Category Archives: Doctorhood Quest

Waiting Impatiently

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The gray of New England spring hung low as I traveled home from the airport. In short time, March would deliver the snow-rain I know the month for in the region where I grew up. I learned that the cold and gray, which can span 9 months out of the year here, was not for me when I left New England the first time. I stayed away for almost a decade until a desire deeper than my love of sun brought back to the state my parents chose for us so long ago, Vermont. I wanted to become a doctor. Medical school takes a forest of strong trees by your side – it takes a lot of willpower on your part coupled with family and friends to complete. Something made me pause when my medical school acceptances gave me the option to leave New England again. I didn’t leave then, choosing to stay close to my parents, my siblings, and my new Vermont friends. My compromise was a plan to move to southern New England, Connecticut, for the second half of medical school because my school had a clinical campus there and it suited me better than their Vermont campus.

I think the choice to stay close to family worked. As I write this, I’m waiting impatiently because in a few long days I learn where I’m headed for residency and, unless I’m gravely mistaken, I’ll leave New England once again. As a side adventure during the Doctorhood Quest, I scooped up a New England-grown husband. I often wonder if understanding the winters here is an important thing he and I have in common or if it’s just everything else that makes us a good match. I’ve also gotten to see my parents and sister more during medical school than in the almost decade leading up to it. I have good friends who saw me through the worst days as a medical student. I’ve come to call my Connecticut town home, even if the designation is fleeting.

This March’s late rain and snow squall isn’t unique to this region at this time of year – though it would seem other places where snow is unusual are getting slammed, weather patterns are becoming more and more confusing as climate change forges on. And while my roots are familiar with the snow and the cold, a few days ago I returned from 7 weeks in Puerto Rico so the coldness and gray is particularly unpleasant this week. It stands out to me how miserable March is here as I look out my window over my flowering orchids and assorted houseplants, many of which grow as weeds in Puerto Rico. It was at the ripe age of 18 that I learned how much I love the sun and living in sunny places even though I require sunblock, shade trees, hats, and other sun protection to enjoy the sun without turning into a lobster.

On Monday this week, I and many medical students across the country found out we matched into residency. And now, in a typical medical school approach of drawing things out longer than is reasonable and with no efficiency and minimal logic, we are all waiting until Friday until we learn the magic WHERE we matched. The day we learn where we will go for residency is called Match Day. Transitioning from medical school to residency is a boring process that makes little sense, so don’t ask about it. Just know that this week is moving at half the speed of any other week these past 4 years and that my excitement for Friday’s discovery is exploding. My excitement even makes the cold and gray outside acceptable though not welcome. Residency is the next and the last phase of the Doctorhood Quest before I am a doctor. I could, of course, continue onto fellowship after residency but that would be to further specialize. Residency will give me the skills needed to practice as an independent generalist in internal medicine (in my case, those pursuing other medical paths might finish residency as surgeons, psychiatrists, or neurologists to name a few areas of medicine that can start after residency).

I’m excited for what’s to come. I made a picture frame for taking pictures at my Match Day party with “Adventure Awaits!!!” written on it. Perhaps you get the Up reference. The picture frame is a party feature that’s a throwback to my Paraguay days. Paraguayans know how to throw a good party. At my Match Day party, there will be an ice cream cake, food, a banner, and streamers. And, of course, I’ll celebrate with my family. I’ve been working towards this day, the day I get into residency, for 10 years. It’s hard to believe I’m here, but it feels real. I can’t wait for it to be Friday, March 17 aka Match Day 2023.

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I Don’t Think That Thought Process Means What You Think It Means*

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One day on rounds (the time when physicians, residents, and students discuss the day’s plan for each patient they’re caring for) I commented on a patient’s amazing carpenter veins (colloquial term for veins on the back of the forearm which tend to be prominent in people who work with their hands). Having once put in IVs for a living, it’s hard to shake my deep appreciation for a good vein when I see one. The physician leading the team and a resident both stopped and asked, “What do you know about carpenters?” They asked this as if I couldn’t possibly know anything about people who are carpenters. It was a joking question which is common in medicine when calling out someone’s knowledge gap.

