Reflections

You might have noticed there have been some design changes around here. I hope you like the new look, I do! In a bout of reflection (read: procrastination), I re-read a bunch of my "med school" posts.

Some reflections...

1. I am SUCH a science geek.
Love of human anatomy? Awestruck by developmental biology? Losing my sensibilities while studying pulmonology?  In disbelief over the fact that we have an aqueduct in our brain? Somethings don't change...

Except now I don't just love it, I fear it. Clinical medicine has shown me up close and personal all the terrible, no good things that can go wrong. Now it's more of a reverence. You've got to pay respect your body so it doesn't go haywire on you. Even if you do pay respects, it still might go bonkers.









2. OMG I have learned so much. 

My posts about the vocabulary I was learning at the time are particular endearing. Medicine is really all about building blocks, which allow you to learn more and more and more.

Mountains and mountains of knowledge.








3. OMG I have forgotten so much. 
This hits me especially as I study for USMLE Step 2. I was like the smartest person in the world when I took Step 1. I really think it's the height of my brain capacity.

Clinical years lead to more medical savvy, but I wouldn't say more medical knowledge...Except of my specific patients. How do you have three patients with cholangiocarcinoma during internal medicine, NMDA receptor encephalitis in neurology, placenta accreta in ob/gyn, but have never treated a patient with Alzheimers or Rheumatoid Arthritis? I've forgotten almost all of neuroanatomy. There is a brain, and spinal cord, and some nerves...(JK I remember a little more than that...)




4. Compassion is the name of the game
I love clinical medicine, because I get to take care of people! I get to figure out what they need medically, but also how to break bad news, break good news, explain tests, ask for help, talk with family, explain that I don't know that answer but I'll find out, explain that we don't know what the heck is going on, explain that we know exactly what is going on but don't have any great treatments, or my personal favorite, we know what is going on and we're going to do something about it! My biggest medical school accomplishment? I am most honored by the fact that I was nominated by my peers to the Gold Humanism Honor Society.

5.  There's just so many ways to be awesome every day!

Medicine is not the end all be all of professions. While for me, it's the right choice, and I'm happy to have the privilege of becoming a doctor. I've gained an ENORMOUS amount of respect for all the other people in the hospital AND the non-health care settings. We need good pharmacists, nurses, respiratory therapists, social workers. We need good parents, good grandparents, good cousins and aunts and uncles and friends. We need good mayors and county supervisors, and state senators. We need good neighbors and small business owners. If there's anything I learned from medical school, is that you certainly don't have to be a doctor to help someone. Just being the best version of yourself. It is SO SO SO important. Be a stay at home mom, be a part time teacher, be an astronaut, be a CEO, or a mailman but make sure you know what your values are, and hold on to them steadfastly.

Okay, I'm all reflected out right now. I'm sure in the future I'll have more reflections to share with you!

A Rant about Foodies

I was going to add a fifth reason to why I joined a CSA, but decided to make it a stand alone blog post. My fifth reason was going to about the whole environment and health part of joining a CSA. However, I have mixed feelings about this. I really don't like things that get overhyped, and there is something about the "locally grown" and "sustainable" trends that irks me. Yes me, the passionate outdoorswoman and environmentalist. I think what rubs be the wrong way is that people are such zealots around here.

I used to eat a lot of fastfood, it's tasty, on the way home, and affordable. I still do, especially when traveling, because $4 at Wendy's vs a vapid overpriced salad seems like a no brainer to me at times. And sometimes after a 10 mile hike what you really want is Carls Jr curly fries and a chocolate shake.  I have fond memories of always stopping at Panda Express on the way home from backpacking in Yosemite. Plus, there are so many people that would in theory love to eat well, but it is overpriced and no one knows how to cook these danged vegetables. I have certainly come a long way from my days of microwaved cheese quesadillas. Yes, I will still keep a stock of frozen vegetables and precut sweet potato fries in my freezer at all times. No I don't have a garden that I love spending hours in. I probably won't until I'm 80. If I'm lucky I'll have an herb garden in which all the herbs don't die in under two weeks. No I don't think brussel sprouts taste amazing and should be eaten raw. I have a giant sweet tooth and rank dulce de leche next to godliness. And yes I have never seen the giant orange/lemon fruit delivered in my box this week, and my giant purple cabbage has an uncertain future, I will try the recipe but will not hesitate to dump it if it tastes bad. Now stop judging me!

The "foodie" movement is overtaken by an air of "I'm better than you are because I eat dirt" that feels elitest and pretentious. When something seems overhyped, I tend to stay away. However, that doesn't mean that I don't agree with the values and principles. Especially in the great state of California, where we have a wonderful climate to grow and harvest delicious foods, I'm going to support our locally grown produce and join the charge against the big guys. I haven't read enough to feel that I can truly speak on the health effects of pesticide-free organic growing methods, but I will say that getting a giant box of any fruits and vegetables on my doorstep is going to be a good thing for my health!

What if?

Every Wal-mart was turned into a Public Library?

Death of a Wal-Mart, Birth of an Award-Winning Library

Courtesy of Boston Magazine
"Who says death can’t be beautiful? Okay, so maybe this Wal-Mart in McAllen, Texas, didn’t die, per se, but it did move, leaving behind an empty warehouse. Rather than let this space be a pox on the community landscape (such as Wal-Marts tend to do) or wait around for another big-box store to move in, these McAlleners transformed the space—greater than two football fields in size—into the largest single-story public library in America. Touchdown."

Quote of the Day

"In everyone's life, at some time, our inner fire goes out. It is then burst into flame by an encounter with another human being. We should all be thankful for those people who rekindle the inner spirit."Albert Schweitzer

I've taken the last 3 weeks "off" from clerkships, spending time talking to attendings, mentors, friends, family about life, career, perspectives. It's been nothing short of awesome. So rarely we remember to take the time to do so, to ask the important questions, to ask those we respect and value their opinions and views. Something that hopefully you don't need time "off" to do. I thank everyone for helping rejuvenate and rekindle my spirit!

The Harvard Red Book

I received my copy of the Harvard Red Book in the mail this week. It's my 5th year reunion this May, and for every reunion, Harvard asks alumni to update their contact information, and if you want, indulge your fellow classmates with what you've been up to since graduating.

As soon as I opened the book, I couldn't put it down, so interesting to read personal accounts of my friends and classmates. I'm sorry I didn't update more than where I'm currently living and doing. Reading the entries made me smile, I truly am so fortunate to have attended Harvard. I have made so many wonderful friendships with interesting, creative people who are all driven in their own, unique way.

I feel uplifted, and reminded that no matter what I do, as long as I continue to follow my gut, I can do whatever I want, and absolutely love it. