The latest edition is on Downtime.
Monday, June 28, 2010
Sunday, June 27, 2010
Down Time
I am a volunteer EMT, giving me the reverse of many. To me, the ambulance is where I go when I need a break from lab and school. Running call is a nice practical break from all my theory. Seeing patients reminds me that not everyone will be as hard to deal with as a squirming mouse.
Yes that is right, a mouse.
I am a research scientist whose focus ranges from pediatric graft versus host disease to immunotherapy for solid tumors. Simplified, I work to cure cancer.
In fact, I have miracle mice.
I cured cancer.
A highly aggressive, clinically relevant, pediatric solid tumor.
Okay, it was only in mice, but it was with limited distress to the mice who had very large, typically incurable by chemo sized tumors. I swore this new drug wasn't going to work, swore that the tumors were too big, swore that I should just give the mice a break and sacrifice them before the experiment was up.
But science and mother nature (and my boss) proved me wrong. While I didn't cure all the mice, I made a very nice dent in what would have otherwise been a death sentence. Over half of my experimental group are alive and currently tumor free. No surgery. No chemo drugs. No hair loss. No damage to the immune system.
In fact, it was their own immune system, with a little help, that cured these mice. All I gave was a drug that makes the immune system a better immune system, breaking the tolerance that many tumors create in a host to protect themselves from the immune system. Breaking that tolerance is hard as the body doesn't like kill off 'self' cells. But it work and better yet, it may even be repeatable.
So yes, I am a science geek and love research almost as much as love my clinical interactions with patients on the unit. I believe that a strong foundation in science, in understand research as the basis for why medicine works and advances is key to being a good clinician. Sure, I am not research emergency medicine and maybe I won't always be research when I reach my goal, but I know that it will help me understand. And hey, in the mean time, I may have just put this drug in the 'to be developed for clinical trials' box. Who ever said research can't save lives :)
Yes that is right, a mouse.
I am a research scientist whose focus ranges from pediatric graft versus host disease to immunotherapy for solid tumors. Simplified, I work to cure cancer.
In fact, I have miracle mice.
I cured cancer.
A highly aggressive, clinically relevant, pediatric solid tumor.
Okay, it was only in mice, but it was with limited distress to the mice who had very large, typically incurable by chemo sized tumors. I swore this new drug wasn't going to work, swore that the tumors were too big, swore that I should just give the mice a break and sacrifice them before the experiment was up.
But science and mother nature (and my boss) proved me wrong. While I didn't cure all the mice, I made a very nice dent in what would have otherwise been a death sentence. Over half of my experimental group are alive and currently tumor free. No surgery. No chemo drugs. No hair loss. No damage to the immune system.
In fact, it was their own immune system, with a little help, that cured these mice. All I gave was a drug that makes the immune system a better immune system, breaking the tolerance that many tumors create in a host to protect themselves from the immune system. Breaking that tolerance is hard as the body doesn't like kill off 'self' cells. But it work and better yet, it may even be repeatable.
So yes, I am a science geek and love research almost as much as love my clinical interactions with patients on the unit. I believe that a strong foundation in science, in understand research as the basis for why medicine works and advances is key to being a good clinician. Sure, I am not research emergency medicine and maybe I won't always be research when I reach my goal, but I know that it will help me understand. And hey, in the mean time, I may have just put this drug in the 'to be developed for clinical trials' box. Who ever said research can't save lives :)
Thursday, June 24, 2010
Friday, June 4, 2010
Exhausted
Exhausted.
Three calls back to back. It’s only the start of our shift. And there was a pediatric patient. They always drain me emotionally, even if they are okay the entire time in my care.
Exhausted.
0500 cardiac arrest call. I end up bagging the patient till the medic unit arrives on scene. The sun rises as we leave the scene.
Exhausted.
Filling out application after application to master’s programs. I need to go back to school. I realize this. But I hate writing personal statements. And in some ways it is still admitting defeat and having to deal with realities of screwing up in college. At least I am waitlisted, at least there might be a sense of hope.
