• 4Dec 11

  Why I Play, Continued

  Last week, a young man came through the emergency department complaining of intractable nausea and vomiting for two days. He was severely dehydrated, dizzy, and lightheaded because he hadn't been able to keep any food or drink down for some time. The first things you think about in your differential for an otherwise healthy-appearing 30-year-old guy with nausea and vomiting are the flu or a simple viral gastroenteritis. Fairly routine.

  Talking with the patient and getting a better idea of his medical history revealed that just a few months earlier he had undergone a complete resection of a craniopharyngioma. These tumors are usually benign masses that grow near the pituitary gland in the brain. The term benign can be somewhat misleading, however, because the growing brain mass can cause increased intracranial pressure, disrupt function of the pituitary gland, and damage the optic nerve simply because of its location in the brain. These changes lead to symptoms like nausea, vomiting, balance issues, hormone imbalances, and problems with vision. Craniopharyngiomas rarely metastasize, which is why they are usually designated as benign.

  With this new information, the next step in figuring out what was going on was to get a CT scan of the patient's head to make sure the tumor was completely gone. We also had some imaging of his abdomen done in case we could find anything there that might be causing his nausea and vomiting. When the results came back, it was my job to tell my patient what we found. I sat down next to his bed, and he looked at me already knowing what I was going to say. He started to tear up before I started talking. The reason he'd been so sick is because his brain tumor that was resected less than six months ago had come back. I also told him that we found a new lesion in his liver. I explained that he still had a number of options. There's surgery, chemotherapy, and radiation. The lesion in his liver might be nothing at all. You try to stay positive in situations like these, but it's very difficult not to focus on the negative, and it's more difficult to maintain your composure with a tearful patient.

  I like working in the emergency department because, most of the time, you're able to see a problem, fix it, and send your patient on his or her way. Unfortunately, sometimes all you can do is give them a little more information than they had coming in and refer them to someone who might be able to help.

  That night, I went home and unwound much like I usually do. Video games help me relax by taking me somewhere completely fantastical and so out of touch with reality that I forget what went on at work. I played one of my favorite franchises, Assassin's Creed. It's a historical science fiction series about a war between the order of Assassins and the Knights Templar. The games are set in various time periods and locales ranging from the Crusades in Jerusalem to Renaissance Italy and 14th century Constantinople. As an assassin, you are tasked with ridding your cities of the oppressive Templar regimes by any means necessary.

  Typically, the games reward you for stealth and strategy more than wanton destruction. But that's not how I played that night. That night, I was brazen with my attacks. I cut paths of murder and destruction from one end of the city to the other with no goal or objective, no in-game reward to reap. It was cathartic.

  Video games get a lot of flack for their consequence-free destruction or violence – and in many cases, rightfully so. Without the proper maturity, the desensitization they cause can be dangerous. Sometimes, though, it's precisely this desensitization that I play for. When the horrible things that happen on a daily basis in medicine can be blocked out, even momentarily, it makes the impact, the care, and the life of even a single patient that much more important. That's why I play.

  Originally posted on DoctorFishypants.com

  • Posted Dec 4, 2011 10:34 am GMT
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• 5Oct 11

  Why I Play

  It's been a rough week. A few days ago, my wife found out that she matched for her neonatology fellowship in St. Louis, MO. She's excited, because she really likes the program and it's a great opportunity. Unfortunately, St. Louis isn't the ideal city for us. I'm fairly certain that emergency medicine is what I want to do with the rest of my life, and there are no osteopathic (D.O.) emergency medicine residencies in Missouri. There are a couple allopathic (M.D.) programs, but I would need to do a traditional rotating internship (TRI) year first to strengthen my application. There is one TRI program in St. Louis, but it's a risky proposition for a number of reasons that I won't get into here. Suffice it to say, I've been feeling very helpless. It seems like no matter what I do, or how much I want to succeed, whatever happens ultimately isn't even up to me or Emily. It's very unsettling.

  ---

  People often ask me why I play so many video games. Granted, I used to play much more than I do now, but I still turn on my DS or PSP for at least a few minutes each night before I go to sleep. Growing up, I used video games as my escape. If life was getting stressful or if I just wanted to procrastinate for a little while, I'd pop in a Zelda game and suddenly be a million miles away in Hyrule, swinging a sword or playing an ocarina.

  But video games are more than escapism. During the most tumultuous times of my life, video games have been therapy. When I feel like I have no control over the things that matter most, video games offer a place where I can feel helpful. Useful. Needed. I'm saving a princess from captivity, a species from annihilation, or world from destruction. The helplessness I felt before is gone and I feel empowered to do something good. Even if that good is for fictional characters, it resonates. When I'm done playing, the feeling of empowerment stays, even if only for a week. A few days. A moment. It builds confidence. It battles depression. It inspires.

  Sony just launched a new ad campaign called LongLivePlay. The video sums up the feeling I've tried to convey here. It's more effective if you're familiar with the characters, but it gets the point across either way.

  Originally posted on DoctorFishypants.com

  • Posted Oct 5, 2011 8:19 am GMT
  • Category: Games
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• 15May 11

  Miscellaneous Life Update #372

  As my third year of medical school nears completion, I'm finding myself much busier than expected. I just finished a month of Obstetrics and Gynecology with an attending who I just didn't mesh well with. He's a fine doctor, and his patients love him, but our learning styles didn't match up well. It was a rough month. I'm much more comfortable now that I'm back on Internal Medicine, but 7am-7pm shifts with 2 call nights a week doesn't leave much time for studying or socializing. I'm also still chugging away on Match Game posts. It always pleasantly surprises me when people I know in real life tell me they read that blog.

  My one-year wedding anniversary is coming up in a couple of weeks. It really doesn't seem that way. Unfortunately, we won't have much time to enjoy it. I have to be in Erie, PA the next day for shelf exams in OB/Gyn and Internal Medicine. Then I have another mandatory 2 days on campus in Erie to prepare for my Step 2 PE, a practical exam where we have to interview and plan treatment for 14 standardized patients.

  Any free time I've had has been taken up by two of my most anticipated video games of the year. Despite the catastrophic PlayStation Network outage this month, I've wasted countless hours in the single player campaign of Portal 2. I can honestly say it's one of the best games I've ever played. Highly recommended. I've also poured plenty of time into the story mode of Mortal Kombat, one of my guiltiest pleasures of video games ever since the original came out when I was entirely too young to play as much of it as I did.

  I also bought a Pokemon game for the first time. Pokemon is the only big Nintendo franchise I've never played before because I was just a bit too old when it originally came out, and I've subsequently associated it with the most evil of gotta-catch-em-all marketing schemes. But every pediatric patient I saw last month was playing it when I walked into the room, so I figured it would give me something to relate to them with. My wife said she did the same with the Twilight movies, but I called bull**** on that one. She loves those things.

  Currently Playing
  PlayStation 3: Mortal Kombat
  NDS: Pokemon Black
  PSP: Final Fantasy IV Complete Collection
  iPod: Words with Friends (Username DrFishypants. Play me!)

  Originally posted on DoctorFishypants.com

  • Posted May 15, 2011 12:38 pm GMT
  • Category: General
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