Friday, November 17, 2006

The Global Missions Health Conference

Last weekend I was able to attend the Global Missions Health Conference in Louisville, Kentucky. The conference is on Christian missions-field medical and health care work, both nationally and internationally (although international medical missions is overwhelmingly represented). I attended the conference with one other person, Halley, a nursing student I am friends with who heard of the conference through the Nursing Christian Fellowship group. We left town together on Thursday night last week to be able to attend the whole day's sessions on Friday. Being a six-and-a-half hour drive from Columbia (seven and a half when factoring in the time I drove in the wrong direction), we arrived in Louisville at 3 a.m. central time. Louisville unfortunately is on eastern time.

After a two hour nap on Friday morning I awoke shortly after six to get over to the conference. The church that it is held at is so big you could fit my entire hometown's population inside the building (West Plains, MO has approximately 10 - 11,000 people now) with room to spare. I spent the day between main conference speakers and breakout sessions discussing where to find equipment for the medical field, leadership lessons, where to send students, inner city medical ministry, and much more. A highlight of the 15-hour day was hearing Steve Saint, son of martyr and companion to Jim Elliot on the trip they both were killed on, give a talk on God's will. Saturday featured a slightly shorter day that ended at 3 p.m. and featured a few more keynote and breakout session speakers (one I enjoyed immensely was a session on integrating academic medical research and training with ministry-based health care centers overseas).

Another feature of the conference was the missions-agency convention. This is held on two stories and is set up like a basic convention; each agency or organization has their own little booth, and people sit behind a table passing out information or answering questions. A few booths had their representatives practicing the "sales-pitch", standing in front of the booths just waiting to make eye contact with passers-by. My feelings regarding the convention are mixed; I believe it is a great opportunity for those earnestly seeking to find a place to serve to do so, but on the flip side some people representing organizations seem to be selling a product to a consumer-minded missionary.

So where does ministry and missions in the medical field find me? I would love to practice medicine as a ministry and do so representing a Christian organization. At this point though, I am not sure I feel that I am to do it full time year 'round. I was very encouraged however to hear many people speak about doing extended short-term mission work internationally, on the level of a few months overseas each year. Something of that nature could be feasible for, say, the summer months. That would be especially doable with a family, when children do not have school. In any case, it's a dream that is not likely to die soon. At this point, however, it is too overwhelming to simply choose an organization and sign my name to a commitment simply for commitment's sake. I want to pray and wait and pray and wait and pray again and wait until I hear a call from God, hopefully occuring somewhere away from the Christendome shopping mall. I want to be ready to plunge in and take the risk of answering that call when I feel it beckon.

I want to heal people. I don't want to lose the idealism that drove me towards medicine as a profession. I want to avoid cynicism and fatalistic thinking. I don't want to live simply to make a buck. I want to be reminded daily why I am valuable to the kingdom of heaven. I want to know that I am making a difference and that I am not beating the air with my fists. I want people to walk away feeling cared for and listened to, not just better off physically.

Wednesday, November 08, 2006

Seeing more patients, a family member diagnosed with a disease, and Health Science Research Day

I apologize in advance for the length of this post, but it will likely be a week before writing again due to a busy schedule at the moment. So sit back and digest this in pieces if you like (although, if you want to know when you can see Dr. Peppers in action, scroll down to the last heading). I've provided some headings for breaking it up a little bit.

Today was the second time my APD (read: advanced physical diagnosis) group met over at the VA hospital. This time however we were actually able to see patients, thanks to Dr. K, who is the resident paired with the attending in charge of our APD group. Dr. K had a talk with us about how she understood we needed to see patients in order for this to be a learning experience at all, and we proceeded to the second floor wards. Today we saw three cases.

This week's cases: VA Hospital
Mr. H was an elderly man who had developed pneumonia and a pleural effusion in his left lung. He was cooperative with allowing student doctors to examine him, however did not seem to be feeling very pleasant in both mood or health (and who could blame him for either, sick in the hospital?). One physical exam sign to look for when listening to a patient with pneumonia and/or a pleural effusion is egophony. Egophony is E to A changes when listening to the lungs with a stethescope; while listening, when the patient makes a long drawn out E sound, the difference in density in the affected lung causes the sound to come out as an A. Mr. H had a very notable egophony.

