Category Archives: medical

reflections on medicine.
the journey through, and the application of

sustainability – hiatus

It’s come to that time of the year, with two months on the clock before our first exam, I have to take a hiatus from the blog. I thought I’d be able to maintain my microblogs every day through out the exam period, but this week particularly has just knocked the wind out of me in terms of physical energy.

And as much as we try to separate ourselves into physical, mental and spiritual, a deficit in one will have an overflow effect into the others.

So the new goal is sustainability – living a lifestyle that glorifies God and at the same time honours him completely in the bio-psycho-social model of health. 

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A friend of mine has recently made the same decision, for the same reasons. Medicine is a taxing course, and these are the most important exams in our degree.

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I hope that my consistent blogging has brought some encouragement to you, whoever you are or wherever you’re reading from and I’ll be back at the end of November with a backlog of ideas for blog posts and exciting news about my elective trip and the future of our Church, SMA as an organisation and other things.

Take care, and God bless.

neonates

FINISHED!

Yesterday marked the end of my Paediatrics team, and my 3-week stint in Neonatology. Working with babies for three weeks taught me to see just how fragile life really is. Most if not all of the children we saw in the special care nursery and the neonatal intensive care unit were born premature, and some (mostly those born before 30 weeks) weighed a lot less than 700g.

I think I remember attending the delivery of 25-week twins who both weighed around 380g each when I was on my Obstetrics term… and it was challenging. Stumbling into the special care nursery at 4am, with darkness outside, the hum of monitoring machines and the bubbling of CPAP, it was a cage of uncertainty.

Now, seeing the special care nursery in the light of day and realising just how much we can do for these infants, it was reassuring to see just how far modern medicine has come.

trivia and application

I was at a quiz night last night, and one of the questions that came up was the number of bones in the human body.

None of us on the table had any idea, and yet we’re all medical students.

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I don’t think this matters as much, because there are some things that are trivia, and some things that have practical life application.

It’s probably the same with other things in life.

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What do we enrich ourselves with? Trivia? Or things that are applicable?

EXAMS

This is the earliest I’ve thought about exams in Medical School history, but our Exams begin in roughly… 88 days.

And there is an overwhelming amount of pressure on us as a cohort right now.

Two 3 hour written exam papers… (and all the Uni students snort in disgust at the fact that there are only two)

And one OSCE – this thing is scary. It’s a 16-station exam, where you move from room to room, and you’re presented with a scenario, and you’ve got to react to it at a 5th year level.

One room might have a mother who needs to be counselled about immunization.

One room might have a gentleman who has recently started anti-hypertensive medication.

One room might have an ECG to interpret…

And one room might have a phone that’s ringing, and on the other end of the line is a mother who’s child is having an asthma attack.

7 minutes per station, with a minute changeover (or something like that) means it’s 128 minutes of fun fun fun.

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I definitely cannot do this on my own, and I am a mediocre medical student. But instead of expecting a magic solution to my problem, I’m going to knuckle down and try and study my hardest.

And the miracle will be God using my inadequate study, and too-casual medical demeanour to bring me through these exams!

just pretend

I heard a lecturer say this during one of her lecturers this week and quickly had to write it down because it sounded so much like an analogy for life / sermon illustration / helpful quote.

She was talking about having to break the bad news to parents that their child has cancer. She said parents often bring their kids in and know that something is wrong – perhaps something serious, but they don’t really think about it. She said it’s like taking a test that you think you’ve failed. Until the results come out, you can pretend that it didn’t happen or you can ignore it.

But once the doctor comes in and tells the parents the situation – there’s no more pretending.

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I know personally there are a lot of things in my life that aren’t right. Things that I can avoid, or put off because they aren’t pressing. Things that don’t really affect the here and now, but I know will definitely affect my trajectory in the long-term.

And I can do a lot of things to avoid them, or ignore them, or pretend that they don’t exist – but once the Great Physician comes in and points it out, and lays down the truth… there’s not really much that I can do but accept it.

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If you’re reading this, then I’m sure that there is that something in your life.

enable

A friend of mine was looking very tired last week, and I don’t know why these words came out of my mouth, but I offered to help with a presentation she was giving and had only just begun preparing. I had no reason to make the offer and looking back I still cannot understand why I did.

But the words came out of my mouth.

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Of course she said no straight away, but that night something urgent came up and she had to actually take me up on that offer that I had already forgotten I’d made.

I was more than happy to help, and managed to get a little bit done on her behalf in preparation so that she wouldn’t be so stressed and could keep her mind focused on the urgent task at hand.

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I can’t be much more specific than that, but we talked about it this week and it turns out that she was in a situation where she couldn’t be distracted at all, but thank God that he could use me to enable her to do what was necessary.

That I could play some part, reminded me of the bigger picture, and the reality of the situation.

hygiene follow up

Gungor: “When did Christianity become a way of medicating us from pain rather than a way of living within the pain? 

