What does computational biology and Pediatrics have in common??

Well, read the following article to see:

http://www.prnewswire.com/news-releases/childrens-national-launches-sequencing-program-featuring-illuminas-nextseq-and-genomoncologys-go-clinical-workbench-300053236.html

Lately, I've been getting more than a few questions about how Comptuational Biology relates to a career as a Clinician, so I was thrilled to find an article which pretty much encompasses what I could do with training in both areas. Of course, reading it was the highlight of my day especially as I think more and more about how much I think I'd enjoy being a pediatrician (that's also trained inIM, 😉).

Outside of that, I'm dealing with some moderately serious health issues that have required my immediate attention. So until I get things under control in that regard, I won't be posting much since I refuse to throw ANY of my academic endeavors off my plate. However, it's simply the fact that regularly putting everyone else's needs ahead of your own, eventually catches up with SuperWoman, LOL!!!!

Go shorty, it's your birthday!!!!!

                                            *Image from Google Images

The week of my birth began with one of my mentors Dr. E, telling me that she's going to do an 18 month RN program at a community college so she can go into administration at the public hospital where she's currently working in Informatics. Now for clarity, NO hellz NO, this isn't my newest career revelation, LOL!! Of course, this is a revelation I was already aware of but for a slightly different reason. After my rotations earlier this year in a variety of clinical specialities in medicine, I was reminded that I was missing a LOT of personal and career satisfaction not being involved in patient care. A whole hellva' lot!!! But the nursing model of medicine has never, EVER appealed to me otherwise I would have followed in the foot steps of my Mom, and become an Advanced Nurse Practitioner. Plus the field is dominated with women...............umm HUGE NO THANKS!!!!

This week, I also had to meet with my 2 advisors and was greeted by the one in my current department with "You're applying to med school this year, right?" before Dr. B even said hello, LOL!! So our conversation started with my plans for matriculating into med school for the class entering in the Fall of 2016 and my current study for the MCAT due to my last scores "expiring" this month (according to some schools, scores are only good for 3 years). We then discussed whether or not I should stay in the Biomedical Informatics department or transfer to the Translational Sciences department. Now this advisor has a joint appointment in both departments which is the main reason I picked him, besides the fact that he was my professor in the Spring and I shadowed him at the county hospital where he's an Attending. So we have a REALLY good relationship!! Anyhoo, he suggested I stay where I'm at giving my very specific interests within Biomedical Informatics and that was a relief, because after meeting with my advisor in Translational Sciences earlier in the day, I felt I should stay in the Informatics dept too. But when he started suggesting classes in Artificial Intelligence (and the preq classes to even enroll in that class), I started to question whether or not I'd made the right decision, ROTFL!! One thing he did make crystal clear is that there is a significant need for Physicians trained in the nuances of Health Informatics (translated, those that understand the programming languages used in Health and Biomedical Informatics) and that I was studying the field at a very good time.


On the "work" front I'm still undecided about the next "group" I'm going to join, but I hope to have more clarity after I meet with the last PI on my radar on Tuesday. In the meantime, my Informatics classes keep me plenty busy these days as does the verbal reasoning/MCAT practice I'm managing to integrate into my daily study routine.

Lastly, I got one year closer to the half-century mark age wise on Thursday and since I meet with 3 different PI's on that day too, I'd say that that isn't a typical way one spends their birthday, ROTFL!!! But at this point in my life, I was VERY happy to spend it the way I did since I have long since grown inpatient with where I am in my career right now ie not in an MD/PhD program. But the knowledge that with each passing day, I'm one day closer to my MD/PhD goal means that I wouldn't change a thing about how my special day was spent! Plus, I'm just happy to still be here when so many of my loved ones are not.

MICU rotation, part 1

I'm pretty sure I'm going to need 2 posts to talk about what I observed in the MICU, it just REALLY blew me away. I didn't have much to say during this rotation, no thoughts on care, because obviously almost EVERYTHING was COMPLETELY over my head! Except, one case of COPD of unknown etiology until I asked about the occupation of the patient. And that happened to be in the chemical industry, so it was no surprise that an illegal immigrant working in a chemical plant, likely without the proper respirator equipment would have full blown COPD with heart failure at the age of 53.

