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Sunday, July 18th, 2004
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11:00 pm - Superior Medistinum
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Tonight I visited JD (to review medistinal anatomy) and before I left I uncovered her face. Whatever empowered me to do that I don’t know, but it reminded me of the last time I really looked at a dead person. As before, my mind seemed to blanket my conscious thoughts, and the form looked more like a mannequin than a human body. I pushed back her gums and noticed that she had no teeth – probably because she wore dentures in the last decades of her life – and her jaw was wired shut. As I have been getting use to, I cleaned up her features, this time by cleaning away debris from her mouth and cheeks. I imagine she was quite the pretty lady when she was of age. Her features had not totally withered with the rest of her mortal body, and she died with most of her more humanly features intact. Not like other female cadaver. That Jane Doe died after a battle with a particularly nasty form of skin cancer, and it left her face looking like ground zero after a cluster bomb explosion. No, JD was in tip-top facial form tonight, and if we were meeting for a different occasion I might think of asking her to dance – but tonight the only Tango I was interested in was the one where the vagus nerve twirled around the Aortic Arch as the Recurrent Laryngeal. When I finished I wrapped her in her plastic blanket and remembered to squirt her with water to keep her tissues soft. As I zipped up the bag I found myself reassuring her that everything was going to be ok – but then she knows that. Because that’s what I am here to do: make sure she is going to be ok.
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| Saturday, July 17th, 2004
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12:52 pm - Is Today the Day Little Bird?
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What a thing death is. I’m not sure why my thoughts have been fixated on it for the past week. Maybe I have deceived myself in thinking that I was detached from the whole experience of dissection; maybe I my friend’s announcement that his mother’s breast cancer is worse than previously thought. My mind has been a whorl of thought, and the bottom is simply not acceptable. Death comes to us all, and it truly is not a respecter of men. But that said, we live our lives in ignorance of it, as if everyday is just that: another day. They aren’t. Everyday is a gift, for once born, we are all cursed to die – and the exact nature of that death is not known to even the wisest of men. So we live – or do we? We collect meaningless objects and power. But to what end? That is the well I have lived in for the past week, and I must find Schrödinger’s cat on to which I can hitch a ride. But hasn’t that always been my weakness? I always look for the way out? Maybe there is no viable way out.
JD’s dissection is progressing. We have finished the brachium/antibrachium (arm/forearm), and moved on to the thorax. I really have seen what no person should freely witness: the inside of a person’s chest. We give it such reverence, but it really is nothing more than a post-thought – an out-pocketing of the gut followed by bending of the neck/head and folding of blood vessels. How blessed I am to hold her heart; how honored to learn the cardiovascular anatomy from this woman. There are some of us that wish we had a body more like the male specimen of of Table 2. He has incredible musculature, and his anatomy more pronounced. But JD is my patient. I cringe every time we cut her, or probe her, or pull on her tendons. I may not like her final perfume choice, but together we are joined in eternity as the knowledge of her anatomy continues to impact my medical practice and all my future patients, and so I down the gloves and bear the smell for one more week.
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| Saturday, June 26th, 2004
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6:51 pm - Memories ...
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Yesterday an odd thing happened in my friend's bathroom. I stepped inside of the room, but did not immediately notice anything; it was several moments later, when standing next to the shower curtain, that the strangest thing happened to me. I suddenly remembered the smell of the bag my cadavor was shipped in. And in that moment, I could recall everything about it: the texture, the transparency, and of course the first sight of Mrs. JD.
Odd how we at first down play major events or tramatic experiences, then later allow them to creep back into our mind in such a way as to be palatible. It's as if the brain cannot accept so much input -- the same as when you step into a purfume shop and are initally overwhelmed by the smells, only to loose a great deal of your ability to descern any smell by the time you leave. How fragile are our minds. We put up subconsious barriers to everything: emotional, physical, and often spiritual stimuli. It's easy to see why some religions and zeigists are built around the tearing down of such walls.
Yet the lack of boundaries are just as damaging. I can think of one person in particular, who is known and avoided by many, that is an incredibly nice person, but wears her heart and soul on her shoulder. She is quick to divulge any and all personal information -- making her an psychologist's dream patient -- and is privately shunned by many of those she seeks aproval from. Becoming too personal too quickly -- letting down one's defenses -- is can also lead to problems in the formation of personal relationships. How many times have you thought you found Mr/Mrs Right and told him/her everything you find that it chased them away? People, like most animals, are good social judges, and they can tell when someone is not like they. Call it what you will -- social evolution, wacko-detector, etc -- we are quick to pick out who is different.
