WILTIMS #117: When life give you dilemmas, make dilemonade!

Today we had 3 hours of neuro, two hours of FCM and two hours of medical ethics. Ethics was definitely the highlight. We had wonderful, intelligent and lively discussions on a whole array of ethical subjects. Throughout the course each student had to take a turn leading the small group through a case study. Today was my day and the topic was fascinating.

I discussed the surprisingly common practice of medical students performing unconsented pelvic exams on anesthetized hysterectomy patients. We discussed the many ways this could be considered unethical, even under the implicit consent of being treated in a teaching hospital. I then brought up other similar scenarios to see if there were situations where unconsented med student involvement could be ethical. If it was an exam of an ear instead of a vagina, people's feelings were more mixed. In another example, we mostly agreed that if a once-in-a-lifetime opportunity to observe a finding unexpectedly presented itself after the patient had already been knocked out, then bringing more people into the room than was consented would be ethical because the benefit to the education of students (and the future good of their patients) would trump the patient's rights, though the situation would have to be explained to the patient afterward. But that the students would merely be observing was a key point in this case.

The SNARE complex: Botox attacks the
BoNT sites while Tetanus targets TeNT

TIL: Botox, short for botulinum toxin, paralyzes muscles by cleaving the SNARE complexes that are responsible for binding of neurotransmitter-containing synaptic vesicles to the synaptic cleft.

Tetanus toxin works similarly but is only effective on inhibitory synapses. When these are deactivated, muscles are allowed to contract continuously. This is why tetanus is also known as lockjaw; early tetanus infection can cause people to uncontrollably clench their jaw. If left untreated, a common outcome is a broken back from all the back muscles contracting simultaneously. Get your tetanus booster shots!