Pica

A quick google search turned up that pica stands for: 1. The Portland Institute of Contemporary Art, 2. the Podiatry Insurance Company of America, and 3. the Printing Industry of the Carolinas. However, the Pica that I am endlessly fascinated with is the "persistent eating of nonnutritive substances." According to emedicine, people with pica eat substances, "including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches." Um, ew. Though pica has always held a morbid fascination for me, this post is inspired by a patient today (not mine, hipaa) who was found by the nurse eating baby powder, and subsequently found to have an earring in her colon on xray. And I had a patient a couple weeks ago who admitted to eating cigarette butts (seriously), but flat out denied eating coins (her exact words: "I save money! I don't eat it!"), though clearly there was a quarter in her cecum on xray. Crazy. Factoids about pica: eating ice chips can be a sign of iron deficiency; and eating clay or dirt is acceptable and a learned behavior in some cultures. Not helping Worcester's infant mortality problem: pregnant Ghanaian women eat clay (though I've heard that this problem gets more press than it's really worth in terms of actual harm to infants). Anyhoo, I got off track. Pica is weirdly cool. Except for the people that eat, you know, razorblades and whatnot.

Pica

A quick google search turned up that pica stands for: 1. The Portland Institute of Contemporary Art, 2. the Podiatry Insurance Company of America, and 3. the Printing Industry of the Carolinas. However, the Pica that I am endlessly fascinated with is the "persistent eating of nonnutritive substances." According to emedicine, people with pica eat substances, "including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches." Um, ew. Though pica has always held a morbid fascination for me, this post is inspired by a patient today (not mine, hipaa) who was found by the nurse eating baby powder, and subsequently found to have an earring in her colon on xray. And I had a patient a couple weeks ago who admitted to eating cigarette butts (seriously), but flat out denied eating coins (her exact words: "I save money! I don't eat it!"), though clearly there was a quarter in her cecum on xray. Crazy. Factoids about pica: eating ice chips can be a sign of iron deficiency; and eating clay or dirt is acceptable and a learned behavior in some cultures. Not helping Worcester's infant mortality problem: pregnant Ghanaian women eat clay (though I've heard that this problem gets more press than it's really worth in terms of actual harm to infants). Anyhoo, I got off track. Pica is weirdly cool. Except for the people that eat, you know, razorblades and whatnot.

Slow Medicine

This has been on my mind for a while, but I read a cool article on nytimes.com that really brought the issue forward again. Seriously, why do we treat death like it's something we can avoid??? We're all going to die. Deal with it. I am, you are, everybody is. You can't put it off forever. Why do people think that good medicine is just curing everything?? Shouldn't the goal at the end of life be maintaining a good quality of life for as long as possible, not merely delaying death?? So this article: it's about a movement at Dartmouth Medical School called Slow Medicine that emphazises comfort rather than cure at the end of life, and you can read it here. Think about it: if you were diagnosed at age 85 with cancer, would you choose surgery, chemo, and radiation, possibly ending up bedridden with DVT's and PE's and urosepsis and godknowswhat else, just for the possibility of another year or two, and not a healthy year or two at that, or would you rather say, "no thanks, I think I'd rather die on my own terms." I feel like I might go for option B (though in reality hopefully I'm quite a few years removed from a decision like that...maybe I would think differently if I were actually 85). It's certainly understandable to be afraid of death and to want to live as long as possible. I mean, life's short and pretty damn fun. But it ends for everyone eventually. When can we make the shift that the goal of good healthcare is helping people live good, quality years at the end of their life and then dying with dignity and with as little pain and suffering as possible? When will our collective mind stop treating death like something that can be avoided forever? Ok, please read that article, it's short and so interesting. And don't pay too much mind to my ramblings. Inpatient medicine is making me bitter and cynical about drastic end-of-life care, and incredibly sad about the state of some unfortunate people's lives. But that's a depressing story for another post. Please go outside and enjoy your working lungs, healthy muscles, the fact that you aren't paraplegic from a freak accident, or have crippling rheumatoid arthritis, or have had 3 strokes, or live in a nursing home at the age of 37. (This has been a fun week.)