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Archive for February, 2013

Abstract dangers

Posted in Science, tagged , , on February 17, 2013| 12 Comments »

Scientific journals aren’t for everyone. Journal articles use technical writing and can be rather dry. They can be long, they can be dull, they can show nothing new and exciting, or the research they describe can be so poorly thought out you wonder how a reviewer ever allowed the paper to go to the presses. Many good article are behind pay walls, so even if you want to read them, sometimes you can’t.

 

Fortunately an abstract of most papers can be found for free.  An abstract is a brief summation drawn up by the authors to get their point across.  Maybe it’s just me, but I sometimes think that abstracts can be a bit like movie trailers- they introduce the major players and they give you a general plot of the movie (and they try and hook you in by showing you all the good scenes).

 

Like a movie trailer, abstracts can be deceiving.  Take the trailer for The Matrix Reloaded– how excited were you when you first saw that trailer? How much did you wish the movie had never been made after you saw the actual feature?

 

Unfortunately, while in the cinematic world people are unlikely to act like they’ve seen the whole movie when all they’ve done is watch a trailer, in the world of scientific literature it often seems that people assume that reading the abstract is as good as reading the paper.

 

It is not.

 

The list of examples is endless, but this morning I stumbled across an example of this that finally pushed me to write about abstract abstraction.

 

It all started when I saw a tweet proclaiming “A high saturated fat mixed meal induces inflammation & insulin resistance & elevated glucose cf [compared to] other types of fats”.  Considering my interest in fats and my particular fondness for saturated fats you may not be surprised to hear that I decided to dig a little deeper.

 

The paper is from an open access journal. The full text is available here.

 

To be fair, the title of the paper is not quite as sensational as the tweet that led to it- The effect of two iso-caloric meals containing equal amounts of fats with a different fat composition on the inflammatory and metabolic markers in apparently healthy volunteers– but the “conclusions” offered in the abstract (the line that anyone who is just skimming the article will jump to) is rather dubious:

 

Metabolic and modest inflammatory changes occur within a few hours after the ingestion of a high SFA meal in apparently healthy adults.

 

I don’t have the time or the inclination to totally dismantle this paper (I really wonder how they did their statistics to show there was a significant difference), but I do want to point out how unwise it can be to draw conclusions from this abstract.

 

Let’s compare the methods sections. In the abstract, the authors say that healthy participants “were given two iso-caloric meals with similar amounts but different composition of fats: a meal high in monounsaturated fats (MUFA), and a meal high in saturated fat (SFA).”

 

The methods section in the paper reveals more detail:

 

The chosen meals represented two very popular meals habitually preferred by the general population: 1. Chicken sausages with fried potatoes, ketchup and mayonnaise (defined as SFA); 2. Pasta with olive oil, ketchup and nuts (defined as MUFA).

 

Seriously?

 

Two entirely different meals, and we’re supposed to believe that any differences in blood markers (of which I am skeptical) are due to the change in the type of fat- fat types that aren’t particularly well represented in at least one of the meals.  Chicken is not high in saturated fat.  Chicken fat is predominantly unsaturated, a combination of MUFA and polyunsaturated fats (PUFA), with less than a third of chicken fat being saturated.  What were the potatoes fried in? These days most things are fried in PUFA rich vegetable oils not SFA rich animal fats or coconut oil.  And mayonnaise? Mayonnaise contains very little saturated fat (because it’s usually made with PUFA-rich vegetable oils).  At least the second diet utilizes olive oil, which is rich in MUFA.

 

The authors state that they used the Israeli Food Database to calculate the breakdown of SFA:MUFA:PUFA in each diet and that the “SFA” and “MUFA” diets contained 24:33:17g and 8:51:14g respectively. Without knowing more about the ingredients (what fats and oils were used in the SFA diet and what nuts were used in the MUFA diet) it’s hard to know if the breakdown is accurate.  The meals are so different in every regard, it’s silly to quibble over the exact proportion of each fatty acid type.

 

The point of this post isn’t (or wasn’t) to pick this paper apart.  The purpose was to show that we should be cautious when drawing conclusions from abstracts.

 

The authors chose to say that any changes (that may or may not be real) occurred after “the ingestion of a high SFA meal”, but they could equally have said “after the consumption of mayonnaise (or potatoes)”… Likewise, they could have claimed that pasta (or nuts) “protects against metabolic changes induced by ketchup”. Of course, all of these claims would be ridiculous- though perhaps less ridiculous than suggesting any changes were due to ingestion of a high SFA meal (something they didn’t even test)!

 

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An evolutionary argument for snuggling

Posted in Anatomy, Evolution, Principle into Practice, tagged , , , , , on February 13, 2013| 20 Comments »

‘Tis the season for cheesy cards, overpriced restaurant dinners, flowers, chocolates, jewelry, and stuffed animals.  I’ll admit that I’ve never been a huge fan of Valentine’s Day.  We started off on the wrong foot, with those awkward grade-school valentine exchanges, and I’ve never seen eye-to-eye with Valentine’s day over the crass-consumerism that seems part-and-parcel with this holiday.  That, and even in my most desperate days I could never understood the gustatory appeal of candy hearts.

 

This year, instead of doing my best to ignore the day, I thought I’d have a little fun. I’ve said it before and I’ll say it again: evolution is everywhere. This is never more true than in the bedroom!

 

Snuggling, cuddling, spooning… name your term.  

 

Why do humans like to cuddle?  There are a number of arguments that can be made for snuggling.  Physical contact in the form of massage increases levels of the “love” hormone oxytocin [1] and decreases cortisol [2] (though some of the data on massage is fuzzy, perhaps because massage, especially in a research setting, can be a rather impersonal experience in comparison to cuddling).  More frequent hugs increase oxytocin levels and lead to lower blood pressure and heart rate in premenopausal women [3]. An interventional trial that looked at the effects of “warm touch” (including hand-holding, hugs, and “cuddling up”) in married couples showed an increase in salivary oxytocin (in husbands and wives) and a decrease in systolic BP (in husbands only) in the treatment group [4].

 

Increased oxytocin seems to enhance the effects of social support on stress responses [5].  Oxytocin also plays a role in the early stages of romantic attachment, and encourages pair-bonding (and parental attachment) [6]. But oxytocin isn’t the only compound that is altered by cuddling-up or that affects the way we feel about other people. There is also evidence that touch alters the release of endorphins[7], and that neuropeptides may play a role in the beneficial nature of physical touch [8].

 

On a day like Valentine’s Day, which purports to revolve around the concept of love (and chocolate sales), the arguments that physical contact reduces stress and increases the hormone associated with pair-bonding are probably king.  Recently  (and I did warn you I’m a bit cynical about this holiday), I’ve been wondering if there is something a little more… “anatomically practical” about cuddling.

 

Why you (men) shouldn’t “hit it and quit it”.

 

Anyone that has spent anytime thinking about human pair bonding has spent time thinking about short-term vs. long-term interests when it comes to the mating game. Yes, humans are predisposed to long-term bonding, but that doesn’t mean that there isn’t a significant role of short-term mating in human procreation (perhaps not as much now, thanks to social norms and the potential for paternity tests, but sources frequently cite that ~10% of children aren’t actually the offspring of the father that raises them, though a more thorough investigation shows that the rate is probably closer to 3% [9].).  As an aside, while on my EMS elective I was repeatedly subjected to the Maury Povich show and it’s ilk while hanging out at headquarters (the lounge TV was usually blaring in the background). I doubt that Frederick Sanger imagined how his great discovery of DNA sequencing would be used when he developed the method in 1975 (for which he later won a Nobel prize in Chemistry- his second). “You are NOT the father!!!” But I digress…

 

Different species have various ways of decreasing paternity uncertainty.  Some animals- canines for example- have a very… awkward (maybe I’m being anthropomorphic, I apologize) way of increasing the likelihood of paternity. After the completion of mating, the male doesn’t leave the female’s side. He can’t. Seriously. He is physically attached.