Mr. B was a robust man who had interstitial lung disease. Mind you, there are several hundred interstitial lung diseases of distinct etiologies, making that a very broad disease specification. His lung disease was due to exposure to metals and chemicals from a history of polishing aluminum engine blocks on racecars. He also had a year's worth of asbestos exposure. Mr. B was in a far better mood than Mr. H, and welcomed the attention of students come to examine him. Listening to his lungs, I could hear the tell-tale velcro sound of a restrictive interstitial fibrosis, and his breathing was rapid and shallow. At the apices of his lungs on both sides was a faint wheeze. I mentioned this to his attending, Dr. O, who proudly put a hand on my shoulder and proceeded to give a mini-lecture on how that was likely due to a superimposed respiratory infection, which Mr. B affirmed by speaking of a chest cold that drove him to the doctor. Dr. O then played the "guess my age" game by asking us to guess how old Mr. B was. We guessed he was roughly 60, 61 years old. We were only off by about 22 years; his actual age was 83, but boy did he look young and energetic.

The third case was Mr. J. Mr. J had chronic obstructive pulmonary disease (or COPD). Whereas a restrictive disease prevents you from filling the lungs, an obstructive disease prevents you from being able to get air out. Try taking a deep breath, as deep as you can, and then making due on short, shallow breaths without fully emptying your lungs. This is what Mr. J feels like. The air trapping is due to airway collapse during expiration, so that air in the lungs gets trapped (hence the term air-trapping). People with COPD will attempt to counteract this by pursing their lips, creating a pressure that helps keep the airways open and allows them to empty their lungs. You also notice more accessory muscle use in their breathing; their sternoclinomastoids and intercostals are visibly engaged in trying to help them breath.

My cousin's diagnosis
Over the weekend, I received a call from my parents passing along some news about my cousin B. She had been having some long standing swelling and pain of her knees and ankles, and had seen the doctor about it recently. Initially the doctors thought that she might have rheumatoid arthritis, an autoimmune disease that affects the distal (far from the central body) joints and is more common in females. Bloodwork apparently was negative, and so they tested her for SLE, or systemic lupus erythematosus. SLE, or lupus as most people know it, is an autoimmune disorder characterized by immune complexes composed of antibodies and compounds called complement settling out of the blood in the vessel lining, causing inflammation of the vessels. After the diagnosis, they presumed that some other symptoms she had involving gastrointestinal distress were likely due to SLE as well.

I was shocked to hear about the diagnosis. My parents seemed to think that all would be just fine, and I agreed, provided that she (my cousin) doesn't develop a severe case of SLE. The most serious complication of SLE is kidney damage; most patients who die of SLE will die of kidney failure due to the overwhelming loss of kidney function. Luckily, with close monitoring and control, this is rare in mild to moderate cases of SLE. I asked if she was on prednisone (a steroid anti-inflammatory drug), and she was. Interestingly, I know that you can also use hydroxychloroquine, which is an anti-malarial drug, to help prevent flare ups of SLE.

The other thing that concerns me about this is that my cousin is only 16. If you read up at all on SLE, you may find that it affects females more than males, and starts during the prime childbearing years (16 - 40); and a concern of mine is how early it is starting for her. That'll be something to be in prayer about.

Health Science Research Day, Thursday Nov. 9th, School of Medicine
After a very straining weekend of work, I've finally finished my research poster presenting my summer research in the pediatrics department. It'll be displayed in the School of Medicine Atrium on Thursday starting at 9 a.m., and will hang until 1 p.m. (just a plug, in case you have a chance of dropping by to see it).

Towards the end of this project, I've begun to grow more disgruntled in having to do it. I have been thinking about all the other things needing to be done (mostly study for school) and my lack of being able to enjoy as much free time as I would if I weren't working all weekend on the poster. The other aspect that has had me disgruntled has been due to my own lack of experience in participating in research, and simply not knowing what goes into making a good poster presentation, and being expected to know what does by my boss/mentor. Some misunderstanding via email led to me receiving a scathing email from my mentor about the precious time wasted correcting discrepancies found in my data, the fact that accuracy should have been a priority of mine, and the confidence that I will one day mature into more than a simple data-gatherer. It was perhaps only meant to motivate (and it did, as I turned out a far better and more complete write up for the poster content that very same day), but the content and wording has still left me feeling less than amiable towards my mentor.

