LEFT TO RIGHT: Winston Churchill, Franklin Delano Roosevelt (cigarette in hand) and Joseph Stalin, Yalta Conference, 1945.

The year was 1945. So much was unknown to mankind at this time and many of the most incredible gadgets and gizmos the world has known didn't come about until much later. But putting aside the fact that there were some pretty nifty inventions in the years that followed, some consideration should be given to the discoveries that came to light around this time. One discovery worth mentioning was made by some very brilliant people who, through some simple plotting of points on a graph and humble analysis, discovered something that would change healthcare for years to come. The discovery was that high blood pressure is bad for you! And the geniuses behind this discovery were not medical doctors at Harvard or Johns Hopkins. Rather, it was a group of folks at 1 Madison Avenue near East 23rd Street in New York City, NY in a building called the Metropolitan Life Insurance Company Tower. To be fair, doctors have commented heavily on what they called "hard pulse disease" for centuries, but they didn't know the extent of it, what to do about it or if they even should do anything about it. Dr. Jon Hay of Liverpool University in 1931 stated "... the greatest danger to a man with a high blood pressure lies in its discovery, because then some fool is certain to try and reduce it." Another doc by the name of Dr. Paul Dudley White in 1937 added this gem, stating that "... hypertension may be an important compensatory mechanism, which should not be tampered with." And author of "Diseases of the Heart," Dr. Charles Friedberg considered 210/100 "mild benign hypertension" and that it "need not be treated."

Adnan Khan, MSIII read these quotes and then said: "LOL!"

Going back to 1945, there's one doctor I just cannot bring myself to laugh at. Poor guy was Navy doc, Admiral Ross T. McIntire, an ear, nose and throat specialist, and personal physician of Franklin Delano Roosevelt. In addition to treating countless ailments of the then troubled, war-time president, he did an interesting thing, which was documenting the president's blood pressures regularly. He found that Roosevelt was frequently found to be hypertensive, but did next to nothing regarding this finding. He continued to follow the president all over the country and the world, which brings us to the Yalta Conference near the region of Crimea of Southern Ukraine (currently making headlines).  

Top line - Roosevelt's systolic blood pressure. Bottom line - Roosevelt's diastolic blood pressure. Both seen steadily rising until his death, just two months after the meeting at Yalta, during which time his blood pressure was almost 350/200.

 

Now, the normal blood pressure we all know that is considered healthy is '120/80' -- a rare finding, and probably not what most of us actually have. However, as you can see to the left, FDR's blood pressures ran a little high. Actually, they ran very high! And shortly after the Yalta Conference, there was a rapid rise in his blood pressure.

Newspaper article printed the day following the death of Roosevelt with Adm. McIntire's famous proclamation and cause of Roosevelt's death.

Obviously, this was not a sustainable situation and one of the complications of malignant hypertension is a stroke, which he subsequently had. Going back to Admiral McIntire, he is famously quoted as expressing his completely being blind-sighted by this event by saying it "came out of clear sky." I believe he is remembered by some as being an incompetent buffoon and ridiculed for his very public confusion.

The truth; however, is that his confusion was probably shared by many more doctors than just him and similar sentiments were quietly echoed from supposed "geniuses" in white coats everywhere.  

The reason I decided to write this was because I have a couple of genuine fears. The first being, I don't want to miss something like this. That's terrible. But you can't blame McIntire for not knowing given the information that he had at the time. And if it weren't for life insurance companies taking note of the fact that their clients with high blood pressure don't seem to live as long, we wouldn't know, either! The other fear has to do with the fact that I'm about to graduate next May. Ahh! The scary part of that is I don't feel as smart as some say and am actually pretty apprehensive about the whole thing. I suppose that is a normal feeling, but I need to iron that out. I'm hoping 4th year takes care of that! One thing I will say, though, is that doctors are just trying to do the best they can. Which is what I'm going to try and do! The best thing any of us can do is learn from past mistakes, I guess...

Still a 3rd year. Can't wait for this to be in the past as well.

aK

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AuthorAdnan Khan
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INT. PATIENT ROOM - MORNING

A cold room with jungle-themed walls, painted mostly green, with cartoonish looking trees, flowers and a large tiger, lounging on a branch. Present in the room is a counter with typical, patient room material and a sink on top, cabinets underneath, an exam table and across from that, two chairs for family to sit in. 

                                        ADNAN

          (knock knock)

Hellooo! Gutierrez family? Hi, my name is

Adnan, so nice to meet you! You're mom? 

Adnan gestures to shake mother's hand.

                                   MOM

          (smiles)

Si. 

Mother, almost reluctantly, shakes Adnan's outstretched hand.

                                   ADNAN

          (also smiling)

Nice to meet you, mom.

Office MA translates throughout. Adnan turns to patient sitting on exam table.

                                   ADNAN (CONT'D)

And who are you?! Hey! I like your shoes! Purple -- just like your shirt!

