Summer break

It's the summer between first and second medical school year. Some advise to travel, visit friends, while others work and study for the upcoming board exams. What ever it is, this summer is the last normal summer a medical student will ever have.

Stress and Dept of U.S. Medical Students

By now the application process is drawing to a close and some of the applicants are either very happy with their acceptance letters while others are gearing up to apply again for the next school year.  I was lucky to get in on the first try, yet I did not understand the many realities of medical school until I started this school year.  

For those that got in, it is important to realize that being accepted does not guarantee graduating medical school.  People will be dropping out after the first semester, second semester, and even third semesters because of academic failure or in minor cases health issues.  A 1994 article in Academic Medicine showed that graduation rate of 1988 matriculates was 81.2%.  Now that may have been not so bad in 1988, but things are very different today.  

The main problem is the cost of education.  Think about it -you probably spent about $60k+ on undergraduate education and now you will be spending at least $50k/year on medical school.  So if for some reason you are not doing well in your first year and fail out, you are now $100,000.00+ in dept.  The situation is made worse by the fact that majority of medical students have basic science education (biology, chemistry, etc...).  With these types of basic degrees it will be difficult to find work.  So you will have to go back to undergrad and get another degree.    

It is this financial stress that hangs over my head all the time.  You need to work hard and pass every test because the alternative is not pretty.  Once you start your first year there is not much opportunity to go back.  

On Acute Radiation Syndrome (radiation sickness)

The following text presents some introductory concepts of radiation and exposure.  This topic is complex and links are provided for additional reading.
In the last couple of months I have been reading about effects of radiation on the human body.  This renewed interest came after the April anniversary of the Chernobyl Disaster during which the firefighters and plant workers that responded to the accident received a lethal dose of radiation.  Those workers and firefighters developed what is called Acute Radiation Syndrome (ARS) or radiation sickness.  Furthermore, I have learned that high radiation exposure can occur not only in nuclear power plants, but in nuclear waste reprocessing plants, research institutions, hospitals, and facilities specializing in food irradiation.  

Radiation & Dose Basics
Radiation is energy released by atoms undergoing decay.  This energy can be converted to heat, as in nuclear reactors, and in biological tissues this energy can cause ionizations.  The ionizing radiation can be in the form of alpha, beta, gamma, electrons. [2]

Amount of such radiation is characterized by a dose.  The commonly used SI unit is Gray (Gy) with units J/kg [3].  Gray describes how much energy has been absorbed per unit of mass.  For example, an 80 kg person that received a dose of 10 Gy had absorbed 800 Joules of energy from particles (alpha, beta, gamma, etc.) that have hit the tissue.

Effects on Body
Radiation has a destructive effect on the body; whereas some amount is tolerable, certain amounts are lethal.  Acute Radiation Syndrome (ARS) occurs when body is exposed to large radiation doses within a short period of time.  The amount of time is critical, for example nuclear plant workers receive small doses over years, which might not be tolerable if received all at once in a matter of seconds.  The dose we are talking about is at least 0.5 Gy to produce mild symptoms and with 3.5+ Gy causing severe symptoms with LD50/30 (50 % of those exposed will die within 30 days if left untreated). 

For a detailed discussion on physiologic effects look at a June 2004 article from Annals of Internal Medicine titled Medical Management of the Acute Radiation Syndrome [4]

The following video shows soldiers on the roof of the containment building of the Chernobyl NPP.  These people are using shovels to clean up radioactive graphite following the explosion.  All of these people received lethal doses of radiation.

Sources:
[1] A technical explanation of dosimetry with equations link
[2] Radiation (wikipedia)
[3] Gray (Gy) (wikipedia)
[4] Medical Management of the Acute Radiation Syndrome link to article

Very Hard Life - Doctors in Iraq

What kind of life does a doctor experience in a war-torn country? This question has been on my mind ever since I listened to reports of casualties following suicide attacks and military operation in the current Iraqi war. I have read a number of articles describing the lives of doctors in Baghdad and the answer was worse than I expected. Living in US, I have come to expect a doctor to have some form of elevated level of security due to the basic need of people with such skills (I even heard rumors of med students/doctors feeling safer in bad neighborhoods due to the fact that their would-be attackers understand that they may rely on their help some day). The current situation in Baghdad is very different; doctors there are afraid for their lives; 2,000 doctors have been murdered since 2003 according to Mother Jones magazine [1], and around 35% left the country. One of the causes is the elevated status doctors have in the society, which leads to kidnappings for ransom. Another, most compelling one, stems from religion; for example Shiite doctors/residents fled when Sunni militia was coming around [2], and a reverse happened when the Mahdi Army took over hospitals and went after Sunnis [3] .The hospitals lack supplies, the staff is afraid to come to work, and patients are being targeted. This topic is of great significance, and should be understood by current students and doctors.

[1] Mother Jones Magazine (link)
[2]Counterpunch.org (link)
This is an eye-opening article by a university professor from Baghdad, which describes the state of medical care as well as lives of doctors in Baghdad.
[3] CBS News (link)
A journalist reporting on Mahdi Army control of hospitals in Baghdad.