There is a first prize of $500 for the best project and presentation, with smaller prizes for second and third. I am not expecting to win, but am excited to be able to have a chance at the very least. My research will be alongside posters from other M1's, M2's, and some M4's who are doing research before graduating.

Sunday, November 05, 2006

Glory, pt. 1

Today was the Rock Equippers retreat. Basically, the equippers retreat is a day long getaway out of town somewhere where the small group leaders can gather together, be encouraged, share stories, and have John Drage remind us of what we have committed to as leaders and renew our commitments to ministry. One of the verses John shared in his introduction of our time together was 1 Peter 2:9. It says:

But you are a chosen people, a royal priesthood, a holy nation, a people belonging to God, that you may declare the praises of him who called you out of darkness into his wonderful light. - 1 Peter 2:9

The verse is exceptionally powerful. I was reminded of the following quote:
"It is a serious thing to live in a society of possible gods and goddesses, to remember that the dullest and most uninteresting person you talk to may one day be a creature which, if you saw it now, you would be strongly tempted to worship....There are no ordinary people. You have never talked to a mere mortal." - C.S. Lewis

These are truly humbling words, yet why should we even feel ashamed? I was also reminded of another quote (which I had thought was from Lewis, but in looking on the internet appears to be widely attributed to Marianne Williamson. I feel certain that I have read it in something by Lewis once before, but I digress):

Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us. We ask ourselves, who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small doesn't serve the world. There's nothing enlightened about shrinking so that other people won't feel insecure around you.

I have lived in this fear for some time, especially this year. I fear to be myself oftentimes, because I am afraid that who I am will run so far from where anyone else is at in their lives that I should alienate those around me. Who am I to be brilliant? Who am I to be talented, or esteemed? Who am I to be someone special? Why should I risk pushing into strange new territory and discover the depth of the potential God has bestowed me? Complacency is far safer territory, and requires far less risk.

While talking to John, I started talking about why I often hold back from taking risks. The fear with risk is that if you would risk seeking something; be it romance, a job, some other opportunity, sharing the gospel with a close unbelieving friend, or anything, you just may find that you are refused. It's funny that I, or anyone for that matter, should deny themselves the chance at realizing some joy for the sake of preserving it's possibility. Let me say that again: if I should never risk losing anything, I will comfortably perpetuate the potential of gaining it, without ever actually attaining it. I settle for a hope instead of a reality. But the comfort I get in enjoying the permanent possibility of gaining is overshadowed by the misery in not attaining what I desire, made greater by the refusal to chase it.

So, tying in to the verse shared above, should I truly believe that I am made a priest before Christ? Should I dare believe I am part of this sacred assembly? Can I grasp that I have a glory that will one day be made fully apparent? Can I live with that knowledge? The fear is to believe that I am truly that wonderful; my false humility makes us believe that we should be lower, undeserving, unworthy of happiness, incapable of being loved by people. And yet, here it is. It's right there. Priesthood. Elsewhere the Bible declares that we are adopted sons of the Most High God. We are in the process of being made into what Christ is. We are indwelt with a power that can literally transform the course of life and history itself, if only we would let it out. That power is the Spirit of Christ.

Living by the Spirit, I've always felt, was a process of letting go. It wasn't about performing some particular skill movement, or thought, or attaining some special knowledge. What it's about is submission to the Spirit and not letting my human mind and rationality stand in the way of the Spirit's desires and intentions. That is the way to glory. The risk is trusting that Spirit with control of my life. The fear is that the journey will be uncomfortable, and that there will be a loss of things I hope in. The reward is more than I can now or ever fathom.


Next time, I will talk about some of those hopes and dreams that need to be risked, and more specific fears. I figured that if I write too much all at once, people are going to fall asleep, haha.

Thursday, November 02, 2006

Tales from the ER

***Note, some of this material may not be suitable for those sensitive to squeemish topics. Those sections will be starred for your own warning***

Last night was my first day of ACE (Ambulatory Care Experience, basically a glorified shadowing patient-seeing experience before your clinical years) and this block I am doing my ACE in the Emergency Department. I was apprehensive at first, not because of what I might see, but because having volunteered there as an undergrad I was not given much to do in terms of volunteer service. In fact, they acted like they didn't know what to do with me.