Yes, the resurrection of Jesus gives us a hope, a future joy for which we are inspired to take up our cross and take another step forward… But that is not the same thing as a numbing delusion that all is well with the world because ‘I’m on my way to Heaven because of the new covenant!’

There is a tension to the Kingdom of Heaven that is here but not yet here. That tension ought to give way to poetry. To lament. To art. Sure, there is room for some celebration, but if our faith has nothing else to it than positive messages and encouraging clichés, perhaps it has become a Band-Aid rather than a surgery. ”

(Via chris.)

Here’s a followup to the hygiene post.

I think we all just need a bit of real sometimes.

inflammation and guilt

This is another “thinking about medicine” post where I write through what is a largely medical idea and try and draw some life application / analogy from it.

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inflammation |ˌinfləˈmāSHən|

nouna localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, esp. as a reaction to injury or infection: chronic inflammation of the nasal cavities.

Steven Furtick spoke a little bit about guilt, and said that it’s not necessarily a bad thing. It’s a reminder of the underlying issue that needs to be dealt with. Chances are, if you feel guilty about something, then you know what needs to be done.

I’m not going to go into the idea of condemnation and justification through Christ, but I think we can all agree that we do feel guilty at times, for perhaps legitimate reasons.

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Inflammation is not pleasant. It’s a reaction to injury or infection. It’s your body’s way of beginning to deal with the underlying cause for concern, and it lets your body know that there is something wrong.

You can take some non-steroidal anti-inflammatory drugs (NSAIDs) to relieve the inflammation, but that doesn’t necessarily help with the healing process of the initial insult.

And in the same way, you can do things to numb your guilt, but that doesn’t eliminate the fact that there is an underlying problem.

hygiene hypothesis

I recently learnt about (or gained a better understanding of) something called the Hygiene Hypothesis. It seeks to explain why there appears to be an increase in the incidence of allergies in children today.

Background info: your immune system can mount short-term responses or long-term responses to allergens which is helped by things called T helper cells 1 or 2, where T helper cell 2 mediates the short-term/immediate response, while T helper cell 1 mediates the longer-term response. IgE vs. IgG.

And it’s believed that you kind of grow out of the IgE response, and have a shift in your body’s balance towards Th1 cells.

The gist of the hypothesis is that because of better sanitation, delayed exposure and other factors, kids aren’t developing that shift towards Th1 cells, and are retaining more of an immediate IgE response. So what happens is, every time they’re exposed to something potentially dangerous, their body is responding immediately, causing inflammation and anaphylaxis.

They have a low tolerance to what otherwise might be considered “normal” or “baseline”, whereas kids who have been exposed earlier can learn to modulate their response to this natural environmental level of… dirtiness, and shift towards a longer-term more appropriate Th1 cell response.

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Medicine aside, what does this have to do with anything?

It got me thinking about the way we react to certain stimuli in our daily lives. If you grew up with a lot of pain and hurt, then perhaps your level of tolerance would be higher to these things than someone else.

Alternatively, if you grew up in a completely insular environment and never failed at anything, then maybe your first failure (and we all WILL fail at some point in our lives) will come as a catastrophic blow to your worldview.

I’m not saying that people should grow up with hurt, or that it’s a good thing, but maybe having exposure and accepting it as a part of life raises your tolerance, and allows you to have a more balanced worldview.

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A question I asked in my small group last week was, is there any point in trying to put so much effort into avoiding suffering/pain when it is inevitable?

And the practical upshot:

If we accept that there’s gonna be a bit of hurt and pain in our lives… then maybe we would be better equipped to get by with things that are more important.

Maybe we could roll with the punches, instead of running from the fight.

personal and professional development

I’ve been writing a few essay entries for a unit at University called Personal and Professional Development (PPD), and have been in two minds about it.

On the one hand, it is really good to reflect on your development as a doctor with issues like self-care, diversity and ethics.

But on the other hand, it’s very artificial having to push through eight to ten pages worth of writing as an assessment for a “pass/fail” mark.

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And as much as I care about my personal and professional development as a doctor, sometimes adding the fact that it’s an assessment to the equation takes the joy and motivation out of it.

I could blog about being a medical student and future doctor all day, but making it an assessment and a requirement to further my career… changes things entirely

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Maybe it’s a reflection on the separation between what we consider important and necessary. Some things are necessary but not important, and vice versa, and sometimes we don’t apply the logic for one to the other.

Exploring that convoluted statement further, there’s a notion in Christian circles that “everything is spiritual” in that everything has implications on your faith. The way you garden, the way you handle your finances, the way you act in relationships and the way you…. you get the idea.

And sometimes we feel like something’s not a “spiritual” matter, so we exclude God. And other times, things are purely spiritual, and we ignore the practicalities.

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This post has completely derailed, but I think the point I was trying to get across was that we face things in life that we might not think are all that important, but they deserve the same level of consideration.