Whipping Goat — or, Scapeboy Fri 3 Feb 12

It’s been a rough week. I’m in a foul mood. Surgery has been riding my ass like a thoroughbred training for the races… But that would imply that I’m doing well in the races.

Allow me to graphically explain myself, with a hospital hierarchy.

Okay, that’s an exaggeration; I can usually manage to push around the ferns. But generally, we’re at the bottom of the pile. Low man on the totem pole. The eternal freshmen. And if you’re not careful, you will be yelled at, blamed, and condescended to until you feel like you might snap. That kind of stress can be hard on your soul… Allow me to express this feeling via youtube:

Acting thusly, of course, gets you kicked out of the OR, makes powerful enemies, and results in terrible evaluations and foul recommendations. So as a student, you have to be a sort of shock absorber for dickishness. It’s been a long week — everyone’s stressed, sick of bullshit, and short-fused. The dickitry spreads like wildfire. You absorb the vibrations of shitty attitudes, you keep your mouth shut, and you try to let it go. To complicate it further, you’re supposed to be learning from these people. That’s the whole point! You have to use the feedback to try to improve yourself, simultaneously weeding out the hyperbolic criticisms and veiled insults.

Turns out, it’s harder than just being happy-go-lucky and not letting people get you down — especially when you’re new to the hospital system. Being at the bottom of the hierarchy, it’s your fault when things go wrong. Standards that apply to other health care workers don’t apply to you. It’s easy to get shit on; even when being amiable, you can’t let your guard down. Rumors start easily in any workplace, and the “whisper down the lane” effect burns you easily. In short, you can’t be friends with anyone. I’ve gotten much more comfortable in the hospital, and I still am never sure exactly what people want from me.

I was at the end of my patience rope today by the end of 10 hours; and when my resident called to ask me to see a consult, I faked a peppy voice, swore loudly (after hanging up), and did it. Smiled the whole time.

Worker’s comp better fucking pay for my rage-induced aneurysm.

Do-Over Sun 1 Jan 12

I’ve never been one for the significance of dates. Birthdays, anniversaries, holidays — that’s all fine, you’ve got to celebrate them sometime. But there’s nothing magical about specific dates. I don’t follow numerology. I might check a horoscope, but only for entertainment purposes. (I do, however, believe it’s significant that I was born under a water sign.) But nothing special happens on your birthday; turning twenty-seven won’t make you feel any different than twenty-six did. Your seven-hundred-thirtieth day of marriage doesn’t suddenly elevate your relationship to a higher level.

It’s always seemed a little odd to me that the middle of the winter, the end of the holiday season, is the arbitrary agreed-upon time for everyone to start over. We make resolutions for how to be better in the next year, as though we’ve suddenly got a clean slate. What’s so special about this time of year? What makes it both the end and a new beginning? It’s odd, and I don’t understand it at all.

That said — it’s got to fall at some point. December is as good a time as any to reflect on where I am in life, in comparison to where I was before and where I want to be in the future. A recap, if you will.

It was a wild sort of year… Romantically, it was my first year I was single since before I graduated college. Also, it was a complete drought; I haven’t had sex since last New Year’s. And yes — it is a bit depressing. I’m reasonably hot, I’m reasonably young. It should not be so difficult for me to get laid. Standards have held me back on more than one occasion.

But being single has made me restructure my priorities. Especially since I’m in a position where I have to start thinking about the next four or five years of my life, I’ve had to remember that my main loyalty is to myself. Whatever I do, I have to do it because it’s right for me. It sounds a bit selfish, but honestly I think it’s been good for me. It reminds me that the future is unwritten, and it could turn out to be just about anything; I shouldn’t be limiting myself or tying myself down to commitments that won’t last.

I grew a lot intellectually… Started working in hospitals, which has bent me over and given me the shocker quite a few times since May. Very few vacations; I didn’t see my family from the beginning of the year through mid-September. I think it took its toll on me, too. And navigating clerkships has been a challenge… I thought I really understood professionalism, but I’ve found that working with different people requires you to amend your behavior. It’s been frustrating and, at times, enraging. It’s also been incredibly exciting to be part of people’s lives & recoveries. I also learned that I can’t always read people as well as I think I can. And naturally, I’ve learned a lot just about taking care of people. I’ve kind of pointed myself toward primary care (specifically Family Medicine), and it’s kind of exciting to ponder where I’ll be a year and a half from now.

