Epigenetics and Behaviour: Part 1

January 27, 2020 ThePinkLadyLeave a comment

A Serendipitous Discovery

I remember the first time I learned about epigenetics. It was during my undergraduate degree in Molecular Genetics. However, I did not learn about it from lecture, but rather while watching an episode of NOVA, a PBS documentary program that focuses on science.

They were talking about a study that discovered a link between a population of people in Ireland who had an increased prevalence of Type II diabetes, high blood pressure and obesity. The Irish potato famine occurred in the 1800s and saw a blithe attack a main food source – potato crops. Here’s a link that discusses the potato famine in more detail – Irish potato famine. The descendants of women who lived through the potato famine gave way to grandchildren who made up that group of people with a higher prevalence of Type II diabetes, high blood pressure and obesity.

How could this be? The group with the higher prevalence of those conditions listed had come from grandmothers who survived the potato famine. The medical conditions seemed to skip a generation. There was no known mechanism that could account for this occurrence. It seemed to fly in the face of the central dogma and the current understanding of evolution. The central dogma states that DNA is transcribed into RNA and then translated into protein. Our understanding of evolution was survival of the fittest – that those who survived to reproduce would have their genome passed on to their offspring.

So what happened? The researchers surmised an incredible and complex mechanism that explained how these conditions had somehow skipped a generation. It goes like this.

Environmental Exposure and Epigenetics

It all starts with a women who is pregnant. The embryo is female. Women are born with all of their ova or eggs developed. These eggs will be released, one by one, at puberty and the onset of the menstrual cycle, for the rest of the woman’s reproductive years . Men, on the other hand, are not born with their full complement of gametes or sperm. For men, their sperm is produced basically on demand at the onset of puberty.

So, the female fetuses’ eggs are being developed in utero. The woman carrying the fetus is exposed to environmental factors (in this case famine) which results in changes to the DNA of the embryo, including the DNA found in the eggs of the developing fetus.

What changes occur in the DNA of the fetus and her developing ova or eggs? The DNA of both the fetus and her eggs is marked with chemicals (based on, in this case, environmental factors) that determine what genes will be expressed and what genes will not be expressed.

The fetus is then born with her full complement of eggs. She reaches puberty and an egg is released at each menstrual cycle. One day, she becomes pregnant and gives birth to a baby. That baby grew from an egg that had been epigentically marked while in utero.

This is how the environmental factors a grandmother experiences can be passed on to not her children but her grandchildren’s genome. These genetic markings are termed the epigenome. The epigenome adds another layer of complexity to genetics and evolution. Next, I’ll discuss behavior and the epigenome.

Adderall · ADHD · Benzadrine · Evolution · Learning · Medicine · mental health · Nature · neuroscience · pomodoro · psychiatry · Psychosis · Ritalin · Science · Stimulants · the brain

Nature vs. New World: The Problem with Today’s Society

May 7, 2018 ThePinkLadyLeave a comment

Being the go-getter that I am, I have been taking an online course through a fantastic online learning website by the name of Coursera. I hope one day to be involved in medical education and so I started with a course called Learning How to Learn. (Note: this is not a plug for the website – I just enjoy providing links to the things I discuss in my articles – Aside: I wish I was supported by ads, perhaps one day!!)

So, here I am, making my way through the course and learning both some valuable study techniques as well as the neuroscience behind how we learn. One of the learning techniques described is what is known as a pomodoro. In short, it is a way to break one’s learning into small, manageable chunks and then provide a small reward after each pomodoro. (I do enjoy this technique, it puts a damper on my tendency to reach for my cell phone or check that latest facebook post). Tonight, I happened to be pomodoro’ing my way through (I just made up a word there) the course whilst watching a Netflix documentary by the name of Take Your Pills.

After each pomodoro, I allowed myself to watch a bit of the documentary as my reward. Well, how serendipitous indeed! Turns out my mind found a link between what I am learning on Coursera and what I am watching on television. (I love how the brain works so naturally when it comes to getting the creative juices flowing!)

Now, I am not here to write a review for either the course I am taking or the documentary I watched. Suffice it to say that they are things that I am both enjoying (I haven’t finished the course yet) and that I enjoyed (I did finish watching the documentary).

