Saturday, April 23, 2011

Lessons From The Clinic

Every time I volunteer at the free clinic where I work as a Spanish medical translator, I come away with something. (So yes, volunteering is important - it's not just something to put on your resume or med school application.) This past Thursday was no different. Two patients in particular stood out to me.

One was a very sweet middle-aged man, probably in his 50s, who was being treated for diabetes, high cholesterol, and thyroid problems (among other things). On the surface, it looked like he was incompliant with his meds - his cholesterol was still high, his A1C was still high, and in spite of 200 mcg of synthroid, his thyroid was still screwy. But as the nurse practitioner and I got further into the appointment, we came to the realization that it wasn't that he was purposely avoiding taking the medications as intended - he probably couldn't read. So while we did the normal routine - wrote out a new medication card, with all of the instructions written out as to which medication to take when, whether with food, etc. (I wrote them out in Spanish, of course) - we also went over the instructions with him verbally, multiple times, and had him repeat the instructions back to make sure that he understood everything. It reminded me that you really have to pay attention to the nuances of a patient visit, and treat the patient individually, because each person's situation is so different. That seems obvious, of course. But when you're rushing and trying to see X number of patients in a day, that can get lost. But really, it can't - because that's why I want to be a doctor.

The second patient who really made an impression on me was a younger woman, about my age. She had been dealing with depression for some time. The physician asked how her depression was, and how she had been doing on her Lexapro. Turns out that she had made some significant life changes on her own - had been attending therapy at the clinic and exercising regularly - and had been able to control her depression without the medication. You could tell she meant it, too. She smiled confidently as she talked about how things were going. Not a hint of the depression that had plagued her before. The young physician beamed as well. Not because he had come up with some fantastic and fancy drug cocktail for the patient, but because she had come up with her own way of coping with her situation, with his encouragement and help. It's not always about prescribing medications or procedures, but about working with patients to find what works for them. And when you see that progress, that woman's smile and her genuine ability to cope with her life situation, what a joy that is. That's how I felt, at least, and I was just the translator, the observer. I can't wait to be one of the participants in the whole process.

Thursday, April 21, 2011

Caffeinated E. Coli

I don't think I've ever been so excited to go to school on a Monday as I was on April 11. Yes, I was actually excited about a Monday. Because at 11:30 a.m., when I walked into my research seminar class, I was going to find out whether my E. coli bacteria had mutated in the presence of caffeine and become antibiotic resistant.

OK, that might not sound like anything worth getting worked up about. So let me back up. My classmates, professor, and I were studying antibiotic resistance in bacteria. This is a poignant research topic, given the rampant rate at which antibiotic-resistant infections such as MRSA spread in hospitals. But we weren't looking to decrease antibiotic resistance; we were looking to increase it. The goal was to learn about how mutations in DNA can allow bacteria to develop antibiotic resistance.

DNA is a sort of "language" that tells cells how to build their proteins. If that "language" is altered, even by a single letter, then the protein structure can also be altered. And that can affect an antibiotic's ability to chemically bind to a bacteria and either destroy it or prevent it from replicating.

Mutations - changes in DNA - occur naturally, at a very low rate. So that's what we looked at first. We grew cultures of bacteria in small glass tubes overnight in a shaking incubator, providing them with a liquid medium that would keep them happy, fed, and replicating. Using what's called spectrophotometry, we were able to determine the concentration of bacteria cells. In essence, we used a machine to measure the amount of light that was absorbed by a sample of the cells in a small cuvette (a fancy name for a plastic tube). Then we distributed 100 microliters (a really tiny squirt) of the cells onto petri dishes which had a jelly-like medium for the cells to grow on.

Half of the petri dishes contained an antibiotic called carbenicillin, but this wouldn't kill the bacteria, because they were engineered with a gene that gave them resistance to this specific antibiotic. These "carb" plates were our controls. They should exhibit explosive growth, but only growth of our desired bacteria - any bacteria from outside that lacked that carbenicillin-resistance gene would die. The other half of the plates contained carbenicillin plus another antibiotic called rifampicin. Rifampicin is a broad-spectrum antibiotic, meaning it kills lots of things. It is now only used to treat tuberculosis as part of a multi-drug cocktail, though, because it has a tendency to promote antibiotic resistance. (Perfect for our purposes.) The rifampicin should kill everything, with the exception of any bacteria that had mutated and developed some way of resisting its effects. Those were the colonies we were after.

We let everything grow over the weekend, and returned to find "lawn" - a very scientific term for prolific - growth on the carbenicillin plates, as we expected. We also found a handful of colonies, which looked a little like mold growing, on the rifampicin plates. Success! We scooped out the colonies, and through a series of processes, amplified and isolated one specific gene of their DNA sequence - a gene that has been implicated in mutations associated with rifampicin resistance. We then had the gene sequenced by an outside company. And sure enough, after a computer program analysis, we found DNA mutations (when compared to the "normal" E. coli gene sequence).

