happythoughts

Joking with your doctor friends about wanting to be with a rich partner so you don’t have to work silly shifts any more (but really, so you don’t have to worry about becoming baknrupt if you have to take time out for sick leave or burnout). Or wanting a house-husband/wife to do everything for you (but really so you can do your job without also having to do most of the housework, particularly if you are a woman).

Single Doctor Culture is…

Trying to be honest with dates about the limitations of your work and lifestyle without sounding like a total downer.

Single Doctor Culture is…

Reflecting on prior people you dated (can you even call them exes?) and second-guessing if it was the lack of spark that made you end it or was it because it was intern year and you had just come off a long stretch of nights.  

Alternatively, thinking about “exes” and wondering if those incompatibilities were REALLY such dealbreakers because what’s so wrong with settling anyway…

…realising it’s that much harder to date when you work unsociable hours, because sometimes you really are too busy and tired for it.  But also knowing people in medicine who were dumped because “you always had to work”, and really hoping that doesn’t happen to you. Trying patiently to explain to people who clearly have all their evenings free that actually, you will probably work late, or actually, you have nights, or actually, you booked a meetup with medic friends like 3 months ago. It can be hard to explain just how difficult your timetable is, sometimes.

Also, not even knowing what is appropriate date conversation with non-medics any more. For Pete’s sake, I’ve mentioned dead bodies so many times on recent dates that it’s become an in-joke at this point.

Not having a ton of time to actually get to know someone in any meaningful way outside of work because you’re at work so goddamned much. 

Single doctor culture is meeting someone at work that you actually click super well with and wanting to date them but then also wondering if it’s an awful idea. Because you work with them and, although you’re totally getting ahead of yourself, if something happens and y’all don’t work out and it’s ugly, you’ll still have to work with said person for however many years of residency you have left and there’s no way to avoid them. But still totally having feelings that are difficult to get over because YOU HAVE TO SEE THEM ALL THE DAMN TIME.

Christian Lutz/AP

The 2018 Nobel Peace Prize has been awarded to Dr. Denis Mukwege, a Congolese gynecologist, and Nadia Murad, a Yazidi survivor of rape and captivity by ISIS, for their contributions toward combating wartime sexual assault.

Nadia Murad

In 2014, Murad, a member of the Yazidi minority in northern Iraq, was taken captive by ISIS members and sexually enslaved for three months before escaping.

Murad has shared her painful story with international media outlets over and over to show the world what happened to Yazidis. She has become a voice for captive women and girls in the process. She urges women who have faced sexual violence to reclaim their lives.

She was honored for her refusal “to remain silent and ashamed of the abuses to which they have been subjected,” said the Norwegian Nobel Committee. At age 25, she is the second-youngest peace prize recipient; Malala Yousafzai was the youngest at age 17.

Read her story here 

Dr. Denis Mukwege

Mukwege is known as “Dr. Miracle” because of his skill and his devotion to helping victims of gang rape during conflict in his country, the Democratic Republic of Congo.

Mukwege has treated tens of thousands of women for rape since opening Panzi Hospital in 1999. Those survivors, who range in age from toddlers to seniors, suffered complex gynecological injuries, inflicted by members of rebel groups and the Congolese military.

“What I’m doing really is not only to treat women — their body,” says Mukwege, “[but] also to fight for their own right, to bring them to be autonomous, and, of course, to support them psychologically. And all of this is a process of healing so women can regain their dignity.”

I’ve had countless sessions and lectures on ECGs. I don’t know how many websites I have bookmarked, or how many times my eyes glazed over reading Dubin. I’m also terrible at cardiology. I was on my way to accepting my fate of being horrible at ECGs forever, until I had a life changing session on ECGs taught by a great ER doc. I want to post it here because it was probably the most useful thing I learned in med school, and it will stick with me for the rest of my career. 

WHEN LOOKING AT ECGs FOR THE FIRST TIME:

1. One ECG is never enough. Always get old ones for comparison. If none available, do another one. Because. One ECG is never enough. 

2. RATE. Look at the number on top of the printed ECG. It’s stupid not to use that number. Yes, you should know the rule, 300-150-100-75-60-50. People say you shouldn’t trust the machine because… well, it’s a machine, and it can make mistakes. This is true. I don’t like to look at their “diagnosis” until I have gone through it myself. But the rate is just a number. Plus you should be able to eyeball it and be able to tell if it’s tachy, brady, etc. If the machine is telling you it’s 200 and if it looks tachy, then it’s probably the right number. 

