Girl Talk!

For the past couple of years, I've been listening to a DJ mash-up artist named Gilbert Gillis or more popularly known as Girl Talk. I first heard of him when he was in relative obscurity, a sampling DJ fighting the RIAA for rights to his newly conglomerated mixes. As far as I understand, he takes free samples of songs given online and loops them to help form mixes that have you dancing all night long. He's famous for some unlikely mixes, such as Radiohead's "Reckoner" with Warren G's "regulators". I can now say, after going to his concert Monday, that I agree with him - even though I heard lyrics to Arcade Fire, in no way was I ever actually listening to Arcade Fire.

Here are some pictures of the bright lights flashing, bass thumping good time. The people next to us were doing cocaine, but I thought it was overkill - the concert itself was all the high I needed.

Yes, that's confetti in my hair and I'm wearing glow-in-the-dark sunglasses

He really wanted the ball full of confetti...

Arcade Fire vs. The Black Eyed Peas

Definitely a good time. Definitely recommend it.

Peace,

Ahmed

The code

Recently, I've been working on the MICU service. This is a team of interns, residents and attending physicians who take care of all patients in the intensive care unit. Physiologically, the science is the same. But the patients are sicker. And everyone's about to die.

One of our responsibilities is to respond to any "code blues" around the hospital. That means that any time a patient is found down, or without a pulse, or not breathing, a "code blue" is called and our team rushes to the bedside to implement a series of actions designed to revive a patient from death/near-death.

On Monday, a "code blue" was called and we all sprinted three flights of stairs to reach the patient's bedside. From report, we were told that she was recovering from surgery and all of a sudden, collapsed and stopped breathing. After the code was called, 15-20 physicians, nurses and respiratory therapists ran to the bedside. The commotion was palpable and tensions ran high. In the end, it was decided that the patient would have to be intubated. Intubation involves carefully placing a small tube down the patient's trachea so that we can hook her up to a ventilator.

All in all, it was a success and the patient was revived. This actually isn't a very rare occurrence except for one detail: she was awake, but paralyzed for the whole thing.

Apparently, somehow, the paralytic from the surgery had some secondary action and acted a second time. She wasn't sedated and she could consciously perceive that she couldn't breathe and couldn't move. She heard the "code blue" over the intercom, saw people run into the room and waited, helplessly, while a tube was put into her throat.

The hospital is a scary place.

Happy Thanksgiving!

Unfortunately, I'll be spending my favorite holiday not with my family in South Carolina but with my patients in the hospital. I've switched to Internal Medicine and I've really enjoyed the switch. I spend all my time in the hospital - being on call every 3 nights is really a drag, but it's really challenging and interesting. I'm still at the point where I feel like I can't do anything right, but I'm quickly improving. It's a tough learning curve.

I'm definitely in the thick of it now. I spent two weeks in the ER , which I loved, and jumped right into the action. You never knew what was coming through the door. I found Psychiatry to be very helpful in that situation. In the end, I found it exciting but a bit depressing. My second day on the job, I found myself cleaning the wounds of a 13-year old who shot himself (accidentally) in the thigh. I irrigated his wounds, made him an outpatient appointment, and sent him on his way. After doing chest compressions on a 15-year old with a bullet in his head, I realized this wasn't the field for me.

This past weekend, something happened that gave me a quick gut check as to where I lived. I was on call Friday, and I remember thinking "hmm...we haven't had an admission in a while."

Apparently, the hospital was diverting all admissions to the ER because the water on the entire East Bank of the city was compromised. The water pressure around the entire city was low due to some sort of turbine breakage and technically, we were on a "boiling water advisory" until Sunday evening. We were urged to boil the water we shower with and bathe with for 48 hours. It reminded me of India. In the early 90s. New Orleans - what's so great about this place is that it's so damn close to America.

As a nice change of pace, I'm coming back to South Carolina for about 36 hours this weekend. I'm flying into Columbia on Friday, post-call and coming back Sunday morning. I'd stay a few more hours, but there were no available flights. Coming out here, I had no idea how much I'd miss home, but sometimes it takes leaving to figure out what you already had. Don't get me wrong, I love it here, but it will be nice coming home.

In the mean time,

Happy Thanksgiving...

Ahmed

Goodbye Psychiatry...

Today marks a transition in my intern year. As you might know, I am a combined internal medicine and psychiatry resident. My first four months of training have been spent in inpatient psychiatry and now I'm transitioning into eight months of internal medicine. I start on a night shift in the ER tonight and, to say the least, I'm apprehensive.

I think I'll survive. But in the mean time, I wanted to take a trip through memory lane - my top 3 moments of Psychiatry training. Cue the montage.

1. Having a very delusional patient tell me that he can "make it rain". To which I respond, "outside or in a strip club?". Unfortunately, he meant outside.

2. Being told "there is no way I can have a urinary tract infection because after I pee I put antibacterial soap in my pussy."

3. A patient insisting that the former cheerleader medical student perform his physical exam. After his request, I looked down and noticed his erection. He was kind of senile, so it was funnier than creepy.

And with that, I move onto Internal Medicine. I'm basically nocturnal the next two weeks and if this afternoon filled with anxious tossing and turning is any indication, it won't be fun.

