Friday, June 21, 2013

Sick as stink

Do medical residents still use the term "sick as stink?" It was how we sometimes conveyed that a patient was in very bad shape back when I was a resident.

A vivid memory of my medical school years is AIDS patients who indeed were sick as stink, very much so. They were most often--at least in my memory--young, gay adult men who, before becoming infected with HIV, were fit and healthy (in contrast to the IV drug abusers, the other major HIV patient population). The AIDS patients presented with a variety of otherwise unusual ailments, often infectious, mostly terrible. My memory is of people who were generally in the prime of their lives and then became horribly ill. One of my first experiences on the wards was seeing a newly-admitted patient walking up to the wards, still in street clothes, with his obviously caring partner--a really nice couple--and thinking that he didn't look that sick and would likely be going home in a few days. He died of pneumocysitis pneumonia a few days later.

Do residents still commonly see Kaposi's sarcoma. pneumocystis pneumonia, toxoplasmosis, cryptococcal meningitis and the rest of the terrible encyclopedia of diseases of immune deficiency that accompany AIDS? It has been amazing to witness the progress against HIV, with patients now having life expectancies approaching normal. Do lawyers witness similar amazing, life-giving advances over the years in their profession? Business consultants?

This is an important part of the big picture of being a physician-scientist: this career makes you an essential part of an enterprise that can really accomplish great things. Advances made in biomedical research reduce human suffering and contribute in a big and permanent way to human progress. This is not a bad thing to think about on those days when I am left wondering "how did I get myself into this? Why didn't I become an attorney/investment banker/Beverly Hills dermatologist like my college classmates?"

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