As far as personal growth goes, well… I’m not too sure. I’ve had quite a few instances of depression throughout the year. It’s been hard to hold onto the blind faith that everything will turn out for the best, that no matter what happens things will be as they’re supposed to be. With my brother’s divorce & dog’s death, the failure of my longest relationship, my inability to find a partner who’s not a complete asshole, and doubts about my choice to pursue medicine — it’s been hard to hold out on the promise that things will be okay someday. I started living alone in 2011. It’s good for me, in some ways; it pushes me to be more reliant on myself, to discipline myself (though I’m not sure that I’ve actually made any progress there). I’m discouraged by my continued need for anti-depressants, and the fact that even with a lot of help from SNRIs, I’m still not exactly “normal.” I decided I should also be seeing a therapist, but spending 60 hours a week at the hospital tends to make scheduling difficult. In short, I guess I have some work to do in 2012.

But all in all, I’m happy with where I am. I’m not where I want to be — not yet. I want to be closer to family so I can be there in a crisis. I want to have more financial independence and stop adding to my debt to the government. I want to be better in medicine; I want to have a definite direction, and I want to feel more confident in clinical situations. I want to find a partner who understands me, who treats me well, someone I can trust.

I stopped making resolutions years ago; I don’t even remember my last one. But the beginning of January is as good a time as any to really take inventory of my life, to identify things I can do better. I guess my beef with New Year’s is that it’s just one day. Self-improvement really needs to be a long-term conscious effort; focusing all the self-improvement on one day of the year just sets you up for failure. Maybe if we had mini-New Year’s once monthly, or even weekly — I’d be forced to look more closely at my actions, my choices, the way I conduct myself, and what I can fix.

Actually — that’s not a bad idea:  shameless, unyielding self-inventory once weekly. The only problem is, there’s no way I’d stick to it.

DNR: Thoughts on Autonomy/Beneficence/Nonmaleficence/Justice Thu 1 Dec 11

"Boo."

Lost my first patient today. He’d been in the hospital more than a month. Shortly after I saw him during morning rounds, he just stopped breathing. Then his heart stopped beating. Then the nurse called our team to tell us he was gone. We’d barely made it down the hall.

In med school, we’ll occasionally have lectures in ethics. There are four core ethical principles in medicine.

Autonomy: The patient has the right to make decisions about their own health. If the choices are antibiotics or death, you have the right to decline the medicine. It’s your body, it’d your life, and you get to do what you want with them. That’s only fair.

Beneficence: Do what’s good for the patient. Obviously, this takes a backseat to autonomy, as in aforementioned example, with one exception. If the choices are antibiotics or death, and sepsis has made you mildly psychotic, you can’t decline the medicine. You’re getting the antibiotics one way or another, because you don’t currently have the mental capacity  to make that decision.

Nonmaleficence: The classic “do no harm.” This is probably the principle that is most violated, though not intentionally. Everything we do has risks; most medicines we hand out are poisons. This is one reason a doctor always informs you of the risks of a procedure before you consent. The other reason is because no one wants to get sued. Cynical, but true.

Justice: Everyone gets treated the same. The chairman on the board of directors gets the same treatment as the homeless man off the street. Ideally, anyway. And we do try… But someone without insurance and without money isn’t getting into an inpatient rehab facility. Wealthy people live longer; it’s statistically proven.

And so we return to my eulogy for Mr. W… It’s not even a real eulogy; I can’t use his name, and I don’t know much about his life. He was in bad shape when I first met him, and he didn’t have any family around. Heart failure, liver disease, too much fluid in his abdomen, trouble breathing. Infected ulcers all over his legs, could barely walk. Every time we thought we might be able to send him home, he’d get worse again. He became septic — with Pseudomonas. (NO ONE gets Pseudomonas sepsis.) We limited the amount he could drink, but he just got out of bed, went to the bathroom and drank out of the faucet. His abdomen filled with fluid again. Most days, he looked pretty miserable. A couple weeks ago, his blood pressure plummeted. His belly was huge; his heart was just too weak to circulate blood. Sent him to the RICU (Respiratory Intensive Care Unit) last week. While he was there over the weekend, he coded:  his heart stopped. The default action in medicine is to keep people alive as long as possible, so they brought him back. But his brain had suffered some damage from being without oxygen. He was transferred back to our service this week, unresponsive. His sister had flown in from California, and she had made him DNR level 3. This is how I saw him today, just before he died.