I was completely dumbstruck by their assertion that I couldn’t have interacted with many carpenters in my life. After a long pause, I mumbled something about having put in IVs as part of my work before medical school where I had many carpenter patients with these veins. I was confused because sometimes I forgot that many people assume all med students have no experience outside of university classrooms and have doctor parents, or at least white-collar parents. If I had been less taken aback, I would have told them I know a lot about carpenters in a happy, matter-of-fact tone.

My father is a carpenter. My stepfather and mother don’t call themselves carpenters but they both do a lot of carpentry as part of their regular lives and as part of their work. I, myself, have helped build houses, furniture, and theater sets. In fact, one of the more memorable childhood photos of me depicts an elementary-aged me hammering a bolt into some floor beams. In double fact, my first work was in carpentry helping my parents build our house and working on paid building projects. Which is to say, short of being a carpenter, I feel confident calling myself an expert in what the life of a carpenter is like (without even mentioning all the carpenters I’ve cared for as patients since I started working in healthcare as an EMT years before medical school).

As humans we make many assumptions because it helps us organize the world – for better or for worse. Physicians are trained to come to quick conclusions and identify disease patterns almost as quickly as their patients decide if they like their new doctor or not. This is why your doctor will often only ask four questions before they decide how to investigate your knee pain – their experience has taught them how best to understand medical situations and make a strategy for those situations in a 15-minute appointment. Obviously, there are many medical situations where more than 4 questions are needed, but I say this as an example of how physicians are trained to make even more assumptions than the average person already does.

Often, the assumptions physicians make about medical symptoms are helpful because they lead to quick recognition of life-threatening medical conditions so they can be addressed in time to save someone’s life or allow the physician to develop a reasonable method for exploring the situation further in the confines of an overburdened, short-for-time system like the US medical system. But, as we all hopefully know, assumptions are dangerous when they come to making conclusions about whole persons. Note the difference between assumptions about symptoms versus about people. It’s assumptions about people that lead to biases.

It’s assumptions that play a role in the dark side of healthcare – like black people having their pain undertreated or receiving inferior medical treatment and transpeople receiving poor medical care (Google these if you want to know more, there’s plenty of data. There are also numerous other examples of disparities in health stemming from biases and assumptions about people).

Now, the assumption that I, a medical student, hadn’t interacted with carpenters before was erroneous on the part of my supervising physician and resident, but it doesn’t compare to disparities in care secondary to biases and assumptions. I brought those up in the previous paragraph to illustrate some of the ways assumptions infiltrate medicine beyond what I experienced and beyond their helpfulness in identifying diseases quickly.

What my situation does show is that the mental picture that many people in the US (including physicians themselves) have of who US doctors are is a bit out-of-date. There was a time when almost all doctors were white men, and many were from doctor families. And, today, the percentage of white male physicians is still greater than the percentage of white males in the population. And, separate category, there are still many medical students who have doctor parents or white-collar parents. Yet, while this is true, it is also true that things have changed a lot in medicine.

Today, there are more women than men enrolled in US medical schools. There is also a growing contingency of doctors and medical students who aren’t Caucasian (check out this article). There is also a growing percentage of medical students who will be the first doctors in their families (check out this article and this data)

There was a time when most physicians became physicians without ever leaving school – they’d pass from high school to college to medical school to residency. Today, the average age of people starting medical school is 24, which means that they took 1-2 years off from school somewhere along the pipeline. And that’s the average, meaning a significant portion of people starting medical school are older than 24; people like me, I was 29.

All this is to say that who medical students are now is different from what most of our older patients and seasoned physicians have seen most of their lives. For example, as the carpenter story suggests, my teaching physicians thought I was naiver than I am and had a different background than I do. As a different example, as a female medical student my older patients (mostly the men) think I’m a nurse. I find this particularly ironic and amusing because my husband is a nurse; he has no interest in being a doctor and he is a far better nurse than I ever would or could be given my nature.

Looking at the modern world of medicine and the medical world we want for our future, it’s time to check our assumptions about medical students and reevaluate who they are because their backgrounds may surprise you. And to disclose one of my biases, I think the diversifying of the physician force is awesome and, perhaps more doomsday, the only way we’ll solve many of the medical profession’s problems.

