Studying and the Dish

We learned a lot this quarter, renal physiology, the gastrointestinal system, a ton of microbes and parasites, skin diseases, endocrine disorders, reproductive health. Too much for me to cram in a week. I've been doing my part all quarter, consistently absorbing and learning the material. We have an "integrated" final exam this Friday. Most of you probably picture me sitting in a small room with glaring lights all day with a pile of books by my side. Sure I could sit in the library all day, plowing through all my books, losing my concentration left and right, spending more money on snacks and beverages than I should, falling asleep at the desk. I could study that way. With our cumulative exams, I take a different approach, and listen to review lectures that are interesting, make me think and cover all the essential material. If I just listened to the lectures while comfortably sitting down, I would be asleep in 5 minutes, so instead I listen while walking. Usually while walking the Dish! So instead, picture me with a smile on my face, listening to lecture reviews, while spotting a stellar jay along the trail, catching up on loop diuretics while taking in a view of the entire peninsula. A perfect blend of studying, exercising, and enjoying a beautiful day. A win-win-win. I'm actually enjoying this! Nailing the practice exams feels good too.

Seasons

Living in Northern California the last 3 and half years, I've finally come to appreciate seasons. SoCal really never felt like 4 different seasons, Boston's winter was so scarring that I declared winter my arch nemesis. But here, in Menlo Park, I actually look forward to the rain, the change of leaves, the expected rainbow in the afternoon after a rainy day. I like that I hold my tea close and snuggle up under my blanket. I look forward to the verdent spring, green Stanford hills, and bright orange poppies filling the fields. Different seasons bring about different daily habits, different emotions, different wardrobes, and different meals. The selections at the Farmers Market has changed from summer squash to winter squash, from strawberries and peaches to sweet potatoes and root vegetables. I not only enjoy the seasonal change, but in a way I even look forward to it. I wouldn't even mind a little snow now and again, though I could do withouth the great Northeastern Blizzards I endured. Seasons are fun, in their own, unique way. With that said, I'll be spending Christmas at the beach. :)

Holidays and the BCC

The weeks between Thanksgiving and Christmas are probably my favorite weeks of the year. I had the priveledge of attending my 4th UCSF Breast Care Center Holiday party tonight. As eventful, festive and fun as always. The Intern skit was once again phenomenal, poking fun at the idiosyncrasies and hysterics that make up the BCC. I absolutely love being able to see old friends and colleagues, hear they are well, and what they are up to now. The BCC really was a work-home, very different than anything I've experience in medical school, and an environment I will really strive to find in the future. I really miss being part of a team working towards a goal, in med school you're constantly floating through teams, never a full fledged member yourself.  It was my first full-time job, where I fell in love with medicine, and realized that work doesn't have to just be work, it can be a passion, a calling, and something you do with friends and colleagues, not just coworkers, something that is fun, creative, and worth your while, What a terrific reminder about what the holidays, and life in general, are all about. Also a good kick in the butt reminder of why I'm doing all this studying now, with finals 6 days from now, its the extra uumf I needed!

Downtown Chicago

Notre Dame

Black Friday

5:45am!

Crocheted Coral Reef

National Portrait Gallery

Running and Jill Biden

While running along the Capital Crescent Trail, I see a fit, blonde woman in a black running outfit speeding along towards my way. Low and behold, it is none other than JILL BIDEN! Wife of Vice President, with two secret services agents huffing and puffing about 10 meters in her dust. How cool is that? Jill Biden rocks. Another great example of why I love running! The run was beautiful, trail goes from Maryland to DC, tree-covered, scenic, perfectly picturesque. AWESOME DAY!

My favorite color is blue

Thank goodness the good state of California agrees with me, a clean sweep! I'm such a California girl at heart. We can get back on track now.

Medical School is sooo right for me

I've been working on this midterm for an elective I'm taking, its mostly an undergraduate class, but it's been incredibly interesting and informative as the class brings in surgeons who have worked on international health projects across the world. I have to write a paper on an international health organization and analyze the org....

This little experience makes me really appreciate medical school. Every day in medical school, I am building a base of knowledge that allows me to understand the inner workings of the human body, a language that allows me to detect and diagnose disease and illness. Medical school has given me a different window into the human body, a language, dictionary, and encyclopedia for understanding. I love it. I stay up late reading about the adrenal cortex. I'm excited for the next NEJM publication, reading about the newest update on asthma management. My bed time reading is often "The Patient History", so I can better know the right questions to ask patients to rule out and rule in diagnoses, to discern a differential and a cause of their illness. Sure sometimes I feel overwhelmed, wiped out, because it's exhausting, I never know enough, I'm never encyclopedic enough, I still have so far to go. But I absolutely love it. I don't have any problems motivating myself to study, usually I have to motivate myself to take a complete break...

But there is never a break from medicine, when I go to the grocery store I see the women with a cane, hobbling down the isle, and I wonder to myself if she has osteoporosis, or maybe a hip replacement due to a recent fall. I see a young boy with a cough and runny nose and catch myself saying "take care of that viral infection", under my breath. I see a gaunt elderly man smoking as I walk home, and I wonder how many pack-years he's smoked, if he's ever tried to quit, whether or not he has emphysema, trying to picture his lungs, or what is left of the millions of alveoli exposed to daily toxin...

So yes, medical school is beyond my wildest dreams. I don't have to do response papers, or analyze an organization or falsely motivate myself to care about term papers or midterms like the years of undergrad. I get to study the human body, I get to investigate, problem solve, and learn to my hearts content.

One of my mentors once told me, "A doctor studies disease. A good doctor studies people. A great doctor studies life."  I'm still at the disease point, but I'm sure my love affair with medicine will continue in ways I can't even begin to imagine.