I’m sure Jenni already knows all this, because designating living wills was her actual job — but I’m going to explain it anyhow. DNR is “do not resuscitate.” (Not to condescend, I just want to be clear.) DNR level 1 means that if you die, we let you die. We’re not going to put you on a ventilator or do CPR; we’re just going to let you go. DNR level 2 is a weird category; it’s a “pick and choose” sort of deal. DNR level 3 means we make no attempts to keep you alive. We don’t try to fix you at all. We don’t treat your diabetes, or your clots, or your infections; we just keep you comfortable, and we send you to hospice.

Mr. W was the first DNR level 3 I’ve seen. It seems like giving up. It’s like accepting that there’s no hope. We’re just going to try to take away the unpleasant feeling that goes along with dying.

I was hoping that by the end of this entry I’d have some answers, I’d have a better idea of how I feel about it all:  about DNR, about letting patients die, about trying to fix someone and failing. I’m personally not very good at accepting death. Most times, of course, I have no choice. But what if I did… What would it take to make me choose death for someone I love, or for myself? In what situation would I finally say, let them die?

Maybe with time, I’ll get over my discomfort with death. Maybe I’ll get over the fear, and I’ll learn to love it, accept it, and to appreciate it as a natural corollary to existence, one that’s just as beautiful as life itself. … But I doubt it.

Creativity Thu 17 Nov 11

Sat across a woman in the hospital cafeteria today. Don’t know her story. She had a journal in front of her; she was flipping thru previous pages and pausing, then writing one-liners on a new page. Sometimes large, sometimes small, sometimes in capital letters. Really trite things, lines that just plain aren’t very good.

“The picture of you with disease is neither true nor real.”

“HARMONY HAS NOT LAPSED.”

No idea what any of it means; to be honest, the critic/snob in me scoffed at it. But I suddenly wish I hadn’t quit writing. Wish I’d had the courage to take the 300-level creative writing course in undergrad. I got used to being told how good I was in the lower-level classes — I think I was afraid of criticism, of being told where I was lacking. This is idiotic, of course, because without criticism I was doomed to hover in that cozy space just above mediocrity but just below being special.

And now — fuck, who’s got the time!! Not that it’s too late now, but I wish I had acted when the opportunity was right in front of me. I actually feel creative tonight — I felt HAPPY when I left the hospital. I thought of chords I could practice on guitar, about anecdotes I could write up. It’s dramatically better than my usual post-5pm state.

I find it so difficult to get things done at all; I’m always exhausted. At the end of the day, when I finally have nothing to do but walk through the hospital toward the door, this heaviness seems to hit me. Of course I’m tired; I’ve been at the hospital for 12 hours, & that much fluorescent lighting will zap anyone’s energy. But it’s disheartening that I so rarely feel the I-learned-and-accomplished-so-much-today kind of tired and so often the goddamn-I’m-so-sick-of-life kind. And then I get depressed. Not a lot — just a little. Because I start to worry that maybe all my days will be like this, that even the relatively good days will end with me feeling hollow and heavy and wishing the day hadn’t begun at all.

Generally, activity is good for me. It keeps me going, it raises my overall energy level.  If I didn’t have responsibilities, I’d lay in bed all day. Hell, I’d skip meals just so I didn’t have to go outside. Being busy is undeniably good for me. I guess I just wish it fixed more. So maybe what I need is a different kind of motivation… Something to do other than studying and solving crosswords to avoid studying. Maybe I should work a little harder on being creative, and maybe with practice it’ll get easier. Just like finding someone’s liver.

——————————————————————-

Also — if you haven’t seen this, you really should.

Is your doctor an idiot? Tue 11 Oct 11

Hi, everybody!!

 

A group of doctors go duck hunting. The psychiatrist is too preoccupied trying to assess how the ducks feel, he never even thinks about shooting any. The family doctor sees a group of ducks and aims his gun, but keeps asking the other doctors what they think he should do. The ER doctor spies a flock overhead and shoots wildly into the sky; he picks up the few ducks that fell, makes sure they’ve been shot, and hands them to the hospitalist saying, “They’re your ducks now.” The surgeon sees another flock, takes careful aim, and brings down a bird; without looking at it, he throws it into the pathologist’s lap  and asks, “What is it?”