*Attempted The Princess Bride reference, not sorry because Inigo Montoya summarizes my thoughts more often than I would like to admit

Remembering

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I don’t remember them because their case was sad, though it was. Nor do I remember them because their case was complex or unique. I remember them because they were a DJ even though they were well beyond middle age. Who knew you could be a DJ when you were that old? Well, I learned after meeting them that you could be.

I learned of their DJ career when I met them briefly after their first stroke. The stroke was thrombotic (caused by a clot that blocked a blood vessel in the brain). Their balance was severely affected, but they were doing well, despite the stroke. There was no way to predict if they’d get their coordination back, but there was hope that they would recover if they made it past the first couple of days after their first stroke without another stroke. There’s the highest risk of another stroke in the days following a stroke.

When I saw them days later, they were not well. Their stroke had converted from thrombotic to hemorrhagic (caused by bleeding in the brain) and they could no longer speak, had limited movement, and were unaware of the world. I was struck by their deterioration. Lost in my reflection on how much the patient had changed and who they were before their brain filled with blood, I included the fact that they were a DJ in my report to the physician supervising me. I think the physician was looking for a focused medical history, but I slipped in the patient’s profession anyway. The physician teaching me paused and then said, “It’s good to get to know something about your patients as people.” It was the physician’s way of giving me positive feedback, but I found myself thinking, that would seem to go without saying.

As I continue my training, I’ve come to understand why this physician pointed out the importance of knowing patients as people: It’s easy to only ask questions related to diagnosis when you’re crunched for time and are actively thinking about what next tests, exams, medications, and treatments you should do to help the patient with their medical concern. Which is to say, the more responsibilities I have as an aspiring physician, the harder it becomes to emphasize getting to know patients beyond their medical conditions.

And, yet, when I do and can learn a tidbit about people’s lives (pets, careers, grandchildren, or whatever they bring up about their life), I’m always grateful I did. Grateful because it helps me remember each patient’s story and because it reminds me why I do medicine in the first place – to help people.

Medicine is awesome because uncovering diseases and making treatment plans involves solving complex puzzles. But the coolness of solving medical challenges is not enough to get me through all the terrible aspects of working in healthcare. My patients do keep me coming back even after the worst days on the job. Even though our interactions are brief, my patients and I have the potential to learn and achieve so much together. And, without a doubt, every patient is a person with an amazing story that I’m excited to hear a tiny bit about.

The “seasoned” DJ will never be a DJ again. This makes me even more glad that my last memory of them included them as a DJ, not just an ICU (intensive care unit) patient with a likely life-ending stroke. I think they’d have preferred to be remembered as a DJ (something they were very proud of) rather than a sick person. I know, if I were dying in the hospital, I’d want the last people to see me to know something about who I had been before I got sick.

Back In the Operating Room

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The patient was undergoing emergency surgery for an aortic dissection (when blood gets between the layers of an artery wall) with an aneurysm (dilation/ballooning out). The aorta is the largest artery in the body. It comes off the top of the heart and then travels through the chest and abdomen until it splits into two big arteries that feed the legs. It has many branches along its path. Because this patient’s dissection and aneurysm were close to their heart, without surgery the dissection could spread and damage their heart. Further, if the aneurysm wasn’t fixed and then ruptured, the patient would likely bleed to death.

Conducting this surgery was one surgeon and one physician’s assistant (PA); they were supported by an anesthesiologist, a resident anesthesiologist, 3-5 nurses, and 1-3 surgical techs. Surgeries are always a team effort. This surgery was complicated, the stakes were high, and bad outcomes were more likely than for many other surgeries (but without surgery death was almost certain). For the first 6 or so hours of the surgery the surgeon and PA worked without a break – no water, no bathroom, and no food. After the most time-sensitive part of the surgery was done, the surgeon sipped some water through a straw that a nurse carefully threaded behind his mask. The nurse joked that he was like a gerbil – no one argued with that analogy.

In all, the surgery would take about 11 hours. As the surgeon was finishing up his work, he looked around the room and thanked each person there for their help. He then looked up at me. I’d been watching the surgery for the better part of 8 hours. “What are you? A resident?” the surgeon asked.

“No, a medical student,” I said.