Bottom line, do I really have to write this 3 page, single spaced, 12pt font, 1 inch margins, response paper critiquing the WHO GIEESC? Because I'd much rather be learning about the physiology of the parathyroids right about now...

Weddings

Weddings can be such beautiful events. This weekend I had the delightful pleasure of attending the wedding of my friends Vivian and Charles.  Understated elegance, simple, pure, and full of love. It was so much fun to celebrate their love and lives with so many of my friends and classmates. It's so beautiful to see two people looking together in the same direction, with the best of intentions and highest of hopes, surrounded by all their friends and family rooting and cheering them on.  It's wonderful to be part of so much love and celebration! So many emotions are wrapped into weddings. The parents and family beam with pride and disbelief at how old and mature their cherished son/daughter has become. Siblings take a reality check, that brother they used to fight with is now a husband... Friends see another side of a friend's life that too often is overlooked or not discussed. A young single woman feels the hope of a similar romance in the future, a seasoned married woman reminisces about her wedding, and the good and bad of her marriage. A gentleman in a budding relationship that is long distance mourns the days without his girl, secretly can't wait until they can be together for good. The older widowed man sheds a tear at the recent loss of his wife, and realizes that he lost the only dance partner who can dance the charleston with him... There are so many emotions running at weddings, no wonder they are so memorable and hold such meanings in all of our lives.

Good advice

Perfection is the enemy of the good.

Happy Halloween!

The Greek goddess Artemis and a witchdoctor

Black Mountain

This afternoon I summitted Black Mountain, along with my mom and Abs. At the top there was a beautiful view of the Bay, even with the dark clouds overhead. The hike was just under  6 miles, and we saw an astounding 24 deer scampering about! Great way to end the week and head into the weekend...

What the World Needs Now, is Love, Sweet Love...

it's the only thing, that there's just, too little of....

The past few days I've been grappling with the loss of my grandmother, Mary Kilroy. The last time I saw her, we sang this song together......

It's never fun to lose someone you love so much. You always wish you had more time. It's always too soon. A life too short. Unfair. Irreplaceable. Your Grandma plays such a unique role in your life, always rooting for you, ready to have fun, to indulge and splurge with all the love and joy a grandmother has for a granddaughter. The pressure is off, no need to impress, no judgements, just love. The loss of a grandmother really hits you hard. Both of my grandmas have very, very special places in my heart. Grandma and I got really close in the last few years, and I will remember and cherish those moments for the rest of my life. I am so blessed to have such loving family. Grandma you are missed and loved. Whenever I eat my butterscotch squares, use my tea kettle or salad spinner, wear my cute Michael Korr skirt suits, travel with one too many bags, read a good book, catch an awesome sale at the mall, or watch a really good cooking show, you know I"ll be thinking of all the wonderful moments we've shared together. Love you. Here's a memory from our post-LA makeovers....

Platelet Donation

The last time I donated blood, I asked the nurse to check if I was eligible to donate platelets. A very small percentage of people are eligible to donate, for a variety of reasons, including prior pregnancies. too small, not enough iron, cytomegalovirus, travel exposures, I could keep going...

A week later I received a call from a very nice woman who was just SO excited to inform me I was an eligible platelet donor. Her words were "there are so few of you out there, I'm so glad you're eligible. You can give every 2 weeks!"

This evening was my first platelet donation. First impression: they take more care of you, give you selections of dvds, a nice tv with headphones, sweet deal. It takes longer than a whole blood donation, but that means I can settle in and read for a while. The platelet process is strange. Whenever I donate blood, I always think of the scene in the StarTrek movie where they enter a hospital on Earth for a sick man who is about to undergo brain surgery, the Space doctors are outraged at the barbaric, ancient care and use a laser to heal him instantly. It makes me think about how in the future, hopefully we'll have synthetic platelets and blood, and we won't need centers all around the country leeching blood from willing donors...The process really is oldschool when you think about it. Nonetheless, the platelet machine is a fancy centrifuge with a lot of dials and ringing bells. It felt very strange feeling blood pushing through my veins back into my body. I also felt a little strange in general after giving, but I'm doing alright.

Why do I give platelets you ask? In honor of my lovely grandmother, who is very fortunate to be the recipient of weekly platelet infusions. And all the other family members, mothers, fathers, daughters, cousins, grandfathers, who wouldn't be here today without platelets. I may not be a doctor yet, but I'm finding ways to contribute to treatment and care in my own way...

So, next time you give blood, check if you can give platelets. It really is a blessing.

Best part of my week

Was this evening, Abbey and I ran and hiked in Arastradero and had the wonderful gift of seeing seven beautiful deer on the trails... By far, the best part of my week! What would I do without a great sister and the outdoors?

SMS II

Medical school is really awesome this year. We focus on one organ system at a time, and have complete immersion: 3 hours of lecture per day, clinical reasoning sessions once a week, brush up on the related physical exam skills, and then we have practicum where we interview real patients and practice our history, physical exam, clinical reasoning and presentation skills. I absolutely love it! TAing anatomy has been really awesome too, I enjoy teaching, I enjoy dissecting, and enjoy relearning the body. It's such an honor to have all of these opportunities, I'm so grateful for all the physicians who put in so much time to teach me, the patients (alive and deceased) that are altruistic and allow me into their world. Medical school is humbling, but its also very rewarding, the more I study, the more I see my clinical skills grow and expand, that's very personally gratifying, so studying doesn't seem too bad, I actually enjoy studying for the most part this year. Still have to work on getting to bed early...I don't think it will ever happen!

PPACA -Health Care Reform

Did you know that the new health care reform doesn't have limits on insurance premium prices? The reform may be better than nothing, but it is seriously lacking...