So, how did a disscussion of Mrs. JD's body bag spawn a disscussion on social boundaries? The truth is that this whole experience creeps me out because it makes me face the undanting fact that one day I will be in that bag, and that is hardest thing to accept.
~D Leone
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| Monday, June 21st, 2004
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5:37 pm - First Cut
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Today was the first day of gross dissection, and as excited as I was to begin -- as sure as I was that this dissection was going to be different from my animal dissections -- it was just another day and another specimen. From the presentation and angle we saw them, our cadavers did not seem to be humans. I had to stop during the four-and-a-half hour procedure to remind myself what I was cutting. That, I think had more implications to me than the actual anatomy.
My cadaver was a 74 year-old woman, a State of Florida (government)worker, who's stated cause of death was metastatic breast cancer. She was, from the presentation of bed sores and atrophied muscle, bed-ridden in her final days. She was obese, but not terribly so; her pelvic area below the sacral crest was not noticeably fat. She gave her body so willingly, to have a group of strangers examine it and learn a skill that might just save another's life. I found myself drawn to those aspects of her anatomy that held the last remnants of her personality.
Her feet were well taken care of, as were her hands, although both were probably tended to post-mortem at the mortuary. Her fingernails still bare the bright red polish, that I imagine was her favorite. Red is such a lively color -- not one you expect on a 74 YO great-grandmother. I can see her full of life maybe even just a few years ago, applying that polish to her nails because to her, she was still that beautiful girl that all the boys just died to meet. I wonder if she out-lived her husband. Did he hold her hand as she transitioned into the great white darkness, or was he there to guide her into eternal bliss?
Technically, she was a rather hard dissection for a first-year student. The atrophy of her muscles limited our ability to discern discrete muscular groups. As always in dissection, the smell is overwhelming, but after an hour it fades in to the subconscious and only bothers those who are unfortunate enough to sit by us at Wendy's. So I found myself engaging the dissection lab as if I were picking up my cat dissections of last fall -- just a bigger cat. That was easy enough to do until I had to work near the head and neck; there you can see the ears and back of the neck.
In the end I held her hand. I paid my respects, and silently asked permission to begin what she had signed so many legal papers for. If I am to desecrate her body, then patient Jane Doe (my first) and I had better share at least one fleeting moment.
Goodnight JD ... I'll see you tomorrow.
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| Tuesday, June 1st, 2004
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11:27 pm
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I have strove for the past two years to get to this point, to get accepted in to medical school, and now that its here I simply cannot believe it. It seems so unreal. My life as I had known it, ended two weeks ago when the dean of admissions called me. I thought I'd be stressed, or I would want to have a huge vacation before starting -- but all I want to do is START.
It is laughable how things don't change. It seems like just yesterday I was 18 and looking for a job, and like the kids from the gay youth group, I found myself pounded into the holes society often forms for its youth: fastfood resturants, theme parks, and server positions. Yet, even with a B.S. from UCF and a M.S. from Georgetown -- I CANNOT FIND A GOOD SUMMER JOB. THEY DO NOT EXIST. Its like the storys our parents use to tell us as children. There is no tooth-fairy, nor was there ever a Santa Claus, or an Easter Bunny. Those stories were just distractions our parents fed us to keep us from ruining their overburdened lives, as the stories of summer jobs prevent us from ruining the economy by taking jobs from adults who cannot get any other type of employment. They put job descriptions on employment listings as if it accurately describes the job; the requirements are even more halarious. They always want lots of experience ... when anyone with half a brain could do the job.
Ahhhh ... that took my mind off medical school for a while. Now if only I could prove that Jeb Bush rigged the election for his brother, I'd be content. GOD COULD YOU IMAGINE HIS FACE IF I WERE TO WAVE THAT AT HIS NEXT PRESS MEETING????
current mood:  hyper
current music: Unspecified composer
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| Thursday, June 20th, 2002
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9:30 pm - El Mi Día Último
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Today was both a gray day and balsamic; I will miss the good people that I worked with every week at the clinic, but I will be glad to come back to civility and order. It was a slow day -- translated to "lazy" ("flojo" in spanish) by the Doctor on call. Today I got to see my first patient with AIDS related Dementia.
