Warning: this post is profoundly nerdy. However, if you caught the title reference, you’ll enjoy it anyway.
In June, I was supposed to take this great class/clinical elective hybrid that focused on trauma and the body’s response to “injury.” Due to a variety of reasons, though (#1 being that the class had a reputation for being way too hard for a burnt-out third year student like me) the section didn’t meet minimum enrollment and was canceled. I was left scrambling for something to do.
After pondering various unpalatable options such as “Let’s Do Biochemistry Again Haha” and “I Bet You Can’t Remember The Name Of This Small Artery,” I decided to make my own way. I was about to start my away rotation swing, and thought, “hey wouldn’t it be cool if I covered some of the other key areas of emergency medicine – ultrasound and toxicology?”
After a few emails and scootching forward on my knees with my hands clasped together, a couple of advisors and I put together a month-long elective that split my time between learning ultrasound in the emergency department and spending time with a medical toxicologist (and EM physician).
Ultrasound is great, especially as ER doctors have made the “point-of-care” ultrasound – better addressed as Let Me Just Wheel This Machine Over For A Second – their personal turf. It has totally changed the way that ED physicians evaluate for heart failure, for instance, and is an invaluable tool in figuring out whether someone who lost a chicken contest with a Mazda has internal injuries.
Nothing against Mazdas, obviously. I have a Mazda.
…I hate my Mazda. It is a piece of shit.
Anyway. I like ultrasound. It fulfills two of my three criteria for Things I Enjoy.
- It is a thing that requires doing, and
- it has buttons.
#3, in case you were wondering, is “Involves fire.” This is why I enjoy flying, football team entrances during the NFL season, and military history.
Anyway, sometimes pressing these buttons on the ultrasound machine is even necessary, to do things such as “Apply Color Flow!” or “Increase Your Depth.” These are code words used by the ultrasound attending to tell me I am doing a bad job without making me look incompetent in front of the patient. Ultrasound also has a wow factor: being able to literally see someone’s heart, or their spleen, is pretty damn cool.
So yes, I like ultrasound. I expected this. What I didn’t expect was that HOLY CRAP TOXICOLOGY IS THE COOLEST THING.
Here is their official symbol:
Just kidding. That’s a biohazard sign with headphones.
Medical Toxicology, as it is formally known, is a tiny, subspecialized field that you can study after completion of an emergency medicine residency. I think there are a couple of other ways to get to it, but in general attaining certification as a medical toxicologist requires a fellowship after an EM residency. This is the same way that, say, a cardiothoracic surgeon has to go through a general surgery residency before subspecializing in the chest.
Toxicology and EM are natural allies: most people who have toxic problems come to the emergency room, not the clinic. It’s a huge area of knowledge that covers everything from accidental (or not) ingestions to occupational exposures to lab accidents to botany. Also, SNAKEBITES.
To quote Professor Jones,
My tox time was spent one-on-one with the medical toxicologist at my institution, otherwise known as The Smartest Human Alive And Would Lay The Intellectual Smackdown on Stephen Hawking.
(Incidentally, she also lives on a farm and has a habit of collecting the poisonous mushrooms that grow there in the spring, which reminds me… never anger a medical toxicologist.)
We’d meet three times a week, and during each session she would hand me a reading assignment and a list of progressively more difficult questions. The readings varied from journal articles to textbook chapters and focused heavily on pharmacology and the nervous system.
My medical school/doctor friends reading the above paragraph are actively vomiting right now, because it sounds like the worst parts of the first year of medical school, all jammed into a month.
In actuality, it was THE COOLEST, although it is hard to explain why. Toxicology requires three important skills/abilities, all of which I crave but do not possess: the intelligence to recognize a “toxidrome*,” which is how a person looks when they have been exposed to a toxic thing; the ability to Do Things to fix the toxified person – which ranges from “nothing” to “stab them in the heart!”, which is only a slight exaggeration; and the curiosity to enjoy the historical bits that make toxicology so interesting.
*Did you see The Rock? With Nic Cage as Stanley Goodspeed, and Sean Connery as the convict Frank Mason, and the psycho Marine dude who tried to unleash nerve gas on San Francisco, which maybe is the only way to lower the rent in the Bay Area? Remember this scene? This is a toxidrome. We call it “toxidrome” because, quite frankly, it sounds awesome to say out loud.
(Okay, so VX gas doesn’t melt your skin off, it gives you muscle spasms and you die by drowning in a flood of your own snot, but whatever you get the idea. Toxidrome.)
(Also, VX gas is sadly not bright green, it is a rather dull amber.)
(Also also, there is no need to ever stab yourself or someone else in the heart, sad as that is, despite the dramatic performances in such classics as this one (The Rock), Pulp Fiction, and Get Him To The Greek. I wish there was, but… sigh.)
As far as the historical bits go, do you know what the phrase “slip ‘em a Mickey” means? Look it up – it’s a great story. A modern day “Mickey” is a squirt or two of Visine in someone’s drink, which besides making your drink taste kind of funny will also give you vomiting, a truly undeserved hangover, and no memory of the previous night’s events post-drugging.
Works great for red eyes, though.
Anyway. Judging from the insane expertise of my teacher that month, I know about 0.01% of what is needed to become a medical toxicologist – and I learned a lot. From how pesticide and nerve gas poisoning works to huffing to what happens if a baby eats the houseplant, we covered a lot of territory.
The main thing I learned is that if a thing exists, people will try to eat it and bad things happen. I think, therefore I ingest.
Or, as it’s known in my home state, “Hold my beer – watch this.”
Emergency medicine physicians will never be out of a job…. and toxicology is awesome.