Categories
General Literature

A farewell to Oliver Sacks

In my life, I haven’t had many heroes. Yes, I have been fascinated with some athletes, scientists, artists, and people around me, but I cannot say that I have had many true role models. In terms of science and medicine, one soul in particular stands out – Oliver Sacks.

In my introductory histology & embryology course, a professor mentioned a funny story during a rather uneventful lecture concerning ocular histology. The story told of an interesting “optical illusion”, and the lecture suddenly became much more engaging. He briefly mentioned that the clinical tale presented was described by Sacks in “The Man Who Mistook His Wife for a Hat”[1]. I often leave many off-side notes, and in this instance I scribbled: do check this guy out. While revising my histology notes for the exam, I spotted this side-note in my “trademark” hieroglyphic handwriting and decided to follow up on it. With that, a new influence in my life began.

Most articles will state that Sacks was a British neurologist, physician, scientist, and prolific author. Although he was born in London, he spent most of his life in New York City. Sacks was a meticulous examiner and analyst of neurological disorders, and he devoted his life to patients who suffered from these debilitating conditions. Many of his works became classics and best-sellers in the arena of popular medicine.

Sacks’ book Awakenings” was used as a scenario for a major Hollywood motion picture [2] . In this true story, Sacks used a new experimental drug, L-DOPA, to treat patients in a state of total paralysis due to “encephalitis lethargica”. The treatment looked promising, as patients seemed to be resurrected and displayed dramatic improvements over their original condition. Unfortunately, the patients eventually regressed, once again falling into despair; once again drifting through the abyss of mere existence, which is what they had been enduring for years before the L-DOPA treatment briefly brought them out of it (the infamous “on-off” pharmacological feature of L-DOPA/Levodopa [3]). This was only one of many adventures that Oliver Sacks embarked upon and described in his novels. He was an intelligent, witty, compassionate, and truly unique writer and clinician who knew how to transpose the emotions, atmosphere, and feelings he encountered during his medical career.

In medical education, we explore different avenues – from basic to clinical sciences, bench to applied medicine, bedside to operating room, small rural ambulances to comprehensive medical centers. We try to reach a correct diagnosis. We try to adjust and find a sweet spot in our therapeutic modalities. We do our best to cut out what is sick and preserve what is still functional. Likewise, we are all attracted to different things. My “thing” is the nervous system and it has been for quite some time. If I was ever in doubt about such a choice, people like Sacks were there to remind me of my passion. Sacks’ stories of neurology and intricate brain puzzles consumed my attention on a daily basis. A few of his books, in particular, made a profound impression on me.

In “Musicophilia”, Sacks writes about the relationship of music and neurological disorders [4]. I was impressed when I learned how different clinical neurologic entities like stroke, cerebral hemorrhage, or head trauma can modify the processing of the sound and even alter someone’s musical inclinations. Likewise, in his book “Hallucinations” he talks extensively about how hallucinations can be generated as a consequence of trauma, drugs, or other physiological alterations [5]. Reading through Sacks’ books, I am continuously re-fascinated by his scholarly capacities alongside his humble and gentle nature. If the equation of human ego equals 1/knowledge, then Sacks had a miniscule, irrelevant amount of ego within himself. I rarely encounter such a trait these days, especially on the wards in daily clinical routines.

The last day of the August was humid and I had just returned home from a beautifully refreshing swim. I was soon struck with the news that Sacks had passed away. I was overwhelmed by the feeling of sadness. The world lost an outstanding individual, a soul that will be dearly missed by many. A few months earlier, in his New York Times column, Sacks wrote that he was diagnosed with metastases originating from his ocular melanoma. In this farewell piece, Sacks sensed his end was near and reflected on his life, which was well lived by any standard [6]. He announced that his final work, an autobiographical sketch of his life entitled “On the Move: A Life”, would soon become available [7]. His life was one of compassion and dedication; he was a source of warmth and kindness for those who were in need. He genuinely understood human suffering and worked to alleviate it to the best of his ability. Although I lived in New York City during my college days, I did not have the privilege of meeting Sacks. Regardless, I can find some consolation in the fact that he only departed physically – his writings, works, and grand opus will continue to inspire generations of minds to come. Goodbye, dear Dr. Oliver Sacks and thank you!