Humans have an innate ability to remember the details of say, a room we walk into, even days or weeks later. We built these natural spatial and visual memory abilities over eons of evolution. Quite rightly so, given that our day to day survival depended on remembering how to get back from a hunt, or where the best place to pick for berries was located.

The documentary Take Your Pills discusses pharmaceutical amphetamines (Adderall, Ritalin, dexedrine, Concerta and Vyvanse, to name most) and the increasing licit (and illicit) use by children and adults in Western society.

It gives an overview of the history of pharmaceutical amphetamines and states that the first article describing the abuse of benzadrine (a prescription drug otherwise known as amphetamine) amongst college students was in Time magazine in the 1930s.

It appears our society has had difficulty focusing on learning school subjects for a long time. Why might that be?

It’s simple. Our brains have been conditioned to learn spatially and visually through movement over hundreds of thousands of years – to survive for the short term, not the long term.

Now stop and think about our children’s learning environments and subject matter. Math, science, english, social studies and more. And how are our children taught these subjects? By sitting in one desk, often in one classroom. Do these two environments and modes of learning jive? I think not.

And where is the short-term benefit? Do years of school provide any short-term benefit or reward? Well, yes, but only if you do well in school. What of the children who do not? Methinks some may end up requiring ADHD medications.

Now, I don’t want to vilify the use of these drugs in today’s world. I do believe they have a place, with judicious use.

We can draw the same analogies with the adult world and our working environments.

The question then becomes, is it us that suffers from a problem, or is it how our society is designed that causes our suffering? I’m betting on the 2nd option.

This is, no doubt, not a novel idea. But, it was a nice A-ha moment for me that I will take to the clinic, and perhaps beyond to the classroom. Our teaching and working conditions need to take advantage of that innate ability to function and learn based on our natural visual and spatial learning abilities. There are even parts of the brain dedicated to learning naturally and easily in this manner! How cool is that!

Thanks for reading, and I hope you learned a thing or two about learning and working in today’s world!

~ ThePinkLady

Criminal Behavior · Forensic Psychiatry · Medicine · mental health · psychiatry · Psychosis · Schizophrenia

A Primer on the Nebulous Field of Forensic Psychiatry

May 6, 2018 ThePinkLadyLeave a comment

As a medical student, I’ve had the opportunity to experience vastly different areas of medicine, from delivering babies to Personality Disorders to removing gallbladders to electroconvulsive therapy. One particularly interesting field of study I undertook was Forensic Psychiatry. In medical school, we are allowed to take elective rotations, which are somewhat comparable to options in a traditional University or College degree.

Early on, I took a liking to the field of Psychiatry. I remember my first patient. He was a middle-aged man admitted to a locked psychiatric ward due to an acute psychosis. He did all sorts of strange things. He was disheveled, smelled like he hadn’t showered in weeks, was talking to people that weren’t there and made no sense at all when he was talking. I will not describe exactly how he was admitted to protect his identity, but suffice it to say he had put himself in a very precarious position that could have resulted in severe injury and even death. Up until that point, I knew very little about psychotic disorders and I was amazed what mental illness could do to one person. I was fascinated that the human brain, while malfunctioning, was capable of such bizarre thinking and behaviour.

Over the six weeks of my rotation, I watched that man go from the one I first observed in such a state that night to one who I could converse with normally and to one who could play piano beautifully.

To say the least, I was hooked. It seemed like I had witnessed a small miracle. It also made me appreciate the power of the antipsychotic medications we have at our disposal today.

I entered into several psychiatric medical electives at that point and one in particular, Forensic Psychiatry.

Most people I have spoken with often confuse psychiatrists with psychologists, and they sure as heck don’t have a clue what Forensic Psychiatry entails. In fact, even a few doctors I’ve met don’t realize that such a field even exists in Medicine.

So, what is Forensic Psychiatry? Forensic Psychiatry deals mostly with those who have entered the criminal justice system and suffer from a mental disorder.