“God bless you,” the surgeon said. He paused. “My son is a third-year resident. I tell him to remember that you’re not supposed to enjoy residency.” The surgeon paused again. “But I still say I would never have wanted to do anything else.”

This surgeon had started working as a surgeon at this hospital when I was 8 years old. Assuming he’d done about 8 years of training to become a cardiothoracic surgeon and that he’d spent his entire career at this one hospital, he’d been operating about as long as I’d been alive.

I reflected on his sense of fulfilment in being a surgeon. I wondered if I’d end up liking my path in medicine as much as he liked his. I wondered if it was possible to enjoy one’s path in medicine as much these days as it was when he started.

~

Medicine has changed a lot in the 30+ years I’ve been alive. We’ve made lots of amazing advancements, but health disparities remain staggering. Work conditions are variable hospital to hospital and clinic to clinic. I love medicine, but I can’t ignore how strained our healthcare system was before the COVID pandemic and how much worse it has become even after the COVID vaccine reached the US public. I also know that my path in medicine will be quite different than that of a surgeon.

I am pursuing a medical career that does not involve surgery or procedures and, therefore, is not a hospital money-maker in our current healthcare system. Money gives power even in healthcare, as such, I’ll neither have the high pay nor inherent influence on hospital administration that surgeons do. All physician roles have amazing components and are important for patient care however to say each physician’s place in the system is the same is not simplification, it’s erroneous. I’ve come to feel the differences between physician types more thoroughly as each new step of my doctorhood quest unfolds.

As I wrap up my time as a medical student, I’ve been reflecting on what I’ve learned and seen in healthcare so far and where I want to end up as a physician. As a student, I’ve seen more parts of the patient care system than I will in any other capacity during the doctorhood quest. I’ve participated in countless conversations throughout the inpatient and outpatient healthcare settings. I’ve been a fly on the wall for even more conversations than I’ve participated in. From insurance navigation nightmares to cool medical cases, from nurse-to-patient ratios to supply chain issues I’ve come to understand that healthcare is a complex group sport where the field and rules change based on geographic location (because of geography itself, demographic composition, and regional laws), insurance status, medical society guidelines, government funding, hospital and/or clinic revenue generation, supply chains, ability to hire healthcare professionals, and many other factors.

I start residency in about 6 months. At that point, I’ll continue to learn what I need to know to be an independent physician. After 3 years, I could graduate residency to work as a hospitalist or primary care physician or I could continue my training to further specialize. I’m excited and hopeful about these rapidly approaching adventures. I wonder what I’ll tell a medical student about my journey 30 years from now. I dream that my message will be as positive as this surgeon’s message was to me.

Heartbroken

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Tears fell down their cheeks. There was a long pause. “My heart broke and I’m just having trouble processing that,” the patient said. They’d been hospitalized for a heart attack several months earlier. I was seeing them at a primary care visit long after discharge. On paper they were recovering well, but they didn’t feel that way. They felt broken.

This interaction resurfaces in my mind periodically because it shows a side of illness that isn’t often seen in the hospital (where I’ve spent most of my time training). This patient had experienced an acute illness (heart injury). They had recovered their functionality. By medical definitions, they were a success story. Yet, they were miserable. How could that be?

In medicine we organize diseases into buckets with specific treatments and endpoints related to the organs affected by each disease. For example, this patient had a disease of the heart which might include endpoints like their ability to tolerate exercise or their heart rhythm. These endpoints are a simplicity required to synthesize something as complex as the human organism. However, as this story shows, looking at only specific endpoints can lead to missing things related to the illness that aren’t listed as clear endpoints to track. In the case of this patient, the heart is connected to the brain which is an organ of personality, mood, and feelings (among other things). While the functionality of this patient’s heart met all medical endpoints, their mood/feelings were severely affected by the experience of surviving a heart injury.

This patient’s experience reminds me that the diagnoses we make and interventions we do have lasting impacts on patients. Remembering this motivates me to provide information and support that I think will empower patients in their processing of what happened to them while they were hospitalized. I often wonder what conversations this heartbroken patient had with their care team while they were in the hospital recovering from their heart attack. Was there anything that their care team could have done differently to lessen the patient’s distress after discharge or was the patient’s feeling of heartbrokenness inevitable? I’ll never know the answer.