No Diet Coke for me

I haven't had diet coke since sometime in earlier August! I decided to stop drinking diet coke after reading about the shaky FDA evaluation of aspartame, and after my own realization that I think it's very addictive. I was drinking 4-5 diet cokes a day, sometimes much more. Since going cold turkey, it hasn't been much of a problem. I drink a lot more tea and water, I focus on getting more sleep, and occasionally I'll have a regular coke when I'm at a gathering etc. It hasn't been too bad. I was so trained to pop a diet coke when I began studying, the hardest part was getting out of the routine. No more diet coke for me!

Monterrey Mushrooms

On Sunday I went to Monterrey Mushrooms, the largest mushroom company in the world, and helped vaccinate their workers. We got a wonderful tour of the farm and free mushrooms to boot!

I ran a 10k

Last Friday night, the Palo Alto Weekly held the annual Moonlight Run around the Baylands Preserve. What fun! It was my first time running a 10k, under a clear sky, beautiful moon and on a nice trail. I averaged under 8 minute pace for the run, so I was happy! A bunch of friends from med school also ran, and Abs finished her first ever 5k, such a blast!

Blogging bug

I've got to catch the blogging bug again...

Something that moved me: Seeing a beautiful stellar jay flying low with the view of Bay behind it...On my Dish run this morning

Something that inspired me: Abs running a sub 8:30 mile around Lake Lagunita. Go Abs!

Something that surprised me:  A delicious home-cooked Indian dinner with lentils, zucchini, squash, and eggplant...YUM.

Something exhilarating: Running a sub-7:30 mile on the last mile of my 6 mile run.

Anatomia

Even though I'm starting my second year of medical school on Thursday, I still made my way to the anatomy labs this evening. The lab was eerily familiar, the scent of formaldehyde, the snap of the purple gloves, the search for nerves in the midst of fascia....It all came back to me so fast! Tomorrow is my first day teaching the first year medical students anatomy, and after doing the TA dissection today, I'm feeling confident, and really excited to share the experience with them. It's a win-win-win for me.  I get to learn anatomy again, get paid, AND get an iPad! Abs and I have been playing on the iPad all night, it's cool in some ways, annoying in others. I wish Apple had gone the extra mile and made a killer technology that included phone, video, and file storage in addition to what the iPad offers.

Wish me luck for my first day of teaching!

Lilly!!!'

Tiger pacing

Orangutan crossing

The Burger Joint

Sweet potato fries!!!!

Divino

What do you order at an Argentinian restuarants? A lot of meat.
Definitely coming back here!!!

Five Guys

The Cajun fries are addictingly delicious.

Man cookie

Brought to you by Leslie's cupcakes

Yes on CA Prop 21

We all pay taxes so we can partake in public goods and services. CA Proposition 21, the State Parks Initiative would remove all entrance fees to California state parks (fees recently increased from $6 to $10 last spring). Prop 21 would add an $18 surcharge on obtaining a vehicle license, and in doing so make our state parks more accessible to all Californians. I strongly support this Proposition and hope that in November you vote yes on Prop 21with me.

Give and Take

On Monday morning, I received an email from the Stanford Blood Center, asking to donate blood because they are very low on their stock of Type A blood for patients. I immediately called and scheduled an appointment to donate that afternoon. I saw giving blood as an opportunity to make amends for my novice blood draws at the free clinic on Saturday. It's the least I could do. It ended up being a family affair, me, my dad and my mom donated! It was the first time my mom had ever donated, but she was a champ. I even convinced Woody, a fellow med student to donate! We all received t-shirts and free pints of baskin robbins ice cream...A pint for a pint...

Life is such a give and take, and I'm glad I took the opportunity to give a little. You can now give blood once every two months, and I'm pledging to do my best to do that this year. I learned that sometimes you can give, sometimes you have to take, but it turns out alright in the end as long as you do your best...

Novice

My first real blood draw. Real in the sense that I was going to draw blood of a real person who needed a real test. Unlike the times early in the year when I drew blood of my classmates for practice. I was hoping for a really big guy, with bulging veins to come around the corner of the phlebotomy lab. Instead a very petite Vietnamese women appeared in front of me. My hopes were dashed that this would be an easy one. I went through the checklist, name and date of birth? check. signature on lab form? check. preparation of phlebotomy materials? check. gloves on? check. tourniquet on? check. Everything going ok so far, I'm gaining a bit of confidence, this isn't too bad.  Then I try to find her veins. It's a skill to feel the vein, and then to slide the needle in properly so the vein doesn't roll on you. After about ten double checks, I think I found an okay vein, it's tiny, and I can't really see it, but it will have to do. As I prepare the needle, the patient begins to squirm. She doesn't speak much english, so she expresses her fear and concern in a series dismayed moans and scared sighs. I try to calm her down, but inside I'm just as nervous and scared as her. I certainly don't want to cause her more discomfort, which I know I'm about to. I move forward, inserting the needle into the small, hidden vein I felt a minute prior, hoping and praying to see a flash of blood in the needle so I can fill up a vial of her blood. Nothing. I slide the needle out a bit, still nothing, slide it in further, nothing. I am very dismayed. I try to explain to the patient that I'm very sorry but I will have to try again. I take out the needle and place a bandaid on her arm. She was moaning and almost crying, but then thanking me and saying "its ok its ok", so I think she understands. Then she gets up to leave-she doesn't understand. I quickly interrupt, "No no, I'm so sorry but I wasn't able to get a proper blood draw, we're going to have to try again" and show her the empty vial. She gets frightened, distraught with the understanding the she has to go through it all again. I'm not really sure who feels worse at this moment in time. Because my heart is wrenching, I inflicted pain upon her, was inept and now I have to do it again. So we go again, this time the other arm. Still no luck. Again, she doesn't understand and I have to explain that again I wasn't able to draw blood. So I call the lab supervisor and have him do it, because there is no way I'm going to try again and fail. I feel so bad for this woman, I didn't mean to inflict so much pain, I really wish she didn't have to be my first real patient. I really wish I was able to draw blood quickly for her. After her blood is drawn, she turns to me and says "It's ok, it's ok" and smiles. An incredibly nice gesture of her, it really meant a lot to me that she recognized how bad I felt for making her undergo 3 blood draws. The other part of it was that I felt bad that I was this inept, shouldn't I have been better? I mean I'm a Stanford Medical Student, I had an undergrad and a high school student shadowing me, and proved to be completely incompetent....
    The rest of the day was very successful actually, I was able to give many vaccinations and did many more successful blood draws. I did my best to put all the patients at ease and appear competent and professional. As I was driving home, reflecting on the morning, I realized that by thinking of myself as a "Stanford Medical student" I really missed the point. Although others may see me like that in the clinic or at the hospital. I'm actually just me, who will be continually thrown into new situations and procedures in my growth as a student of medicine, and I will always try my best, but if I fail, it's not a reflection of me as a person, its a reflection of being a novice, and not having much experience. If I continue to do my best, I will become the best doctor I can be. Whether or not I live up to the title of "Stanford medical student" in the eyes of others is completely besides the point. This way of thinking gave me peace with the incident in the morning. I really did try my best, my best at putting the patient at ease, as well as trying to draw blood. By not running away from the situation, I learned, and I got better and was able to do my best for others later in the day. Medicine is tough-and this was just a blood draw.