 

The joke is, all doctors are flawed. Psychiatrists look at intangible values rather than physical evidence. Family doctors always look to specialists. Emergency doctors are only concerned with getting the patient out of the ER, whether back home or into a hospital ward. Surgeons cut out anything that looks suspicious, and they wait for pathology to tell them the diagnosis. And I hear so many disgruntled patients claiming that their doctor doesn’t know what he’s talking about. “Dammit, I went in there and told him I got trouble breathing, and he’s nagging me about cholesterol! He don’t know what the problem is….”

So maybe, at least sometimes, they’re right. God knows doctors don’t have a good opinion of each other. Even “evidence-based medicine” has discrepancies. I know a doctor who firmly believes that the government created the diabetes/obesity epidemic by encouraging low-fat diets in the early 90s; as a result, America replaced their fat intake with carb intake and BAM — diabetes, type 2. Nothing to do with portion sizes, or sedentary lifestyle, or McDonald’s; it’s all the government. He’ll talk about it for hours (and I’d never interrupt). If you’re overweight, this doctor would recommend Atkins. No question. Alternately, I know a doctor or two who would disagree…

I kind of think I’d like to be a family doctor in a small town. … Preferably with less Christians. I like the idea of knowing my patients, knowing my community. And maybe I won’t be able to do it all — maybe I won’t go into any of my patients’ surgeries, maybe I’ll make a lot of referrals because I won’t always know what I’m doing. Maybe other doctors will look down on me for having less procedural skills or making less money. But hell– someone will always find a reason to feel superior to me, and that’s no basis to make decisions about my career. I just have to figure out what I want, what’s important to me.

And once I get there, I’ll probably still be an idiot.

A Change Thu 7 Jul 11

Walked into my kitchen tonight… the dishwasher has been clean for nearly a week (I’m guessing), but I never got around to putting any dishes away. Things are disorganized, messy, possibly growing organisms in standing water while idling in the sink. Told myself aloud, “I need to do something about this” and, gesturing my arms in an encompassing circular pattern, “all of this.”

It’s a metaphor, in case you didn’t catch that.

Funny part is, I don’t know what I need to change. Feels like more is already going on than I can handle; shouldn’t I be trying to keep things the same? My brother’s wife is leaving him — that probably shouldn’t stress me out quite so much, but it does. I keep looking for something I can actually do about it, but I’m powerless & pretty much out of good advice. I’m currently in psychiatry — even though it’s one of the more laid-back practices, I feel ashamed at my ineptitude at least once a day. As a med student in the hospital hierarchy, I rank just below the plastic ferns sitting in the lobby; sometimes I forget that. It’s generally not long before somebody reminds me. I always remember that it’s not personal — it just comes with being the least skilled person in the room — but it’s always a rather sharp blow that leaves me with my tail between my legs, at least for the rest of the day. And having the hospital’s Chief of Medicine as a supervising attending could either have a really good or a really bad outcome…

And then there’s the romantic front… I actually have a date tomorrow — my first one since the break-up. The guy’s nice, he’s a psychiatry resident (though he has no impact on my grade), and he thinks I have a pretty face. I don’t know where the problem is here… but after he asked me (& I assented), I got in the elevator to leave, leaned against the wall, and just felt like crying. To be fair, that’s not a rare feeling at the end of the day. But still, I’m not too thrilled about this date. It’s hard to remember the last time I was actually asked out, the last time I’ve been out with someone I didn’t know too well — I’m not even sure how to act!! And there are all these little negative thoughts…. I’ll make an ass of myself, we won’t be compatible, he’ll realize he doesn’t like much beyond the pretty face… There’s no reason to believe these to be necessarily true. Maybe I don’t want it to work out so I can sit at home and quietly lament love lost.

In an aside… one of the first patients I saw at this hospital was a woman who had tried to commit suicide by overdosing on her prescriptions. I’d guess her BMI to be about 17; she was what we call “cachectic” (fun word, scary sight). She’d recently spent 2 1/2 months in a different hospital just for being underweight. We were talking to her, basically getting her life story so we could figure out how to help her. She insisted that she didn’t think she was fat; she knew she was deathly thin, but eating made her feel sick. There were some foods she couldn’t eat at all;  an actual meal would never be able to fit inside her. So we asked her what she could eat, told her we’d try to get some bland snacks on the ward to be available for her throughout the day. (This only makes sense; we wanted her eating as much as she was willing!) She folded her arms on the table, lay her head down, and started crying uncontrollably. She sobbed, “This is the first time anyone’s been nice to be in so long . . . Why would they? I’m a loser, I’m a crackhead…”

I could relate. I’ve never been a homeless crack addict who tried to kill myself by taking too much of an antipsychotic — but I know what’s like to feel like you’re worth nothing, and what it’s like to actually believe it. And still, it was amazing to me that the simplest, most natural of things — being nice — had such a strong effect.

