The Funny Current

is actually a current controlling heart rate.

Month: January, 2013

Inspiration and That Asian Supermarket Smell

Today, I called up a list of parents whose kids we had done the fluoride varnishings on. The grant for this says we need to follow-up with them to make sure they got a dental appointment afterwards. I feel like I understand The Office a little more.

Betty and I had some good talks. Everyone has their little quirks. She just gets so excited when she feels really strongly about something, then just talks your ear off. Not that I don’t enjoy listening to her, but thankfully I haven’t had to go to the bathroom in the middle of one of her rants. It’s actually really nice to know people who are genuinely passionate about what they do. Between medical students, it’s almost a badge of honor to complain about how much work you have yet to do and how hard everything is, and sometimes, it really gets me down when that’s the only kind of talk going on. Betty reminds me that I’m just depressing myself. Yes, there are realistic factors you have to consider in your life/career, but hell, if you want something, just run over everyone else to get it. No one’s going to do it for you.

Afterwards, I finally hit the bank. Once again, NYC, I miss your redundant Chase banks. Then, my battered pelvis got me to the local Asian supermarket where I got some shopping down. I started a diet (which created all sorts of other problems for me) and just haven’t been eating as much. I finally decided to go back and buy some stuff I liked to eat.

I splurged on Pocky (which I NEVER buy EVER), some other random cookie, ramen, and a coconut. I have to say, I felt pretty naughty. I even grabbed a shrimp taco on the way back home.

I have yet to encounter this smell in any other grocery, but all Asian ones have this really particular almost like bad produce and meat smell. I think it really reminds me of home because I caught myself just standing there breathing it in. Cranial Nerve 1, which are you so strange.

I always feel like I get special treatment here because the cashiers are super nice (unheard of!) and seem to think I’m Vietnamese.

Superbowl coming up. If I were with my old “League” buddies, I’m sure I’d go over to their place with some lasagna and chat up some football. Alas, we’re scattered all over the country now (mostly my fault). I just found out there’s a long weekend. This might mean biting the bullet and planning a trip.

Grand Canyon? Sonoma?

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Flu Shots and Quakers

I feel like an inoculating machine. I gave about 5 flu shots last week. Now I know to use a 21-23 g needle for these guys. I looked at my notes and realized about half of our Ob patients from our Wednesday group declined vaccines. I remember they said they were afraid it would make them more sick and a few said they never had the flu so they saw no reason to get scared about it. Flu’s been pretty bad this year and pregnant women and elderly are supposed to be the first to get the shot– oh well. This is a good indicator that more education might be needed.

It’s strange. I’ve heard a lot about the history of the Mobile Health Clinic, but I think a lot of the services have faded away. There used to be workshops for the pregnant women to attend, talk to each other, and learn various techniques or how pregnancy works. I don’t see any of that now. The only formal education is just what we tell them during a check-up, but that really depends on how much time we have that day.

 

I went to a Quaker wedding over the weekend. That was pretty…interesting. Church services are held in silence and people “clap” but shaking their hands like jazz hands. I felt like I was doing it wrong, like I should be thinking of something instead of, “wow, it’s really hard not to make any noise”. The directions on the program said that when we felt ready we could rise and say something meaningful for the couple. We even had a man with a banjo at the end singing a little ditty that was pretty catchy. The weirdest part was that the church was literally across the block from my house here. How did I not notice it before??

 

 

Sketchbook Project 2012 Pages

A few of the better ones out of the book I submitted. Next time I'm going to go with my gut and do a proper comic.

Between a Rock and a Hard Place

You get a 38 week pregnant woman with no medical records and no insurance. She’s never had any prenatal care. What do you do?

Apparently the correct answer is: if you can’t get records, she has to go to the ER when her water breaks.

 

Everyone is Depressed

Healthcare on a large scale is a complex system that requires services be rationed.  So it stands to reason that we would withhold “extra” services for later and give more important ones now.

I’m starting to see that physical and mental health are really intertwined. Americans complain that their taxes are too high, that people are mooching off of welfare, that the Danes are the happiest people in the world– why aren’t we? It’s pretty obvious that we’re doing it to ourselves.

What are the things that we value? Cheap food. Expensive thrills. These things reflect in our politics and how the country is run. We want more healthcare but cheaper healthcare but better healthcare with “hotshot” doctors.

There are a lot of problems with the American healthcare system, which I’m not even going to try and untangle right now. But it doesn’t cover a lot of things because they’re not considered essential to living. Dental and Eye exams are often things that are left out on skinnier plans. For sure, mental wellness is not something included on every insurance plan…. but should it be an option?

The world is a stressful place. We need to perform at work, at home, and if we’re not at either place, we need to look for them. People’s happiness really could be a proxy for their mental well-being. Why? Because if otherwise you’re unhappy, sad, depressed, apathetic, things that aren’t the “normal” state of feeling. And negative emotions have been proven to adversely affect our physical health– the most drastic being suicide. Wouldn’t it be more human, ethical even, to include a small number, say 3, psychologist visits on every plan?

Granted the population I’m working with stacks the deck a bit– all uninsured patients. But depression really seems to compound the stress of living. They’re overwhelmed or consumed by this pit of “no good things shall come to pass”, and it translates to taking poorer care of one’s self. The direct economic result is a strain on resources, because the mobile health clinic can’t take care of a lot of things and then we can only refer them to the Emergency Room. Someone out there is complaining of rising healthcare costs. Rinse and repeat.

