Monday, January 28, 2013

One college down, "X" number to go

So yesterday we attended an open house at one of the colleges my daughter is considering for college since those apps will be due later this year! GEEZ, where DID all the time go? Anyhoo, it took everything I had to keep from crying at the intro given by the President, students, ect, I don't know WHY I'm such a cry baby when it comes to my kid! This school is a majority institution, to be distinguished from an HBCU or Historical Black College or University, and is unranked for Engineering, to be contrasted with one of the top schools of engineering recruiting my kid since she was in middle school (so you can probably guess where this is heading........). But this school is small and after having a disturbing dorm stay last summer during engineering camp at that "top school" that's recruiting her, my kid wanted to look into other options. And this option lasted all of about 10 mins into the tour given by the school of engineering, LOL!!!

Now I guess I kinda get it that when your parents are graduates from top universities there's probably an enormous amount of pressure on said kid to follow suit. And my response to that is HELL YEAH IT IS!!!!! However, my attendance at a certain SEC university that was NOT top ranked, is the one "do over" I wouldn't mind having, so I'm trying to remain objective about my kid's choices.

*politically incorrect statement alert*

My first red flag was raised when I didn't see ONE Asian student at the open house for Engineering, NOT. A. ONE. And what I've learned that means in the last 25 years in and around academia is that there's some "quality" issues with an institution when NOT ONE Asian student is interested in their Engineering program. Okay, I knew that going in about the school's "quality", but not seeing ONE Asian student at this open house? Strike 1! The second strike came when we had to walk 3 floors to the basement (broken elevator in the CIVIL engineering building, WTH?) and that told me that the Civil Engineering department is the "step-child" of the department. Strikes 3 to infinity were the COMPLETE lack of ANY Black students in the program, few publications last year, most of the students needing to take out loans to pay for school (this was a private school, but d@mn), and on and on, and on. Needless to say, I was ready to go not long after I got there, LOL!!!
So while eating the great lunch they provided for attendees (I didn't dislike it enough to pass on a good meal, LOL!!), my daughter told us that she thinks she needs to just "suck it up" and go to "top school" if they accept her! And the clouds broke away and the hallelujah choir began to sing!!!!

Now DH attended a top Engineering school for undergrad/grad school, but was supportive of this visit (he's ALWAYS the "good cop" in 99.9% of parenting situations which REALLY works my nerves!!!). But when talking to me, he agreed with me, just not as....... how shall we say......... vocally, LOL!!!

Of course, I understand that this is not about me it's about my kid, I'd just like her to get the best education she can. And I also understand what she dislikes about "top school", it has over 35K students. But as I've seen over and over again, engineering majors tend to create their own "worlds", working together in ways that I've NEVER observed with any other majors. And given that "top school" has lots of Asian and some Black students, it has the diversity and status I'm looking for along with folks my kid can socialize and form friendships with.

Next visit, a top HBCU!!!

** Images from Google images

Sunday, January 20, 2013

"Pathology people" versus "people-people"

And herein lies the dilemma of a non clinical specialty versus a clinical one. I've come across one too many acerbic personality bearing pathologists (and staff) in the past 3-4 years, that have me running toward the hills of clinical medicine. Add to that the fact that I've never felt that my hyperactive self "fit in" among the type of people that typically work in Pathology, it's somewhat of a surprise I've been able to do as well as I have. And if I'm really being honest, I have to throw Scientist types in there too and with this in mind, it may very well be the reason that while I've been supremely stimulated intellectually with my career choices so far, the emotional/personal stimulation has been pretty much non existent due to the personality "issues". Yes, I KNOW that frosty personalities are found in ALL career fields, but I don't think it's a coincidence that most of the Scientists and Pathologists I've ever known are just plain salty a LOT of the time. And the thing I've come to terms with in the past 3-5 years of having the worst employment experiences in a career that began in 1988, is that the personality of the people you work with/around is more important than what you do, at least that's how I'm feeling now.