He reports that he uses the Ensure (dietary supplement), but refuses to take any of the other AIDS medications; he reports occasional use of the antibacterials. He is emaciated, with evidence of dehydration. The nurse administered intravenous fluids and vitamins (B1 & B12). Patient became aggressive and combative, but we were able to maintain communication. The person who accompanied him, who the patient reported is his lover, was instructed as to the severity of the situation and the need to maintain a drug schedule.
This patient presented the clinic with an unusual dilemma: should they discontinue treatment of the patient in light of the fact he is unwilling to cooperate with the established treatment? Half of the staff was in favor of discontinuing his treatment, while the other half was against such a measure. With such a split, and the doctor against the measure, treatment was continued until the next office visit. With such limited resources, what could the clinic do? They are faced with day-to-day decisions as to who should be given priority in treatment, and who can afford a drug vacation.
My daily patient was seen to day by the staff physician, and is doing much better. His health is rebounding, and he is even gaining weight. I am glad to report his Herpes related shingles are disappearing, and he reports no dizziness. He also reports the ability to walk the two kilometers to the office without assistance. This type of recovery, although not permanent, is what dives me daily and keeps my faith in the never-ending battle against suffering.
°°°Dominick Leone°°° June 20, 2002 10:55pm
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| Monday, June 17th, 2002
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11:59 am - LIFE
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Life never ceases to amaze me. Today I had the opportunity to give injections to two different species: human and feline. One was to reinforce life, and the other was to take it. What amazes me is the difference in the fight that each individual put up to impending death.
One of the patients I saw in the ACOSIDA clinic found me today, and he asked if I could give him an intramuscular injection of a drug called Doloneurobion. It is a non-steroidal antinflamatory agent that was prescribed for his herpes-related shingles. The medication, sold by Merk, isn't available in the USA, and I had quite a bit of difficulty finding reliable dosage and formulary information, but I went to Merk's Mexican webpage and read the information in Spanish. I found the patient at home, watching the soccer game, barely able to move. After mixing the two ampoules that the drug came in, I had the patient pull his shorts down over his glutes, and I observed that much of his muscle mass had atrophied. The patient reports no appetite, nor eating much in the past 72 hrs. His motivation to live is low, and he barely seems interested in living.
When I gave him the injection he barely even reacted to the pain, but I, on the other-hand, was more than aware of the process. I lacked gloves, a sharps container, and EVERYTHING needed for general precautions. After injecting the meds, during which I forgot to check to see I wasn't in a vein/artery, I had a new problem: where to put the needle that was contaminated with HIV. I ended up putting it in a make-shift sharps container, and sealing it with aluminum foil.
Then later in the evening, I found one of the neighbor's cats with a shattered femur. It was clearly in pain, and the landlady was complaining about the noise, so I was asked to put it to sleep. I felt like Bones from Star Trek: "I'm a student, not a vetinarian!" But I went to the pharmacy and bought some sodium penathol and a needle, and took it to the local animal shoppe. There the attendant showed me how to give the animal the injection directly in to the heart. I never felt anything that was as strong, nor fought so hard as that animal when I started to push the plunger into the needle. It fought so hard for life, struggling for its last breaths; even five minutes after the injection, which bent the needle at almost a ninety degree angle, the animal was still moving.
It amazed me how much our will has in determining when we die -- even when faced with certain death.
~Dominick Leone~ June 11, 2002 11:59am
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| Thursday, June 13th, 2002
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10:17 pm - Politics and Medicine are Poor Bed Fellows
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Today OCOSIDA was very busy with patients; the most interesting things I learned today were not in the office, but standing outside of it. I thought that the need for good medical care in Mexico might bring people together, mending differences in creed and lifestyle, but instead it has only masked those differences. The reservations, that some of the organizations here have for each other -- which sometimes breaks out into out-right distrust -- is disconcerting, but is a necessity in Mexico the same as drinking bottled water is a necessity.
The best way to describe the problems that different organizations have with each other, was summed up by a volunteer at ACOSIDA as follows: people come to volunteer in Mexico for various reasons -- some to get a tax break, some to have sex with the indigent, and some to help because they truly care. The problem is you never know what the motivation is, and like most things in Tijuana, nothing is as it seems -- and all things are possible. I have seen more acts of kindness, and more goodness in one summer than I have ever seen in my life. But I have seen the other side as well: the evil intentions of man and his base desires unbridled.