With this patient’s experience in mind, I try to ask myself if there is anything missing or left unclear before I discharge a patient. Healthcare is far from perfect (it’s quite broken actually) yet, even in a broken system, we can choose to communicate and help as best we can.

Sometimes People Step Up to Be Heroes

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The patient sat with a blanket over their head. They were a little goofy and fairly expressed their distaste of their bed and various lines (IVs, urinary catheter, etc.). I didn’t blame them for not liking the hospital; nobody wants to get sick. The patient answered many questions correctly – they knew their name and their spouse’s name – but they couldn’t tell me where they were, why they were there, or what month it was. Yet, to see them sitting there alert and able to talk with me was a miracle that I was humbled to see.

The patient’s spouse and child had saved them. The patient had a cardiac arrest (their heart stopped) after going to bed one night. Their spouse noticed, pulled them to the floor, and started chest compressions. Sometime in that whirlwind, 9-1-1 was called and their teenaged child helped the spouse do compressions. The spouse and child did compressions for 45 minutes, just the two of them, until an ambulance showed up. Once the ambulance crew arrived, the patient received a couple of shocks and then, the patient’s pulse returned.

When I started as an EMT, my first medical experience, my crew chief told me cardiac arrest is death. All we can do is try to give the person’s whose heart stopped a chance at a cat life by doing CPR to pump blood while the heart isn’t pumping, delivering shocks (if indicated) to jumpstart the heart, and giving medications that sometimes help the heart restart. 

It’s important to realize that getting a pulse back isn’t the end of cardiac arrest. After getting a pulse back the main question is whether the heart stopped so long that the brain was irreversibly damaged by lack of blood flow. The likelihood of brain damage from lack of blood increases the longer the patient remains without a pulse. 45 minutes of CPR, especially CPR by non-medical people who don’t have access to a device that can deliver a shock, is a REALLY long time.

Most people won’t wake up after 45 minutes of CPR. But this patient did. They woke up and their brain was well enough to talk and move their body. It was too early to know if they’d fully recover to the mental state they’d had before their heart stopped. However, what was obvious when they woke up was that they were mostly there. Their brain had survived 45 minutes without a pumping heart thanks to their spouse and child.

When we successfully get a pulse back after CPR and the patient doesn’t immediately wake up, usually they are sedated and put on a ventilator (breathing machine) for 72 hours. This gives their brain time to rest after not receiving good blood flow. Usually after those 72 hours of rest, we decrease their sedation (medications used to put people to sleep while on a ventilator) and see how their brain is working. This patient underwent this process of sedation and then wakening after 72 hours.

It’s impossible to know exactly what the patient’s spouse and child felt as they waited those 72 hours to see if their loved one would wake up. What I can say from seeing them sitting at the patient’s bedside and sleeping in the hospital waiting room, is that the experience changed them. Once the patient woke up, the stress floating away from their family members was almost tangible. The spouse and child had saved the patient’s life; they had stepped up when the powers that be asked them to step up. They had given the patient a second chance at life. They were, by all definitions I know, heroes.

Listening in Medicine

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This patient was always cheerful. Despite approaching a month in the hospital. Despite extensive injuries for which they required multiple procedures, surgeries, and a long course of antibiotics. Every time I checked in, they had a visitor, were listening to mass, or were simply doing life things.

One day when I stopped in, the patient was different. Still as pleasant as ever, but their cheer was guarded. I noticed that their voice was heavier. That their eyes were drooping at the edges. Their smile seemed more effortful. “Is everything okay? Are you okay?” I asked. In the minutes I was with the patient, I asked these questions periodically. Interleaving with the normal questions about signs and symptoms and physical exams I needed to do. I’ve learned that if you create space for things that haven’t been said to be said, sometimes patients share what’s bothering them and you can do something about it.

I paused as I was preparing to leave and asked one more time if the patient was okay. They started crying. I waited. “It’s just I haven’t seen my children. I miss my children,” the patient said. I’d come to learn that they had two young children who they hadn’t seen since their admission. They video called them but, obviously, that wasn’t the same as seeing their children and giving them hugs.