A Forensic Psychiatrist might evaluate a patient for a mental disorder in what is known as an NCR defense (in Canada). An NCR defense means the defendant is Not Criminally Responsible on account of mental disorder. The criminal code defines not criminally responsible on account of mental disorder as follows “No person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered the person incapable of appreciating the nature and quality of the act or omission or of knowing that it was wrong.” Essentially, this means that two criteria must be met:

1. The defendant must have suffered from a mental disorder at the time of the offense;
2. The mental disorder rendered the defendant incapable of understanding the wrongness of his or her actions.

The example I always use is that of the tragic death of Tim McLean at the hands of Vince Li on a Greyhound bus in Alberta, Canada in 2008. I remember that even I was appalled that this man had been determined not criminally responsible by reason of mental disorder for such a heinous act. Of course, that was before I understood just what depths of madness a mental disorder like schizophrenia could drive a person to, a madness so deep that one loses all awareness and beliefs about ones’ self, the world around them and their relationship to it.

Many people were outraged by the verdict. That said, what many may not realize is that an NCR court ruling may, in fact, keep the perpetrator institutionalized even longer than the traditional prison system… it may even keep them incarcerated in a mental institution for life. This is an interesting tidbit of information about the criminal justice system in Canada where we do not have life sentences. (Note: That said, we do have a dangerous defender status which can keep a prisoner incarcerated for life).

The reason is thus; a perpetrator institutionalized in a psychiatric facility will only be released when they are no longer considered a harm to the public. If their mental disorder keeps them in a perpetual state of danger (no matter how small) to the public, then quite simply, they stay institutionalized.

Forensic Psychiatrists also assess the ability to stand trial. The criminal code states that if a defendant cannot understand the basic criminal proceedings of a trial, then they are not fit to undergo trial.

I have seen patients who are not fit to stand trial – for example, an elderly man accused of assaulting his common-law wife – who become perpetually incarcerated in psychiatric facilities. The man suffered from severe alcohol-related dementia and was not capable of understanding the court proceedings. He probably never would. It was a real eye-opener for me because cases like this happen all the time, and our Forensic Psychiatric wards are sorely underfunded. Patients such as these eventually end up going to facilities designed for elderly patients with dementia.

These are probably the better-known roles of a Forensic Psychiatrist. Others include treating incarcerated patients for their mental disorders (even if their mental disorder did not cause them to commit a crime), following up with them in the community after release, and sitting on release boards that determine whether a patient incarcerated in a forensic psychiatric facility should be released back into society.

An interesting civil case was once shared during a lecture. The Forensic Psychiatrist was required to assess and present at a hearing on behalf of a woman who suffered PTSD after a horrific car accident where she saw her friend beheaded. The insurance company did not want to pay out for a non-physical ailment. But indeed, pay they did, and so they should – just because one walks away from a car accident physically unharmed, does not mean they remain unscarred.

So, there you have it. Forensic Psychiatry in a nutshell. I hope it was an eye-opening and interesting read for you!

~ ThePinkLady

Medicine · patient care · PTSD · Public Health Care Systems · Quality of Care · Trauma

Part 1: Trauma, Mind-Body Disconnect & the Doctor-Patient Relationship

April 23, 2018April 23, 2018 ThePinkLady2 Comments

I noticed something on a recent trip to the doctor’s office with my mom. She required an assessment with a cardiologist for a suspected heart problem. The doctor went through his assessment as per usual, starting first with a history.

The components of a full patient medical history include a section entitled History of Presenting Illness or HPI for short. We use the mnemonic OPQRST to remember the important questions to ask. The mnemonic stands for Onset (of symptoms), Palliative/Provoking factors (things that make the symptom worse or better), Quality (for example, of pain, using descriptive terms such as sharp, stabbing or dull), Region and Radiation (Is the pain in one spot? Or does it radiate to other places?), Severity (How severe is the pain, on a scale of 1 to 10?), and last, Timing (When does the pain occur? Does it come and go or is it persistent?)

As you can see, each question requires an intimate knowledge of one’s body and how it feels. As the doctor asked my mom questions, I noted that she seemed unable to answer them in a succinct manner. I realized that my mom, who grew up in a dysfunctional household that exposed her to traumatic situations, seemed disconnected from her body and how it feels to her.