References

  1. Sacks O. The Man Who Mistook His Wife For A Hat: And Other Clinical Tales: Odyssey Editions; 2010.
  2. Sacks O. Awakenings: Knopf Doubleday Publishing Group; 2013.
  3. Lloyd K, Davidson L, Hornykiewicz O. The neurochemistry of Parkinson’s disease: effect of L-dopa therapy. Journal of Pharmacology and Experimental Therapeutics. 1975;195(3):453-64.
  4. Sacks O. Musicophilia: Knopf Doubleday Publishing Group; 2008.
  5. Sacks O. Hallucinations: Pan Macmillan; 2012.
  6. Sacks O. My Own Life New York, NY: The New York Times; 2015 [cited 2015 02/19/2015]. Available from: http://www.nytimes.com/2015/02/19/opinion/oliver-sacks-on-learning-he-has-terminal-cancer.html.
  7. Sacks O. On the Move: A Life: Knopf Doubleday Publishing Group; 2015.
Featured image:
oliver_sacks by Mars Hill Church Seattle
Categories
Clinical Emotion Lifestyle Narrative

A letter from a patient with anorexia nervosa

Dear Doctor,

What I need from you is validation that what I am experiencing is real; recognize this is more than just a burden for me.

At first it was a rush. The best feeling I’d ever had. I was getting compliments, attention, and my jeans felt wonderfully loose.  But it didn’t take long until it became everything; an obsession.  My eating disorder (ED) has become all I think about.  Every second of every day is consumed with what I eat, what I avoid, how I can avoid it, when I will exercise and for how long. I can’t escape.  Even if I actually wanted to gain weight back, it’s not that easy.

I know you might understand, but at least acknowledge that it’s not about the food. The truth is, when you say it’s about the food, it’s more tangible, easier to categorize, like a patient with a broken wrist.  People think that if I “just eat a sandwich” I will be fine, but this is far from accurate.

Sometimes ED hints at me, other times it screams. Either way, ED is a part of my life; it is a part of who I am right now. I have a deep connection to this diagnosis. Because of this, I will defend and validate ED, and conjure any excuse to hold on to this relationship just a little longer. For patients like me, ED becomes another member of the family, the third wheel in a relationship, or even another personality who needs attention.

I still struggle often, but I have good days too.  I am not just another girl with anorexia.  I’m a young woman who never takes life too seriously, loves road trips and playing the piano, and who fights back against anorexia every single day.  I know it’s your mission, but you cannot fix me. Only I can do that and I am going to need your support.

So right now, take a seat on my rollercoaster, listen to me, and let’s get to the end of this ride.

Sincerely,

Your ED patient

 

* Inspired by a loved one

Featured image:
Anorexia. by Mary Lock

 

Categories
General MSPress Announcements Public Health Reflection

“Fulfillment in Practice”: Dr. Howard K. Koh, 2015 Commencement Address of the Yale School of Medicine

We are excited to publish the final contributor to this year’s Commencement Archive, Dr. Koh’s 2015 commencement speech to the Yale School of Medicine, “Finding your calling.”

Howard Kyongju Koh is the former United States Assistant Secretary for Health for the U.S. Department of Health and Human Services (HHS).  

Screen Shot 2015-10-06 at 8.08.49 PMDr. Koh oversaw the HHS Office of Public Health and Science, the Commissioned Corps of the U.S. Public Health Service, and the Office of the Surgeon General. At the Office of Public Health and Science, he spearheaded programs related to disease prevention, health promotion, the reduction of health disparities, women’s and minority health, HIV/AIDS, vaccine programs, physical fitness and sports, bioethics, population affairs, blood supply, research integrity and human research protections.

Dr. Koh graduated from Yale College and earned his medical degree from Yale University School of Medicine. He has earned board certification in four medical fields: internal medicine, hematology, medical oncology, and dermatology, as well as a Master of Public Health degree from Boston University. 

Dr. Koh previously served as the Harvey V. Fineberg Professor of the Practice of Public Health, Associate Dean for Public Health Practice, and Director of the Division of Public Health Practice at the Harvard School of Public Health.  

Dr. Koh begins his speech by advising students to find meaning and fulfillment in medicine, regardless of external expectations,

“Please listen carefully to your inner soul so that you can discover your own sacred calling.  Doing so will help you express yourself, not just prove yourself. Doing so will help you determine in your life what is ultimate versus what is merely important.”

He continues by reminding students that patients will be teachers as well, and may be key factors in finding that calling,

“One way to learn more about meaning through your journey is to respect how your patients find meaning in their own. They can teach you in unexpected and profound ways. Sometimes the patients who will educate you the most will be the ones you couldn’t cure, no matter how hard you tried.”

He concludes and advises students to enjoy every step of the way,

“So please pay great attention to how you live your lives, not just as doctors, but as individual human beings.”

Visit the Medical Commencement Archive to read Dr. Koh’s full speech here

Categories
Lifestyle

Just Give Me Ten Minutes

As medical students, we are undoubtedly busy. Between studying and trying to maintain some semblance of a normal life, we don’t pause. Sometimes the only quiet we get is the car ride to class, or the few minutes before we fall asleep. A recent experience showed me that we might need a little more of this “quiet.”