Since COVID, hospital visitation policies have become more restrictive. There are reasons for these restrictions, however the unintended consequence is patient social isolation which is bad for patient mental health to put it simply. At the time when I was seeing this patient, the hospital I was in was not allowing children to enter the hospital as visitors. Rules, though, usually have exceptions. I spoke with the nursing staff, as they steward hospital floors, and they were able to arrange for the patient to see their children.

This patient interaction reminded me how listening is critical in medicine. The hospital is a difficult place to have a good conversation as patient. The hospital is confusing and foreign to most people; there are unintentional power differences that exist as medical knowledge and understanding are uncommon among those who didn’t study medicine; there are many faces with different roles in the hospital so it’s impossible to keep track of who is the right person to ask for what; and the hospital is busy and short-staffed, so healthcare workers are doing their best but they are always running behind. Given these barriers to communication, the burden falls not on the patient but on their care team to ensure that time to hear patients’ needs is made. To do this doesn’t necessitate longer patient interactions, necessarily, but it does necessitate listening for more than reports of a fever or bowel changes.

It can be hard to listen for things that don’t directly relate to changing a patient’s care plan. Yet, patients are more than carriers of disease and, therefore, to best support them in their journey to better health we in healthcare must listen to all ailments. Sometimes we can lessen a burden and sometimes we can’t. Arranging for a parent to see their children after weeks in the hospital is something we can solve easily. I was glad I was able to help this patient see their children, but I wondered how long the patient had suffered from missing their children. Perhaps, if one of us from their care team had listened more carefully earlier, the patient wouldn’t have had to wait almost a month before seeing their children. To me, it seemed unreasonable to add the burden of missing loved ones to this patient’s burden of healing from an accident that had almost killed them and injuries that would likely change their life. Being sick is hard enough; let us in healthcare not forget the human things, like social supports, that can help make healing less daunting. 

Windows to the Soul

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I looked into the eyes of a patient for brief moments when they opened their eyelids before falling asleep again. Their eyes were like wells, but there was no sparkle in them like there is in a healthy person. The patient had a bacterial infection of the blood that had attacked their heart resulting in a large vegetation (collection of bacteria and other gunk) on one of their heart valves. Pieces broke off this vegetation, traveled through the blood vessels, and seeded infected clots in the patient’s lungs and spleen. That wasn’t all though. Their body was so inflamed some of the proteins in their blood were destroyed, consumed, or their production reduced. At first, the patient needed transfusions of red blood cells and platelets to survive.

In other words, the patient was sick. They were not just sick, their chance of death within 30 days increased by 16% each day their blood had bacteria in it according to one study.1 Their chance of death was about 40% by another estimate.2 It took us about a week of antibiotics to clear the infection from the patient’s blood, but that wasn’t the end of the patient’s need for antibiotics because of their heart infection and septic clots. They would need at least 6 weeks of antibiotics and likely several procedures and surgery to fix their heart.

I looked into the patient’s eyes each day, hoping to see a sparkle there that would suggest they were awakening from the depths of illness. I hoped and yearned to meet them rather than just examine their feverishness. I was rooting for them. I root for all my patients, but this patient’s eyes were so empty I knew they needed my thoughts more than the other patients I was caring for at the time.

It would take over a week, but one day the patient’s eyes shone with the flame that I think of as the soul, that spark of life. The patient was here with me. They could tell me their name and what was going on. They were awake! How the weeks ahead would unfold could not be predicted. In medicine, we don’t have a crystal ball that tells the future any better than a meteorologist can forecast the weather 10 days out.

My rotation would end before the patient was close to healthy enough to leave the hospital. They were sleepy when I last saw them because they were recovering from their first heart procedure. I touched their shoulder briefly and looked into their eyes. They were so strong and so brave. I reminded them of this and of how much they’d healed since we met. I told them to hang in there. It wasn’t much, I knew, but it was the best I could offer as I prepared to join a different medical team.

In the hospital, we often meet people at the worst crossroads of their lives. We do our best to help them navigate to a destination of better health, but we often don’t get to see where our patients end up after we care for them. We must be comfortable with unfinished odysseys. So, to conclude my telling of this patient’s story, the last time I saw the patient with the wells for eyes, their eyes shown with the brilliance of victory. I will remember them by that brilliance.  