3. RHYTHM. Is there a p-wave for every QRS and a QRS for every p-wave? Is the p-wave upright in lead II and down in aVR? Good. Done. BOOM. It’s sinus rhythm. ***if you cannot clearly see the p-waves then you cannot call sinus. move on.

4. AXIS. Again, look at the number at the top of the page. If it’s between 0 and +90, then it’s normal axis. If the number isn’t provided, or if your preceptor doesn’t believe in the convenience of machines/technology, look at the QRS complex of lead I and lead II. 

up in lead I, up in lead II: normal axis

up in lead I, down in lead II: left axis deviation (most common causes are left anterior hemi block and left ventricular hypertrophy)

down in lead I, up in lead II: right axis deviation (most common causes are right ventricular hypertrophy…PE)

5. did someone say HYPERTROPHY?

look at V1

is the R wave tall? (greater than 7mm?) right ventricular hypertrophy.

is the S wave tall? (greater than 11mm?) left ventricular hypertrophy.

  6. P-waves

look at lead II

is it wide? left atrial enlargement.

is it tall? right atrial enlargement.

7. PR interval

should be between 0.12 sec and 0.2 sec (3-5 small boxes). I used to always get this interval and QRS complex (less than 0.12 sec) mixed up. Think: atria depolarizing + shit getting to ventricles is gonna take longer than ventricles depolarizing. [2 things happening] versus [1 thing happening]. [0.12 sec-0.2 sec] versus [<0.12 sec].

long PR interval means there’s some sort of block at the AV node. 

1st deg block. PR interval is long. everything else is normal. cool. 

2nd deg block

type I: PR interval progressively gets long. eventually a dropped QRS.

type II: PR interval is constant, but randomly dropped QRS. 

3rd deg block “complete block”

there is no association between P waves and QRS. they run separately. **QRS does NOT have to be wide. Just look for P wave/QRS complex disassociation. I sometimes get this and 2nd deg type II mixed up. The only difference I try to remember is that PR interval is constant in 2nd deg type II, but is variable in 3rd deg. 

8. QRS complex

narrow or wide? 

narrow: good. signal coming from somewhere above ventricles. 

wide: think BBB (bundle branch block)

LOOK AT V1 ONLY.

if the last deflection of QRS is DOWN, then it’s a left BBB

if the last deflection of QRS is UP, then it’s a right BBB. super easy. no more of this bunny ears crap. 

9. ST segment

always look from J point, and compare with the isoelectric line of T-P segment (NOT PR interval). 

elevated/depressed… STEMI… duh. indicates ACUTE ischemic changes. 

look for reciprocal changes of the heart. if ST elevation in lateral leads, could see ST depression in the septal leads. PAILS:

posterior up, anterior down

anterior up, inferior down

inferior up, lateral down

lateral up, septal down.  

LBBB can look like STEMI. How to tell?

disconcordant changes is normal. (QRS and STEMI on opposite sides of the isoelectric line.)

concordant changes is abnormal. 

massive discordance is abnormal. (STEMI is greater than 5mm)

this isn’t that important. Moving on. 

Inferior STEMI. Could right ventricle be involved? 

DO NOT GIVE NITRO DO NOT GIVE NITRO DO NOT GIVE NITRO.

order a 15 lead

is STE in lead III > lead II? likely RV involvement

INFERIOR MI? 15 LEAD NO NITRO

INFERIOR MI? 15 LEAD NO NITRO

INFERIOR MI? 15 LEAD NO NITRO

10. T waves

is it inverted? indicates recent ischemic changes. 

11. Q waves

is it significant? indicates old ischemic changes. will likely be present if followed rule number 1 of reading ECGs. (1 ECG is never enough= look at old ECGs). 

I literally go through this list of 11 points in my head when I’m reading an ECG, regardless of whether or not I have an atrial flutter jumping at my face or if I see a massive anterolateral STEMI. Obviously I needed background knowledge on ECGs and the physiology of the heart before constructing this list, but this basic checklist has been very, very useful to me so far. It might look lengthy, but it doesn’t take a lot of time at all- a patient is not likely going to have all these issues with their heart. 

  Anyway. I still don’t love ECGs, but it feels pretty wonderful to be able to be able to evaluate it in a systematic manner, and get the theory behind interpreting the scribbles of an ECG reading. I don’t get these moments as much as I would like to, but it’s that crosspoint where my classroom learning actually meets real-life applications that gives me happy brain-gasms for days. I love knowing things and more importantly, knowing why.

It’s tempting to subscribe to a just world theory, where good things happen to good people (or people who make good decisions), and problems befall problem people, but that just isn’t the world we live in.