 

Dog mating is significantly different from that of humans. When the dog’s penis is first inserted into the vagina it isn’t actually erect and is only able to penetrate thanks to the penis bone, also known as the baculum. After insertion, the penis swells and the bulbus glandis at the base of the penis literally locks the penis in place, preventing the removal of the penis. This is known as “knotting” or “tying”.  This cumbersome position usually lasts 5-20 minutes after ejaculation.

 

At least one book on dog genetics says that this process seems “quite irrational”, but the authors submit that it “must serve a purpose as it has remained despite apparent drawbacks, such as vulnerability to attacks during the act.” [10]. I doubt I’m the first to suggest that the advantage of this prolonged intimacy is an increase in certainty of paternity.  It seems rather obvious that this method of copulation gives the lucky suitor’s sperm time to gain advantage in the race to fertilization, before another competitor’s sperm can enter the race.

 

Fortunately, humans have not evolved this mechanism of assuring paternity. Instead, I’d argue that post-coital snuggling can offer some of the advantages of canine-coupling.

 

Some people might think that humans are above such an animalistic tendency. If a man doesn’t stick around long enough to ensure that his sperm have time to reach their destination, would another man’s actually get the chance?

 

Well maybe…  It has actually been argued that the human penis is evolutionarily shaped (literally) to help a man get his semen where it needs to be, even if it didn’t actually get there first.  In the article “The human penis as a semen displacement device*”, researchers argue that the shape of the human penis is “designed” to remove semen from the vagina during sex, clearing the way for new semen to be deposited in the most advantageous location (increasing the likelihood of paternity) [11].  This strengthens the argument that if you’re a man, and you want to ensure paternity, it’s probably best you hang around to make sure your sperm doesn’t have any competition in reaching it’s goal.

 

So there you have it, the “principle into practice evolutionary argument for snuggling”.  Sure, in the modern world men may not WANT paternity with every sexual encounter, but that doesn’t mean that the evolutionary mechanisms and behavioral predispositions aren’t already in place to improve paternity-certainty.  On a day like Valentine’s day, you might rather focus on how cuddling increases oxytocin, leading to emotional bonding.  Just remember that snuggling also physically bonds you, and that may not be such a bad thing…

 

*This paper wins the award for most giggle-worthy methods. Some of the lines could be right at home at #overlyhonestmethods. E.g.: “… this recipe was judged by three sexually experienced males to best approximate the viscosity and texture of human seminal fluid.”

 

 

1.            Morhenn, V., L.E. Beavin, and P.J. Zak, Massage increases oxytocin and reduces adrenocorticotropin hormone in humans. Altern Ther Health Med, 2012. 18(6): p. 11-8.

2.            Rapaport, M.H., P. Schettler, and C. Bresee, A preliminary study of the effects of repeated massage on hypothalamic-pituitary-adrenal and immune function in healthy individuals: a study of mechanisms of action and dosage. J Altern Complement Med, 2012. 18(8): p. 789-97.

3.            Light, K.C., K.M. Grewen, and J.A. Amico, More frequent partner hugs and higher oxytocin levels are linked to lower blood pressure and heart rate in premenopausal women. Biol Psychol, 2005. 69(1): p. 5-21.

4.            Holt-Lunstad, J., W.A. Birmingham, and K.C. Light, Influence of a “warm touch” support enhancement intervention among married couples on ambulatory blood pressure, oxytocin, alpha amylase, and cortisol. Psychosom Med, 2008. 70(9): p. 976-85.

5.            Heinrichs, M., T. Baumgartner, C. Kirschbaum, and U. Ehlert, Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biol Psychiatry, 2003. 54(12): p. 1389-98.

6.            Schneiderman, I., O. Zagoory-Sharon, J.F. Leckman, and R. Feldman, Oxytocin during the initial stages of romantic attachment: relations to couples’ interactive reciprocity. Psychoneuroendocrinology, 2012. 37(8): p. 1277-85.

7.            Keverne, E.B., N.D. Martensz, and B. Tuite, Beta-endorphin concentrations in cerebrospinal fluid of monkeys are influenced by grooming relationships. Psychoneuroendocrinology, 1989. 14(1-2): p. 155-61.

