Take A Second Look

I watch the TV show House only occasionally. I happened to catch it this week and the episode that aired got me to thinking about my own clinical practice.

The story revolved around this 40-something male, polysubstance abuser who collapsed in a coughing fit, in an alley, and was brought to the hospital. Further workup revealed all sorts of vague symptoms on this guy (bleeding, respiratory distress, blood clots in his fingers). The doctors attending to him were in a race to see who could come up with the correct diagnosis.

One of the doctors kept arriving at drug-related diagnoses, i.e. diseases or symptoms explained by sharing needles, using inhalants, etc. In a heated moment, another colleague confronted her about her stereotyping this guy and assuming all his problems were drug-related. She could not see past his substance abuse to the larger picture. Her colleague said it best when she finally yells, "He has an addiction!"

This same doctor, the one who favored drug-related diagnoses, tries to have a heart-to-heart with her patient at the end, as he's dying.

(paraphrased)

"You've used so many drugs and drank so heavily for so many years. Don't you have any regrets?"
"I've used a lot of drugs and drank a lot. Everything else, I regret."

We see a lot of polysubstance abusers and legitimate drug-related diagnoses in the ICU. In my own practice and conversations with my patients, it would behoove me to remind myself that substance abuse does not the individual make. That every ailment or social problem cannot be attributed to their drug use. That they have an addiction, not a character flaw. That they may not even regret their drug use. It would behoove me to step back and take a second look.

"After Linking New Strain of Staph to Gay Men, University Scrambles to Clarify"

Here is a follow-up article to the one I posted a few days ago regarding MRSA infection. It is interesting and admittedly irritating to see how different groups responded to the initial article that was published in last Tuesday's New York Times.

A confession

Consider this my PostSecret confession, which stems from a very frustrating last few weeks at work:

Whenever patients are admitted to the ICU who:

• got drunk and fell down on their head and now have blood in their brain
• overdosed on drugs
• took cocaine and now complain of chest pain
• stopped drinking abruptly, knowing they have a 20 beer/day habit
• tried to swing a punch at me and/or kick me
• engaged in irresponsible behavior, expecting a responsible outcome

instead of being an empathic, understanding, level-headed clinician, I want to look into their eyes and scream YOU'RE AN IDIOT!!!!!

A bit worrisome

My roommate told me about an article in yesterday's New York Times entitled "New Bacteria Strain Is Striking Gay Men". It's basically a bug called MRSA that is infecting the MSM population much more frequently than the general population. It does not appear to be dependent on HIV serostatus, but does appear to be at least partially linked to sexual activity.

Check out the article here.

This is obviously a bit worrisome for a few reasons:

1) Unsafe sex continues to be problematic in the MSM population (as well as the general pop.).

2) They didn't know much about HIV/AIDS when it first caught the public's eye; just knew that it was a mysterious infection more commonly found in the MSM population. That sounds a lot like what's going on here.

3) MRSA is not easy to treat (i.e. multi-drug resistant).

Very hopefully, more research will elucidate this situation and maybe it'll turn out to be not that big of a deal. My gut may tell me otherwise, though.

This Is How We Roll

Over the weekend, I hosted in my apartment a student from Harding University who was coming to New York to check out the city and see what it would be like to live and work here. I've been in that situation before, in my last year of school, so I thought it only fair that someone extend to him the same welcome that was extended to me. That said, I'll admit that I was battling some pre-conceived notions about a Harding kid hanging out with me, Wilber, and Casey for the weekend. What will he think? How uncomfortable will he be? What will we talk about?

The trip went smoothly. We hit up a mixture of tourist sites and everday haps here in the city. We spent time in Brooklyn and Queens (let's hear it for the outer boroughs!), Chelsea (it's the second happiest place on earth, next to Disneyland), lower Manhattan, and Little Italy. He wanted to see the "everyday New York", so I showed him just that. Lots of time on the subway, running errands, running into friends on the street, etc.

We had good conversation about church backgrounds and where we both stand regarding our beliefs in worship. To my surprise, we're not that different. He attends a non-denominational church in Searcy, AR, which blew my mind. I didn't think such churches existed there. That shows my ignorance. He's also done a lot of mission work overseas and has a heart for social justice. Very cool.

We went to CCfB on Sunday morning and he got to see how we roll there. He liked it. Maybe he'll be back someday.

I daresay that the weekend was an eye-opening experience for us both. He changed my idea of what the typical Harding student looks like, and likely I changed his mind of what the typical Christian looks like. Good for both of us.