Adnan continues to state obvious things about the little girl's attire while the patient smiles a luminous, toothy grin as she enjoys compliments for her matching abilities. Meanwhile, the MA, who has been translating for Adnan all day, wonders about Adnan and his strange fascination with little, girl's shoes. 

                                                       ADNAN (CONT'D)

         (now seated next to the patient)

Sooo… they told me that your throat has been hurting? How long has that been going on? Two days! Aw, I'm sorry! Hurts to eat and drink, you say? Let's get you feeling better! Anything else going on? Mom, have you noticed anything?

Adnan turns to the mother and watches intently as she answers in Spanish. She speaks her native tongue elegantly and for a long time. Adnan begins to wonder what she might be saying, anticipating quite a history of this present illness. It almost sounds like the Spanish audio version of Harry Potter and the Strep Throat. The MA finally turns to Adnan and says that the patient has also experienced a fever. Apparently, that was all the mother said.

                                                       ADNAN (CONT'D)

     (once again, looking at the patient)

That's no fun! Anything else bothering you, little one? In your head, eyes, ears, nose? Are you coughing at all? Tummy ache? Going to the bathroom okay? Are you itching anywhere? 

Adnan, having chosen to speak with a bizarre cadence and intonation as he asks these questions, realizes too late that he sounds like a scary, carnival clown. He proceeds regardless as it would be just as weird to suddenly switch to a normal voice now. Everyone carries on as if none of this is creepy. But it is. Patient denies any other symptoms. A silence brews, but then...

                                                                      PATIENT

          (thrusts hand in the air, wishing to add)

I'M FIVE-YEARS OLD!

Adnan can't help but smile and chuckle at this young patient's enthusiasm about her age. Funnier than that is the odd timing of this outburst and his near-sarcastic reply, which was completely unintentional.

                                                       ADNAN

          (smiling)

That's great!

Any-freakin'-way.

                                                       ADNAN (CONT'D)

          (disembarks from the table)

Well, I'm gonna take a look at her, just kind of head to toe. Her vitals are better than mine! And no fever when they checked her in, so that's good. 

Adnan states every single normal finding from her temperature to her absent lymph nodes. Reassures mom that nothing more serious is going on and when it comes time to tell mom about the slightly erythematous oropharynx with bilateral tonsillar exudates, she'll see that there's not much more to worry about. For some reason, Adnan feels compelled to tell the story of how antibodies formed an army against the evil M proteins of Group A ß-Hemolytic streptococcus species and the importance of treating this with Amoxil is based on our valiant efforts to stamp out rheumatic fever in young persons because those same antibodies can be damaging to the heart muscle. Whew! Shortly thereafter, it becomes abundantly clear to Adnan that no one freakin' cares and that Adnan should shut up once in a while.

                                                       VOICE IN ADNAN'S HEAD

          (deep, angry, commanding)

Seriously, dude. Stop talking.

                                                   ADNAN

         (smiling once again)

Okay! Let me go talk to my doctor. I suspect that we will be prescribing that antibiotic that I mentioned earlier. Any questions? Preguntas? 

Adnan, realizing too late how ridiculous it is too introduce some Spanish at this juncture, with an MA translator standing two feet away, can't help contain the inner Latino that wants to break free. 

Mother and child say their thank yous. 

Adnan does the same and exits the room.

END SCENE

aK

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AuthorAdnan Khan
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… I would open two. The first one would be called 'Grave Danger,' featuring the finest Italian cuisine, which could easily, easily rival anything coming out of Branson, Missouri. And right next door to this restaurant would be my other restaurant! Yes! And this one is going to be known as 'Mortal Peril," which would serve… I don't know, classic American? Burgers and stuff! 

Anyway, picture this:

It's Saturday night, 7:33PM. Dinner time for most. A group of diners meets at one of the restaurants, only to notice that one of their own is missing. They frantically call the guy -- they say, "Hey man! Where are you?! We're in Grave Danger!" Guy on the other line says, "Oh, no! I'm in Mortal Peril!" This conversation would happen many, many times (hopefully -- that's the intended purpose for this sad escapade in entrepreneurship). And both restaurants would most definitely fail. And I would most certainly go bankrupt. And all of this would occur faster than it took for that generous, half-smile to fade from your face. Thanks for reading. More to come. I should stick to being a pretend doctor.

