The strange ethics of vaccination, male contraception in comparison to cancer screening

We are facing a global crisis with an absurd amount of people refusing vaccination. I have nearly hourly conversations with patients about the importance of vaccination and largely my professional advice falls on deaf ears. To be honest, I’ve probably overly entertained the ethics and decision challenges regarding vaccination and find some similarities between that and male contraception in comparison to cancer screening.

Discussing specifically the medical ethics of immunization for rare diseases, it is kind of a strange practice. In the context of covid-19 vaccination this is moot given the absurd prevalence and declining the vaccine is really just an inability to make adult decisions. Nothing else. However, in the case of rare diseases, when we choose vaccination we choose to take a therapy that may potentially in even more rare circumstances cause us harm in order to protect those around us. It is an individually and medically absurd decision, but socially is absolutely vital. Continue reading The strange ethics of vaccination, male contraception in comparison to cancer screening

The sin of the rvu

I could never have fathomed how badly residency and medicine in the US could try to beat the compassion out of me. We all went into medical school with bright eyes, touting our love and desire to help people as our primary motivation for pursuing this career. It is likely what made us special, what marketed us as exceptional beyond the grades, MCAT scores, and extracurriculars. And yet a year and half into residency I am finding persistently berated by moral injury of a desire to help people in a system that seemingly strives to make it nearly impossible to do that.

A few months ago my residency transitioned all of our appointments to 30 minute slots, a subtle but heinously impactful change from a mix of 30-45 minutes appointments prior. Independent of new patient or established, routine or presenting with a dozen chronic diseases, we have 30 minutes to meet another human being, learn what makes them who they are and why they strive for health, and make recommendations to help influence their lives. The system is set up this way because of financial incentives to decrease duration of visits while maintaining revenue, a meaningless need to reach the arbitrary number of 1650 patient encounters before the end of residency, and a need to supply care for seemingly infinite demand with extremely limited supply. Continue reading The sin of the rvu

When to hold back?

Yesterday I led a case conference regarding ambiguous care for a complex patient. It was with regards a patient with shoulder pain with a small labrum tear, multiple comorbidities, severe illness anxiety who was maxed out on medical therapy, pain refractory to physical therapy and other conservative interventions. I hesitated very much on referring her to a surgeon because I knew she would likely get a surgery of questionable benefit with possibly worse outcomes. There is gross incentive for the surgeon to still perform surgery and it’s hard to refuse a patient when they likely will just go find a surgeon who will do it. I know that was the pathway and that is what happened. And then she got worse. Continue reading When to hold back?

A moral dilemma of placebo in american healthcare

I have been caring for patients for nearly a year and a half now in residency and have come across some of the more subtly haunting realizations in American healthcare. Recently I watched a presentation by Lorimer Moseley on pain psychology which highlighted some of the variables in placebo effect. Early in my training I naively believed in the therapies I was providing. Things needed to be more clear cut and I sought evidence based medicine by tracking down randomized controlled trials or meta-analyses relentlessly. The further along I am the more I have realized that a significant portion of the things we do in medicine are either completely useless or of questionable efficacy. Because of this I realized that largely my patients were having benefit because of natural history of their disease process (aka they were going to get better independent of what I did) or due to placebo. Continue reading A moral dilemma of placebo in american healthcare

Bikepacking Pisgah

I looked and saw the chance of rain was 0% for the next two days. Today, large raindrops clacked on my windshield and a dense fog surrounded my car. We couldn’t climb because of the weather today but I needed to seize the opportunity for an adventure tomorrow. In my car I have all the tools for an epic adventure: a full trad rack, a sleeping bag and sleeping pad, a hammock and a tarp, and a mountain bike on top. The mountains are open, I just needed to decide what tool I wanted to use to explore them. Continue reading Bikepacking Pisgah