An article of a personal account by a physician from a private hospital in Baghdad. (link)

Image Sources
Image-1: wounded in Iraqi hospital (Reuters)
Image-2: Iraqi doctors in Baghdad emergency room (AP Photo/Ali Abed)

Treating AF - A look at Cox Maze IV procedure

My interest is surgery, and this post will give a quick look at the Cox-Maze procedure. The goal of the procedure is to treat atrial fibrilation (AF), which is a cardiac arrhythmia. The physical contraction of heart muscle results from conduction of electrical signal over the muscle. The heart has pathways that guide the signal from SA node down to the ventricles. In AF this conduction is disrupted in the atria, resulting in abnormal heartbeat.

Surgical Procedure
In the 1980s James Cox, MD developed a procedure that involved making scars on the atria in a certain pattern such that normal electrical signal conduction would be restored (The pattern of these scars resembles a maze). The original procedure was called Cox-Maze III, and was quite challenging. The latest advancement came in 2006, when surgeons from University of Washington, St. Louis integrated bipolar radiofrequency device, in what became known as Cox-Maze IV. The procedure uses radiofrequency to create scars, instead of the manual incisions and suturing.

Read the journal article, The Cox-Maze IV procedure for lone atrial fibrillation for an in-depth discussion.

image source: Ecardio.org

Don't See Your Doctor Right Before Graduation - A Lesson in Health Insurance

This post is for those students that are going to be graduating and loosing their health insurance. Right before I graduated, I went to my physician to get a physical to make sure that everything was OK. At the time, this made sense and so I got my physical only to find out that there was something wrong and required specialized treatment. But once I graduated and started looking for alternative health coverage I realized that I made a mistake. Insurance companies have this thing called pre-condition, which is their way of saying that they won't cover any ailments you had on the previous insurance plan. So when my physician diagnosed me, I had fallen into this pre-condition trap. If I were to get an insurance plan with a pre-condition clause, I would not be covered for treatment related to that condition.

Now there are some nuances. Pre-condition is usually present in "cheap" insurance. I say this because even the cheapest, descent insurance is $300.00+/month. Good health plans, usually offered through employers, don't have pre-condition stuff. But the health plan advertisements you might get from your school or mail, are usually crap.

The lesson:
1. Don't go to your doctor right before you graduate, wait till you get health coverage through med school or job following graduation.

2. Get COBRA coverage. Its usually offered through your parents' plan an will give you the coverage you previously had under their plan but with a monthly premium ($300.00-$400.00/month).

3. DO NOT be without health insurance. Get a basic plan which you can afford. The worst thing is to be without nothing b/c a couple nights at the hospital can cost you the equivalent of a down payment for a house. The $200.00-$300.00/month will save you thousands in case something happens (and since you are young and very active it probably will)

My Interview Impressions & Experiences

I have now completed eight (8) interviews and would like to share my impressions on this process. Interviewing was at times a lot of fun and other times a big drag. The most positive experience was traveling; I got to travel to some pretty cool places such as NYC and the beaches of Florida. There were times when I was running out of money and did a red-eye interview and another time I stayed with my friends and had a great night. This brings me to a good point - if possible stay with a friend or another med student. You will learn way more about the location as well as have a less stressful stay.

There was a number of schools that impressed me due to their program and facilities. For example, Mount Sinai had the best view of any school, the Central Park. Their anatomy lab faces the Central Park and is an impressive site. The location is nice too, and the living cost is reasonable ($800.00) for a shared apartment, which is great for NYC. Ohio State impressed me with their Asian and Hispanic student run clinics. These clinics are ran by students and a lot of skills can be learned early on. LECOM Bradenton was a lot of fun because the day before I was on the beach, which is only 30 minutes away from the school. The school is on a nature preserve and has an alligator swimming in a pond that is next to the school. Their program is PBL only, and students love it; I sat in for a 2 hour session and was amazed at how the students are able to use what they learned to figure out cases.

Advice:

1. Go to every interview!
Even if you have an acceptance somewhere don't become complacent. Give yourself as many options as possible; you spent all that time studying and applying, interviewing is the fun part. Personally, there were schools that I thought I would not like at all, but was very impressed when I was actually there.
2. If you can avoid hotel stay, do so.
It is sometimes tough, but I did one red-eye and it worked out well for me.
3. Carry-on luggage only (or at least put your suit in there).
I was at Philly and was waiting for my luggage for an hour, only to find out that I was at the wrong luggage place. Thankfully I got my luggage, but I was getting ready to attend the two interviews in jeans and a smelly t-shirt.
4. The two interview questions I encountered most:
a. Why do you want to go to this school?
b. What are your three (3) strengths and three (3) weaknesses?
5. How you feel about the interview does not necessarily predict the outcome.
At the beginning I naturally felt that a positive interview would somehow result in an admission letter. But this is not the case; I was at an interview that I thought went terrible and yet I got what I wanted.

At this point I am still unsure as to where I will go next year, but I will keep you posted.

Sources:
Central Park Image: www.edsphotoblog.com
Beach Image: http://www.siestakeyassociation.com/Images/siestakeybeach.jpg