There are various definitions of traumatic disorders, some contained within the Diagnostic Statistical Manual or the DSM for short (used by doctors, psychiatrists and psychologists worldwide), and others in the lexicon of psychological disorders that are not included in the DSM. First, most have heard of Post-Traumatic Stress Disorder or PTSD for short. PTSD is defined by several specific criteria. The first is criterion A, which requires exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Furthermore, the exposure must occur in one of the following ways:

Direct exposure
Witnessing the trauma
Learning that a relative or close friend was exposed to a trauma
Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g. doctors, nurses, first responders, medics)

(DSM-5 Criteria for PTSD)

Another, less well known, but certainly often experienced traumatic psychological disorder is that of Complex post-traumatic stress disorder. Wikipedia provides the following definition: “Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder thought to occur as a result of repetitive, prolonged trauma involving sustained abuse or abandonment by a caregiver or other interpersonal relationships with an uneven power dynamic. C-PTSD is associated with sexual, emotional or physical abuse or neglect in childhood, intimate partner violence, victims of kidnapping and hostage situations, indentured servants, victims of slavery, sweatshop workers, prisoners of war, victims of bullying, concentration camp survivors, residential school survivors, and defectors of cults or cult-like organizations. Situations involving captivity/entrapment (a situation lacking a viable escape route for the victim or a perception of such) can lead to C-PTSD-like symptoms, which include prolonged feelings of terror, worthlessness, helplessness, and deformation of one’s identity and sense of self.”

After witnessing my mother’s difficulty in answering the doctor’s necessary questions, I ruminated that first, the HPI is an important part of a patient’s history, as it can cue the doctor to follow and investigate a certain diagnosis. Sometimes a diagnosis can be made based on history and physical exam alone, doing away with the need for many expensive laboratory tests. Second, I realized that people with traumatic psychological disorders may be disconnected from their body (due to, for example, suppressing the uncomfortable physical sensations and thus the psyche’s negative response to those sensations). Tying these two thoughts together, I surmised that this potential phenomenon can lead to a decreased quality of care, owing to the decreased ability of the traumatized patient to communicate their medical needs effectively.

So, I decided to do a literature search to confirm my reasoning. I started with a simple Google search trauma and body disconnect where I found a plethora of articles confirming that this is indeed a known phenomenon in traumatized patients.

One article entitled Reconnecting With Your Body After Trauma highlighted two things. First, the term mind-body disconnect in medical terms is known as dissociation and people affected by traumatic psychological disorders often dissociate (or experience a mind-body disconnect) for the reasons mentioned above. Second, I read about an experiment conducted by Dr. Bessel van der Kolk. Dr. van der Kolk is a world-renowned expert on traumatic psychological disorders (in fact, I have been slowly making my way through his book The Body Keeps the Score.) In the experiment, he asked his patients to hold certain objects in their hand (a car key, a coin or a can opener) and found that they were often not able to identify the object without looking.

If patients cannot identify an object by feel alone, then how can they be expected to identify a symptom that makes their body feel a certain way so they can answer the OPQRST questions I wrote about above? This is certainly a more complex task than recognizing a car key by touch.

Next, I used PubMed to search for any literature on the effects of trauma, dissociation, the ability of a patient to provide a succinct medical history and the resultant quality of care.

A quick search provided no results. Although there are a plethora of articles on the neurobiology and the effect dissociation has on specific medical disorders, patient populations and situations (for example, HIV, Borderline Personality Disorder, immigrants and refugees and mother-infant bonding), I could find none that addressed the answers I seek.

Why are the questions I am pondering important at all? In medicine, we are taught two things that can be at odds with one another, and to balance the two. The first is to provide patient-centered care. This means that it is important for the physician to view each patient as an individual and to address their complex biopsychosocial and medical needs to provide the best care possible for that person. As such, I believe identifying and acknowledging the individualized needs of trauma survivors is important. Second, we operate in a limited resource health care system and thus should aim to choose intelligent and prudent health care tests and treatments. No doubt about it, healthcare systems are burgeoning worldwide and as a Canadian medical practitioner, I am even more acutely aware of the effect on patient care. Saving money is always a plus and true, it is a balancing act to provide the best healthcare to each individual patient while mitigating the costs to the system.