When I was volunteering at Hope Lodge, a place for cancer patients and their families, I led a few short segments on meditation. Each segment was only ten minutes, but its benefits lasted much longer. After only ten minutes of focusing on my breathing and my body, I felt rejuvenated. We are often told that thirty minutes of moderate exercise, five times a week, will help us feel awake and alive. While this is correct, it’s still hard to find time to go to the gym regularly (especially during exam week). For meditation, you don’t have to get sweaty, leave your room, or change your clothes. Don’t get me wrong—I still love and encourage regular exercise. Yet if you feel too overwhelmed, stressed, or tired to exercise at the gym, give yourself ten minutes of meditation. These ten minutes will give you the clarity your body is craving.

So, what exactly do you do?

You can go about meditating in three ways:

  1. Complete silence
  2. Soothing music or sounds (such as a steady waterfall, a running stream, or nature’s lovely birds)
  3. Guided mediation with a voice accompaniment
    Both (1) and (2) can be found on YouTube. One of my favorites for (c) is this 15 minute video.

Once you have made your choice, give yourself at least five minutes to reap the benefits. You’ll find that even five minutes of focused breathing can do wonders for your mind and body.

Sit down in a comfortable position, close your eyes, and start breathing. Breathe in through your nose and exhale through your mouth.

When you are done, get up, and enjoy your renewed alertness!

There is no right or wrong way to meditate, and I am far from an expert. I only ask that you try it.

Further strengthening the therapeutic value of meditation, an article by the Huffington Post discusses the role of meditation in cancer patients. We all know about telomeres—telomeres shorten as we age, and shortened telomeres increase one’s risk for cancer. This article discusses a study where patients who participated in a mindfulness intervention had longer telomeres.

So give yourself ten minutes. You won’t regret it.

 

Featured image:
Meditation Transcendence by Hartwig HTG

Categories
General Reflection

Medical Conferences: Are they worth it?

Each year there are many medical conferences held around the world. These could be conferences about new research, medical education or, perhaps, a gathering of those in a specific specialty. Last year I was lucky enough to attend the American Medical Women’s Association (AMWA) Centennial Conference in Chicago, IL. After attending my first medical conference, I have made it a personal goal to attend at least one each year.

So, was it worth it? In my opinion, it is a definitive yes. I’ll break down some of the pros and cons based on my experience so you can decide for yourself if you’ll be attending a conference (or two) within your medical school years.

Pros

  1. Connections. I can’t go on long enough about how many new connections I made. I met physicians from around the nation in different specialties. I heard from speakers who had written books, gotten double board certified while raising a family of four, and even travelled to the moon (I’m not kidding, Mae Jemison was in attendance). An easy way to stay in touch with the new colleagues you’ve met is LinkedIn. After hearing from them at the conference I connected with them on LinkedIn, which allows me to see what they are doing professionally and keep them in my network for any future communications.
  2. Relationship growth within my organization. The AMWA chapter at my medical school has always been a tight-knit group, but this trip made many of us even closer. It was a great way to get the entire group motivated for an awesome upcoming year. We were able to bond over our favorite speakers and chat about some of the important issues being discussed on the women’s rights front.
  3. Stepping outside of your comfort zone. In advance, the conference paired student attendees with physicians and asked students to meet with and interview the physician. I ended up getting paired with an internal medicine physician coming from the renowned Tuft’s University. I was intimidated at first because she came from such a prestigious university, but she turned out to be incredibly down to earth and friendly. I had the opportunity to talk to her about her personal journey and how being a woman in a once male-dominated field affected her.  She told me a story of when she was involved in a patient’s care when they began coding. As if this weren’t stressful enough, she was seven and a half months pregnant and started having contractions. Womanhood presents unique obstacles, but this physician was able to overcome them with flying colors.
  4. Exploring a city! The conference allowed me to experience Chicago in a new way. We stayed right in the heart of downtown and went on quite a few sight-seeing adventures. Next year the AMWA conference is in Miami, which would be so much fun to visit! Heading out of town for a conference can feel like a mini vacation from the hectic life of a medical student.
  5. Intellectual growth. The AMWA conference placed a strong emphasis on the advancement of women in medicine. We heard from numerous female physicians about their experiences within the field and how they got onto their current path. It was empowering to listen to women who had written numerous books, founded various organizations and impacted society so greatly. Additionally, I was able to hear from numerous female physicians about raising a family and having their dream career. It gave me hope that the life I want is doable. I think this conference truly revitalized my energy after a long first year in medical school. It allowed me to see past the current grueling coursework to what my career could potentially blossom into.
Cons
  1. Money. Okay, to be honest, this AMWA conference was actually affordable, but I know many are super pricey. My advice is to seek funding from various sources. This year I’d really like to go to the conference again, so I plan to set up a Go Fund Me account that will allow my relatives to donate some money to help me attend. Last year, I was fortunate enough to get some money to support my travel. Most student organizations can get some funding from their school, which is what our AMWA group was able to do. In addition, many conferences have grants or scholarships to help students attend. I recommend looking at a few different conferences you find interesting and pick one that is the most economical. Another option is to create a poster (or research) to present and most likely you can get a grant from your school to present it at a conference.
  2. Time. The conference I went to was an entire weekend event, so I wasn’t able to study at all. In the little down time we did get, I wanted to explore the city or just relax for a few minutes. Plan ahead and study during the car (or plane) ride. Check your schedule and make sure the conference falls during a time that isn’t incredibly hectic for you. Even though conferences are a large commitment, the time “lost” I think ends up being an overall gain when you consider the benefits.
I think medical students should look further into the idea of attending a conference. Many of us are hesitant because we think it will just cost extra money we don’t have. I urge each of you to look deeper than the price tag and make a plan to go to a conference at least once during your four years of medical school. To find out more information about the AMWA Centennial conference click here.