8.            Dunbar, R.I., The social role of touch in humans and primates: behavioural function and neurobiological mechanisms. Neurosci Biobehav Rev, 2010. 34(2): p. 260-8.

9.            Anderson, K.G., How Well Does Paternity Confidence Match Actual Paternity. Current Anthropology, 2006. 47(3): p. 513-520.

10.            Ruvinsky, A. and J. Sampson, The Genetics of the Dog. http://www.google.com/books?id=bgZwjdB4xgEC&source=gbs_navlinks_s ed. 2001: Google Books.

11.            Gallup, G.G., R.L. Burch, M.L. Zappieri, R.A. Parvez, M.L. Stockwell, and J.A. Davis, The human penis as a semen displacement device. Evolution and Human Behavior, 2003. 24: p. 277-289.

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Physicians and Ancestral Health

Posted in Evolutionary Medicine, Med school, tagged , , on February 11, 2013| 7 Comments »

There are a lot of smart people who are interested in ancestral and evolutionary health. Personally, I find it very encouraging to see people from various backgrounds thinking deeply about how looking back into human history can help us improve our present-day wellbeing.  These people come from all walks of life and each person has come to this way of thinking by a unique path, but many have similar stories.  Sharing a story breeds camaraderie, and I think part of the reason the “paleo” movement has developed such a strong online community is because of the solidarity that comes from sharing a similar personal journey (that’s not to say there isn’t division and strife in the community- there is plenty!).  Sharing core principles also promotes professional camaraderie. Alas, few of us in the medical profession share an interest in ancestral and evolutionary thinking.

 

I have been very fortunate in my brief clinical experience to have worked alongside and under (medical academics is definitely a hierarchy) people who have indulged me in conversations about how evolutionary and ancestral theories apply to modern medicine. But while some are happy to talk about select topics in ancestral health, few think about it deeply or use ancestral thinking in their medical practice.  There are physicians who think about ancestral health and evolutionary medicine, and I am always enthusiastic (perhaps a little bit too enthusiastic?) to meet and interact with physicians who share my academic interests.

 

As I said above, sharing a journey breeds camaraderie (that definitely seems to be the “word-of-the-post”), and it frequently seems that the tougher the journey, the greater the camaraderie. Medical training is a gauntlet. After an undergraduate degree, medical degree, internship, and residency (to say nothing of longer residencies, an added fellowship, or additional degree(s)), a physician in the US has spent a minimum of 11 years in “higher education” to become a practicing clinician. As I wrote in my last post, “nocturning“, clinical training is physically and mentally exhausting (and decidedly unhealthy). Other allied-health and research professionals also travel long academic roads, and surely the trials and tribulations of the academic journey of each profession fosters camaraderie within each group.  Similarly, for those of us who have achieved a PhD- we may have done research in different labs, under different mentors, and in very different fields, but there is a mutual understanding of what one endures to finally earn those three letters after one’s name.

 

I have been fortunate that I have built some strong personal relationships in the ancestral health community.  One of the first “ancestrally minded” people I met in real life was Dr. Emily Deans– a psychiatrist with a deep interest in the interaction between nutrition and mental health.  While we are separated by some distance, it is good to have a friend who not only shares my passion for ancestral and evolutionary health but who also understands the arduous journey of becoming a physician. In the past couple years I have also met a number of other physicians; first online, and then last August at the Ancestral Health Symposium (AHS) I had the pleasure of meeting many in person.  Less than a year ago, a few likeminded physicians thought it would be beneficial to form an organization for physicians (MDs, DOs, and international equivalents) interested in ancestral health. This idea blossomed at AHS, and in the last few months a meeting was organized to bring such an organization into fruition.