Longs Peak Winter Cables Route Summit

During the summer five years ago, for a last hurrah before starting med school, I opted for a cross-country road trip. From Richmond, Virginia I beelined across the country to Rocky Mountain National Park as my first stop. When I caught my first glimpse of the beautiful craggy summit of Longs Peak, I knew I wanted to hit up the class 3 scramble route to get to the summit. After years of living on the East Coast with mountains no bigger than the foothills at the base of the Rockies, I was hooked at first sight. A few days of acclimatizing got me to the Boulderfield, the campsite at 12,700 feet elevation at the start of the scramble part of the Keyhole Route to the summit of Longs. While eating dinner and chatting with another camper, we saw two guys rappel down another route on an imposing face and come strolling through the campsite. I asked them how they got into that and got the scoop. Step one: join the local gym. Beyond that everything else would fall in place. It seemed like an arduous process for someone who was used to being rapidly self-taught. But as I’ve learned, mountaineering is no joke and definitely takes time to get down. Continue reading Longs Peak Winter Cables Route Summit

Winter 14ers for Beginner Mountaineers: Top 10

With the fall and winter months approaching quickly, Colorado mountaineers are whipping out the crampons and double boots in lieu of the trad rack and trail runners. But if you’re new to the big mountains, the cold and snow can be quite intimidating for good reason. If you’re looking to bag some winter 14ers but don’t want to risk your life to do so, this list list can help steer you to some solid safer climbs. Whether you’re looking for a more intense climb than the summer hikes or love the solitude of the off-season, winter 14ers can be an amazing experience.

However, before even considering attempting any of these winter 14ers, I would recommend that you have experience with climbing 14ers or at least 13ers in the warmer months, or at minimum go with someone who is familiar with the mountain and the cold. For nearly all of these climbs, I recommend having at minimum microspikes and trekking poles. It was a very rare day that these aren’t essential pieces of gear. In addition to that, most of the climbs call for snowshoes, especially after a storm or on the less travelled routes, and many of them necessitate an ice axe and the experience with using one. 10 point crampons are rarely if ever necessary on most of these routes.

This is not meant to be an all inclusive guide to each climb, just merely an introduction to help you decide which climbs to do. Always check weather and route conditions beforehand. I’ve linked to some helpful resources at the bottom.

The short and sweet winter 14ers:

1. Quandary Peak (East ridge)

Quandary peak winter
The route up Quandary follows that ridge and kicks up there in the last third.

Continue reading Winter 14ers for Beginner Mountaineers: Top 10

Bikepacking the Blue Ridge Wrangler

Bikepacking:

verb

  1. a portmanteau of biking and backpacking

  2. combing traits of long distance bicycle touring with the minimalist priorities of backpacking, usually favoring trails and gravel over paved roads

  3. Potential for laughably massive amounts of suffering and hilarity

Day 1, Blue Ridge Wrangler

We set out at 8pm with a sensible goal of getting a few miles into the Blue Ridge Wrangler, a 185 mile bikepacking loop, just to get away from the road for a night of camping. Neither I nor my friend Scott had ever bikepacked before and we were about to ride away from the comfort of our cars. Onto unknown trails. Thirty minutes before sunset. On gravel bikes.

Bikepacking Blue Ridge Wrangler
My trusty steed

Continue reading Bikepacking the Blue Ridge Wrangler

Rock climbing Buzzard Rocks near accident

This past weekend I went climbing with a few friends at Elizabeth Furnace up in Northern Virginia. On Saturday we hit up a small roadside crag called Talking Headwall where we cranked over some pretty fun well protected roofs. We wore ourselves out and then the next day went to go climb Buzzard Rocks on some classic slab routes, a nice two mile hike up the mountain from Talking Headwall. It was a great weekend with some super fun climbing ranging from crimpy face climbs to juggy overhangs to featureless slab but you may deduce from me writing about it that in classic Grayson adventure fashion, things didn’t quite go as well as intended. Continue reading Rock climbing Buzzard Rocks near accident

Balancing adulting vs adventuring

Nearly constantly people are trying to talk me out of doing the things I love. My mom cringes when she hears plans for the next adventure. My aunts and family friends comment on facebook pictures demanding that I come home right this instant. Park rangers warn me of the dangers up above, ski patrol reminds me they won’t rescue me, hikers exclaim how dangerous rock climbing is and how many people die doing it. They’re not wrong to have those thoughts and I’ll admit that to reconcile those sentiments and my own fears with my cravings and love for adventures in the backcountry is a constant struggle. It’s the mountaineers dilemma to balance life at home and family with our own very selfish need to explore. Continue reading Balancing adulting vs adventuring

Adventures of a medical student