Exhausted.
There is an ever growing pile of laundry to do. Dirty to wash so I have pants. Clean to fold so I have somewhere to sleep. We are not even going to into how much I need to clean my desk off.
Exhausted.
Treating mice every single day with oral drugs. For two weeks straight. Three weeks straight. Four weeks straight. On weekends too. Measuring tumors. Trying to finish experiments up. Trying to get everything done and leaving every day thinking I should have done more.
Exhausted.
My brain just wants to shut off and zone out to a book or TV. The sofa is at least a horizontal surface. I wake at 0300, all the lights still on, still dressed in what I wore to work, and all I can do is turn off the lights before curling back up on the sofa and sleeping.
Exhausted.
Medical school applications need to be started. Again. Maybe I will have a glimmer of hope this year. Maybe I will finally at least get an interview.
Exhausted.
House fire. No one is hurt. We check vitals signs and make sure no one is over heating. And we pack hose. Lots of hose. Its actually rather fun. But I am also the smallest person on scene and am seriously lacking upper body strength. I’ll but sore but I will have had a good time.
Exhausted.
Four calls, two back to back and the rest close enough together that sleep is questionable. They are all good calls. They all teach me something. The medic that hops on twice teaches me too. But I have to go to work in the morning and the last call gets me back into the station just at shift change.
Exhausted.
Three calls back to back. It’s only the start of our shift. And there was a pediatric patient. They always drain me emotionally, even if they are okay the entire time in my care.
Exhausted.
0500 cardiac arrest call. I end up bagging the patient till the medic unit arrives on scene. The sun rises as we leave the scene.
Exhausted.
Filling out application after application to master’s programs. I need to go back to school. I realize this. But I hate writing personal statements. And in some ways it is still admitting defeat and having to deal with realities of screwing up in college. At least I am waitlisted, at least there might be a sense of hope.
Exhausted.
There is an ever growing pile of laundry to do. Dirty to wash so I have pants. Clean to fold so I have somewhere to sleep. We are not even going to into how much I need to clean my desk off.
Exhausted.
Treating mice every single day with oral drugs. For two weeks straight. Three weeks straight. Four weeks straight. On weekends too. Measuring tumors. Trying to finish experiments up. Trying to get everything done and leaving every day thinking I should have done more.
Exhausted.
My brain just wants to shut off and zone out to a book or TV. The sofa is at least a horizontal surface. I wake at 0300, all the lights still on, still dressed in what I wore to work, and all I can do is turn off the lights before curling back up on the sofa and sleeping.
Exhausted.
Medical school applications need to be started. Again. Maybe I will have a glimmer of hope this year. Maybe I will finally at least get an interview.
Exhausted.
House fire. No one is hurt. We check vitals signs and make sure no one is over heating. And we pack hose. Lots of hose. Its actually rather fun. But I am also the smallest person on scene and am seriously lacking upper body strength. I’ll but sore but I will have had a good time.
Exhausted.
Four calls, two back to back and the rest close enough together that sleep is questionable. They are all good calls. They all teach me something. The medic that hops on twice teaches me too. But I have to go to work in the morning and the last call gets me back into the station just at shift change.
Exhausted.
Monday, April 19, 2010
For the greater good
Now that I have had a thorough streak of EMS, a little lab divergence is needed, though apologies are needed for the general lack of posting. I am neck deep in work, applications, and the firehouse.
Disclaimer: If you do not want to hear about the nitty gritty of laboratory research with lab animals (aka mice) do not read any further. I have heard and understand both sides of the lab animal argument and this is not a post about that.
When I started my job, my project was heavily focused on bone marrow transplants and finding new pathways/potential treatment options for graft versus host disease, a possible side effect of a non-self bone marrow transplant (if you want to know more about these in general, leave a comment and I will write a post).