 

This past weekend I travelled to Salt Lake City for the Physicians and Ancestral Health (PAH) Winter Meeting.  Leaving the northeast as a blizzard approached to head to snowy Salt Lake City seemed a bit like jumping “out of the frying-pan and into the crockpot” meteorologically speaking, but personally and professionally the trip was fantastic (and people in Utah seem to handle the snow in stride, quite unlike home in the northeast!).  This was the first official meeting of PAH, and twelve physicians from around the county (and Canada) got together to discuss what we know, what we’d like to know, how to share our information, and what we need to do to grow. We discussed different types of research, the need for more research investigating and supporting an ancestral approach to medicine, and the importance of producing and publishing results.

 

A word on research…  Physicians are not scientists (save for physician scientists, a truly minuscule blip in the Venn diagram of the ancestral health community) and while anecdotes can be powerful, they are not the kind of evidence that will sway physicians, scientists, and practice.  I recognize that as an MD/PhD student I am well positioned to make some waves in this area- I’ll try not to get too overwhelmed by the thought!  Fortunately, there are already some physician scientists producing data and publishing papers, one of whom I got to meet this weekend.

 

I had a bit of fun making a Venn diagram… nothing is to scale, but you get the idea…

 

venn

 

A slightly more amusing diagram might looks something like this… 

 

I highly recommend checking out PhDcomics.com, and “What should we call med school” as well as “What should be call paleo” if you find yourself represented above. (Sorry, I'm not blog-literate enough to hyperlink from the image!)

I highly recommend checking out PhDcomics.com, and “What should we call med school” as well as “What should be call paleo life” if you find yourself represented anywhere above. (Sorry, I’m not blog-literate enough to hyperlink from the image!)

 

In addition to setting up the framework for our nascent organization and discussing how we might foster ancestral-thinking in modern medicine, this meeting was an opportunity to form new friendships and strengthen old ones.  As the lone medical student at the meeting, I felt very fortunate to interact with enthusiastic and supportive physicians from several different fields who all share an interest in ancestral health.  I enjoyed talking about research with Dr. Lynda Frassetto, who’s papers I frequently reference when talking about the benefits of an “ancestral” diet. It was great to get a chance to talk about functional movement with Dr. Jacob Egbert and then go to Ute CrossFit where he led a practical session.  I’m straight out of my Ob/Gyn clerkship, so I loved sharing stories with Dr. Don Wilson, an Ob/Gyn from Canada with first hand knowledge of the health of indigenous First Nation people.  I had the chance to talk about the opportunities I’ll have if I decide to pursue a residency in family medicine with Dr. Rick Henriksen and other family docs.  It wasn’t all a rosy picture (though Rick is nothing if not enthusiastic), but I got a lot of honest and useful information from these physicians. There was also a preponderance of psychiatrists (or is that a contemplation of psychiatrists?), including my good friend Emily Deans, as well as a cardio-thoracic surgeon. I’m glad to have met Dr. Ede, and to have been introduced to her impressive website Diet Diagnosis.  It was also a pleasure to catch up with Dallas Hartwig, from Whole9 Life, who spoke with the group about functional medicine.

 

A nature break- some ancestrally minded physicians snowshoeing in Wasatch National Forest.

A nature break- some ancestrally minded physicians snowshoeing in Wasatch National Forest. From left to right, Polina Sayess, me, Don Wilson, Emily Deans, and Jacob Egbert

 

A lot of knowledge and information was shared this weekend, and I think we all walked away from the weekend with new friendships, a renewed sense of camaraderie with fellow physicians, and thoughts on how we can each do our part to help promote ancestral health.  Personally, I have a number of goals, not all of which I need to share.  I will say, however, that I feel there is a strong need to champion non-nutritional aspect of ancestral and evolutionary health. As the Hartwig’s book beautifully argues- It Starts with Food– but there are many other ways to incorporate ancestral and evolutionary thinking into modern medicine. That is one of my goals on this blog, though of late I have been writing more random ramblings than thoughts on distinct elements of evolutionary medicine.

 

As I officially make the transition from MSIII to MSIV (as of today I have completed all the 3rd year requirements of my medical degree), I hope that I’ll have more time to write about a number of topics in evolutionary medicine. Until then, I appreciate that readers follow along with my random ramblings, and am very glad that there are physicians who share a passion for understanding human health in the context of our evolutionary past.

