearwood, a former patient of the Stanford Women’s Cancer Center, featuring her daughters — singer Trisha Yearwood and Beth Bernard. Then, out came Yearwood and her husband, Garth Brooks to serenade the attendees. “Our family is so grateful,” Yearwood said. “We’re an example of the many families who have benefited from (Stanford) care.”

In appreciation of their service, each donor left the luncheon with a pink umbrella, which came in handy as the Bay Area received much-needed rain in the following days.

Additional information about the group is available on its Facebook page.

Previously: Stanford Women’s Cancer Center: Peace of mind and advanced care under one umbrella, At Stanford event, cancer advocate Susan Love talks about  ”a future with no breast cancer” and Don’t hide from breast cancer — facing it early is key 
Photo by 55Laney69

Parenting, Pediatrics, Pregnancy, Technology, Women's Health

Stanford alumni aim to redesign the breast pump

Stanford alumni aim to redesign the breast pump

2014-11-21 15.02.36

Three Stanford graduates have an idea that could dramatically impact the daily life of active breastfeeding women: They plan to design and build a breast pump that is discreet, intuitive, and supportive of mothers. This may sound obvious, but nothing like it currently exists. In August of this year, Cara Delzer, MBA; Gabrielle Guthrie, MFA; and Santhi Analytis, PhD, founded Moxxly, “a consumer products company designing for women.” They’re in the final stretch of their 16-week incubation with Highway 1, which helps hardware startups move from a concept to a prototype ready for production.

“We’ve talked to women, hundreds of women, who have told us things like ‘pumping makes me feel like a cow,’” shares Delzer, Moxxly’s CEO, who I interviewed in late November. So she and her colleagues are aiming to re-imagine the pumping experience.

Delzer experienced the current, poorly-imagined pumps firsthand after the recent birth of her child: “I just remember watching my husband take piece after piece out of the pump box for the first time thinking, how in the world am I going to put this together? All those pieces, and clean them? I was already overwhelmed as a new mom, but completely overwhelmed by the pump.” Once she went back to work, she found that she was spending 25 percent of her day dealing with the logistics of pumping – mentally integrating it into her schedule, worrying about having all the parts. The experience is similar for many of today’s busy, mobile moms.

Meanwhile, Guthrie was at Stanford developing her passion for designing for women, Delzer recounts. “A lot of things that have been designed for women and girls in the past have followed this ‘shrink it and pink it’ trope where you literally make it smaller and bright pink and think, ‘Oh, now the girls will buy it.’ Well, Gabrielle doesn’t buy it.” For her masters’ thesis, Guthrie interviewed working moms, and the breast pump kept coming up as something that needed to be redesigned. She spent much of her last year at Stanford working on just that. At a hackathon, she and Analytis worked together to put the new designs into practice, and Analytis, whose PhD is in mechanical engineering, was hooked on solving this problem as well.

The three women “got together, looked one another in the eyes and said, ‘Do we believe this is a problem? Do we believe we can solve it? Do we believe the time is now?’ And it was yes, yes, yes,” said Delzer. They took on the challenge despite the fact that the breast pump is an FDA-regulated medical device and they will face a lengthy review process. They invented the name “Moxxly” with the intent of conveying spunkiness and strength, and incorporated XX to signify women.

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Grand Roundup

Grand Roundup: Top posts for week of Nov. 30

Grand Roundup: Top posts for week of Nov. 30

The five most-read stories this week on Scope were:

Why I screamed when my boyfriend hugged me: In the latest installment of our SMS Unplugged series, a second-year medical student reflects on her own prejudices and calls for people to admit their imperfections and “to challenge ourselves to be better.”

Stanford bioengineer develops a 50-cent paper microscopeManu Prakash, PhD, assistant professor of bioengineering, has developed an ultra-low-cost paper microscope to aid disease diagnosis in developing regions. The device is further described in a technical paper.

Stanford-led study suggests changes to brain scanning guidelines for preemies: For a just-published study, a group of researchers at Stanford and elsewhere examined what type and timing of brain scans give doctors the greatest ability to predict preemies’ neurodevelopmental outcomes in toddlerhood.

A doctor’s attire – what works best?: A recent article in The Atlantic focused on physicians’ clothing and highlighted the subtle effects a doctor’s dress may have on patients.

How one mom learned the importance of the flu shot – the hard way: In this first-person piece, a mom discusses her daughters’ experience with influenza and shares how it served as a reminder to not become complacent about disease and illness prevention.

And still going strong – the most popular post from the past:

What are the consequences of sleep deprivation?: Brandon Peters, MD, an adjunct clinical faculty member at the Stanford Center for Sleep Sciences and Medicine, explains how lack of sleep can negatively affect a person’s well-being in this Huffington Post piece.

Scope Announcements

Scope is taking a break on Friday

Scope is taking a break on Friday

We’re doing some routine maintenance on the blog, and we won’t be publishing on Friday. We’ll resume our normal publishing schedule on Monday.

Happy Weekend!

Global Health, Infectious Disease, Microbiology, Public Health, Videos

‘Tis the season for norovirus

'Tis the season for norovirus

The week before Thanksgiving, some kind of stomach bug, which I suspect was norovirus, spread like wildfire among my daughter’s daycare. Several of her classmates became sick and like dominos so did the parents, including us.

So I was more than sympathetic when I came across this video by John Green (of the vlogbrothers fame and author of “The Fault in Our Stars”) about his family’s Thanksgiving troubles with a norovirus infection that seems to have left no GI system untouched in their household.