Tijuana is the perfect place to observe the struggle between good and evil as it exists in the world today. This city sits only five minutes from the United States, and in being so close it has inherited all of the sins of its younger brother cities, but it has none of its infrastructure to keep it in balance. The competitive nature of the United States has worn-off on all of Mexico, feeding widespread corruption in both the government and the people themselves as they struggle for day-to-day existence. This envirnoment creates a place where no one trusts anyone, and not even civil organizations are spared.
On a more interesting note, I saw a case that really surprised me: I thought that most physicians treated HIV as a priority, but in the in case I saw today the physician treated an infection as the priority. The patient had gastritis, and was severely dehydrated. The patient was given an injection to treat the infection, and treatment of the HIV was considered secondary to the gastritis. The hope was to get the infection under control so that the patient can continue his HIV treatment.
The pharmacy was again without Epivir this week, and supplies of AZT ran out about half-way through the night. How the clinic does so much with so little I will never know, but they are helping. One of the women that brings the medications across the border is almost always tired. She does all she can to collect the needed medications, and she often stays at the clinic until 9pm only to drive home to San Diego. We must all work together to end the AIDS epidemic: Catholic and Protestant, Mexican and American, Black and White, Muslim and Christian, Republican and Democrat, Heterosexual and Homosexual. We are all partners in this fight, for together we live and divided we die.
°°°Dominick Leone°°° June 14, 2002 10:15pm
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| Thursday, June 6th, 2002
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11:01 pm - Limitations in Under-Served populations
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Today I spent most of my time in the Pharmacy, filling out scripts. There is usually three doctors on-call in the clinic: Dr. Yamzsoch, Dr. Martin Briseño, and Dr. Consuelo. PSC. Ricardo Dueñez served as psychological counsel. The night was long, and we worked well into the evening.
The pharmacy is surprisingly well stocked, and the clinic even supplies Human Growth Hormone to two patients. But one of the most important HIV medications is lacking: Epivir. The clinic has been without the capacity to distribute Epivir for over a month.
I was brought into the exam room only once, to discuss a patient with a confirmed case of Syphilis. The patient was approximately forty years old, and had been on HIV treatment for ten years. Patient reports allergies to Penicillin. He also cannot remember the first lesion, nor when he first showed symptoms. No lesions present in the anus, mouth, or on the penis: this lends to a diagnosis of stage two or three. Dr. Briseño prescribed tetracycline. The assumption was that he is in stage two, but without sufficient lab reports the physician was unable to rule out a stage three infection. I am told that in the third stage, syphilis attacks the brain and can cerebral fluid in the spinal column. But the tetracycline will not cross the blood brain barrier of the spinal cord. Patient was told to return weekly for a blood check. I was told the next measure is to give an IV drip.
°°°Dominick Leone°°° June 7, 2003 1:48pm
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| Thursday, May 30th, 2002
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10:00 pm - My First Patient
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Today I saw my first patient ever! I don't know who was more excited, the woman or me. I took patient vitals and histories for approximately an hour, when the doctor on call came in to the primero quartro to invite me to -- what I thought was -- observe. Instead I found myself gloved up and examining the patient. She was one of only two patients that I was allowed to actively examine.
Female HIV+ patient returned to clinic as scheduled without complaints of nausea, headache, and tells me that she has seen no diseases. Upon physical examination I found one lump in the cervical lymph gland approx. 2-3 cm in size. No physical manifestations of disease present in the optic region. No thrush or other fungal infections on the tongue. Palpation of the abdominal region reveled nothing, and pulmonary function was good. Neuropathology is negative, and patient is in good humor.
After the patient left, the doctor informed me that the clinic lacks orthoscopes, and therefore they are severely limited in their ability to detect secondary infections. The detection of secondary opportunistic infections is, I am told, the key to detecting a mutation in the strain of HIV that a patient has; in Tijuana, the doctors are unable to order phenotype/genotype tests to dictate the treatment course due to drug-resistant mutations. Most of the drug prescriptions are given with ease-of-use in mind: the patient must trust and talk to the physician to inform him of any changes in effectiveness. This means making all doses easy to take (simple schedule), giving a full explanation of all the drugs and their uses, and informing the patient of possible side-effects.
My second patient was actually not physically examined because she was only being tested. Examinations are reserved for patients with confirmed cases of HIV. This patient was extremely troubling, as she presented with signs of psychological problems.