2 Lipomas and a Pterygium

Talk about being common. We started off the day seeing a man who said he was worried about a lump on his back. It had appeared mysteriously and was pretty sizable. We hadn’t even seen the patient yet and I was thinking maybe this was a lipoma, but I thought nothing of it.

We go in, lo and behold, we can pinch off the entire lump and it really does seem to be a lipoma. It’s probably the best lump you can walk into the doctor’s office with– although explaining in Spanish that it’s a benign tumor is always scary for the patient. They hear “tumor” and you start seeing a sympathetic reaction– whites of eyes, blood pumping, heart thumping, sitting straight up– right away.

Looks a lot like our patient’s, but a little higher up.

Towards the end of clinic, we have a straggler come in. He’s a young Hispanic who’s clearly anxious. We find him on the stool for the doctors, but it’s no big deal, and the resident starts to ask him some questions.

In a strange way, it’s almost a blessing to have a patient who is in real distress. They won’t pussyfoot around the issue and try to give you superfluous information, they just yell at you their chief complaint. This guy blurted out that he was worried about this lump on his right hip. The resident and I were being pretty laid back about it, just wanting to get the whole picture, but he kept bringing it up and so we got him on the exam chair and started to examine him.

I feel like he knew someone with a strangulated hernia, because he was afraid that’s what he had. It most definitely wasn’t. Although he reported a little pain, the lump was just like the lipoma was saw before. We could feel around all the “edges” and squeezing it didn’t elicit much pain. It was also right on top of his hip bone, which isn’t where a hernia would show up.

The poor guy was in tears from the anxiety, he was convinced he was going to the hospital. After some more Spanish finagling– but I think saying “Muchas personas tiene eso, es muy comun. Es solo una bola de grasa” (A lot of people have this, it’s very common, it’s only a ball of fat/grease) was ok. He seemed to be relieved. But there’s not much you can do about it except leave it and for someone without insurance, excising it is almost a waste.

The next issue was his eye. I’m sure the resident and I had seen it right off the bat, he had some sort of growth or worm-like thing in his left eye, just interrupting the iris.

It reminded me of Prometheus” Alien precursors. He described it as a “carnosidad“. I can’t help but get excited that there’s something new, a parasite! Finally! I look it up quickly on my phone, but it’s a Spanish word, not Latin, and it directs me to a “pterigion”, which somehow also is Spanish. But it doesn’t look like a parasite– hopes dashed.

I pop out for a second to ask Betty what she thinks from my description of it and she nails it– a Pterygium, an overgrowth of the conjunctiva due to excessive dryness/dust/UV exposure. The resident agrees. She does a quick eye exam to see if it’s obscuring his vision, but he does pretty well on both eyes. So what can he do he asks. Keep his eyes protected from the sun, keep them hydrated from drops, if his vision starts to deteriorate, then he’ll have to go to Mexico to see an ophthalmologist to think about surgery.

Linden Street mural

On my way for cheap mushrooms. Not what it sounds.

Urology humor

I’m so excited for 3rd year.

It's a SnakeBridge!!

Interesting design.
Also, I hate Tucson sun. You would think by now I could expose correctly…but I can’t.

Poverty and Cell Phones

There’s one patient (let’s pretend Fiona) who comes in fairly regularly and tends to brag about how they have no income. It could be a brand of exceptionally dark self-deprecating humor, but I was always confused by the seeming incongruity of her statements to her presentation. There are brand new sports sneakers on her feet and a slick Android in her hand. The clothes I can find more explanations for, but the phone? Don’t you need a credit line for a phone? How can you do that if you have “no income”?

inflamed yet?

A google search on just the words “poverty” and “cell phone” brings back a huge explosion of arguments (this picture being a subject of many).

A lot of people rant that the poor don’t deserve to have luxury items like the newest cell phones. Some bring up the possibility that it could be a gift. I personally find it hard to believe that anyone in any income bracket would give an iPhone as a gift since the hardware is expensive and it puts the burden of a data plan on the recipient.

I think this picture has the quality of awful humor, but is really fixated on a wrong point. Food stamps have nothing to do with cell phones. US grad students are eligible for food stamps and I’m sure no one is lambasting them for owning fancy gadgets. Food stamps also don’t tell someone how much money they make but only give you a range to guess within.

I’m not saying in any way that people in bad financial shape shouldn’t have cell phones. In fact, a cell phone is crucial to securing a job if you don’t have any other form of long distance communication. I would argue however, that getting a newly-released smartphone with all the bells and whistles a young college student could dream for is not the best use of funds.

In trying to understand how Fiona was able to get her phone, I found you could get an unlocked phone from craigslist or similar “disposable” phones from more reputable dealers. Once getting the phone, she could insert a SIM card for the carrier of her choice to get service. This still doesn’t explain how she can pay it off if she doesn’t have a credit card. The only ways I’ve found to get a credit card without income is to have a family member with good credit to cosign for your card or open a savings checking account with a minimum balance. I find this second method a little suspect since the accounts I have require a minimum balance of $1000 or more and then have a monthly service fee.

There are some free phones for eligible people. Budget Mobile is a provider of free cell phones with free service for 12 months.

The only answer I can really come up with is that Fiona must have some minimal amount of income she writes in for a credit card. When she says “no income” does that literally mean no cash, or that it’s so small it’s just a drop in the bucket?

More Reading

Budget Mobile FAQ

Baylor: Understanding Poverty