As such, I am always interested in discovering new avenues of research if they impact patient care and if they can potentially reduce the costs to the healthcare system. Thus, I believe the effects trauma and dissociation on quality of care and costs is an important avenue of research.

The take-home point for me is to recognize that traumatized patients may not be able to adequately describe their physical symptoms. Therefore, I need to be mindful of that while taking my patient history and come up with novel ways to tease the required information out of my future patients.

~ ThePinkLady

Grief · Love of life · Medicine · poetry · Science · The Arts in Medicine

We Built Ourselves a Darkness Near

March 14, 2018March 15, 2018 ThePinkLadyLeave a comment

As a forward to this post, I`d like to say that, indeed, I have posted a lot of poetry as of late. I certainly do have many more doctor-patient stories to tell, and other nuanced (i.e. juicy and scandalous!) medical school details to post.

That said, I have found an outlet in poetry as an adult… it was something I dabbled in as a youth – but I`m afraid to say that much of it was very, VERY obviously written by a teenager. (I`m a sucker, at this age, for a little, and sometimes a lot of, self-deprecating humour).

I`ve always been fascinated by space and time – most especially since I first began to understand physics – and in part, the Twin Paradox.

Over the years, much of my poetry has focused on such topics, contrasting with the knowledge of life I’ve gained both through personal experience and in my training as a medical doctor.

I wrote, what I think was, the first (good) poem at the age of 17 – after my sister had lost her life in a brutal and tragic car accident at the tender age of 25. She was my best friend.

I am not a religious person. I do not believe in God, at least not as has been written in so many religious texts… Given that acknowledgment, I did experience something after she died. Something that I cannot explain. I felt her sit next to me as I was sitting on my bed, blow-drying my hair, much the same way as I’d done time and time again in those years.

It gave me comfort. And although it may have just been a psychological expression of my grief and fatigue following the mind-bending news of her death – I felt inspired to write as though she still existed.

The poem I wrote for her came naturally – it poured out of my fingertips as easily as the ink flowed from the pen I held. It became a thing of beauty; rich with imagery of the night sky and a wish for her to let go – and to be one with the stars. It was my way of saying goodbye and my way to wish her well. Ultimately, it was a way to let her know I would be OK without her. A benevolent wish for her to let me go and to go forth into that peaceful abyss that is the night sky. Of course, it was incredibly cathartic.

That poem now exists only on the 1999 printer paper connected to the 1999 computer on which I used (what I think may have been the original MS Office Word software application?) to transcribe the poem I had handwritten. (I like to remind myself of how far technology has come, in my very short life. Remember the old school and finicky to print perforated printer paper?? I’m quite sure that was the paper I used…)

Then, as any typical girlish teenager would do – I burnt the edges and then glued that paper to a construction paper booklet, along with one of a kind pictures of my family and I. I wanted to send her off with a unique gift that did not exist any other place in the world.

It was a beautiful poem. I was asked to read it at her wake, but I was too full of tears to do so. A close and very well-spoken family friend did so on my behalf. Everyone was moved to tears. I was too sad to feel proud, at that moment.

Now, selfishly, today, I do at times wish I could read that poem again. But then I remind myself steadfastly that I wrote that poem and placed it with her so that it would be hers, and only hers, forever.

~~~

After that (huge!!) tangent, allow me to get to my point. Today, the world lost a great mind. As I said, I’ve always been by fascinated space and time – owing to my rather simple and brief introduction to the ideas of general relativity and quantum physics. Of course, Einstein was what caught my attention – followed (very, very closely) by the other fathers of astrophysics – Copernicus, Kepler, Galileo and Newton. Now, Stephen Hawking certainly continued on with the groundwork laid by those giants of science. I suppose those gents have been so greatly admired and revered that they have attained somewhat of a mythical-like status, much the same as the great Hercules or Achilles…

That man will attain the same status in the future – and there will be another curious young mind, just like me, along with many others, who will ponder in awe about just what it was like to be alive and to share an era with such a great thinker. And we will have ceased to exist at that point.

I am happy to die just knowing that there will be another like me, one day, who will ponder and wonder and live and breath and enjoy all of life’s mysteries and never stop thinking and never stop learning and never stop feeling until that very last breath.

And so, I wholeheartedly support Stephen Hawking’s endeavour to explain the importance of the continuation of the human race. Without the knowledge of a continued future of our species… I am nothing. There is no hope to be had. I would fully give into stardust at death – only, if only, our species continues to learn and grow and adapt and advance and evolve.

