Pain and Prejudice

In the summer of 1904, a Grenadian embarked on a journey to Chicago to attend dental school. The student, Walter Clement Noel, upon arriving to the United States was plagued with health complications requiring his internist to perform a blood smear, a relatively new technique not frequently used in diagnosis. This gave rise to the first documented finding of sickle cell-shaped blood cells which was presented to the world in a case study in 1910.

Almost 100 years later, a Chicagoan receives admission to a graduate program in Grenada, only to complete a thesis on sickle cell and chronic pain in the country that gave birth to a man whose blood gave name to a chronic disease.

Herrick

Dr. James B. Herrick, credited with the first description of sickle cell disease, taught and practiced in Chicago, Illinois.

In science and research, life and circumstances often influence and shape your focus. A son who lost his mother to breast cancer is propelled to devote his energies discovering oncogenes. An impressionable college freshman is captivated by her professor and his research resonates in her own through the years. Inspiration can often be quite predictable. With me, however, someone with no prior exposure or bearings on any blood disorders, I have to believe that sometimes the research chooses you, a phantom deliberately lighting paths and dimming others, making you falsely believe your decisions are truly your own.

A little more than a century separate the opposite journeys that Walter and I took. And yet in that chasm of time, I’ve learned that just because we’ve given a disorder a name does not translate to a cure or even a standard global practice in managing the pain. My thesis helped me more than becoming a published primary author this past summer; it opened my eyes into seeing firsthand how medicine is much more than just biology, but also one part sociology, one part politics and policy, one part psychology, and even some parts geography. Continue reading

The Beat of A Different Drum

As a student known to sleep through a larger portion of my immunology lectures, the material, for me personally, lacked a little oomph. IgM. APC. CD28. C4b2a3b. A litany of cells, cytokines, and receptor molecules with unimaginative names and, often, even less enticing tasks that sounded more like a roll call for Star Wars characters. Little did I know, however, that the lessons imprinted on me in immunology translated to a much broader message.

Our biological well-being relies on the body’s meticulous ability to distinguish between the innate and the foreign. Thus, recognizing our own self is a lesson imbued to us by our own immune system. If the crux of good health relies on our body’s ability to recognize the “self” from “non-self” then being a good doctor, in my opinion, is about recognizing one’s own motives, perceptions, and attitudes against the backdrop of competing interests.

While conducting a research study on undertreated pain in sickle cell patients in a small middle-income nation, I interviewed around 40 sickle cell patients. After several long weeks of talking to patients, they all seemed to blend together as one in my head. However, one particular patient would always stick out in my mind. William, as I’ll call him, was rather gaunt and scraggly when he walked into the clinic where I was conducting interviews. His uncharacteristically hollow and worn face spoke volumes about his disposition and how mismanaged his pain was as a result of his disease.

Nevertheless, it wasn’t his face or his stature that made him more noticeable in my mind, but rather something about his eyes. There was a glaring yellowish tone within them, signs of full-blown jaundice, a common symptom of the disease, but even that was far from what made them distinctive. It was, instead, the dejected look he carried about him, a man who lost that sustaining spark to carry on. More so than his body, it was his spirit that was crippled. Continue reading

Response: Questions Regarding MPH

NS writes:

Hey Palak,

I am planning to start the MPH to MD pathway at SGU this August.  I came across your blog and have read through it.  I found it interesting and informative.  I had a few follow up questions, if you do don’t mind addressing them.

1)Based on your latest post, it seems like several students believe their MPH coursework wasn’t well structured.  Did you find this to be the case?
2)After your first semester of the MPH, did you opt not to start the MD program?  It seems as though your grades would have qualified you to, based on the post you made during finals time.
3) Would you say a majority of MPH to MD candidates progress to start the MD the following semester? Or is this group the minority? From your experience, does this come down to largely effort, or is grading fairly subjective?
4) How is the program changing? Is it becoming more competitive? Are class sizes growing?

Thanks for your blog! Continue reading

Palak Shah, MPH

It’s been exactly 60 days since I last posted. A mere 2 months. It’s not exactly a monumental length of time. A year on Mercury is longer, Watermelons take longer to harvest. The sex of a fetus is not even apparent yet. And still, I don’t feel the same as I once did. In those 1,440 hours between the present and my last  encounter with this blog, lives were lost, others were changed, philosophies were adopted, others were discarded, old paths were burned in search of higher latitudes, and out of a hazy resolve arose a trenchant redefinition concerning my direction and purpose. I’ve deferred my entrance into medical school for a year, switched gears and am applying to DO schools, finished my graduate thesis on sickle cell disease and pain, lost a young friend in the blink of an eye, and left the island I’ve come to think of as home. Although I cannot begin to do justice to all of these turn of events that have occurred in the past two months in one post, I’ll just start with a couple initial details… Continue reading

“Home” is a relative term

While packing for our cruise, it hit me how crazy Kate and I probably appear to someone living in

Our first stop after our cruise left Miami was the Grand Cayman Islands, south of Cuba.

the United States. We had to be a handful of people leaving the Caribbean (actually, more like relocating) to start our vacation. Nevertheless, even as term 2 of my master’s program had just ended, I couldn’t  quite desert the public-health-tinted lenses with which I was learning the view the world through. Driving through Belize and through the island of Roatan, Honduras, I couldn’t help but to catch sight of the public health campaigns each country had devised in order to promulgate healthier behaviors. I also could not help to evaluate the range of development.

How did each region filter their water? Did each region have access to internet, broadcasts, and other forms of acquiring information? Were the tour guides that were helping us zip-line or climb the Mayan ruins aware of occupational hazards? Of course, an interest in the answers of these questions can be piqued regardless of one’s involvement in the field of public health. However, it just goes to show that you can take the student out of the public health forum, but you can’t take the principles learned out of the student. That probably goes for all healthcare specialties. What you learn haunts you for life. Continue reading