Bens Chili Bowl

Note sign in lower right

Georgetown Cupcake

Yum! As seen on reality tv

World Bank

Me and GW

Wish List for post-July 2009

To continue my quest to be top chef in 2010:

• Wok
• Rice Cooker
• Butcher knife
• Chef's knife
• Cutting board
• Microwave
• Toaster Oven/Toaster
• Good Tupperware
• Spice rack

For my sanity:

• Laundry drying rack, iron
• Vacuum cleaner, mop, sponges, rubbing alcohol, baking soda, toilet brush
• Pepper spray
• TV
• printer/scanner combo, shredder

In case of disaster:

• Flashlight and extra batteries
• Small radio
• Fire Extinguisher

Cool tech stuff that may be necessary (or not):

• Flash drive (minimum 4GB)
• Powermat wireless charger (minimum version 2)
• Telephoto lens for my amazingly awesome canon slr rebel xti

• APC Power-Saving Essential SurgeArrest 7 outlet

So I don't freeze to death:

• Space heater
• Hot water maker/keeper
• Big waterproof snow boots
• Ultra gloves
• Shovel for car
• Ice scraper for car
• Automatic starter for car
• Car (with 4WD preferably)
• Warm running jacket
• Running gloves
• Running cap

So I can be the smart kid in school:

• First Aid for the Boards
• "First Aid for the Match" and/or "Iserson's Getting into residency"
• Underground clinical vignettes for step 1
• BRS physiology review book
• current edition Rohen atlas
• Chung anatomy review
• Netter anatomy flashcards
• The book First Aid

Do you have any of these things lying around your house that you would like to give to me?

• Can opener
• Spatula
• Measuring cups
• Measuring spoons
• Vegetable peeler/Zester
• Strainer
• Whisk

Hike #3: Yosemite

Amazing vistas, waterfalls and well worth the tough hike out of the valley.

Hike #2: Skyline to the Sea Trail

30+ miles in less than 2 days with my mom. We made it to the beach!

Hike #1: Big Sur

Testing out some new gear in the Ventana Wilderness

1/4 of a Doctor

As of 10am today, I am 1/4th of a doctor. Officially done with my first year of medical school! It's one of those times when you should be celebrating, but instead you are more in disbelief. Time off? Relax? No studying? I hardly know what to do with myself. I feel bewildered, really, free time?

WOOHOO!!!!!!!!  Busy finalizing plans for the hiking trip of the century (more on that later), and time for real life (finishing taxes, financial aid, good stuff like that).

Looking back at my first year, I feel a strong sense of pride, I worked hard, I tried my best, I learned more than I thought possible to learn, and had a really good time. I actually enjoyed my first year of medical school, probably learned just as much about myself as I did about the human body...but now...FREEDOM!!!!!!!

Number 25

I think it's fitting that National Hikes Day falls on my birthday! To celebrate, I enjoyed a relaxing 4 mile hike this morning with the fam, followed by wildberry frozen yogurt and a picnic for lunch... Then relaxed by the duck pond all afternoon, reviewing for my final exam. What a wonderful day, with chinese food for dinner and angel food cake to top it off! Beautiful weather, wonderful company, and a reason to celebrate, what more could I ask for?

Number 25 is certainly off to a fabulous start.

NEJM Letter on Arizon Immigration Law

Thought it necessary to share this brief letter to the editor...While I was reading it, I was struck by the fact that the Arizona law has such similarity to the Fugitive Slave Law of 1850 that made it illegal for people in the Northern states to "conceal, harbor or shield" a slave and effectively turned police officers into "slave catchers". This is wrong. If I ever am subjected to such inhumane laws, I will choose to nonviolently protest and disobey.

