Medical What?

Soggy graham crackers with a hint of Windex. That is the predominant scent in the waiting room. It’s undoubtedly a lot better than a lot of the other aromas I’ve smelled in pediatrics.

The one elective I have during third year finds me on peds/quasi-adult immunology at White Memorial Medical Center. The doctor with whom I am working, Dr. Patel, is an excellent teacher and I get the feeling she remembers exactly what it is like to be a medical student (as fellow med students will quickly attest, many attending doctors don’t seem to remember this stage of life so well). We are able to spend a pleasantly extended amount of time with each patient because it is a specialty practice, and it has exposed me to a variety of patients.

Dr. Patel sends me in to see patient X, one of her adult patients, and instructs me to take a more thorough history than I normally would for a follow-up appointment.

“So tell me patient X, other than the meds you’re on now, is there anything else you’ve done to help out with the eczema? Special lotions, wet towels, anything?”

“Yeah, I’ll smoke a joint to help with the itching. When I was seventeen I got a prescription for medical marijuana. Don’t worry, I carry my card with me everywhere. It’s right here in my back pocket if you want to see it.”

“Oh. Er, huh.”

“I always have my card with me. Oh yeah, and I tried a special oil from Mexico once, but it smelled too strong.”

“That’s great.” I hope my slightly confused, lackluster voice doesn’t come across as judgmental. I’ve thought about the use of medical cannabis, and I have a bit of an unformed opinion, but I’m a little at a loss for words right now. Now I know what I need to read more of over the weekend.

Cannabis for chronic pain or nausea/anorexia in chemotherapy seems legitimate, but for itching?

Patient X had the most horrendous, poorly-treated case of eczema I’ve ever seen. Since seeing our attending physician for the past few months, patient X’s skin has improved drastically. Yet in her 30’s, with impaired vision from over-prescribed oral steroids (as opposed to the normal topical ones for eczema), and widespread, disfiguring scarring from decades of uncontrolled eczema that wasn’t completely addressed by physicians in the past. Patient X’s ears, eyelids, and lips are hardened and disfigured by scar tissue, and there are open, mildly infected lesions on the waistline and both shins. And this is considered an drastic improvement.

“So the marijuana, does that help?”

“Oh yeah, yeah yeah, for sure. It cuts down on my focusing on the itching, you know, when I can’t control the itching, and then everything gets worse from there – I mean, you’re a doctor, you know about eczema. So yeah, I smoke it to keep the itching at bay and then I don’t scratch the sores. And really, I always have my card with me, everywhere.”

This isn’t a blog post of the pros and cons of an alternative, somewhat questionable treatment. But let me say, having a glimpse into the misery that this disease has caused this man, it is reasonable to say that I will give the benefit of a doubt to a patient if he goes outside of accepted Western medicine to try to alleviate the frustration of a chronic disease. I have much faith in Western medicine, but I would be naïve and prideful to say that it is always 100% sufficient. Alternative medicine, whether meditation or Chinese herbal medicines or medical cannabis – oh yeah, and there’s also Indian medicine, acupuncture/acupressure, and all sorts of psychotherapy, I do believe have varying degrees of usefulness in the everyday patient’s life, as long as personal safety and abuse issues are thoroughly addressed. And so although I am still not sure of my position regarding this alternative treatment, as far as I was concerned patient X’s need for relief and alleviation should be a top priority for me as part of the healthcare team, and I cannot blame him for searching elsewhere after seeing the almost horrific severity of his condition.

NOTE: None of the offices at White Memorial Medical Center prescribe the medical cannabis, nor do they refer patients to such clinics, and the same can be said for Loma Linda’s offices as well.

On a more peppy note: I went to Catalina Island this week with my boyfriend to visit our friend doing research there. Between the three of us we had a medical student, engineering student, and marine biology student, so it was a very nerdy, scientific day. And a great one!

Here is a picture of a BISON (!) in a utility yard!

And here is a picture of a medical student and an engineering student:

A word of advice to pre-med, 1st, and 2nd year students: make sure that you find people whom you love, and make sure you do things together that you both love. Then go back to medicine and make sure that you love that too.