I called the ER to get the passcode for entry shortly before 4 p.m., and then, donning my white coat, proceeded down the hallway leading towards the west elevators and turned the corner towards the ER door. I let myself in, walked confidently up to the first person manning a desk station, and asked for the attending. There were two that night, and I was recommended to go to Dr. D. Introducing myself to Dr. D, I was then told he needed to catch up some stuff and to introduce myself to Dr. C. Dr. C was very busy, and it was a good 10 minutes before she finally stopped and slowed down to catch my name. And then she embarrassed me thoroughly by yelling for the entire ER to not show me anything except "interesting" stuff, and that I wasn't here to see anything boring.

After I had been sitting around a while, I finally managed to see my first patient. It had only taken about a 30 or 40 minute wait for someone to offer to take me in tow on their duties. So I ended up with an M4 named A, and saw my first case of the night.

S was a 20 yo student at the University who had had a terrible headache for the course of the day that was localized behind her left eye, accompanied by photophobia (an aversion to lights) and an episode of syncope upon standing in class (fainting, likely due to low blood fluid levels). I got to perform a funduscopic (eye) exam, just to be sure she didn't have any increase intracranial pressure from some more serious pathology. She was later discharged with some migraine medicine I believe.

Dr. D later motioned for me to follow him, and I was led to a room where M4 L was working on a kid's ear. His barbell had been ripped out of his earlobe sideways while he was playing with some dog, and he was going to get his earlobe sutured back on. Dr. D said he would let me suture except it was the ear and not as easy as somewhere more accessible. After Dr. D left however, L asked me if I wanted to learn to suture and she taught me how to do the tie off and how to insert the sutures. Most people get their first practice on pig's feet, but mine was on some guy's ragged ear.

****
"Want to see a guy with priapism?" Dr. D asked as he started to walk towards an exam area. I didn't see anything better to do but to follow, not seeing any patients at the moment. Priapism, for the unawares, is a painful non-excited erection that can lead to serious consequences (read: loss of the male organ) if not treated. I didn't stay in there long, as there was not much to do but see the man's priapism and leave. It turned out that the man had sickle cell anemia, a red blood cell disease that causes the red blood cells to "sickle" or elongate into long hard slivers, almost like tiny shards of glass. When they pass through the tiny capillary vessels, they can get stuck and cause a lot of pain. In this guy, they happened to get stuck and block the venous outflow of his penis.

Case 3 was a Hispanic woman who had awoken that morning at 4 a.m. with the "worst headache of [her] life". Mind you, this is always a red flag, as it could signify a subarachnoid hemorrhage (a bleed into the brain that can cause serious damage due to the increased pressure), but she had no neurologic deficits upon physical exam. She had an aversion to noise and mindly to light. Since it was already past 5 pm and she wasn't dead, the subarachnoid bleed seemed less likely, but she was sent for a CT anyways. The M4 I was accompanying, SS, almost didn't do a fundoscopic exam, but finally remembered to do so and I mentioned I would have suggested it had he not.

****
Priapism wasn't finished with me yet, and I was motioned to join Dr. D and the physicians assistant back to the priaprism room. They had paged a Urologist who was going to take charge of the case. The means of treating the man entailed draining the organ via a butterfly needle inserted into the side and having the sickled blood pumped out via a syringe. I watched about 70 - 100 mL of blood pumped out (roughly three syringes) until I got tired of balancing on the edge of a vaso-vagal response and left the room.

Case 5 was an intoxicated man named J who said he "fell down". However, a single glance at his face would say that if he did indeed fall down, the curb had beat the living bejeezus out of him for violating it's personal space. He had several lacerations, one on his chin which very evidently was from hitting a curb or something rough, but several other cleaner cuts that looked like they were inflicted by a sharp knife or other tool. He was given a shot of Ativan and SS, a female physician's assistant, and myself proceeded to scrub J's face and start suturing. With the door closed, this was the calmest area of the ER to be in at that point. SS and lady calmly sutured in quiet, all of us lightly conversing until it had reached 8 p.m., and I announced that I had other stuff I needed to get done that night and took off.

Life in the ER will be continued next week.