Arizona Immigration Law and Medical Practice

To the Editor: The new Arizona state immigration bill (SB-1070) signed into law on April 23 will seriously obstruct, if not undermine, the practice of medicine in the state of Arizona. It specifies that those who "conceal, harbor or shield or attempt to conceal, harbor or shield" a foreign person who came to the United States illicitly "are guilty of a class 1 misdemeanor" punishable by a fine of at least $1,000 (Sec. 5, Section 13-2929).¹ It can be argued that health care providers who neglect to report illegal immigrants under their care will violate the law and be considered criminals. The bill provides physicians with no guidance as to what constitutes "reasonable grounds" to suspect that somebody is in the country illegally, leaving the particulars of such scrutiny to anyone's imagination (although the fact that Arizona shares a border with Mexico rather than a European country suggests that whites will not be "reasonable" suspects). One interpretation is that health care providers in Arizona will need to ask for a passport before seeing certain patients (and providers themselves will need to carry their own passports at all times, depending on their physical appearance or accent). Arizona practitioners, hospitals, and medical associations need to ponder the extent of their liability under the new law and draft clear institutional policies to defend their patients and employees from potential harassment. Asking patients to produce immigration documents violates the trust that physicians, nurses, and other health care workers endeavor to earn from them.
This bill threatens one of the oldest traditions of medicine: physicians shall protect patients regardless of nationality or race.² This legislation, if unchallenged, will force health care providers to choose between the dignity of their profession and the indignity of violating the law.

Lucas Restrepo, M.D.
Barrow Neurological Institute
Phoenix, AZ

The 6 things between me and summer break

Last lecture of the year
HHD Pediatric cardiology lab
Mini-CPX exam
CV End Block Exam
Practice of Medicine Exam
Integrated Final Exam.

then: DONE WITH MY FIRST YEAR OF MEDICAL SCHOOL!!!!!! 1 year closer to caring for patients...

Quote of the Day

"To relentlessly force the tender wisdom, thoughtful reflection, and perceptive honesty of the human heart to conform to the ridiculously impossible, inhuman speed of the world, its effortlessly generated images and mind-driven technologies, is to do violence to our most precious, valuable treasure: the necessary guidance of the human heart. Without it, we may get more and more done, and push ever faster through the gauntlet of our to do list, but we may never, in the end, catch up to anything."

The amazing world you discover...

Rough test today, followed by a rougher 5 hours of continuous class, and it was rainy and cold... I was ready to be released from the cage...counting down the minutes to 5pm. And I'm out, quickly change and get moving. I start my usually route, around Lake Lagunita. I get somewhat annoyed by all the moths that seem to be around the ground, then as I look closer...and realize, that they aren't little moths, they are FROGS. BABY FROGS EVERYWHERE! I'm talking about hundreds and hundreds of baby frogs on the trail and in the surrounding meadow. So, of course I stop running, stoop down and enjoy the gleefully hopping frogs for a while, They hopped around so much, all my iphone photos are blurry. I walk lightly amongst the beautifully simple baby frogs for about a 1/4 mile...Amazing right? Where did they all come from? Why today? How wonderful, mysterious and beautiful. Nature always having a way of giving me a wake up call at the right moment...

Not all in life is perfect and beautiful though...As I continued to walk along the trail full of hopping froggies, I began seeing squashed frogs. My elation dampened. More dead frogs, all over the trail...People had been running them over all day.  People had been enjoying their run, unaware of the world around them, ignorant of the small beautiful creatures beneath their feet...It made me really sad. It was so terrible to see all of the tiny little lives, squished into oblivion.

After thinking about it, I think this occurrence represents something bigger for me. If you aren't cognizant and alert of your surroundings, you really won't be able to fathom the potential impact you and others may be having. I think this example shows what can negative results can occur because of this lack of perspective, but I think the flip side is also true, you can do a lot of good if you pay close enough attention. In my case, I managed to avoid stepping on frogs, and warned a few runners about them and they stopped their run and started walking too. Sometimes you don't even know what you're looking for, but keeping your eyes out, and your mind clear, you just might come across something amazing. In my case today, hundreds of tiny, hopping froggies.

New home!

Stanford Med is more awesome than ever. We have official access to our new home, the awesome LKSC 4th floor student space, including student lounge, workout center, beautiful view of the Stanford Hills, and great study spaces! I love it! Having a beautiful vista sure puts the hardcore studying into perspective...

Yet again I'm learning a new language...La lingua de corazon....
What is that I hear? A diastolic murmor? S2 split? S3 or S4? How about supraventricular tachycardia, or a right bundle branch block as seen in the V1 lead of the EKG? Or what about atherosclerosis, thromboemboli and Virkow's Triad? Any ST elevations or inverted P waves? Don't remind me of alpha vs beta, muscarinic vs nicotinic, Beta agonists, Beta blockers, nonselective, indirect, antiacetylcholinesterases, sympathomimetics, neostigmine, atropine, phenylephrine, or isoproterenol....

What does this mean for you? Exercise, eat your greens, get your sleep and stay away from insecticides. Organophosphate poisoning is bad news! Back to work, exam on Monday for me. Love this new med school home!

Hetch Hetchy for Mother's Day!

The crew packed up and headed to Yosemite National Park this weekend in celebration of Mother's Day. Our destination: Hetch Hetchy, the Yosemite Valley that never was...Yup, in 1908 they damned up this beautiful valley against the activism of John Muir and naturalists around the country. That damn dam! After seeing it for myself, I can't believe it. A true travesty, because it is an absolutely amazing place. I'll be writing my representatives about this one...Even with the ugly dam, it's a remarkable place. We did an overnight backpacking trip, hiked up the valley, camped amongst the bears (no joke), and had an all around wonderful weekend. Happy Mother's Day Mom! Hope you enjoyed yourself as much as I did!