Now, my project is focused on non-standard chemotherapy drug screening for cancers. The theory behind it is awesome, as these drugs don’t destroy rapidly growing cells, but instead make the immune system better at fighting off cancer. Now I am talking about small amounts of cancer in the setting of someone who has had a tumor/cancer removed but may be a high risk for relapse. These drugs would help with the relapse (perhaps more, but that will be another post :) ).
In order to have the most clinically relevant results possible at this stage, we decided to give these drugs orally instead of injecting them, as most patients would take the final form of this in pill form, not necessarily an IV drip. So I inject my mice with tumor, wait a few days and then start treating them with my drugs to see if any will ultimately kill the cancer. Easy you think.
Think again.
Giving a mouse a specific amount of a drug orally is no easy task. It involves much dissolving, aliquoting, and mixing of said to start with. Then there is the actual problem of giving the mouse the drug, seeing as just having them drink the small volume will never fly in the scientific world. This leads to EMT GFP taking very small metal feeding needles (they are blunt tipped, not sharp at all) attached to a 1cc syringe and accurately dosing each and every mouse.
After scuffing the mouse so it will theoretically not move.
And navigating a mouse’s pharynx blind to avoid a trachea (hey! its the reverse of intubation! Well kind of) and not puncture the esophagus.
It stresses me out, because try as I might, there is always one mouse that manages to squirm and pull, causing me to tighten my grip and occasionally accidently start to strangle to mouse. The second I see this I always put the mouse down but it still stresses me out that I did it. I think the mice are cute and I don’t want to be hurting them. But they are the ones who are squirming, though I know telling them to hold still does absolutely no good.
And then they pee on me, which, while I am wearing gloves and a gown (and booties and a mask and a hair cover), I still dislike.
Or the ones that try to struggle and struggle despite my good grip on them and freak out like they can’t breath even though I know they have an airway (if you are squeaking, you have an airway).
And then each and every tumor has to be measured. At least twice a week. More when the tumors get big. Not as bad as giving them drugs, but tedious. Oh so tedious and not entertaining as the mice try to struggle. Again.
Bone marrow transplants are so much less stressful…
But, if I can get through these compounds, if I can surviving being a human high through put machine, I may find something that helps. I may find a new drug to fight cancer. And at the very least, I can cure mice of cancer. In the end, it will be worth it.
Disclaimer: If you do not want to hear about the nitty gritty of laboratory research with lab animals (aka mice) do not read any further. I have heard and understand both sides of the lab animal argument and this is not a post about that.
When I started my job, my project was heavily focused on bone marrow transplants and finding new pathways/potential treatment options for graft versus host disease, a possible side effect of a non-self bone marrow transplant (if you want to know more about these in general, leave a comment and I will write a post).
Now, my project is focused on non-standard chemotherapy drug screening for cancers. The theory behind it is awesome, as these drugs don’t destroy rapidly growing cells, but instead make the immune system better at fighting off cancer. Now I am talking about small amounts of cancer in the setting of someone who has had a tumor/cancer removed but may be a high risk for relapse. These drugs would help with the relapse (perhaps more, but that will be another post :) ).
In order to have the most clinically relevant results possible at this stage, we decided to give these drugs orally instead of injecting them, as most patients would take the final form of this in pill form, not necessarily an IV drip. So I inject my mice with tumor, wait a few days and then start treating them with my drugs to see if any will ultimately kill the cancer. Easy you think.
Think again.
Giving a mouse a specific amount of a drug orally is no easy task. It involves much dissolving, aliquoting, and mixing of said to start with. Then there is the actual problem of giving the mouse the drug, seeing as just having them drink the small volume will never fly in the scientific world. This leads to EMT GFP taking very small metal feeding needles (they are blunt tipped, not sharp at all) attached to a 1cc syringe and accurately dosing each and every mouse.
After scuffing the mouse so it will theoretically not move.
And navigating a mouse’s pharynx blind to avoid a trachea (hey! its the reverse of intubation! Well kind of) and not puncture the esophagus.
