Caring for the Family Is Part of the Job, Too

Living with my mom, who is a home health care hospice nurse, I am learning all kinds of things. As she was relating her "adventures" the other day, something dawned on me. And while this may sound obvious, it is something that I believe many physicians forget to consider. But it is something I believe we should consider, on a daily basis. I know that after this realization, I will be.

As medical practitioners, it is key for us to consider a patient's family, in addition to the patient's own well-being, illness, and treatment.

Why? For one thing, the family helps create the environment in which the patient lives, which can definitely (and sometimes adversely) affect the patient's well-being, illness, and treatment. An example from my mom's experience: she had a patient who was declining, health-wise, and had required a long visit. The patient's caregiver, another family member, mentioned that one of the patient's sons was supposed to come visit later that day. But the caregiver was concerned about this visit, and having to relay the news his mother was declining, because the son had serious mental health issues. My mom asked whether it was possible that the son might hurt someone, or himself ... and the caregiver said, basically, I'm not sure. That impending visit - clearly a family issue, and not a specific patient health issue - might have put my mom's patient in a dangerous situation. So my mom brainstormed with the caregiver, and they decided to cancel the visit that was supposed to happen. My mom also called one of her hospice's social workers to help with the situation. (Another lesson: it's important to work as a team, and to know what your resources are.)

In hospice, and in other scenarios (especially ones involving the elderly, and long-term, chronic conditions), family members are often the ones giving care - administering medications, that sort of thing. While the family members might not even have a high school diploma, they are being asked, in essence, to act as nurses or nurse's aides for the patients. So it is very important to take the social and family situation into account, and make sure the family members are adequately educated about the patient's care.

With other diseases, such as diabetes, the family environment can very much affect the patient's condition. For example, if the family members often cook fried foods, and incorporate very few vegetables or healthy foods into their diet, that is a serious problem for maintaining the patient's blood glucose level, as well as cholesterol, blood pressure, and other common comorbidities of diabetes. Then you wonder why the patient's hemoglobin A1C comes back at 10 ... so understanding the social situation, again, is imperative.

This does, of course, take some effort. And effort requires a bit extra time. Which, of course, is always in short supply for physicians. But I believe that it falls in the category of preventive care, which can save time, money, and a patient's health in the long run. So isn't it worth it?

Joining the Ranks of the Uninsured?

United States health insurance coverage statistics from
the Kaiser Family Foundation's Web site.

According to the Kaiser Family Foundation, 16% of Americans - that's 49 million people, folks - were uninsured in 2010. I am on the brink of joining their ranks.

When I was a student, I had health care coverage, a decent PPO at that, through my university. It wasn't that expensive, either (a little over $100 a month). That coverage runs out at the end of August. Which is in ... *gulp* ... about six weeks. I was hoping that my part-time lab job might, just might, offer health benefits. But I just got the new-hire paperwork e-mailed to me today, and one of the stipulations for the position is that I don't qualify for benefits. None.

So I am left in a quandary. There is absolutely no way I can afford comprehensive (i.e., decent) coverage out of pocket. And as I understand it, the Affordable Care Act health insurance "exchanges" that would make decent insurance more affordable for people like me don't go into effect until 2014. By that time, I will hopefully be starting medical school, and will be again covered under a university policy.

The question remains: What do I do until then?

The uninsured rate for children has gone down between
2007 and 2010 (thank god!), but has risen for
nonelderly adults from 19.1% to 22.0%, according
to this data from the Kaiser Family Foundation's site.

When my sister was in a similar situation, she purchased very basic insurance. Emergency insurance, really, in case of a serious accident or illness. That's my plan as well. Because knowing my luck, if I don't purchase some type of coverage, something terrible will happen.

For kicks, I just now got an online insurance quote from Blue Cross and Blue Shield of Illinois. Out of curiosity, more than anything; mainly I chose BCBS IL because they were my previous insurance carrier and I'm familiar with them. The coverage I was quoted (which is obviously not guaranteed) ranges from about $175 (for a $5,000 deductible plan with 80% coverage after that) to almost $700 (for a $0 deductible plan with 100% coverage). Even for the most basic plan, which would provide me with absolutely no benefits unless something catastrophic happened, I would be paying $60 more than I am paying for my student plan now, which offers excellent benefits. It's a sad situation. For me, and for 49 million other Americans.