Riding my bike

For the past week I've been using a bike as my primary mode of transportation, I thought I would share my thoughts:

• It takes me less time door-to-door to bike to class then to drive, park and walk to class. About 13 minutes on a bike, 20 by car. 
• Cars smell bad, are too big, and are scary.
• It's really hard to turn left as a biker, because of the smelly, big, scary cars I mentioned above. 
• Biking is really enjoyable when your breaks don't squeak.
• Biking prevents me from wearing skirts and dresses. Slightly annoying. 
• You see a lot more animals and small wildflowers when you bike than when you drive. 
• I used to hate locking up my bike, but it really only takes me the same time as starting a car. 
• Helmets aren't that bad. 
• I think more when I bike, I get annoyed at other drivers when I drive.
• Still don't know what I'd do if it was pouring rain tomorrow. Will have to figure that out. 
• I could easily bike to cool hikes if I had a better bike.
• Biking makes it a lot more likely that I'll go to the Farmers Market on Sunday rather than loading up on giant bags of groceries at Safeway.
• Biking doesn't require filling up a gas tank and spending money.

I like biking.

Really, 0/46?

This evening, after studying cardiac reflexes for a few hours, I decided to skim over all the lectures in my Cardiac Block. By the time I got to page 360 in the syllabus, I casually noted that there hadn't been a female professor yet. So I continued on, quickly turning  page after page, growing more dismayed...I made it to page 561, the last page, and was shocked to realize that I wouldn't have a single female lecturer in the Cardiac Block of HHD. I double checked the Table of Contents. Sure enough, it struck out, 0/46. Zero female professors.

I'm chagrined at this finding. I think its statistically highly improbable. I doubt that there are zero highly-qualified and capable female physician-educators at Stanford to teach the cardiovascular system to medical students. If there are zero, that's a whole other problem. I wonder how this could happen, how it could be unnoticed. I will make sure to raise this point with my peers, faculty mentors, and administration.

One of my favorite quotations is by Dr. Martin Luther King, "Injustice anywhere is a threat to justice everywhere". I try my best to be alert and cognizant of the small, seemingly innocuous injustices that happen everyday around me. This is one that I'm speaking up about.

Wilderness First Aid Training

After 16 hours of training, I'm now Wilderness First Aid certified! I can assess spinal cord injury, hypothermia, heat stroke. I can fix up your broken ankle, clean that dirty wound, and splint up your dislocated patella. I will be investing in many more additions to my first aid kit after realizing all the terrible things that can happen in the wilderness. What an awesome weekend with my SWEAT crew.

Yosemite Highlights

Had a great trip to Yosemite recently. Here are some photos I just uploaded.

This is why I run

To decompress after my Lung Block Exam, I went on a great run in Arastradero Preserve this evening. About a mile into my run, I took a break to look around, and realized I was a step away from landing on a small 12 inch snake, it was slender with reddish-brown and yellow stripes. Continuing along, after a big climb, my efforts were rewarded with a gorgeous view of the surrounding landscape, extending all the way to the Bay.

The best part about a big ascent is the winding downhill run that follows, I was practically sprinting for almost a mile, all the while keeping my eyes peeled for other cool animal sightings. About a 100m before finishing, I slam on the breaks. There is a HUGE rattle snake in the middle of the trail!  I'm talking 4 feet long, big rattler, smack in the middle of the trail, with a dead mouse in its dust. So, fortunately I stop. Spend about 10 minutes in awe of this creature as it meanders off the trail into some gofer hole. Then I sprint to my car, slightly terrified of every sound along the trail, but joyous of my chance encounter with two beautiful snakes just minding their business on a sunny Monday evening.  This is why I run.

Quote of the Day

"...Instead of being the currency of a social justice or conscience-driven movement, "human rights" has increasingly become the specialized language of a select professional cadre with its own rites of passage and methods of certification. Far from being a badge of honor, human rights activism is, in some places I have observed it, increasingly a certificate of privilege."

-A quotation from Chidi Anselm Odinkalu, in the opening of Pathologies of Power, a book by Paul Farmer

Insurer targeted breast cancer patients to cancel

This is exactly why for-profit companies should not be in the business of providing health insurance. Sickening.  http://bit.ly/9WLvzF

Now that's what I call spring

Go Stanford!

Such is life

1. ME
2. Understanding the information in school so I can help my future patients
3. Everything else

There are so many cool things to do during medical school, health policy, free clinic volunteering, advocacy, student groups, clubs, cool talks. Then there are so many cool fun things to do in life, like hiking, camping, traveling, hanging out with family, friends, reading, watching tv, reading blogs, blogging. But then there is me. Just me. 24 hours in a day. I've decided that the only way I can become a good doctor is by first being healthy myself. So last weekend I went to Yosemite, it was incredible. Since then I've vowed to exercise everyday, because I love it. I've done 2 trail runs, a fun run to a vista of Menlo Park, and a quick tough work out at the gym. I've had decent meals every day. I've even made my bed. It's sad when I am proud of myself for making my bed, but small things like that matter. I'm also getting better at saying no...sort of. It's a work in progress really. Med school is exhausting, is summer here yet?

Yosemite

Made it to Yosemite! On the way learned all about antibacterial drugs,
had a great dinner at InNOut, and saw two deer and a gorgeous sunset.
Great start to the weekend I'd say!

Sent from my iPhone
-Julia

Lost my sensibiility

V-Q, CO2, PA02, A-aO2, Hbg, DLCO, FEV1, TLC, VD/VT, FI02, RV, IRV, ERV, VC, FRV, FEV, CO, N2O, pH, SaO2, HCO3

Welcome to my new language! It's called: Respiratory Physiology (oooooh, ahhhhh). Who knew that everything you learned in general chemistry the first semester of college 7 years ago would be so valuable? Partial Pressures, Dalton's Law, Fick's Law of Diffusion, it's all important to understanding the lung! If only they had told me that at the time....