References:

1. Minejima E, Mai N, Bui N, et al. Defining the Breakpoint Duration of Staphylococcus aureus Bacteremia Predictive of Poor Outcomes. Clin Infect Dis. 2020;70(4):566-573. doi:10.1093/cid/ciz257

2. Kuehl R, Morata L, Boeing C, et al. Defining persistent Staphylococcus aureus bacteraemia: secondary analysis of a prospective cohort study. Lancet Infect Dis. 2020;20(12):1409-1417. doi:10.1016/S1473-3099(20)30447-3

Anticipation

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I live across from a café that is also as an event venue. The other weekend, I glanced out my window when music uncommon to my neighborhood wiggled through my window screens. My gaze fell upon empty tables perfectly spaced with little plant centerpieces, lawn games in the parking lot, a grill, and green cones outlining the event space. The event organizers meandered around arranged things, chatting, and smiling. Soon the guests would arrive; the evening would unfold. There was no predicting exactly how it would go, but everything was carefully planned with the hope that good things would come.  

I found myself amused by the scene across the street from my home. I’d seen it so many times before, not only in my personal life, but also in a past job when I was an event planner. I’d seen many physical set ups like this one and, perhaps more often, I’d experienced setups and waiting for nontangible events to unfold. The metaphor for my current state of being was obvious. My wedding will be in less than a month (the planning is done). I apply to residency programs the rest of the year (it’s a long process, please don’t ask). My soon-to-be husband is about to move to Connecticut and start his first job as a nurse. Those are the major events soon to unfold; of course, there are zillions of little events where the music is just about to start too.

Life is full of wind ups, waits, activity, clean up, and recovery on repeat. Some versions of these relentless series take more effort and planning than others. Some have more ways they could go wrong. Some events are set up and then no one shows up. Some events last longer than expected. Some events turn out better than you imagined. That’s life. Having gone through these actions over and over again, I believe waiting is the worst. Clean up is also hard, but waiting is the hardest. While my neighbors wait for the food they prepared to disappear into hungry mouths and the games they set up to spark laughter; I find myself waiting for other things that took many more moments (years actually) than cones, tables, and food to set up.

Neurocysticercosis

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Repost of a post I wrote for the Global Health Diaries, the blog of the Global Health Program at the University of Vermont Robert Larner M.D. College of Medicine and the Western Connecticut Health Network. Find the original here.

Recently, I treated a patient with neurocysticercosis. While infection with Taenia solium is not common in the US, neurocysticercosis is not a zebra in Danbury, Connecticut because many patients are originally from countries where Taenia infection is a threat. The patient I saw was young and presented after having a seizure. Though they had received their diagnosis several years earlier at another US hospital, the disease course had started long before. Initially after their diagnosis, antiseizure medications were effective. The latest seizure occurred after a series of unfortunate events caused the patient to stop the medications.

The CT scan showed speckled calcifications throughout the brain. MRI revealed several enhancing lesions convincing us there was a need for antiparasitic and steroid treatment. The patient did well after treatment initiation and was discharged home to complete their albendazole and steroid course with a plan to follow-up with neurology. Their case lingered in my mind. It lingered not because of sadness or complexity, but because it reminded me of how connected our global population is and because the patient had impressed me with their calmness.

COVID-19 has highlighted how easily communicable diseases can travel and how important the health of the global community is for the health of our local communities. And while Taenia solium is an infectious disease, it does not spread like COVID-19. My chances of infection with Taenia solium are meager while living in Danbury, CT. Yet, we have patients with neurocysticercosis because people are mobile. I find it fascinating that the mix of diseases that are the most common in a particular hospital is not only dependent on the vectors and circumstance of life in the hospital region, but also the experiences and diseases prevalent in the places from which the people who make up the community around the hospital came.

As I contemplated our connectedness, the patient impressed me with their politeness and trust. Here was a person who was sick and did not speak English, yet they had complete faith that we could help them. I found myself humbled remembering that patients rely on us, the medical community, to guide them to better health when disease strikes. The patient’s calmness spread to anyone who spoke with them. There is something impressive about patients who can impart positive feelings on those around them despite being sick. I thought about the patient’s history and all the roads they had traveled so that our paths crossed during my medical training. Mobility is an amazing feature of the human experience. It both connects and separates us.