Really, this is why I decided on med school. It’s more obvious in some specialties than others: when someone goes to the doctor or ends up in the hospital, they’re in their most vulnerable state. A doctor can make a patient feel terrified or at ease, powerless or in control, invincible or fragile, like he’s whole or like he’s falling apart. A lot of doctors I’ve been to myself seem to forget that (maybe because they don’t see it every day), but it’s just as true in general practice as it is in oncology, or psychiatry, or palliative care. Because beyond all the science, it’s just caring about people. That‘s why I’m here.

Glad we cleared that up.

Macrocytosis Mon 21 Mar 11

I’m actually doing fairly well in heme/onc. At least – I understand what’s going on (usually). Now actually remembering everything will be the tricky part. Making huge sets of flashcards online, because it takes too long in real life. My memory has just be awful lately; maybe it’s all the crap I’ve been trying to cram into it.

Also – every time I’ve tried to type “lately” today, I’ve inadvertently typed “latelet.” This is because I’ve typed the word “platelet” so much that my fingers can’t help themselves. That’s either really good, or really bad.

Feeling weighty lately. (Typed that correctly, but I had to think about it.) Granted, it is a weighty sort of period in my life. Even without relationship troubles, it’s a stressful time. In 43 days, I have my first licensing exam; I’m not sure I’ll have the drive to buckle down and push myself to study, to do better than just pass. (The USMLE Step 1 is a fairly large determinant of what field of medicine you can get into, or whether you’ll get the residency you want when you graduate. By the time I graduate, there will supposedly be more graduating students than available positions, so “just passing” isn’t good enough.) With that hanging over my head, I have a final exam on Friday, a “Doctoring” exam on Monday, and a cumulative exam — yes, as in everything from the past two years — next Thursday. I think it’s perfectly acceptable for me to feel overwhelmed.

That’s not really the weightiness though… This feeling like I’m carrying around an extra 20 lbs., the sensation that the cells in my blood are too large (macrocytosis!) and my heart is having trouble pushing them through… I’m fairly certain this is all personal. I don’t know what I want — and in a way, that’s my only problem. I’m confused like a gay teen at Jesus camp. I’m ridiculously lonely sometimes; I find myself wondering if I could find a guy friend who’d be willing to platonically spoon me. (“Cuddle buddy” rather than “fuck buddy”? Sounds improbable – and un-smart.) Simultaneously, I often find Alisha to be way too smothering, too loud, too touchy-feely — when I really just want to be left alone.

Really felt the weight when driving home today… It was really a “stream of consciousness” type of event. I thought of telling my nephew once, when he was being needy, that I needed him to go play by himself. (Actually, I said with himself, which is what made it memorable.) And I remembered when I had a problem, N would ask what I needed from him. And I thought to myself, how would I ever find someone who would treat me as well?

I figure the best strategy is the “watch and wait”… Try to maintain sanity, keep my options open. And if the situation changes, re-evaluate, and adjust my plan accordingly. Just like stage I myeloma.

Delicious. Wed 2 Mar 11

Realized last weekend that March was coming. Nearly had a panic attack. That’s two months to review two years worth of physiology, pharmacology, anatomy, biochemistry… And I’m so damned behind on my study plan…

Breathing much easier now. Still scared.
Been weird & depressive this week – no actual reason. Sure I’m stressed about things, but I can’t seem to find a particular cause for my pissy and/or sullen moods (unless it would be menstrual). Yesterday it was while I was running errands – which is odd, because getting around usually helps to keep my mind occupied. But it was also a very gray, blah sort of day. Today was sunny & beautiful; after a capella rehearsal, I just felt so cramped, impinged, like there were way too many people in the room, way too much movement and noise all around me. I really wanted to get out of there, just to be fucking alone somewhere — but I didn’t want to fly out of the room like a psychopath. So instead I sat there quietly, trying to ignore everyone around me… like a psychopath.

Speaking of – how bout that Charlie Sheen, eh? My theory is drug-induced psychosis. The way he talks really reminds me of a psychotic patient. It’s possible that the psychosis came first and led to the drugs, but it’s rare that it’d just pop up in middle-age like that. Plus he still appears to actually know who/where/when he is, so he’s got some connection with reality. Narcissistic personality disorder, at the very least.