It stresses me out, because try as I might, there is always one mouse that manages to squirm and pull, causing me to tighten my grip and occasionally accidently start to strangle to mouse. The second I see this I always put the mouse down but it still stresses me out that I did it. I think the mice are cute and I don’t want to be hurting them. But they are the ones who are squirming, though I know telling them to hold still does absolutely no good.
And then they pee on me, which, while I am wearing gloves and a gown (and booties and a mask and a hair cover), I still dislike.
Or the ones that try to struggle and struggle despite my good grip on them and freak out like they can’t breath even though I know they have an airway (if you are squeaking, you have an airway).
And then each and every tumor has to be measured. At least twice a week. More when the tumors get big. Not as bad as giving them drugs, but tedious. Oh so tedious and not entertaining as the mice try to struggle. Again.
Bone marrow transplants are so much less stressful…
But, if I can get through these compounds, if I can surviving being a human high through put machine, I may find something that helps. I may find a new drug to fight cancer. And at the very least, I can cure mice of cancer. In the end, it will be worth it.
Tuesday, April 6, 2010
Lessons Learned and Thoughts Provoked
I was rather excited to discover that my area as a whole may have learned a few things after the Blizzard of 2009 for the Blizzard of 2010. For the large part, no one was out. This is in sharp contrast to the 2009 blizzard in which many people were out driving in cars that could not handle snow and on roads that really were not good for cars, ambulances too for that matter, period. Its was eerily quiet on the medical side of the fence where I was. Unfortunately, I know that our engine had to go out numerous times for downed lines and tree limbs despite the weather. Further, I know several other stations in the area around us were running numerous medical and engine calls in drifts of snow that were waist deep almost the whole blizzard.
Now, right at the beginning of the 2010 blizzard, my crew and I did get a call which made me think. It was after dark and the snow was just starting to really come down. There was maybe four inches of snow on the ground, enough for us to take twice as long getting to the house as it would have normally, even with chains on the tires.
When we get there, we find a patient and his wife in the bedroom. He hasn't been feeling well and was throwing up a bit earlier. His vital signs were stable and he had been able to keep some water down earlier. Now, I am no doctor but I was fairly confident that he was not about to code, have serious dehydration, or die on us in the next hour at the very least. In fact, he looked rather good for being sick, maybe a bit warm and a bit weak, but that is expected if someone if fighting off the flu, be it regular or stomach.
Now here comes the sticky part, when we look out the window, its snowing cats, dogs, mice, rabbits, and maybe a few horses thrown in for good measure, significantly heavier than when we had arrived at the house. Now, we had no qualms about transporting the patient to hospital, but we were worried about his ability to get back home after he was discharged. If this was the "nice" end of the storm, the middle was sure to be horrible (and it was, nearly white out conditions by morning. They actually stopped plowing a bit at one point) and driving was going to be nearly impossible.
After some conversation and discussion about what we could and could not do (sorry, we can't treat you, we really only can transport you as an Basic unit and even an ALS unit could not have done much more for you but have your tried calling your doctor or pharmacy?), the patient decided that it was probably best to wait out the night and see if he felt any better in the morning. He would call us if anything got worse, encouraged by us really to call if anything got worse, and call his doctor in the morning. I don't like refusals in general, as I feel that if someone called 911 there probably was a reason, but I did agree with this patient that perhaps the risk of leaving his house was greater than staying in with a currently non-life threatening illness.
This is where I do truly envy the system over in the UK where medics are able to contact other forms of medicine than just the ER to help their patients. As an EMT, I can only encourage people to contact their doctors, not call one for them. It would be great to have other options beyond transport or not transport, particularly when the call is not life threatening and the patient really wants someone to help him figure out what to do or just get a ride to the local ER. Particularly in the middle of snow storm!