Featured image:
Conférence NWX2012 by Frédéric BISSON


Categories
General

“The Three Ingredients of Medicine” Dr. Myron Cohen, 2015 Commencement Address of UNC Chapel Hill Medical School

This week, Dr. Myron  Cohen’s 2015 Commencement Speech at the UNC School of Medicine entitled, “Becoming a Citizen of the World” debuts via the Medical Student Press.

Screen Shot 2015-10-01 at 9.25.18 PMDr. Myron Cohen is known for his invaluable contributions to the construction of the HIV Prevention Trials Network 052, which established that treating an HIV patient with antivirals makes them less contagious to their sexual partners.

Dr. Cohen earned his medical degree from Rush Medical College, completed his residency in internal medicine at the University of Michigan, and did his infectious disease fellowship at Yale University.

Dr. Cohen is the Associate Vice Chancellor for Global Health, the Yeargan-Bate Distinguished Professor of Medicine, Microbiology and Immunology and Epidemiology, Chief of Division of Infectious Diseases and Director of the Institute for Global Health and Infectious Diseases.

Dr. Cohen’s research work focuses on the transmission and prevention of transmission of STD pathogens. Dr. Cohen and his coworkers have identified the concentration of HIV in genital secretions required for transmission of HIV, and the effects of genital tract inflammation on HIV.

Dr. Cohen structured his speech based on three “ingredients” of medicine that are essential to identify: change, being a citizen of the world and humanity.

“Diseases do not respect borders… Tomorrow -wherever you go- you might well be asked to deal with a patient from West Africa at risk for Ebola, or to make recommendations about measles vaccination.”

He continues by advising graduates to remain compulsive and balanced or the pleasure and significance of medicine may be harder to appreciate. He then concludes with reminding graduates of the privilege they now have of being physicians:

“And with this privilege and recognition comes responsibility: the responsibility to do your very best for your patients; the responsibility to contribute to the health of people in your community; and the opportunity for leadership for the graduates of UNC who will move to communities all over this great state.”

Read Dr. Myron Cohen’s full commencement address.

Categories
General Lecture

Hazardous Attitudes

A few months ago I attended a medical conference organised by The Medical Student Journal Club in Slovenia. The conference consisted of debates between medical students, which is a great concept that I thought worked very well. Two medical students, usually from different countries, take on the same topic, one presenting the Pro side and the other the Contra side. They have a short Powerpoint presentation, after which the audience is invited to comment and ask questions. This was the third Pro et Contra congress I attended, having been an active participant each year since it was first organized. It was an easy decision to come back each year because it’s different than the medical conferences I’m used to. It takes place during the weekend, and it’s a perfect blend of learning about medicine in a more interactive way, sharing opinions with my peers and senior doctors, meeting medical students from different countries and having a nice time exploring Slovenia. Not to mention the organization is absolutely amazing, with every moment of our stay taken care of.

I realize most of the readers of this Blog are from the USA, and the likelihood of one of you visiting this medical congress in Slovenia is very low. I’d be happy if I got more people to attend the Pro et Contra congress; however that’s not what this post is about. Even though the debates at the last Pro et Contra congress were amazing, the opening ceremony involved a group of doctors performing a few popular song parodies on different medical hot topics, the audience participated in discussions more than ever before, and I went home with a prize for the best foreign speaker (a generous gift of Harrison’s manual of medicine), what made the biggest impact on me was the guest lecture given by a pilot, captain Tomaž Prezelj. Yes, a pilot gave a lecture at a medical conference, and it was simply superb. It is almost two hours long, but I advise you to take time out of your busy schedule to watch it. Captain Prezelj compares five different attitudes of pilots and the ways they can affect flight safety. The great responsibility, human nature, and high risk environment pilots work in easily translate to the experience of doctors and medicine. It’s all about human error. So, without further ado –