I can play guitar now. Considering I’ve been at it for two weeks, I’m pretty damned good. Today I learned the easier chord ever:  Em7.

My cat always steps on my abdomen with his front paws and kneads until I feel like he’s bruising me. I have multiple theories on this: He could be claiming me; he could be reminding me that he’s in charge (this speaks more to the stepping on me than the kneading); he could be trying to soften my stomach so I’m more comfortable to lie on; he could be checking my vitality to make sure I’ll be alive to feed him tomorrow; he could be trying to help my digestive health by massaging air out of my colon. Animals are such a mystery…

Midterm this Friday… Every three weeks, just like clockwork. Gastrointestinal – all that fun pooping and yakking, bile and stomach acid, gallstones and colon cancer… Delicious.

Mu Receptor Agonists Sun 13 Feb 11

It’s been a long, confusing week. May or may not have completely worn myself out in studying for the neuro/musculoskeletal/connective tissue exam. Passed the final (barely), and spent the better part of today napping with the cat – which was unwise, because 1) I’m now wide awake, 2) I have a LOT to get done this weekend, and 3) I’ve been having some really disturbing (and sometimes vivid) dreams… Although I did get to fly in last night’s.

And now I’m watching Deliverance. Because nothing eases your tension like the classic story of camping trip disaster… And inbred hillbilly rapists.

Had a text-fight with N on Monday night. We  were not on the same wavelength at all… I was really doubting our entire relationship. We clarified things a bit the next night, which really softened the irritation. Didn’t have much time to worry about it throughout the week, given all the time I spent in the library; it still weighed on me pretty heavily, though. Just spoke to him tonight, and now I’m sure (again) that he’s the one for me, and that we’ll get through this.

Confusing enough?

Ordered Doctors In Training – a study mechanism for the boards in May. Part of the program is biweekly emails — Mondays and Thursdays, 15 questions each — to help you review various concepts. Of course, I didn’t have a whole lot of time to deal with it last week; but they also sent me the last eight sets that I’d missed since January. So that makes . . . what, 150 questions to catch up on?

Next week will be rather exciting… New block:  GI & Heme/Onc. I have enough trouble keeping cancers straight when we cover them with the rest of their body system. (For example, last block included cancers of brain, bone, soft tissue, and skin.) All of them together? … What a way to close out the year. And this time, I will keep up on the first week, so as not to screw myself while trying to catch up later. Also next week: two history/physical exams (H&Ps) – ungraded – in preparation for the H&P at the end of the year (which is graded), and a Thursday afternoon in the pediatric hospital. I’m tired already. But it is 3AM…  Let’s see if I can keep tonight’s sleep down to 9 hrs.

Three-Letter Words Thu 13 Jan 11

Everything in medicine can be abbreviated into three letters. I suppose it’s for simplicity – so you don’t have to specifically spell it out every time, you don’t have to waste syllables in saying it. Why write “chicken pox” when you could just use “VZV”? Why refer to the vaccine against the B antigen of Haemophilus influenzae as anything other than “Hib” – so long as everyone knows what you’re talking about.

This actually seems rather strange to me.  Medicine’s always making up longer words for things that we already know how to describe. And as if it wasn’t enough to have complicated names for parts of the body — erythrocyte, hippocampus, juxtaglomerular apparatus — every disorder has to have extended descriptions, too. “Dysphagia” means trouble swallowing. “Papular” means bumpy. “Tachypnea” means breathing too fast. “Hypersomnia” means sleeping too much. “Erythema” means red. (Seriously. It means red.) And “lesion” just means something’s wrong. Got an ulcer? It’s a lesion. A tumor? It’s a lesion. Got TB in your lungs? Lesions. I swear, it’s the most vague, useless word…

I suppose that’s why it seems so strange to abbreviate certain things. When we’re expected to describe a “lesion” as “labial, maculopapular and erythmatous,” why would we call the disease just HSV1? It almost seems disrespectful. We gave it the damned name; we can at least have enough respect to use it.

Fairly certain I’m in the midst of an MDE. But that may be because we’re studying psych. And I could be fatigued from low Hct, decreased RBCs. Couldn’t be EBV, or I’d barely be mobile. HHV-6 is a sign of HIV, but TB with HIV is much more fatal. If I tried hard enough, I could probably write an entire paragraph using just abbreviations.

But I was serious about that MDE.