Why I want to be a doctor part II

So we left off in the physio workshop. My group consisted of 2 girls and 2 other guys, 1 of which is married (there are a LOT of married people in med school). We sit down and we read this case, silently, I'm marking up my notes (as you can see from the scans I uploaded) and then we broke off into our groups and we discussed what the problem could potentially be. And all the other groups are immediately thinking out loud food poisoning, botulism, blah blah blah, but one of my guys used to be an EMT and he immediately goes "This sounds a lot like organophosphate poisoning." I'm thinking to myself what on earth is OP poisoning, but I'm smiling and nodding with the rest of them. Turns out organophosphates are like stuff that's used in insecticides, and it makes sense because the patient is in landscaping. He pulls out his iPhone and searches organophosphate poisoning and it says that that Organophosphates basically inactivates acetylcholine esterase. Now THIS is where it got really cool... we all got together and we were like, ok, what is acetylcholine esterase? Why, it degrades acetylcholine to Choline and Acetyl CoA, of course. Where does that happen? Why, in the synaptic cleft, of course. What does that mean? That means when the nerve fires, the neurotransmitter Acetylcholine doesn't get degraded like it should... so... maybe.. it keeps on binding to the receptors... so it keeps firing the nerve or muscle that it is innervating. Now, the grand finale... what nerves use Acetylcholine? Why, All presynaptic sympathetics, select post synaptic sympathetics, and both pre and post synaptic synaptic parasympathetics. That means that there will be an exponential increase of parasympathetic activity.


Im sure you all are familiar with sympathetic vs parasympathetic nerves: sympathetic = fight or flight, parasympathetic = rest and digest. But what happens if you rest and digest wayyy too much? Your breathing slows down, you have a ton of mucus being secreted in your lungs (hence the moist rales) your pupils don't dialate, you salivate like crazy, and you start throwing up (these are the related symptoms particular to our case). And thne you have the muscle faciculations, which makes sense because motor nerves use Acetylcholine, and the subsequent flaccidness of muscles/paralysis was due to receptors becoming desensitized (aka accomodation).


Anyways, the name of these posts were why I want to be a doctor, and I mentioned the difference between the science of medicine and the art of medicine, and how dark dark darrrrrrrrrrrrrrk it can get in medical school. Speaking of which, let me go off on a little tangent: Recently, before my histology exam, I stayed up 2 nights in a row and then gave my exam. On my second all nighter it was around 3 AM I decided to take a nap, so I left all my stuff at the cafeteria (that's where I was studying at the time) and I came home to sleep squished next to the 1 man flooring bed that Sadaf was occupying and I put my alarm at around 4:45. A man can not really sleep under those conditions. The fear of oversleeping does not allow you to keep your eyes closed more than 3 minutes at a time. When it was time to get up, I felt like hell... and as I sat there on the dark floor thinking about my life... right then and there I gave up medicine. Because there is nothing in the world that could justify this much pain. There was a time I was volunteering in Cook County ER a man came in with gout in his ankle. If you know anything about gout you will know it is excruciatingly painful. This man was in so much pain he was sweating, and we gave him so much morphine that a normal person would've been alseep a long time prior, but it barely made his pain go away. He made a comment, he said that I don't wish this pain on anybody. At that time in my life I hated certain people, a real hatred, hatred that would confuse someone for the devil (Marin would know what I am talking about), and I thought to myself, really? I would never expirience any pain which I wouldn't wish on the people I hated. Well my children, at that moment, the despair, the panic, and the utter defeat felt so horrible, I wouldn't wish that on anybody. All of you who sleep at night, when you lay in bed and expirience that moment of peace, of comfort, thank Allah for it. Your life would go to hell in no time flat if Allah decided that you would never sleep again. The act of laying down in bed during the night with little to no life threatening concerns is probably the biggest blessing you take for granted. You better thank Allah before He takes it away.


Anyways, the point of all this is that sometimes we get so caught up studying the science of medicine that you lose sight of why you are during this, and that all these little names and details and muscles and enzymes and cofactors will actually mean anything one day. (To finish the story about my histo exam, I had to walk back to the cafeteria to get my stuff, so when I got there there were other students there... and I thought to myself... it's not so bad =) Anyways, to tie everything all together... to sit in that physio workshop and to deduce everything and put stuff together, it was pure magic. And for that one moment of awe... I remembered why I wanted to be a doctor.