And this is what makes the prospect of clinical work seem so cool, on those days when the people you work with are working your nerves (and I've seen/heard of horror stories about hospital staff), there's a patient somewhere in that hospital or clinic that can put a smile back on your face. And for me it's usually one in a little diaper, and I specify little due to some "challenging" experiences with adults who need to wear diapers, not throwing shade though, just keepin' it real. In contrast, microarrays and H&E's don't smile, although they're VERY cool to look at.

Thursday, January 17, 2013

From Comment to post, January 2013

"Hold up! What post did you read that got all these synapses firing away from patient care? Not knocking the decision. . . just curious. . .

Most important, you are listening to your spirit. Good for you!"

Talk about irony, LOL!! I had literally just finished reading an article about Hospice and Palliative care choices among Blacks, when I logged into my blog to see a comment by the one and only, GradyDoctor herself!! Man, am I pleasantly surprised!!!

Here's the article:

I mentioned some of what I do NOT like about patient care in my last post. But for the last several months, I'd been reading the blog of an amazing author named Nancy Stephan, about the last months of her daughter's life which has me pretty undecided about patient care if I'm honest with myself. Her story about her daughter's care who was diagnosed with diabetes in elementary school, was rife from my perspective, with what's so wrong with how medicine is practiced and how so often, people of color get disparate care. And with every post I read, I became more and more angry about situations which to me, reeked of racism. So as not to just focus on the negative, her blog also opened my eyes to other disease processes, in this case diabetes, which like many other chronic diseases, strikes Black folks at significantly higher rates than Whites. And that was a good thing for me, because I think it's good to keep my options especially now where I'm ardently looking for suitable research positions using Informatics tools. One thought lead to another, and I ended up reading an article in the NYtimes about end-of-life care:

Unfortunately, I know from experience that when it comes to the distribution of pain meds, I've gotten the short end of the stick, no doubt due to the belief of some in the medical community, that many Black folks have "drug issues". So when I read something similar in Nancy's blog regarding her daughter's care in her last months, I got doubly mad. But anger isn't an emotion that usually results in getting things done OR in developing good solutions, so I turned all that anger into something useful by educating myself journal wise in Diabetes and in the field of Hospice and Palliative care.

I've briefly mentioned the fact that I've been dealing with "death issues" since I was about 13 which seems too damn early to attend the funeral of a close relative. In this case, it was my Cousin who died from cervical cancer at 16 (her mother had taken DES while pregnant with her). Three years later, my neighbor was brutally murdered and 3 years after that, one of my best friends from high school died under circumstances which have never been explained. Those experiences were the impetus for me double majoring in Arts and Science, with the arts degree in Religion and a thesis on death and dying issues among young adults. I also completed training as a hospice volunteer during the same time.

So after thinking things through over the past couple days, I think it's my fear that a patient will die over some disparate care BS that bothers me the most about patient care. I also worry that so much of patient care is about patient compliance, and the fact that I'd feel like I made more of a real difference in my patients lives if they were compliant. And that puts fields like Internal Medicine and Oncology near the top of my patient care possible lists, because the ability to meet new people in variety of diseases states, and the fact that no two days would be the same, combine with the fact that there's also a TON of interesting medical science in both specialties. And THAT sounds pretty interesting, professionally speaking!

More recently, it was Nancy's blog post about her daughter's hospice care that got me rethinking patient care again in ways I don't think I can properly articulate except that it made me think about my Father's last days in Hospice, my own training as a Hospice volunteer, and the idea that death is a "tough subject" in Black communities. Thus, this field could provide an almost ideal way to make a difference in the life and in this case death of a patient, and there also appears to be a SIGNIFICANT need in this reasonably new specialty.

Anyhoo, I say all that to say that I will keep all my options open as EVERY future medical student should.

Tuesday, January 15, 2013

Diabetes and Boogers

*Image credit
So as not to absolutely disgust my readers, I won' t bother with certains kinds of visuals for this post, LOL!! But I have to say that after leaving elementary school, I hadn't thought much about the word "booger". And when I took my first biology class in high school and from that point forward, I began referring to boogers as "superficial mucosal material".

