On the 40th Anniversary of Roe V. Wade

Today marks 40 years since the highest court in the land ruled women who want to end their pregnancies can legally, safely do so.  Where we have come since then is a long, confusing, at times sad path.  Over at http://bostonreprojustice.blogspot.com/ a number of Boston area professionals and professional students have put together a day long reflection in honor of this anniversary.  I encourage everyone to check it out.  I'll be reading it all day today, and my contribution  as well as several of my classmates will show up at some point.

Thanks.

Nazi Eponyms and Medical Training

I came across this article today: Modern Medical Terms Are Still Named After Nazi Doctors

The author's analysis is excellent, but since this is something I've been thinking about for a long time, I wanted to draw out a couple of other points.  Specifically I think the struggle over eponymous terms highlights one of the most confusing things about medical training: how subject it can be to individual variation.

It's important to note that in medical school, all your courses are broken up and taught be experts.  At our institution, there are one or two individuals responsible for ordering and organizing each class, but they do not give all or even necessarily a majority of the lectures themselves.  Most learning content comes from pHD's and MD's (occasionally JD's and MPH's as well) who are specifically expert in the topic of the day.  This may mean I have 12 different lecturers in the course of a 15 lecture week.  We work more closely with younger faculty members, such as fellows, who lead smaller group discussions.

The point is, there is ample room for disunity.  While in one class the course director stood up and apologized for the phrase, used by a visiting lecturer, "breast-feeding Nazis;" in another we were introduced to the Clara cell without pause or caveat.  Until I read the article above I had no idea it connected with Nazi doctors.  It's hard to eradicate terminology when there is no continuity in the training of the next generation.

One disease in particular highlighted the challenges I see: granulomatosis with polyangiitis, formerly (and often currently) known as Wegener's.  The day we were supposed to have a lecture on that particular disease was the day of Hurricane Sandy.  So we were all instructed to stay home and instead watched last year's videos.  In that video the doctor giving the presentation went into some detail about the Nazi link to the name Wegener's and in fact showed us several papers he had co-written advocating the name change.  This year's lecture was scheduled to be given by a different doctor, whose slides showed no sign of discussing the controversy - although he did use the updated name, unlike some of the fellows who taught our discussion section.  Topping this off,  this disease is complex and influences multiple systems meaning we see it referred to again and again and again.  When we see the same disease presented repeatedly with no unity in the name, it's not hard to see why this terminology is still around.

Could this same phenomenon be at work when it comes to vast differences in outcomes across hospitals and regions?  When we may be taught by one person to describe consciousness in specific terminology, then by another to do it completely differently doesn't it impact quality of care?  My classmates and I will go our separate ways after graduation, scattering across the country to work with diverse institutions and instructors. Even as soon as next year we will all be working at different sites with different doctors teaching us their preferred methodology for each task we must do.  Medicine, for a discipline that claims its roots in science, is absurdly subject to its own history and to local cultural fluctuations.  This can make it a delightful and unique journey, or it can make it imprecise and fallible.  We must acknowledge its vagaries to ensure that we are not falling into the latter category.

Mwen Pa Konnen

This post is titled "I don't know" in Haitian Creole.  Not just because I said that phrase so many times over the five weeks I spent in Haiti - to the children, to the local staff, in English to the project director - but because ultimately it's the best phrase I can come up with to summarize my experience.  I know perhaps more than I did before I went, but even more sharply I understand there are many things I don't know.

But I supposed I should first finished the story I began way back here and continued earlier this week.

After spending a week and a half planning out how to get Julio an x-ray and an ultrasound, checking the costs, planning how to get to the lab, etc.  We finally had a plan.  Except we didn't go.  

Not because of the costs, although of course everything is ultimately about the cost/benefit ratio, but because over that period of time it became increasingly clear that there was nothing really wrong with our little friend.  If asked, he complains of vague stomach pain that comes and goes every couple of days.  But in the same hour he'll launch himself into a hug with me that betrays no such pain, even with some surreptitious (and then less surreptitious, building up to a rib-cracking hug me tighter contest) taps and squeezes in the area of this "pain."

I don't doubt that he still has a long struggle ahead - he'll still have kidney stones, and have to manage that for probably the rest of his life.  But at least for now we're no longer worried about an acute problem.  I know this doesn't make a perfect story - I'm telling it partly because I hope you might be curious to know how Julio's path continued, but mostly because I feel like it's a great way for me to convey that my time in Haiti didn't particularly make a perfect story.  Didn't fit into boxes, didn't end with a particular bang or a denouement.  The work continues.  The children scramble on, managing health problems, learning deficiencies, developmental delays, and behavioral trails - just as they have for years now.  Sometimes we had great days:  Little Kevens, 7 years old but no bigger than a 5 year old and very learning delayed thanks to severe malnutrition, can tie his sneakers all on his own now.  Somewhere in the madness of driving to the doctor's office, I taught Julio how to subtract bigger numbers.  Leyla can successful identify the color green (and a handful more, if she's focused that second).  I talked with Mica in Creole, made jokes, made her laugh, encouraged her to stand up to the driver, maybe even taught her how to do the accounting work she's supposed to be doing for the garden project.  None of that is glorious.  None of it makes a great finale, but in the end it's that work that I'm the most proud of.  

I spent close to five weeks in Haiti.  I still don't speak Haitian Creole perfectly, and I still don't understand the country at all.  Mwen pa konnen, mwen pa comprann.  I don't know, I don't understand.  But I'm glad I went.