While I guess I won't be completely uninsured, I will be practically uninsured, which is scary. If I get sick, I will have to pay to go see the doctor. And those bills can add up really quickly. Well, let's hope they don't, right?

ADCOM Q&A: Reading a Book (for Pleasure?!)

One theme I have noticed in admissions interview questions for medical school is that they want to see that applicants are well rounded, and do things other than study, work in a lab, or volunteer. I.e., that they involve themselves in activities that don't necessarily strengthen their med school applications. That they know how to decompress and relax. Because these are skills that are so important, especially in such a high-pressure field. So, one of the ADCOM questions I want to answer is this: Discuss a book that you have recently read for pleasure. Why does this book interest you?

And here was my answer, as of a few days ago: Uhhhh ... pleasure? I don't have TIME to read for pleasure!

Thankfully, I do have a little more time now, as I am not in school (and inundated with the requirement of reading textbooks). So I picked up a of book a few days ago, and started reading for "pleasure" again. And it's felt absolutely wonderful. While I haven't finished it, I will tell you a little bit about it, and what I have learned thus far. I will also share my reading list, books that I hope to read throughout the next months (when I will still have more time, before the insanity of medical school starts).

What I'm Currently Reading:

Nature's Robots: A History of Proteins

(Charles Tanford and Jacqueline Reynolds, 2004)

I downloaded this Kindle book (to read on my iPad) on Dec. 25, 2011, according to my Amazon.com account. And honestly, I totally forgot I had it. But I was looking at my Kindle books a few days ago, and there it was! I was thrilled, it was like Christmas (even though I bought it for myself). I started reading it that evening. And was pleasantly surprised. It's definitely a history book, at least thus far. But there's a lot of science - especially chemistry and biochemistry - in there, which makes me happy. And the authors detail a lot of the theories, and arguments over theories, that were proposed in the past regarding proteins. I've made it through chapter 5, and am quite pleased with how the book is going. Proteins were my first "love" in science, and they continue to fascinate me. They are such an important part of our lives, and anyone who is in the biological sciences needs to have a good understanding of them. Learning about their history, in terms of scientific advances, is a way for me to understand where we have been, as a scientific community, and also to be inspired about where we are going in the future.

My Future Reading List:

Fiction:

 

The Life All Around Me by Ellen Foster
(Kaye Gibbons, 2011)

One of my favorite authors is Flannery O'Connor, and Kaye Gibbons reminds me of O'Connor (very high praise, in my book - pun intended). This book is a follow-up to the book Ellen Foster, which I read several years ago. After reading that, I flew through several other Gibbons novels. I look forward to reading more about this lonely girl, and the struggles she goes through.

A Wizard of Earthsea
(Ursula Le Guin, 1970)

I was first exposed to Ursula Le Guin when I was a textbook editor, and worked on the American Literature lesson for the hilarious but disturbing short story SQ. "SQ" stands for "sanity quotient," and the story is a wonderful parody. I highly recommend it, even if you are not a huge short story lover (I am not). I immediately checked out Le Guin's Earthsea series, and this book is the first of that series. I have read it before, but I want to read it again. And I rarely read books twice, simply because there are so many books I want to sample.
On your Facebook info page, you can list favorite quotations. I have only one listed, and it's from this book, from the creation story that is entwined throughout. I find it beautiful, poignant, and enigmatic, something to ponder:

Only in silence the word,
only in dark the light,
only in dying life:
bright the hawk's flight
on the empty sky.

- The Creation of Éa

 Memoirs:


Genetic Rounds: A Doctor's Encounters in the Field That Revolutionized Medicine
(Robert Marion, 2009)

This book, which I found rather randomly while searching my library's online catalog, looks fascinating to me. I don't know much about it, don't know whether it's well written, but the topic is definitely something that interests me. I enjoy a good medical memoir for sure, because it gives me a glimpse into the field I will be entering soon. And this one piqued my curiosity in particular because it marries medicine and genetics, which is something I am interested in doing myself in the future.