Now that we're in the organ blocks, we are really getting down to business...We have 3 lectures a day, 4 days a week, just on the lung, meaning that we cover 12 hours of intense material each week. In two weeks we're already passed the 20 lectures point...talk about fast-pace. But of course, life also continues to happen, so I've been grappling with my summer options, extracurricullar activities and writing a research proposal. I'm getting the hang of it though, key words: SLOW DOWN and enjoy the flowers. No seriously, the wildflowers are in bloom all over campus. It's beautiful.

The lung is really neat, but not so neat if you have asthma, or COPD, or brochiectasis, or idiopathic pulmonary fibrosis, cystic fibrosis, interstitial lung disease, bacterial pneumonia, pulmonary edema, respiratory distress syndrome, alpha-1 antitrypsin deficiency, or anything similar. Like my new vocabulary? Don't forget crackles, rhonchi, wheezes, spirometry, arterial blood gases, or body boxes, beta agonists, muscarinic antagonists and steroids.

 I try to immerse myself in the new language, so I read the recent NEJM article on the impact of 9/11 debris on pulmonary function of firefighters and emergency rescue workers. Hopefully that study will help secure funding for additional health coverage for those workers.

And, I've considerably lost my vision from studying too much. If only there was a spare moment to see an ophthalmologist, then the lecture slides could be clear again!

Rock on!

Female Pitcher To Play Pro Baseball In U.S.

Sent from my iPhone

-Julia

My first exhibit

Malcolm Gladwell at Medicine at the Muse

Need to Expand Number of Hours in the Day

Apparently my blog has become a photo blog...I apologize for that.

Latest news in a nutshell...
I'm becoming environmentally friendly! Proven by the fact that I biked to and from school today.
My photographs will be on exhibit tomorrow evening! At the Medicine and the Muse Event.
I'm learning about the all-powerful amazing and sometimes asthmatic lung! Lungs are COOL. Don't mess up your V/Q ratio though. That's BAD news.
I can distinguish the lung sounds of wheezes, crackles, and rhonchi by auscultation.
An owl visited me the other day on my way home, it was outstandingly amazing and surreal.
As usual I drink too much diet coke.

I have way more thoughts, comments, and experiences than that, but I really have to write this proposal. It will get me $12k of funding and we all know that's a lot of money for a med student.

Quote of the Day

"Thought is the strongest thing we have. Work done by true and profound thought -that is the real force" -Albert Schweitzer

The Girl Effect

Cupcake goodness!

White House

Sleep well America!

Go reform!

Si se puede!

What do we want?

Immigration reform!
When do we want it? NOW

Si se puede!

Gorilla confrontation

Chatty Flamingos

Giant Panda at the National Zoo!

Giant Panda at the National Zoo!

A view from the eyes of history makers

Spring Break!

Freedom! I made it through a grueling week of final exams, and then Abs and I hopped on a plane for DC! Really excited to be a tourist for the next 10 days. If you have advice on hidden gems of DC let me know. Tired, relieved, and happy to have a much earned break from studying.

New med school building!

The benches in front are perfect for reviewing neuro!

Winter quarter reflections

Sometimes the irony of studying memory consolidation, sleep, memory disorders, and expression of emotions while in the midst of final exams in med school is too much for me! Once I get over it, and get beyond the basics, I realize that I really genuinely enjoy learning about the brain, the different disorders, the different pathways. It is so fascinating, and we still don't know so much about all the things that make us human, things that endless amounts of animal studies will never be able to answer for us. How we learn, the role of sleep, how we produce language is incredibly fascinating.

In retrospect, I have learned an incredible amount of material this quarter, including details on bugs (viruses, bacteria, fungi), common respiratory tract infections, head and neck anatomy, all the basics of our immune system, and of course, fundamentals of neuroscience. It's a good feeling to know that I can now carry on endless conversations about all of these topics, I have the vocabulary and structure to understand all of the complexities I'll be presented with in the future. If you asked me a week ago how I enjoyed winter quarter, I would have had a low rating. For some reason the experience of learning all of this at once was quite overwhelming from a day-to-day perspective-I wish that could be changed, because I actually LOVE all of the material and information now that I've learned it! It's all so intriguing. Once again, hindsight is 20/20. 4 more exams to go before I get to go on a true vacation! Watch out D.C.!

Thought of the day

Never worry alone. 

~Jim Conway as relayed to me by Dr. Welton

Need a check up?

Tomorrow afternoon I have my physical exam assessment. 45 minutes to conduct a comprehensive physical exam on a standardized patient, with my preceptor watching the whole time. I've been practicing all week, with classmates and willing family members (thanks Abs-you're the best patient ever!). I feel confident in my knowledge: inspect, palpate, percuss, auscultate, repeat. The extent of my current skills includes:

Vitals (Pulse, Respiratory Rate, Blood Pressure)
HEENT (Head Eyes, Ears Nose and Throat): Say Ahh!
Pulmonary Exam: Take a deep breath in and out...
Cardiovascular Exam: Now I'm going to listen to your heart and check your pulses...
Abdominal Exam: Palpating the liver, spleen, kidneys, intestines
Musculoskeletal Exam: Check for joint pain, range of motion
Neurological Exam: Mental Status, Cranial Nerves, Sensory, Motor, Coordination, Reflexes, Gait

After much practice, the order feels smooth and is easily remembered. I wouldn't say it feels natural yet, I still have trouble thinking up relevant questions, and often lack an easy flow of conversation since I have to concentrate so much on my task at hand... I've come a long way though. In January, it was so foreign to listen to the lungs, or look into someone's ears, I am really impressed with how much I've learned. Far from perfect, but significant strides have been made. Fall quarter we learned the basics of talking with patients about personal medical information, I now feel the added weight of examining their bodies closely. Without  realizing it, I'm becoming more "doctorly" every day. I remember back in September when even wearing a white coat felt so foreign, like I was an imposter, pretending to play doctor. I'm slowly earning the white coat, and becoming more comfortable with the responsibility that comes with the coat and the stethoscope.