Twenty-five year-old female patient presents for HIV examination. She is overly concerned with her weight, which is probably in excess by less than 20%. She shows signs of possible bulimia: obsessive/compulsive, unrealistic concern with weight, and signs of self-mutilation (a "Cutter"). BP was high for her age, but her temperature was normal. I advised the clinic psychologist who counseled her for thirty minutes: patient reports wounds are adolescent in nature. I feel they are more recent, with one being less than a year old. After talking with patient I would consider a schizoid diagnosis, but there is no clear break with reality in this patient.
I have to wonder what kind of psychological help such patients can receive. With her presence in an HIV clinic, I would think that her promiscuity has a definite origin, and with the self-mutilation, I might suggest counseling for sexual abuse.
~Dominick Leone~ 11:23pm May 30, 2002.
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| Saturday, May 25th, 2002
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10:10 pm - Changing approach to HIV infection
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When did we become so complacent about HIV? I had lunch with a San Diego physician/researcher, whom I believe to be infected with HIV, to discuss modern approaches to treatment. "Steve" told me that he wears two hats: the "Doom and Gloom" one for those who are HIV- and one of hope for those that are HIV+. But what is more distressing is this physician willingness to accept infection as a normal status in life: "All of us will get some disease in our life, and this one you can live with ... it's not bad". I am not prepared to accept defeat in this fight.
It seems that, from our meeting, that research is still not directed at preventing the virus itself from mutating. This is the key to successful elimination of the virus! I do not believe its possible to treat any number of patients beyond a hundred with any combination of cocktails -- yet the research into this approach continues. How blind we have become with the money of the drug companies. How blind will I become?
°°°Dominick Leone°°° May 26, 2003
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| Thursday, May 23rd, 2002
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9:28 pm - ACOSIDA
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Today was my first day in the ACOSIDA clinic, and it was more relaxed than when I was there in September of 2001. Most of the patients were gone by 7:00pm, but there was still an eye full when we closed the clinic at 9:00pm.
Because of the nature of the language -- adjectives after the noun -- HIV and AIDS not only have different acyronyms in spanish, but they are also backwards from their respective American ones: VIH and SIDA. ACOSIDA is the Agency Against AIDS, and their contact information is:
CLINICA ACOSIDA TIJUANA, A.C.
Apdo. Postal 663
Zona Centro
Tijuana, B.C. C.P. 22000
(tel) 011-52-664-685-9163
http://acosida.freeservers.com/
As the night progressed, I was able to talk with the woman responsible for bringing the medications across the border; she is an incredible person -- as they all are -- whose job in the US is a social worker. Having run a home for women and children with HIV in both the US and Mexico, she has a unique and valuable prospective on the coming crisis: we discussed the changing belief system of the Mexican People, and how that's effecting treatment and containment of HIV in Mexico and the US.
In the past, Mexicans, being mostly Catholics, did not believe in the use of condoms to prevent infections because of the church's stance. But that has changed, and so has their belief system. No longer are Mexicans refraining from protected sex because of a religous belief, but rather because of the lack of physical sensation when wearing a condom. Mexican men, according to this social worker, also tend to believe that they are not homosexual merely because they have sex with men. So bisexuality is becoming more accepted in Mexico and among Mexicans in the US, which is fueling the outbreak by spreading it to Hetersexual women and to their children.
We know that the strains of HIV found in the US and North America are mostly spread by homosexual contact, while the strains in Africa and in some other places is mostly spread by heterosexual contact. This could fuel a further diversification of HIV, as it evolves, an cause HIV to shift more to the heterosexual population that it already has. This shift began in the early ninties, when the homosexual population began to practice safer sexual practices, and the virus began to show up more (new cases) in heterosexual women.
I hope to work next week with the PROCABÉ clinic, on a different day.
°°Dominick Leone°°
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| Tuesday, May 21st, 2002
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10:24 am - Dia Uno
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I never realized how small this seemingly large world is: after only a couple of plane rides, I have gone from a typical American community to a uniquely Mexican community. But even here people are still people, for better or for worse.
After locating my wayward luggage, and navigating the airport to a bus, I was finally on my way to the Sana Fe Trolley Station which would take me to the border, when I decided I needed a bit of help finding the station in the dark of night. A immigrant worker on the bus, noting my distress, offered me help in finding the station, and even offered me a ride across the border to alleviate any difficulties. I am so amazed to find that this woman who had nothing, was so willing to help others: she gave rides to two other riders. That is why I am here, because if someone with so little can give so much of herself than how much more should I be capable of?
It takes people working together to stem the tide of violence and hate in this world. Sometimes one person is all there is between death, destruction, and chaos -- thank god it only takes one person to make a difference.
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