Winter, from about November to April, is prime norovirus season. The treacherous illness, which as Green says “has amazing superpowers,” spreads when you come into contact with feces or vomit of an infected person. It can take less than a pinhead of virus particles to make this happen. Unlike other viruses, it can live on surfaces for surprising long periods, which is how a reusable grocery bag caused an outbreak among a girls soccer team in 2012. Plus, an infected person can continue to shed the virus for about three or four days after recovering. It’s possible to disinfect after an infection, but it’s a pretty intense job.

Given these characteristics it’s not surprising that this tiny virus (even by virus standards) causes about 20 million illnesses each year. Although for most people it’s a mild illness, for the very young,  old or those with compromised immune systems—it can be severe. About 56,000-71,000 people are hospitalized and 570-800 die from norovirus infections.

The situation is worse in developing countries, where, as Green points out, rehydration therapy is harder to come by for the most vulnerable. About 200,000 deaths are caused by norovirus infections in poor parts of the world.

In his typical funny and thoughtful style, Green talks about what lack of simple—and cheap—rehydration therapy means for many on our planet. It’s one more thing that it’s easy to take for granted, and one more thing to be thankful for.

Previously: Stanford pediatrician and others urge people to shun raw milk and products and Science weighs in on food safety and the three-second rule

Cancer, Mental Health, Research, Women's Health

Women with mental illness less likely to be screened for breast cancer

Women with mental illness less likely to be screened for breast cancer

Previous research has shown that women are up to 40 percent more likely to experience a mental-health condition than men. Now findings published in the British Journal of Psychiatry caution that women with depression, anxiety or other mood disorders are likely missing out on important breast-cancer screenings.

In the study, British researchers conducted a systematic review and meta-analysis and comparing rates of mammography screening between women with mental illness and those without. PsychCentral reports:

Researchers found that there were significantly reduced rates of mammography screening in women with mental illness, depression, and severe mental illness such as schizophrenia.

The effect was not present in women with distress alone, suggesting distress was not the explanation.

“In this study, we found that mental ill health was linked with 45,000 missed screens which potentially could account for 90 avoidable deaths per annum in the UK alone. Clearly patients with mental illness should receive care that is at least comparable with care given to the general population. Every effort should be made to educate and support women with mental illness called for screening,” [said Alex Mitchell, MD, who led the study.]

Previously: A new way of reaching women who need mammograms, Despite genetic advances, detection still key in breast cancer, Medicine X explores the relationship between mental and physical health: “I don’t usually talk about this”Examining link between bipolar disorder, early death and Examining the connection between mental and physical health

Infectious Disease, Parenting, Pediatrics, Public Health

How one mom learned the importance of the flu shot – the hard way

How one mom learned the importance of the flu shot - the hard way

tamiflu‘Wow, I’m a pathetic sight,’ I thought as I stepped out of the bright fluorescent light onto the rainy pavement, fumbling with my half-open umbrella and crying. I was coming from Walgreens, clutching on to a crisp white paper bag containing Tamiflu and bottles of Children’s Tylenol (cherry and grape) and re-playing in my head the comments a pharmacist had just made to me. “Did they not get their flu shots?” she had asked, not unkindly, as she packaged up my loot. “Is that why your kids got sick?” Hence my (guilty and big) tears.

My two girls – ages eight and five – had indeed not gotten their flu shot. I had meant to take them in – I’m a super-organized mama who usually follows doctors’ orders to a tee, the type who carefully monitored and recorded the contents of her newborns’ diapers for weeks and who typically schedules well-child exams as close to her kids’ actual birthday as possible. And yet time slipped away from me this fall, I hadn’t taken them in (no excuses – just life), and earlier that day my oldest had tested positive for a particularly nasty type of Influenza A. Hours later we were called by the girls’ school: The little one was now sick with a high fever (and likely the flu). The doctor suggested we start her on Tamiflu, too, and hope for the best.

My guilt, as I watched my kindergartener later cry out in pain (when my husband asked what she wanted for Hanukkah, in an effort to get her mind off her sickness, she moaned, “I just want to feel better”), was practically all-consuming. How could we have not taken them in? I kept asking myself. I go every year, and I always follow the pediatrician’s recommendations about vaccines. I believe in the importance of vaccines. So what was I thinking?

Later that evening, after the kids (following much negotiation and crying) agreed to take their “yucky”-tasting Tamiflu and had finally gotten to sleep, I took to Facebook, where friends and acquaintances sweetly tried to cheer me up and came to my defense. The girls might have gotten sick even if they had gotten a flu shot, some suggested. (Although: This year’s vaccine offers protection from this particular strain.) They could have had a reaction from the shot itself, someone pointed out. (Yet: My kids have never experienced side-effects from being vaccinated.) The pharmacist was just trying to fill a quota for flu shots or make you feel bad, one old college friend suggested. (But: The pharmacist actually wasn’t being pushy or judgmental with her question; she seemed more curious than anything.)

The bottom line is that I messed up and didn’t come through in protecting my kids this time around. It was a hard pill to swallow. But what comforted me in the end was the thought that my daughters’ illness is temporary and in the grand scheme of things, not all that bad. I am blessed for my children’s overall good health (I know many parents have to face far, far worse things than the flu), and I am blessed to have the resources that enable us to see a good doctor and purchase not-inexpensive antivirals.

The experience, also, reminded me of some valuable lessons. A parent – or anyone, really – should never take good health for granted. And one should never become complacent about disease and illness prevention.

I’m fairly confident this is the last year my girls will ever go without a flu shot.

Previously: Side effects of childhood vaccines are extremely rare, new study finds, The earlier the better: Study makes vaccination recommendations for next flu pandemic, Working to create a universal flu vaccine, Ask Stanford Med: Answers to your questions about seasonal influenza and European experts debunk six myths about flu shot
Photo by kanonn

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