~~~

Last, I would like to share a poem. I wrote this the Christmas after my father passed away after a short and heartbreaking battle with lung cancer. I had nearly forgotten about it and decided to read it today, on the day of the death of the most important figure in modern day cosmology. It’s rife with the imagery and metaphors of the big bang and particle physics… and of course, with life too. Very fitting, and I am glad I was drawn to revisit that writing. Comforting, once again, just like the poem I wrote for the sister I once cherished and lost.

We Built Ourselves a Darkness Near

Darkness did exist sincerely.
Then, eons ago a blast
A brilliant light shone briefly
From whence a bazillion particles sprung fast.

They floated eons more,
Slipping past one another so briefly,
And continued on their lonely quest,
Not knowing their purpose so easily.

Alas, one moment a change.
They did not slide past so freely,
As though one called out to another,
And the other responded so keenly.

Two bodies came together,
Their bodies ever so slight,
So slight in stature and form,
They clung to each other so tight.

They moved through space together,
Others joining as they passed,
Soon they were not alone,
And together a shadow they cast.

They cast a shadow so large,
They began to forget their past.
Shadows became the norms of our cities,
And we could not remember how things were once so vast.

The shadows joined one another,
the shadows they did coalesce,
A new type of darkness unfolded,
But this time with much less zest.

Our history did not repeat.
How we travelled backward with such ease!
Flowed seamlessly against time
And again, the darkness we did meet.

Our shadows formed an abyss,
In a prison we now exist.
This hole we did create
We have no light with which to escape.

~~~

The Pink Lady

Medicine · The Arts in Medicine

An Ode to Breathing

February 6, 2018February 7, 2018 ThePinkLadyLeave a comment

An Ode to Breathing

As I glance outside,

With no effort –

I see the frozen trees breathing.

Them green ferns sway

a kaleidoscope just a-beaming.

Moving to-and-fro;

I find my conscious over-leaning.

I see below

just to my left.

An image, yet so ever seeming.

At once I sense

A breath

It blows

It’s left without much meaning.

Except to those

who hold on for a feeling.

A feeling right,

a shrug with great might.

Let’s leave with no shame tonight.

~ The Pink Lady

Medicine · The Arts in Medicine

Days and Life Beyond

January 19, 2018January 22, 2018 ThePinkLadyLeave a comment

A day well spent
is a day without maleficence.

Certain am I,
of this usual decry.

Yet where lies the in between?
What day with the perfect mean?

Spent high, spent low
with spent smile and furrow.

Rising high,
then crashing down.

The tidal wave
it all surrounds

surrounds me all
surrounds me best

then coughs me up
just to the West

just on the edge,
nearing rest.

Sunshine bright.
We crawl and climb

we push, we pull,
we churn below.

And holding tight,
within the light –

We ebb, we flow
we meet the ground below.

An end too soon
An end so late

An end we each reciprocate.

A lifetime spent
with such usual days

A deathbed brings
a most peaceful lay.

~ The Pink Lady

Medicine

Why The Pink Lady, You Ask?

July 12, 2017January 24, 2018 ThePinkLadyLeave a comment

For my inaugural blog post, I’d like to begin by sharing an anecdote, a story – just one of more to come – from my journey through medical school and beyond.

I have been blessed to rotate on – what I think – are some of the most entertaining, best, and friendliest hospital wards my city has to offer.

Cue the nursing team. No, not the unit clerk. Yes, that’s right, the other ladies (and gents!) on the ward. Such hospital staff can be tough to tell apart sometimes. I’ve sustained many an eye-roll by approaching the charge to ask a question better suited for the unit clerk and vice-versa.

A good nursing squad makes any rotation a delight. Often, they can be like surrogate mothers at 3AM when your head hasn’t yet hit the pillow and one chides you to sit down and “Eat dear! Eat!”

After one particularly busy night, I show up to the early morning chaos of shift change. Now, any rotating medical intern knows exactly what I mean by that statement. For those who do not, I shall do my best to set the scene.

First of all, medical interns (as I myself was and still am) are often sleep-deprived. We sleep overnight in a small hospital room on an uncomfortable hospital bed – in the very same beds and with the very same bedding as the patients we have the privilege of meeting, assessing and caring for as part of our training.

And, not unlike those very same patients, we are awakened irregularly, at the behest of the very same doctors, resident physicians-in-training, and other hospital staff who come knocking at all hours of the night and day.

The only difference is that they are not knocking and asking for more information or blood draws or other prods and pokes – with us interns, instead, we receive a page. Yes, that’s right, straight outta the 1990s (at least that is the last time I remember ever seeing a pager before medical school). Bih-beep Bih-beep! I must say, that sound has and continues to haunt my nightmares.

And so, that particular day, come early morning, as any responsible medical intern does in spite of a night without restful sleep – I awoke to complete the rounds expected of me before my teaching physician and fellow learners arrived.

Now, that might look like any other twenty-something who has just crawled out of bed to grab a coffee at the local Tims’ after an all-night frat rager. With the fog of sleep still lingering in both my eyes and on my breath, I can certainly see how one of my very own patients could mistake me for the same.

As I peer over the turnstile of aged navy-blue binders that encase patient information – much the same way as the biofilm that surely lines them – I sense an impatient presence just to my left. Tepidly, I ask if I can be of assistance.

Shyly, a nurse, not much more experienced than myself, informs me that the patient in bed 10-2 has been complaining of abdominal cramps.