 

PAH doesn’t have a website up yet, but for more information you can go here.

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Nocturning

Posted in Life, Med school, tagged , , , , on February 2, 2013| 4 Comments »

I have been a zombie today.

I’ve wanted to write this post all day, but I’ve been spinning my wheels, unable to find the focus to sit and write.

I know where my inability to focus comes from. It’s the same thing that’s been causing my insatiable hunger and serious sweet-tooth.

I had a night shift on Thursday night.

The health industry is notoriously unhealthy. Even during the best of times the medical community tends to get things wrong with seminars on preventative health being coupled with breakfasts that consist of pastries, margarine to schmear on bagels, and fat-free non-dairy creamer to opacify a foul smelling substance that masquerades as coffee.

Practicing medicine is not easy on the body.  Being a doctor is stressful and, of course, spending your days around people who are sick makes you prone to getting sick yourself.  Lack of sleep is another big problem.

Of all the clerkships that medical students rotate through, the surgical ones- surgery and obstetrics/gynecology- have the worst hours. Depending on a school’s program, this is where students first get to experience the joys (by which I mean terrors) of 24+ hour call and “night float”.

At my school, the surgery clerkship has maintained the traditional call schedule (you work a day and then when you’re on call you stay for the night and finally go home the next morning when you are “post call”), while the ob/gyn clerkship has adopted a “night float” schedule for students, where we switch from day service to night service for a few days running during the clerkship.  These two clerkships were separated by 8 months in my schedule, so it’s perhaps hard to accurately compare them.  Nonetheless, I’d like to write about my experience with these two notoriously rough clerkships.

Surgery…

My school still follows a traditional call schedule for students on the surgery clerkship: every 4th or 5th day we would be “on call” after our normal day in the hospital. For the first half of this clerkship I was at a hospital 45 minutes away from my apartment. I was up between 4:25 and 4:30 each morning to be in the hospital by 5:30 to round on my patients before we “ran the list” as a team shortly after 6 and then headed to the OR for the day.

My problems on this clerkship started early. I had just come off my psychiatry clerkship where I’d been enjoying the psyche hours of 9-4… surgery hours were a big change. I couldn’t convince myself to eat breakfast before 4:30 and instead started my mornings with 1 or 2 double-shot espressos before heading to the hospital. The hospital to which I was assigned doesn’t have great quarters for medical students on surgery, so I was left to share a miniscule locker with 3 other students.  We barely had space to store our clothes, let alone space for real food. While there was a residents’ lounge, it was adorned with a large sign warning “Med students- do not leave your shit here”, and we didn’t have access to a fridge or a microwave. Lunch was a hit-or-miss occurrence, and the general mantra for med students during a surgery rotation is “eat when you can, you don’t know when you’ll have the opportunity next.”

Here’s a classic from Whatshouldwecallmedschool

During that first month I subsisted on my morning espressos and my best attempts at healthy snacks- unsweetened banana chips, jerky, nuts, and 85% chocolate. In the evenings I’d eat a proper dinner before putting myself to bed before 9 on most nights. I occasionally managed to make it to the gym, but I tended to feel rather weak and pathetic when I managed to get in a workout. Every 4th or 5th night I was on call, and instead of heading home around 5pm as per usual, I would grab dinner in the hospital cafeteria and see patients in the emergency department and go to the OR for emergency cases.  At some point during the evening (usually between 11pm and 1am) the night resident would tell the med students to retreat to our on-call room for some sleep, promising to page us if anything interesting came through. For me, at that hospital, I was never paged during the night.

My second month of surgery was on the trauma team at our university hospital, which is a level 1 trauma center.  Start time was similar at this hospital, but I was now 25 minutes closer, giving me 25 more blissful minutes of sleep. Also, at school we have a students’ lounge with a fridge and microwave, and I was able to start eating real lunches again. I also had realized that going to the gym in my stressed and sleep-deprived state was doing me no favors so I put my gym membership on hold.  Our call schedule was similar on trauma service, but unlike the general surgery service at a community hospital, the trauma team at our inner-city hospital was constantly getting paged in the wee-hours of the morning. I don’t think I ever got more than 2 hours of sleep when I was on call, and was always woken by the screams of the pager rather than the dulcet tones of my cell phone’s alarm (I occasionally hear a pager with the same ring-tone as the trauma pager and it still sends chills down my spine).