Anyhoo, almost every patient on the floor was on a ventilator. Including a patient whose family I met at the nearby cafe which was on the same floor and around the corner from the MICU. And in the strangest form of irony, this was also the patient that coded while I was in the MICU. I accidentally met the family of the patient when I thought I was lost and was asking people I saw in the area if I were in the right place. The sister of the patient told me that the doctor I was looking for was her sister's doctor and that the doctor was a very nice lady (which she was and REALLY sharp too). I told her that I hoped her sister would have a speedy recovery and she slowly shock her head no then her head dropped down for a second. When she looked up, she had tears in her eyes and she replied that no, her sister probably wasn't going to be OK. And to that I said that I would pray for her sister and family anyway and I reminded her that God has the final say. At that point, it was time for me to report to the MICU.

The first patient I saw was the man with the advanced COPD, followed by a terminal case of squamous cell carcinoma of the throat, a case of cirrhosis of the liver, a brittle diabetic, and finally the sister of the woman I saw at the cafe, a case of AML which had not responded to treatment (As I understand it, AML is the worst Leukemia to have). The AML patient was my age 47, and had been diagnosed 4 months ago. Unfortunately, she wasn't responding well to treatment and had been in the hospital for the past 5 or so days. She was one of the last patients I saw and when I looked in her room, the sister I had seen at the cafe looked at me as if to say hello and I responded by smiling slightly and nodding my head.

Our group was just about done rounding when I heard all kinds of alarms going off and all the doctors in our group headed straight for the room of the patient with AML. Her head was tilted so that it was pointing down which I assumed meant she was having a blood pressure problem but I don't know for sure because I had to leave before rounds ended (I'm going to check with the doctor to see how this patient is doing, our being the same age struck a nerve with me). What I do remember is that she had had problems the night before due to an improperly placed Dobhoff tube causing a pneumothorax. A pneumothorax that was missed by the Resident and caught by the Attending who was none too pleased (Gosh, being a Resident must REALLY be hard). And I could tell the Resident who missed it really cared about the patient, unlike the 5'2", balding Jewish Resident who I overheard calling rounding "a bunch of crap". (He had on a Yamaka which is how I knew he was Jewish, and with Jewish ancestors, I'm comfortable calling his arse out!). I digress, I was happy that the patient's sister had already left when the emergency began but I'm pretty sure she was called back in. When I left, she was stable but her prognosis didn't seem very promising.

The other patient I remember well was a brittle diabetic, a Black woman who not surprisingly, was "very well nourished" and around my age too. In fact, EVERY minority I saw on the floor was overweight, reminding me that minorities really gotta' work on NOT "digging graves with forks". In her case, her diabetes wasn't well managed though I didn't really know why besides the fact that she looked non compliant based on her weight and poorly managed disease though I know the 2 aren't always associated. However overnight, her feedings had been withdrawn for reasons I can't recall. But what I do recall was that she was given 2 units of insulin in a fasting state so needless to say, things weren't looking good for her during rounds the following day. I also recall that this patient was assigned to the balding Jewish guy, and my immediate first thought was that his flippant attitude about rounding seemed to be carrying over into his bedside manner. So my question then became how in the hell did HE get into medical school?

Honestly, these are the kind of situations that have always worried me about going into patient care, what do you do when the person you're rounding with or are in school with seems to not care about what they do? It would be so hard for me to be silent knowing that my silence could cost someone their life, literally. But then I've already lost 2 jobs for not being willing to stand idly by as life threatening decisions are made, such as passing off bad data for a clinical trial. I just pray and I pray REAL hard that God doesn't allow anything like this to happen around me. Because I know if I were the patient, I'd certainly want someone speaking up to save my life.

Patient 2, Internal Medicine rotation

The second patient I saw on IM rounds was a 45 year old Black man who was HIV positive. I can't exactly recall what led to his ER visit, but I remember quite well that his T-cell count was near 0 upon admission. I also remember that the others on the team wouldn't go into his room and while I gathered that he was a difficult patient, it seems VERY strange to me a group of current/future doctors would be "afraid" to go into the room of an HIV positive patient. At least that's how I read it, as fear. I mean if Mr. Jackson was throwing poop at folks when they walked in the room, I could understand "the fear" to some extent. But to me, their fear was just ignorant. You see I was a volunteer AIDS counselor for many years and used to do blood draws for HIV test at a rural public health clinic. So, I figured that since I wasn't planning on having sex with Mr. Jackson, I didn't have anything to worry about.

So I put on the disposable gown and went to visit Mr. Jackson with Dr. B.

The room was very dimly lit and the only other person in the room was Mr. Jackson's daughter. And she was beyond pleasant and thankful to Dr. B for essentially saving her Dad's life. Turns out, Mr. Jackson had a BIG problem with taking pills and I surmised that after almost 20 years of being HIV positive, he had grown weary of taking lots of pills everyday. So Dr. B had ordered a Hospice consult for Mr. Jackson not out of need per se, but to "encourage" Mr. Jackson to take his medication. And immediately after the hospice folks left, Mr. Jackson started taking his HIV meds. The day of our visit, his T-cell count was almost back to normal and Dr. B was checking in on how he was doing.