~~~

As an aside, I must add that referring to patients by their room number only serves to confuse my already sleep-deprived mind.

At this point, I haven’t yet slept for the last 24 hours. I’m not sure I know one actual human being who wouldn’t be irritated at just that circumstance alone. Nevermind the fact that I now have to match a room number with the face of a real live human being.

To be fair, I think I understand why medical staff might train in this manner. Nonetheless, I do not think I will ever become accustomed to the above-accepted medical
nomenclature of human beings.

~~~

To acknowledge my affirmation, I nod. As I glance atop the spinning turnstile, the overnight nursing staff comes into view.

Beneath the green-fluorescent lighting, the scene appears dated and torn straight out of a local and now-defunct community hospital, which resides just to the Northwest and not far from my current writing position.

The charge nurse from the night before pops into sight, looking much more put together than my own self, given her blue eyeshadow and well-coiffed blonde perm. Feeling like a waitress communicating with a short-order cook across the pass, I half-shout over the din the same information just relayed to me regarding the patient in bed 10-2.

Another senior nurse yells back over the turnstile “order her a pink lady!” Again, I am ever so briefly reminded of a late-night bar scene, due to the harried nature and cacophony of the early morning hospital ward.

Flipping through the binder labelled bed 10-2 – while affecting a relaxed pace despite the frantic energy lying just beneath – my fingers fumble to find the pink order sheet.

Writing the date and time (after a quick, albeit arduous mental calculation, from the 12-hour clock to the militaristic 24-hour clock) I scribble in capital letters:

1. ONE PINK LADY STAT

As I do customarily, I print my first initial and last name, followed neatly by my signature and pager number written directly beneath.

I pop the binder back into the correct turnstile slot while eyeing the next to grab.

Not a minute later, I hear a noticeable guffaw. I look up to catch the glance of the same senior nurse for whom I just wrote the order for bed 10-2.

She sees my attention is drawn to her as well – and laughs out loud in my direction – “No! Don’t write that!!”

——

And, here I am, years later, writing about the very first Pink Lady order I ever scribed into existence.

Thank you for bothering to read my inaugural post. I certainly hope it has added some levity to my fellow medical learners’ journeys while providing an inner view of medical training to those who are not privy to the same.

Best,
The Pink Lady