At the first hospital, after being on call, we were usually dismissed after we “ran the list”- frequently being on the way home shortly after 7am. On trauma we would run the list, go to radiology rounds, and then physically round on our patients as a team before being sent home.  Alas, our list of patients grew malignantly during my month of trauma and at one point we had over 30 patients, with some on each floor of the hospital. After a night on trauma I would usually find myself driving home after over 30 hours in the hospital (sometimes with no sleep) willing myself to get home safely (I really didn’t want to end up in the trauma bay as a patient- nothing like the fear of having your classmates cut your clothes off with shears to keep you awake!).

It’s amazing what lack of sleep does… I remember being asked a simple question one post-call morning on rounds and completely drawing a total blank. The funny thing was, it was a simple question that I actually felt very strongly about (Why do so many of our hospitalized patients have messed up electrolyte levels? We do it to them by flooding them with fluids!). Also, despite eating a lot less than I usually do, I definitely put on weight during my surgery clerkship.

Eight months later, as I faced the prospect of another notoriously rough clerkship (ob/gyn), I prepared myself a bit better.  While I was again stationed at the hospital 45 minutes from my apartment, this time I made sure that I ate breakfast before starting each day. I had also weaned myself completely off coffee before the start of the clerkship and never drank more than a single double-shot espresso each morning. I also preemptively put my gym-membership on hold.

We didn’t have call on ob/gyn and instead had a brief stint of “night float”, where we were in the hospital from 7pm-9am for a number of days consecutively.  This is a more realistic experience of life as an intern (with current intern rules), and has the advantage of allowing you to “switch over” from days to nights. I did a bit of research and when I switched over to nights I did a combination of fasting and napping that saw me switch over easily.

During ob/gyn I didn’t have much of a social life- I was going to bed between 8:30 and 9:30 most nights and most of my time was spent in the hospital or sleeping, but all things considered I think I held up very well.  I’ve long liked ending showers with a brief cold-water rinse (I think of it as a healthy bit of hormesis), but during surgery I lost the ability to tolerate cold showers.  Actually the worst part of being “post call” was the dreadful, inescapable cold that would come over me early on the post-call morning.  I’ve always been a warm-handed person, but on surgery I developed cold hands on a regular basis. While my hands weren’t always warm, I didn’t develop terrible chills on ob/gyn.

Med school is, of course, a learning experience, and a big part of the experience is learning what your body can handle and what it can’t (and what you need to do to keep yourself healthy, happy, and sane).  I’m not looking forward to the rough hours of residency, but I know the importance of prioritizing sleep, food, and socialization and I’m learning how to balance these things to keep myself well.

Alas, just after celebrating my successful navigation of ob/gyn (at least on the “feeling good” front, I’m still waiting for grades to be posted), I was knocked almost flat by a night shift on my current EMS elective.  While a night shift is not *required* during this elective it is strongly recommended, and I went out with the night crew on Thursday night to get an idea of what night-life on an ambulance in a rough inner-city is like (short answer- it does not disappoint).  While I was out with a great team and saw some pretty interesting things, I’ve been suffering the consequences since.  On Friday morning I had an insatiable appetite and was battling sugar-cravings (something I don’t usually have) for the rest of the day. Even after getting 11 hours of sleep last night I was still pretty groggy and fairly useless most of today.

There are no more night-shift in my foreseeable future (though I know we’ll meet again during my Emergency Medicine clerkship) and I’m confident that with another good night’s sleep I’ll be back to normal, but this has been a good reminder of just how brutal sleep deprivation can be.  My time with EMS (though only brief) has also reminded me that being in the health profession is often not a healthy practice. The people I’ve been working with sometimes risk their lives to save a stranger, but they also risk their health on a daily basis by living a lifestyle for which our bodies are ill-suited.

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