MICU

So today I met with Dr. Thomas Kalb, a Pulmonology/Critical Care physician who works at Mount Sinai's Medical ICU. I didn't get a chance to shadow him because he had some family matters to take care of, it was great to get a chance to talk to him for a while. He was a really nice guy to talk to, and was really interested in hearing about what I want to do and telling me about pulmonology. He thought my decision to do the MPH before medical school was a great idea, and it would be very beneficial during the learning process in medical school. He also really supported my interests in global health, and gave me some advice as far as what I can do with that. He said that in general, critical care is a technology-dependant field, and is really not relevant to situations in the developing world. If I wanted to have skills that could be used in other parts of the world, I should either look into general surgery or ID. Those are the two fields, he said, that have the most in common with global health work. Not to say that pulmonology is not important, but there is only a limited amount of work that I would be able to accomplish with it. I thought that what he said held a lot of truth-- and I think this is where my interest in global health comes into conflict with my desire to be grounded in one place and be financially stable. I genuinely think that is is possible to do both, but I'm not sure if I have found out the right way to do that yet. Still Dr. Kalb was extremely nice to me, and offered me a chance to round with him after his teaching duties are over for the year, some time in early June. I'm not sure how I'll feel by that point, but I think I'll take him up on that offer.

After thinking about what he had to say, I don't think I would count pulmonology out, but it certainly has moved a little further down my list. Walking through the ward on my way out made me realize that all the patients in the MICU are generally elderly, and are all attached to a machine of some sort. It was remarkably quiet on the floor, and there was just this sense of keeping people alive using machines.

The Belize experience has made me think a little more about ER, because that seems to be a field that be highly involved with global health (at leave three or four of the physicians coming with us are ER docs), has reasonable hours and lifestyle (on a shift, so no phone calls in the middle of the night), is compensated quite well (avg. is $200,000) and has only a 3 year residency that isn't horribly competitive (according to this website, it's middle of the pack: a relative competativeness rating of 0.84, as opposed to derm which is 1.26 and medicine which is 0.53). I'm going to try to shadow an ER doc at Elmhurst sometime in the near future, as soon as I get a hold of him.

Late night thoughts on histo...

"Wet Seal"

Conference Call

I just finished a conference call with the other members of the AMSA Global Scholars Program, where we talked to Saranya Kurapati, the health action organizer for Physicians for Human Rights. It was great to listen, even for a brief amount of time, to someone who is very comfortable talking about issues surrounding human rights on a level that is far more sophisticated than the conversations that we have among medical students. It made me realize how different all of this is from the types of discussions we were having at Columbia. And I don't think it has anything to do with Sinai-- this is the nature of medical school. I was talking with my roommate about this kind of thing, and he was commenting that he feels that everyone has this nature of being so self-absorbed, only worried about how to pad their resumes and what subspecialty they are going to do. There is something about school that can be so all-consuming, so homogenous, that it is impossible to have outside beliefs or interests or plans. This may be a cynical thought, but I am still tired after that first round of midterms that we had, and the prospect of starting to think about the final exams in Histo and Physio is disheartening. Things with Belize are starting to pile up, and I find that summer plans are being pushed to the back burner. All that manages to do is get me more anxious.

The Global Health Scholars are going to have a conference call with Stephen Lewis in a few weeks, which I think is very exciting. He worked at the CGHED while I was there, and I saw his speak a number of times at Columbia, he's a wonderful speaker.

I went to an ID panel this past Tuesday which was really interesting. It felt very comfortable to talk to ID docs about the diseases that they work with on a daily basis, and I think that I could do something along the lines of what they do. Although, as far as doctors go, ID docs kind of get the shaft I think-- they are up there with peds as getting the least respect for what they do. It really bothers me that some surgery subspecialties do nothing more than the same hernia surgery every single day, day in and day out, and receive an enormous amount of compensation and respect, while subspecialties of medicine get none of that. I heard a pulmonologist talk on Thursday, and that was really cool I thought. I'm going to try to shadow him this coming week.

Here is a table from the WHO Global Burden of Disease Project that gives an estimate of diseases or injuries with the highest mortality rates in 2020. There is little I would be able to do about road traffic accidents, war and violence, and I really don't think I want to work with mental health issues (i.e. unipolar depression and self-inflicted injuries) or with obstetrics (i.e. perinatal conditions and congenital anomalies). That leaves CVD (HD and stroke), ID (diarrheal disease, pneumonia, TB and HIV) and lung diseases (COPD and lung cancer). Fully four of the fifteen diseases are related to the lungs (pneumonia, TB, COPD and lung cancer). Of course these are data from all over the world, and different parts of the world will have different rates of diseases. It is quite interesting that the major diseases of the world are still related to ID, heart disease, and lung disease.

Rank of diseases and injuries attributed to the highest mortality rates, 2020

1	Ischemic heart disease
2	Unipolar major depression
3	Road traffic accidents
4	Stroke
5	COPD
6	Pneumonia
7	TB
8	War
9	Diarrheal diseases
10	HIV
11	Perinatal conditions
12	Violence
13	Congenital anomalies
14	Self-inflicted injuries
15	Trachea, bronchus and lung cancer

Alright, renal physio calls, so I'd better be going.

Global Health Scholars Program

I got a phone call yesterday telling me that I had been accepted by the AMSA for the Global Health Scholars Program, which is a new certificate program for medical students interested in global health. It was a pretty competitive program-- out of about 100 people who applied around the country, they said, they interviewed 10 students, and accepted 4. One is from Yale, the other is from GW, and the third I can't remember. Anyway, it involves a 6 month curriculum of sorts and a couple of stipulations for things we have to do to finish the certificate. The first step is to read Paul Farmer's Pathologies of Power, and then in April we are going to have a conference call discussion with him about his work and the topics in the book. I think that is very exciting-- I saw Dr. Farmer give Grand Rounds at Columbia once while I was there, and he gave a very inspiring talk. On top of that, there is a chance that they are going to want the four of us to sit on a panel during the AMSA National Convention that is being held this April in Chicago. Again, also very exciting. Of course, all of this means more work, but it's still some great opportunities.

In other news, I took my Histo exam this past Monday, and it was overall a very frustrating endeavor. The questions were overly ambiquous I thought and I spent more time trying to figure out what they were asking than actually thinking about the correct answers. Sufficed to say I didn't do a stellar job-- enough to pass, but not enough so that I can coast through the final. Stupid practical. If there was any doubt about pathology before, I think I can safely say that it's definitely out of the running now.

I started my elective in Clinical Immunology today. It was kind of strange, to be honest, since it was just me and another student sitting in a room as this pediatric allergist gave us a talk that she have given that week to immunology residents. I must say that I think I understood a lot of it, but that was from an amalgam of personal experience and stuff I sort of remembered from the NIH. On the whole, it was somewhat interesting, but I kind of got a sense of it being dry and even a little boring. I don't know. We have another session next Monday and another one on Friday, maybe those will be more exciting. I mean, it doesn't have to be anything out of an ER episode, but I was just thinking about what Eric is doing for his elective (scrubbing in on ENT surgeries), and even though I don't think I'm going to end up doing something like that, it still sounds far more interesting. This week my specialty-of-choice is critical care. I'm not sure if I would be able to work in an ICU, but it seems to have a little bit of everything. I emailed a pulmonologist who works in the MICU to see what he has to say. I'll keep you posted.