But it was time to take things a step further. So my professor, Dr. Kreher, asked each of us to come up with some substance - any substance - that we thought might induce additional mutations in the bacteria and increase the rifampicin-resistance rate. In other words, a substance that would cause more colonies to grow on the rifampicin plates. Everyone chose something different, from cigarettes to deodorant to caffeine (mine).  I found a number of research papers on PubMed (research article heaven) that indicated caffeine is indeed a mutagen at high concentrations. So I grew more bacteria, and then prepared a solution using water and anhydrous (powdered) caffeine, and mixed it in with the jelly-like medium that goes into the plastic petri dishes. I used two concentrations of caffeine to see whether there was a difference related to dose. When all was said and done, I had 48 dishes to plate. Being a rather novice microbiologist, it took me the better part of my Friday afternoon to squirt all those cells onto the plates and spread them around. But I got it done, and Dr. Kreher and I loaded the plates into an incubator.

Come Monday, all 48 plates were stacked up at my lab bench. I started combing through them, looking for colonies ... and found only two. Far fewer colonies than we had found without using caffeine, meaning I had a very low resistance rate. But I found something else interesting: the higher concentration of caffeine actually killed most of the bacteria on my control plates (the carbenicillin plates) - which should have had that "lawn" growth. So our bacteria definitely did not like caffeine.

I'm still working out my specific conclusions from the experiment. And while I know those are important, what I found even more valuable was just the whole process - this was the first experiment I had really designed and carried out on my own. I wouldn't have known the first place to begin on such a thing when I started out the semester. I have come a long way as a ... scientist.

(Scientist: I'm trying that word on to see how it fits, and I like it.)

Oh, and a note for you coffee drinkers (of whom I am one): have no fear. The caffeine in coffee (or soda) will not cause your cells to mutate. The concentrations of caffeine studied in the papers I read would require a person to drink more than 100 cups of coffee, basically at once, which one author noted would be toxic. So you can have your coffee and drink it too.

Saturday, April 9, 2011

When Constants Change

There are few things in life that are constants. Except, perhaps as they say, death and taxes (and in today's world, I would argue, Internet spam). That said, as humans, I think we expect certain things to remain in our lives for the long haul, especially relationships. I know that is true of me, at least.

But I have been jolted into the awareness that this expectation is not necessarily true: The relationship I expected to be most constant - my marriage - is ending. Because my husband wants a divorce. (I still cringe when I hear that word ...)

As it is in all such situations, this one is complicated. Parts of it I understand, parts of it I don't. What I do understand is that in a short time, I will be living on my own again - something I haven't done in seven years, since we bought the house where we currently live. Not only that, I will not have the emotional support of this relationship, this person, who has been by my side for the last decade. Both of those thoughts are terrifying.

Several of my friends have asked how I am making it through this difficult situation, which is made all the  more awkward by virtue of the fact that my soon-to-be-ex-husband and I are still living in the same house due to financial constraints. I am not a religious person, but I very much believe in the sentiment of the Serenity Prayer, in a secular sense:

God grant me the serenity to accept the things I cannot change, 
Courage to change the things I can,
And wisdom to know the difference.

I think about this both in terms of change, and in terms of control. There are many things I cannot change/control right now: I cannot change the fact that I am about to get a divorce. Trying would be fruitless, and would waste time and effort that would be better spent on other things. I can, however, change/control other things: I can change my own attitude. I can control my school situation, how much I study, whether I continue to do well or whether I let this derail me. The key is the "wisdom to know the difference." And then once discernment has been made, taking effective action. Which both yields progress, and also actually helps me feel better emotionally as well, because I am taking my situation into my own hands.

I recently wrote a post about coping with stress; I am putting into action many of the strategies I outlined there, because this is indeed a very stressful situation.

I am also trying to look toward the future instead of ruminating on the past: what I will do with my new apartment, which courses I want to take next year, which medical schools I want to apply to, which medical fields interest me, and so on. I do this not to negate the past, but to give myself hope that I do have a future, that this is not in any way the end of my life. Things change. This is one of those changes. And I must cope with it the best I can.

Another strategy is doing my best to do things that make me feel happy. That doesn't mean dropping $1,000 on Michigan Avenue (not that I have $1,000 anyway!). For me, it's more about the little things: taking time out for phone calls to friends and family, for example. Making sure I keep the frig stocked with my favorite kind of hummus (jalapeno and cilantro). Wearing clothes that make me feel good about myself - quite often something fun, colorful, and vintage.

I would not wish this situation on my worst enemy. But I will make it through. Because the one thing that truly is constant in life is yourself: "Wherever you go, there you are," as the saying goes. I am strong. And I will take that strength with me, wherever I go.