Now, right at the beginning of the 2010 blizzard, my crew and I did get a call which made me think. It was after dark and the snow was just starting to really come down. There was maybe four inches of snow on the ground, enough for us to take twice as long getting to the house as it would have normally, even with chains on the tires.
When we get there, we find a patient and his wife in the bedroom. He hasn't been feeling well and was throwing up a bit earlier. His vital signs were stable and he had been able to keep some water down earlier. Now, I am no doctor but I was fairly confident that he was not about to code, have serious dehydration, or die on us in the next hour at the very least. In fact, he looked rather good for being sick, maybe a bit warm and a bit weak, but that is expected if someone if fighting off the flu, be it regular or stomach.
Now here comes the sticky part, when we look out the window, its snowing cats, dogs, mice, rabbits, and maybe a few horses thrown in for good measure, significantly heavier than when we had arrived at the house. Now, we had no qualms about transporting the patient to hospital, but we were worried about his ability to get back home after he was discharged. If this was the "nice" end of the storm, the middle was sure to be horrible (and it was, nearly white out conditions by morning. They actually stopped plowing a bit at one point) and driving was going to be nearly impossible.
After some conversation and discussion about what we could and could not do (sorry, we can't treat you, we really only can transport you as an Basic unit and even an ALS unit could not have done much more for you but have your tried calling your doctor or pharmacy?), the patient decided that it was probably best to wait out the night and see if he felt any better in the morning. He would call us if anything got worse, encouraged by us really to call if anything got worse, and call his doctor in the morning. I don't like refusals in general, as I feel that if someone called 911 there probably was a reason, but I did agree with this patient that perhaps the risk of leaving his house was greater than staying in with a currently non-life threatening illness.
This is where I do truly envy the system over in the UK where medics are able to contact other forms of medicine than just the ER to help their patients. As an EMT, I can only encourage people to contact their doctors, not call one for them. It would be great to have other options beyond transport or not transport, particularly when the call is not life threatening and the patient really wants someone to help him figure out what to do or just get a ride to the local ER. Particularly in the middle of snow storm!
Friday, April 2, 2010
In like a Lion, Out like a... Lion
Seeing as its just now April and the weather has decided to not be lambish, the past few weeks have been interesting. First, there is STILL snow on the ground where there had been large piles and shade, even after warm weather. I was so glad when it transitioned from the grey, cold, rather depressing beginning to March to at least sunlight. I function much better with sunlight. Don’t get me wrong, I love snow, but the weather had been getting to me after a massive snow storm in February and the grey weather to start March.
A few weekends ago when my friends had come in for a visit, the weather was absolutely wonderful, cloudless skies, sunny blazing down and 70 degrees! Of course, this also led to the downside of nearly sunburning myself (hazards of Irish ancestry, I don’t tan well at all, just burn), but it was totally worth it to be outside with friends.
And then last weekend it not only rains, but its cold! As in overnight lows near freezing! I can expect this from central NY, but not down here! Its not supposed to be so cold down here. Needless to say, I am ready for some nice, consistent, warm, spring-like weather. We finally are getting hints at the nice weather but I am holding out my hope till it stays this way for over two weeks before I get my hopes up. This EMT needs her sunlight and warmth! Plus, it means I can stop wearing two to three layers when I go on shift.
A few weekends ago when my friends had come in for a visit, the weather was absolutely wonderful, cloudless skies, sunny blazing down and 70 degrees! Of course, this also led to the downside of nearly sunburning myself (hazards of Irish ancestry, I don’t tan well at all, just burn), but it was totally worth it to be outside with friends.
And then last weekend it not only rains, but its cold! As in overnight lows near freezing! I can expect this from central NY, but not down here! Its not supposed to be so cold down here. Needless to say, I am ready for some nice, consistent, warm, spring-like weather. We finally are getting hints at the nice weather but I am holding out my hope till it stays this way for over two weeks before I get my hopes up. This EMT needs her sunlight and warmth! Plus, it means I can stop wearing two to three layers when I go on shift.
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