The Spirit Catches You and You Fall Down
(Anne Fadiman, 2012)

This was recommended to me by a physician I highly respect as "must read" for any physician, or physician-to-be. According to Amazon, its "explores the clash between a small county hospital in California and a refugee family from Laos over the care of Lia Lee, a Hmong child diagnosed with severe epilepsy. Lia’s parents and her doctors both wanted what was best for Lia, but the lack of understanding between them led to tragedy." Given my interest in multicultural issues, and health literacy, it seems a poignant book to read right now.

Nonfiction:

The Immortal Life of Henrietta Lacks
(Rebecca Skloot, 2011)

One of my dear friends - who is most definitely not a science person - read this book and told me it was amazing. Here is a portion of the summary posted on Amazon: "Her name was Henrietta Lacks, but scientists know her as HeLa. She was a poor Southern tobacco farmer who worked the same land as her slave ancestors, yet her cells—taken without her knowledge—became one of the most important tools in medicine. The first “immortal” human cells grown in culture, they are still alive today, though she has been dead for more than sixty years. If you could pile all HeLa cells ever grown onto a scale, they’d weigh more than 50 million metric tons—as much as a hundred Empire State Buildings. HeLa cells were vital for developing the polio vaccine; uncovered secrets of cancer, viruses, and the atom bomb’s effects; helped lead to important advances like in vitro fertilization, cloning, and gene mapping; and have been bought and sold by the billions."
If you read any scientific literature, you are bound to come across HeLa cells as a subject of study. Reading the story of their "birth," so to speak, and such a controversial and heartbreaking one, seems like a natural thing to do for a budding scientist such as myself.

The Disappearing Spoon: And Other True Tales of Madness, Love, and the History of the World from the Periodic Table of the Elements
(Sam Kean, 2011)

It was my chemistry major friend who recommended this one to me. And as you know from some of my previous posts, chemistry - and the periodic table - have piqued my interest of late. I look forward to reading the history of this seminal scientific tool. This is what the Amazon summary says about the book: "The Periodic Table is a crowning scientific achievement, but it's also a treasure trove of adventure, betrayal, and obsession. These fascinating tales follow every element on the table as they play out their parts in human history, and in the lives of the (frequently) mad scientists who discovered them. THE DISAPPEARING SPOON masterfully fuses science with the classic lore of invention, investigation, and discovery--from the Big Bang through the end of time." Sounds pretty cool, eh?

Conclusion:

Clearly, I have plenty to keep myself busy. The wonderful thing is, I'm not afraid to use my local library (or the wonderful library loan system). So reading all of these amazing books won't cost me anything. In addition, a couple of these books are available through my library's digital lending center, which will allow me to read them on my iPad. As I read these treasures, I will definitely post about them. So stay tuned ...

Periodic Tables: One more (for the writer and editor in me)

I know, I know - I posted a boatload of periodic tables in my last blog post. But I came across this one in a recent Google search, and I just HAD to post it here. It represents a confluence of my interests in science and writing/editing. Plus, it makes me laugh. And as we future physicians know, laughter is the best medicine, right?

Thinking Outside the Box, er, Table

There are some things that we just take for granted, it seems. The sky is blue, the grass is green, and the chemistry periodic table of elements looks something like this (see photo at right):

But, as is the case with so many things, there are multiple ways of representing the information on the periodic table. There is a Web site called The Internet Database of Periodic Tables that I recently discovered, thanks to a dear friend who is a chemistry major, which has images of literally hundreds of periodic table representations. It fascinates me that there are so many ways of showing what we take for granted in chemistry class. Some of them are, perhaps, not so accurate anymore based on current information and data. Others are not really very scientific, and are more novelty items. Regardless, how amazing that people have taken the time (and you will see that many of these have REALLY taken time) to develop different ways of thinking about what our world is made of. Here are a few of my favorites. But I really encourage you, if you like any of what you see here, to visit the Web site and peruse the photos. You will laugh, scratch your head, and laugh again, I guarantee it.