Finished with Anatomy Lab

On Tuesday we had our final anatomy lab of the year. We've now officially completed a memorable chapter in our training to become a physician. Final exams are around the corner, so I'll still find myself in the lab over the next week. Anatomy has been full of emotions for me, sadness, humility, hunger, joy, pain, annoyance, and deep reverence. It was nothing like I expected and everything I expected.

Yesterday marked the beginning of my studying for winter quarter final exams, two more days of class left. I actually enjoy studying for exams, the days are very long, even brutal, but I really enjoy the completeness and concreteness of it. No need to worry about more information coming my way, the goal is to attack and understand everything you've already learned. Med school is still amazing, it builds up a great endurance in me that I didn't even know I had. I will never be a ultamarathoner, but I am a medical student, and there's not much difference between the two. Slow and steady, keep your priorities simple and focused, mind over matter and repeat.

Quote of the Day

"To each one of you the practice of medicine will be very much as you make it- to one a worry, a care, a perpetual annoyance; to another, a daily joy and a life of as much happiness and usefullness as can well fall to the lot of man"

-William Osler

What saves me when I have 6 hours of neuro class

Musings on medicine and money

The more problems I see with medicine, the more I blame the infusion of money and business for the erosion of the medical profession. As a profession, we need to do more to uphold the integrity and ethos of our practice. This means being open source, nonprofit, honest and transparent. It's easier now than ever to make money as a doctor, through biotech, boutique medicine, private practice, and if we want to keep medicine as a profession, we need to stop this. Patients should always feel 100% confident that the tests we order, the surgeries we do, and the visits we schedule, are in their best interests, there should be no doubt about this. If you want to join me in making sure that medicine stays an independent, noble, and honorable profession, please let me know. Support open source software, support the removal of big pharma from our education and practice, and speak up against those who say otherwise. I'm reclaiming medicine as an honorable profession, I'm proud to work hard now to help my patients in the future. The debt, time, and hard work is worth the honor and esteem that comes along with being a doctor, and mark my word I will be a physician of virtue and always act in the best interests of my patients. When the integrity of medicine is doubted, physicians lose their power. Our voices are supposed to be the ones advocating for better care for our patients, better political policies and social programs. It should NOT be the case that medical societies speak up in the name of their paycheck and not their patients. That is a disgrace to medicine and other physcians, me included, need to vocalize this dismay. If we don't, who will?

A Walk to Beautiful

"A powerful story of healing and hope for women in Ethiopia devastated by childbirth injuries." You can watch the entire documentary online here.

Anatomy Update

I love anatomy. I hate bone dust, the sound of saws, the sound of saws through bone, but I love dissecting. Today I spent about 3 hours dissecting out the submandibular region of the face. After a while, I get in a groove, losing complete sense of time, methodically probing and removing fascia to reveal the beautiful arteries, nerves, muscles, glands and such that enabled this altruistic person, now my cadaver, to sense the world, move about, speak and taste and do all the things that makes us human and who we are. I was lost in my work, humbled at finally finding the hyoglossus, a muscle that controls tongue movement, relieved to finally differentiate the submandibular duct from a vein whose name I do not yet know, inspired when I eventually came across the hypoglossal nerve and saw how it beautifully sent fibers to innervate the hyoglossus. Before I knew it, it was past 5:30pm, and me and my anatomy partner, Felipe, were the only 2 left still dissecting. It is such an honor to have this opportunity, I see people differently, I understand movements more clearly, I have such a better scientific sense of pain and feeling after traveling so many feet of nerves through the body. What once was a foreign thing, the idea of blood circulation, is obvious when you dissect out all the arteries and veins, how beautifully unique they flow, diverge, and connect as they become smaller and smaller. Yes, anatomy class is a blessing, I couldn't imagine learning medicine without it, dissections make the body real, the organ systems concrete, disease pathological. I have so much gratitude towards the men and women who bequeath their bodies for our learning. Sometimes I imagine that I'm the first person to ever dissect a body, how much attention to detail, perseverance, and dedication it took to complete the first Atlas of Human Anatomy. I wonder what it would have been like to come across the vast array of fascia, arteries, muscles, and nerves with no concept as to their function. What a thrill!

How I Study

I spend most of my time these days studying, morning, afternoon, and night. I actually enjoy studying for the most part, since what we learn is interesting. Half the battle in medical school is figuring out the best way to study all the material you need to learn. Since I spend so much time studying, I figured I'd finally blog about it.

Two strategies I really like are "3 minute writes" and the "White Board" strategy". I do a 3-minute write at the end of my class-day, for each class I attended that day. It is exactly what it sounds like, for 3 minutes I write everything I can remember about the lecture. Then I know my starting point and go back with a different colored pen and fill in what I didn't remember/got wrong. For me, this is a great way of consolidating my knowledge and narrowing my studying to what I really don't know.

The second strategy, the "White Board strategy", is when I use the white board to study, I write all the major concepts and details on the board, in a way that I could teach it to someone else, and I talk through it aloud, either to myself or someone else. I'm great at big concepts, but the white board strategy ensures that I'm also covering the details I need to know and I've found it really effective for me.

Below are some of my white boards. If you have any advice on efficient and effective ways to study, let me know!

Microbiology fundamentals: 

Vasculature/Innervation of Head:

 

Cranial Nerve nuclei:

 

Usually all this studying means I'm at Stanford past sunset, makes for pretty sunsets at least!