Peace,

Ahmed

Medical University of AstraZeneca

Here's the question: Who is responsible for your medical education?

I ran across a really interesting website the other day. Apparently, there were multiple lawsuits involving pharmaceutical companies that helped disclose 260 million dollars worth of pharmaceutical payoffs to physicians. See the searchable database here.

I took a curious look because I, being in the medical field, understand the temptation involved in pharmaceutical speaking fees, consulting fees, "educational reimbursements", etc. After searching my friends and family, I went to the next obvious target, my alma mater. It only took a second to realize that the results were appalling.

At quick glance, it seems that clinical faculty at MUSC have been paid $230,000 in speaking fees in 2009 alone.

You know, I've thought about this for a while and come to this more moderate conclusion.

I can get over the fact that you get pharm dollars, just tell me about it.

I had no idea that my clinical faculty had these ties to pharmaceutical companies. I don't know if anyone did. But the bottom line is this: If you're telling me that Seroquel is first-line treatment for schizoaffective disorder, tell me that AstraZeneca, who makes Seroquel, also happened to give you $63,000 last year.

Which isn't to say that this problem is isolated to MUSC. As you can imagine, this is a problem in conflict of interest that pervades all medical institutions. Just recently, Harvard Medical College had its own pharmaceutical scandal develop and decided, in response, to institute its own monitoring program for potential conflicts of interest.

And in that vain, there is an easy solution to this problem. Require all of your academic faculty to disclose financial conflicts of interest. Then, put them online and send an e-mail.

In summary, a lesson: Forget betadine. Sunlight is the best disinfectant

Peace,

Ahmed

I've been away for a while...

Damn boards...most of my free time for the past month has gone towards studying for Step 3. Now it's done. Here's a quick picture update of my life and a resolution to post at least once, maybe twice a week. I'm sure this happens to all blogs made by procrastinating, intermittently busy people, but here goes.

Brad and Ellen got married. Awesome time and happy for them. Here's the first dance.

Slapshots!

Beautiful day surfing

Saw the family...

Art for art's sake. This guy is pretty intimidating. In retrospect, I'm not sure if he was part of the show or just happened to be there.

Took Step 3. Parkview Bakery. Nothing beats a shrimp/roast beef po'boy after a 14-hour test. I'm back and will keep everyone updated.

I'll talk to everyone soon,

Ahmed

Song of the week - Cee Lo - "No One's Gonna Love You"

The history of Psychiatry...

Last week, I took a trip to Jackson, Louisiana. Most people don't know that this town exists and if you blink, you miss it. What is interesting about this town, though, is the East Louisiana State Hospital. This hospital has been in existence since 1890 and for years was the mainstay of psychiatric treatment in the state of Louisiana.

The first part of the trip was to the forensic unit. This unit was so aptly named because it is where patients who are deemed unable to tell right and wrong during their crime or "not guilty by reason of insanity." Also, this is where people who are deemed incompetent to stand trial stay until their competency is restored. The facility was interesting and really was in-between a hospital and a jail. We met a few classic patients including one psychotic patient who had pulled out both of his eyes. Why, you may ask.

Matthew 5:29

"And if thy right eye offend thee, pluck it out, and cast it from thee: for it is profitable for thee that one of thy members should perish, and not that thy whole body should be cast into hell.

He apparently took the bible pretty literally.

Then, we met another patient who didn't realize that he had burned down a local supermarket and another who spoke "French" and "Chinese" but really just spoke jibberish. Interesting place with some really sick patients.

Then, we went to the other side of town to visit the long-term inpatient unit. This side was notable for its history. It was founded in the 1880s and was known as the place where psychotic patients were sent "up the river" from Charity hospital. We live in an age of antidepressants, ECT, antipsychotics and medication management. It's hard to fathom what psychiatrists will think of our practices 50 or even 15 years from now. For some perspective, we visited the dungeons.

The dungeons were in operation until around the Great Depression. When patients became acutely psychotic or manic, they were chained underground and held. There were no bathrooms and there was no air conditioning (temperatures regularly got above 100). There were no medications and there was no use of sedatives. The picture speaks for itself.

We then took a look at the records. They were a very interesting reflection upon the understanding of psychiatry at the time. I know that we use a DSM and that we have standardized ways of looking at patients, but records like these really bring home the point that we don't understand psychiatric processes and that most of what we do is in theory. We know we can help, but we don't really understand how. When looking at these records, remember that these patients were seen by doctors once per year and that their one record is this line. The left column is the "diagnosis" and the right column is the "cause".

"Diagnosis: Acute Mania. Cause: Religion."

"Diagnosis: Dementia, Chronic. Cause: Masturbation"

Apparently your palms grow hair and you become demented.

Lastly, we stopped by to bathe in the solace of the cemetery. It was a nice day outside and we strolled through the graveyard, pausing at the sheer number of patients who died at this facility. So many of these patients' birth names were not known, so these tombs of unknown patients gives this facility an Arlington cemetery-like feel. We stood at the graves, paused in reflection, and went back to New Orleans.

Peace,

Ahmed