So I was super, duper surprised to see the word booger in a response to a case-study article about distinguishing type 1 from type 2 diabates. The statement, mentioned in a letter to the editors of that article, is here:

Now there were a couple things that stood out about the response other than the very BOLD use of the word booger. I was very intrigued by his brief discussion of how as a Resident, he had not supported the decision of Attending and the result had been the death of the patient. That got me thinking about a similar story on GradyDoctor's blog about how she had been "vetoed" by a Resident Surgeon, only to be correct (I can't recall if this case resulted in an amputation or the death of the patient). In both cases, I'm reminded of why patient care is NOT appealing to me, because I don't know how I would react if I made a decision about a case, had my decision vetoed by a superior, and the patient died as a result. I'm thinking I wouldn't respond very well.

Now, I imagine Docs deal with this type of thing all the time, but it probably isn't talked much about due to the litigious society we live in. And I understand that perfectly well. Of course, no one Doctor knows it all, all the time, and obviously I get that too. But part of why I think health disparities exist is because some well meaning Docs have NO CLUE of the nuisances that make providing care to minority patients different from the majority. For example, I recall when I was a volunteer in a rural health clinic an elderly woman came into the clinic for services (and I can't for the life of me remember exactly what that was). Anyway, the Doctor asked her when she had last taken her medicine and she responded "fo' day in the morning". I had a great relationship with this Doc, so when she proceeded to write 4 o' clock in the morning in her chart, I whispered to her that fo' day in the morning meant dawn, which at that time of year, was 2 hours later than she thought. I can't recall what the medication was, but I DO remember that giving the patient another dose of whatever it was so soon after the first one could have been catastrophic for the patient.

Unfortunately, I think this type of "miscommunication" happens a LOT more than folks probably want to admit, simply because there aren't enough culturally diverse folks IN medicine. The thing now is that having been accused one too many times of being a "know-it-all" in a couple professional settings (99.9% in Pharma), I'd be slightly hesitant to speak up. But here is where I'll need to sew another layer of elephant skin onto the one I already have, because potentially saving a life is worth whatever flack I could possible receive for speaking up (at least, that's what I keep telling myself when I think about my time working in Pharma). I'm just hoping that in medicine, unlike in Pharma, being right (about the new drug they were rushing through clinical trials) won't result in me being shown the door. And based on my medical experiences over the years, I'm reasonably certain that will be the case.

Other news this week is that I had a tutoring session with a local med student taking Medical Pharmacology, and it was an absolute BLAST!!! Besides the obvious reminder of what "the goal" is, it was just a lot of fun going over the material. Man, I'm SUCH a geek!

Tuesday, January 8, 2013

Going back down the same Path

* Image from Google images
** edited due to some serious, pre coffee errors, LOL!!
So I was reading a blog post on Gradydoctor about a patient encounter she had and I realized that as good as I think I would be at patient care, I don't think a career in it is for me. And obviously this is a HUGE change of heart from what I've been blogging about lately.

There was something about that post where a loved one was dying and the difficult decision was being made to decide to not provide any additional care that had me thinking that I couldn't do this on a regular basis simply because 1) I'm a cry baby and 2), being one regularly basis in a professional setting would be very stressful for me. It also occurred to me that I hadn't done any "people to people" volunteer work in over a year and that that may have been the reason why I was feeling so people contact needy!

You may recall I used to volunteer regularly with Komen but stopped after they decided not to provide funds to planned parenthood, a decision they reversed. I also wasn't pleased at how much of their budget actually goes to providing services to women. But after giving the issue a lot of thought (well over a years worth) and thinking of all the wonderful people I'd met because of this organization, I decided get back involved with them. So I signed up for an event in March of this year where I'll be speaking at a Black church. Speaking of volunteering, I decided against the public health gig after realizing they would need me to be available only during the day and for emergencies, and that wouldn't work for my schedule.

Other news, is that my email was literally blowing up with potential fellowships yesterday, including one with that super big wig I meet with back in October. And it's funny because Sunday, I was feeling like I would have a gig by the end of the week, Monday at the latest. And hopefully I'm right!