Alternate views of the periodic table of elements:

Étienne François Geoffroy’s 1718 Affinity Table.
At the head of the column is a substance with
which all the substances below can combine.

Angular Form of the Periodic Table by Kamal Akhtar:
"The complete periodic table is consists of two circles,
principal circle and auxiliary circle. The principal circle
is consist of seven tracks (periods) and eighteen sectors
(groups). The auxiliary circle is consist of only two tracks,
inner track and outer track. There is no division of sectors
in auxiliary circle." (2008)

By Alexander Makeyev – integrated
interdisciplinary researcher, inventor, poet (2011)

From Protege Publishing comes the Progressive Periodic Table:
"The PPTE allows you to observe and learn the periodicity of the elements
in a more aesthetically pleasing form. It removes confusion
from the growth pattern between shell pairs, and solves the problem
of keeping the lanthanides and actinides in sequence with the rest of the table."

Bydgoszcz's Periodic Table (2008).

Harrington Projection for The 270 AMU Structure (2010).

Normal vs Correction Shell "Pi Paradox" for 1-270 AMUs

Origionally developed in 1933, the colour version of
Clark's arrangement is from Life Magazine, May 1949.
This was the model for Longman's 1951 mural.

Rafael Poza's Elements and the Magnetosphere (2008).

In 1944 Müller produced a formulation
based on Darwin's tree of life.

A 1970 periodic table by Prof. Wm. F. Sheehan
of the University of Santa Clara that claims
to show the elements according to
relative abundance at the Earth's surface.

Walter Russell's Periodic Chart of The Elements 1 (1926).

Walter Russell's Periodic Chart of The Elements 2 (1926).

Stedman's conic system of 1947.

The Wheel of Motion (WoM) representation of the periodic
table of elements shows the periodic nature of the elements,
as developed in the Reciprocal System of Physical Theory (RST).

Note: Photos and caption text taken from The Internet Database of Periodic Tables

A Kind Word Turns Away Wrath ...

Words we've all heard:
"What do you think you're doing?"
"What is wrong with you?"
"Don't you know any better?"

We've all been there: borne the brunt of whatever the woman in the photo to the right is saying. Had fingers pointed at us. Been yelled at. Criticized for something that wasn't our fault. That's a given, in life. What differentiates people is not whether that happens, but how one responds.

I'm headed into a world - medical school, and eventually a career in medicine itself - where the people around me will not always be nice, no matter how nice I am to them. Another fact of life.

I was reminded of this fact recently as I talked with a friend who is currently in medical school, and doing her hospital rotations. She recently started in general surgery, and BOOM. Another med student, who wants to go into a surgical specialty, immediately showed himself to be a know-it-all, and a pretty nasty person all around in terms of making my friend feel incompetent and useless (even though this was her first week on the rotation). My friend, thankfully, maintained decorum and professionalism all the way through. (I'm so proud of you!) When this other med student was breathing down her neck about her not being able to figure out a charting issue, she told him that she understood that it was taking her longer than it might take him, but in a few days, she would have the system figured out. When he responded that he was just trying to help, she told him, basically, that she appreciated that fact, but that his standing right behind her and raising his voice was actually more distracting than helpful.

My friend could have easily gone off on this guy, yelled back, and from some people's viewpoints, she would have been justified in doing so. But in the world of medicine, where there will be people like this, you have to learn to deal with them in an appropriate, healthy way (albeit not letting them walk all over you). Because if you let them get to you, it hurts only you, not them.

My mom, who is a hospice nurse, and I talked about this topic this morning. She reminded me of a biblical proverb:

A kind word turns away wrath, but a harsh word stirs up anger.

While I'm not a religious person, I do believe in this sentiment. If you respond in kind to harsh words, things tend to escalate and get worse. That's not to say you let yourself be a doormat - you can have a backbone but still be respectful and professional.

That's how I want to handle such situations when I'm in medical school, and when I am a physician. And now is a great time to start doing just that.