What I learned that day was that despite CLEAR evidence for how HIV is likely transmitted, people are STILL ignorant about it. And to see medical folks behave out of fear was mind boggling. I mean, all one student did was touch the door handle of Mr. Jackson's room and he disinfected his hands immediately after he let it go. And no, I didn't see him do the same with ANY other patient we saw that day.

Again, ALL I could think about was how what I saw that day rounding emphasizes the need for both more compassionate and minority Doctors. I also thought that my personal argument for why no one under age 25 should be admitted to med school was substantiated as well.

Patient 1, Internal Medicine rotation.

* Image from Google Images

**While the following case is based on a true patient, the true identity of the patient has been changed in the interest of privacy.


Dr. B: "Kimberly, how good are your powers of persuasion"?

I knew as soon as Dr. B asked this question I was once again being tasked with talking to a patient with serious medical "issues". Ironically, the exact same thing used to happen over 25 years ago when I volunteered at a rural health clinic. Why folks seem to think I'm skilled in this area I don't know, but I like a challenge, so I accepted not being sure of what I was agreeing to.

Doc201X: " I think I'm pretty persuasive...........hang on, what am I agreeing to?"

Dr. B: "Thank you Kimberly, you've just volunteered to talk our 400 pound patient into getting out of bed twice a day."

And with that he proceeded to give us the clinical presentation of Mr. Hernandez as we surrounded him at the "cart".

Dr. B: "Mr. Hernandez is a 450 pound well nourished Hispanic male, whose chief complaint upon admission to the ER was severe back pain. After an X-Ray, it was determined that Mr. Hernandez has a compressed spine likely due to his excessive weight. Kimberly, we've been trying for almost a week to get Mr. Hernandez to get out if bed, do you have any ideas"?

Doc201X: "Sure......Maybe, but I'll give it a shot anyway!".

As soon as I took one long survey of Mr. Hernandez's extra large bed with a mini crane looking attachment, I immediately identified the problem with Mr. Hernandez getting out of bed.

Dr. B:"Buenas Dias, Señor Hernandez, como' estas?"

Doc201X: "Buenas Dias, Señor Hernandez."

Mr. Hernandez: "Something in Spanish I did NOT understand".

I immediately looked at Dr. B in utter confusion because while my Spanish is pretty good, I can't understand a lick Mr. Hernandez is saying because Mr. Hernandez has NO teeth.

Dr. B: "Lo siento señor Hernández. ¿Ha tratado de salir de la cama hoy?

Mr. Hernandez: "No, mi espalda todavía me duele mucho. Y me caí de la cama cuando trataba de ponerse de pie."

Doc201X: "Perdone, pero no entiendo porque estás hablando muy rápido". Habla mucho despacio por favor."

He repeates himself slower this time.

Doc201X: "Lo seinto, señor. ¿Te gustaría una cama más baja?"

And with that, Mr. Hernandez's problem may have been solved. He was about 5'3" tall and his VERY large bed looked about 2 feet off the ground. So with him being so large, he would practically fall out of bed trying to get out of bed, hence his reluctance to get out of bed. DUH!!!

The assumption of the team had been that Mr. Hernandez was just being lazy. Which may have been true to some extent, but how no one noticed how high the bed was off the floor and how short/large he was in realtion to it, still boggles my mind when I think about it. I get why the Doc could have overlooked this because he has a thousand other patients to think about. But for the others to joke about the guy and write him off as lazy just rubbed me the wrong way. So after finishing up with his patient record and discussing what they knew of his life and history, it occurred to me to ask if a Psych eval had been done on him. The team looked perplexed by the question, but Dr. B asked me why I thought it was necessary. I responded that no one I know wants to be 450 pounds and given what we had discussed about his history of using the ER as a primary care facility and other family/medical issues, that perhaps he needed a Psych eval. Dr. B mulled it over for a second, then ordered the Psych eval.

Clinical medicine, here I come!

I almost forgot to mention that I'm interviewing for a Bioinformatics Informatics fellowship tomorrow!!!

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: http://www.divinity.duke.edu/initiatives-centers/iceol/resources/last-miles/papers/08

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:

http://www.nytimes.com/2009/12/27/health/27sedation.html?pagewanted=5&_r=0

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.

Diabetes and Boogers

*Image credit diabetes.org
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:

www.ccjm.org/content/76/9/507.1.full.pdf

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!