At any rate, I think it's VERY safe to say that I'm likely going to stick with Pathology or perhaps something like Preventative Medicine which now has a fellowship option in Clinical Informatics, because as much because I enjoy it, at some point in person's life, starting over and over again needs to come to an end. So now and possibly forever, it's back to Path201X!

Monday, January 7, 2013

Marinate your mind!

I think this is an appropriate post given how good I'm FINALLY feeling about my career over the next couple years!! No, I haven't yet heard back yet from that combo path/informatics gig, but I AM being considered for TWO new Informatics fellowship positions at the NIH. And even though there's a about a 30K pay disparity between the "real" gig and fellowship position, I'd take the fellowship position in heart beat! When you know you know, and right now given my career goals, getting in an environment KNOWN to get folks to terminal degree programs is simply the best way for me to stay focused on my goals and make good progress toward them! Tuition assistance, freedom to attend all the seminars I want is something I REALLY miss from my time at the NCI so hopefully I'll be back at it ASAP!!!

I also started an online course in Health Informatics a couple weeks ago, and lemme tell you, I'm REALLY enjoying it! I haven't yet made it to the lectures directly related to health information, but the background I'm getting in the healthcare industry is phenomenal! There's so much that's changed in the last 10 years that I don't know how I would have done in a med school interview with a question about the field and medicine and healthcare in general. I mean, I thought I knew a lot about what's going on, I read journal articles and papers regularly, but to be interacting with Profs who are at "ground zero" of the practice of medicine is an amazing experience!

So I'm feeling very good about my career these days and I think that it's just a matter of time before a good opportunity to do what I really want to do presents itself!

Tuesday, January 1, 2013

Too many career changes?

As I prepared for the interview I had last Friday for the job I think I've already been blessed with (the one which will put me back into the pathology field), I thought a lot about a recent blog post I read recently about the advantages and disadvantages of changing careers too much. And I thought it reminded me of me.(Is that bad english, or what, LOL??)

As an adult with ADD, I'll admit that it's a struggle to stay interested in things that don't change with much frequency. That's also a large part of the reason why I think I'm a perfect fit for the field of medicine because there's ALWAYS something new to learn. But changing jobs frequently can also be a curse of sorts since I realize that if I had stayed on the first gig I had when I moved to Metro DC after my first MS degree, I'd have that "long term career stability" that every employer seems to look for in potential hires these days. But the flip side of that is that I wouldn't have the overall VERY satisfying career experiences I've had to this point either.

Which brings me back to the field of Pathology in a BIG way. It's not just that I've been doing something related to the field since 2002. It's not even that I really enjoy the "science" of the field and think I'm pretty good at it too. These days, it's about the fact that even the idea of doing something that isn't at least peripherally related to Pathology would be like throwing away everything I've learned in the past 11 years.

Now I'm pretty lucky in that a LOT of what makes up Health Informatics my newest interest, is somehow related to Pathology whether I'm talking about electronic health records (EHR's) which are 70% path lab report data or biomarker evaluation of a recently removed breast tumor. So in this field, my education, training, and recent job experiences aren't a "waste", not that I believe in that term anyway. But the idea of doing something which involves direct patient contact in the future, would not only require learning a LOT of new things, it wouldn't allow for a significant use of what I already know so well.

So I get it, it's waaayyyyy t0o early for me to start thinking along residency lines but I guess I'm starting to think a little more long term about "change" than I had in the past. It just seems that there has to be a point where I get tired of "reinventing the wheel", and I think I crossed that point not that long ago. I'm also a believer in the fact that things don't happen in our lives by accident, so that microscope that I imagined was chasing me down the street may actually have been trying to tell me something really important. And now that I'm too tired to run any further, I've decided to slow down long enough to hear what it has to say.

PS - I haven't lost my mind in the new year, I realize that microscopes don't have legs and can't talk, LOL!!!

PSS- I came across the following case while spending a little quality time on the Hopkins unknown pathology website. It shows an an aggressive form of HPV in the nasal cavity. Now I understand how/why there are increased cancer cases caused by HPV in the throat. But I can't for the life of me figure out how someone ended up with it in their nose. Nor do I want to.