Currently doing pediatrics. 

aK 

Posted
AuthorAdnan Khan

Perhaps it'll be early in the morning for you, too. Someone will come in. An unsuspecting someone -- scared, vulnerable, looking for help. Looking to you! The world to them has changed; it's unclear, it's unfamiliar, it's blurry and it's been going on for two days. Yes, they have been urinating more frequently! Yes, they have a headache! No, they haven't been eating more, do I look fat to you?! Wait a minute -- what are you saying? Why are you asking me about my family? Medical problems will run in their family -- by the way, what an odd way to personify disease. We battle cancer, diseases ravage us, and apparently, they like to do laps through our family trees, skipping generations along the way and being passed on like batons in a relay to the newcomers by marriage or what have you. Back to our person with "the sugar." And you! Standing there with all the answers, and more importantly, the answer to this person's problem. Standing there and trying all the while to hide that smile playing about your lips because after all, you can't possibly be right about something. You're an MSIII! But how can you be wrong when this is as clear as the lungs in your chest (that's not the saying, I know), and nailing the Dx is a dense, highly glycemic piece of cake?! You're about to break the news and you're downright giddy at this point. The feelings of purpose and pride in your achievement collide in a magnificent swirl, similar to the ones this person probably indulged in -- of course, those ingredients weren't there. It was probably frozen yogurt with chocolate & vanilla flavoring. Mmm, flavoring. The emotions don't stop there, how can you be excited at a time like this? It's a conflicting feeling -- Disneyland meets Vietnam. I am sad for this person because they are not much older than me, and this could be me or anyone else I know or care about. Their road is a long one, diabetes is a war not a battle as the cliche goes. And it comes with so many other morbidities, which I don't have the time to explain and probably need to review. I compose myself, get a grip, because this person has a disease. I tell them what I think. They agree, they suspected as much. I tell them what we are going to do. They are agreeable to the plan. Accu-Check says 348 mg/dL. Shit, I'm right. I don't always hate being right, but I did right there. In my pursuit of being right, I'll make sure it's for the right reasons. 

Amanda, a friend and soon-to-be rockstar PA, did a lot of work for the Native American community here and their issues with diabetes. In addition to that, she's got me interested in a site that I've passed along to a few patients during my stay at urgent care. Take a look!

http://www.diabeteslocal.com 

aK  

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AuthorAdnan Khan
CategoriesSchool

Midwestern University 

AZCOM Class of 2015

... in Latin, roughly translates to mean, "through hardships, the stars." There you see my class. AZCOM's class of 2015 -- a lovely bunch, some of the hardest working people I have come to know. I sort of remember when this was taken -- a Friday afternoon in the spring of 2012, after a long day of class (right after Ethics and Jurisprudence, maybe)? We had been instructed to bring our white coats that day because we were going to take this group picture. By that time, I had become a rather curmudgeonly and cantankerous person -- fed up with school, with first year and just burnt out from it all. It's about a year later now that I'm writing this to you. It's just as hot as it was back then, I still comb my hair to the right (a tired and uninspired style I've sported since I've had hair) and I'm still in medical school. BUT -- I'm (almost officially) a third-year now, my attitude is nowhere near as sourly and I'm actually pretty happy! Thankful, too, for having known such great people. For those not in the biz, it must seem like this blog entry is about us graduating. We're not doing that, but it kind of feels that way to me. Especially since our day-to-day is about to change very drastically. 

This feeling of departure always brings to mind the same things, no matter what it is I'm leaving behind. Whether it was high school, college, a birthday party or just a get-together -- I often wonder to myself "Man, I hope I didn't piss anyone off." Honestly. Not because I expect some evil hex to be placed on me. No -- it is my genuine hope that I never said anything to upset anyone, to bring them down, to offend them or make them feel sad. Everyone was so nice to me these past two years and while I hope I reciprocated that, I realize I often speak more than I should. And what comes out of my mouth probably should have gone through some kind of editing process beforehand. 

The reality is, I really like making people smile and figuring out the kinds of things that make them laugh. Normally, this is pretty easy to do and to be perfectly honest, I land jokes like Cessnas!

imhilarious.jpg

OMG. Just kidding. The reality is -- while I do enjoy making people laugh and smile, I fall flat most of the time. So often, in fact, that I now suffer a rare form of plagiocephaly of the face. 

Despite the sarcastic, smattering of applause, pity laughs and the "There there, no one laughed at your joke, it's going to be okay" pats on the back -- I'll still try! And I hope by doing so, I brighten someone's day. But going back to what I said earlier, I do mean it when I say this -- I'm sorry. Sorry if I said anything to you that may have upset you, class of 2015. It's always in jest and it's never meant to be mean. I really should be more cognizant of what I say, especially considering the field we are entering. 

Truthfully, I really did enjoy going to class with these people. That is, of course, the times when I did go to class. I came to know many of them and some of them became very good friends of mine! My hope is that I maintain at least some of these friendships I made along the way and that any one of them will feel comfortable enough to come on here and drop me a line. This is my blog -- welcome! Stay a while and leave a message if you'd like. What we are about to do as a class is really something incredible. We will learn what a joy it can be to care for someone and perhaps, we'll save a life or two along the way. You've worked very hard these past two years, class of 2015, you deserve to be proud of yourselves. Good luck on boards, on rotations, matching and being doctors. Don't forget the hardships and as corny as this most definitely is, reach for the stars! 

Per aspera Ad astra

aK

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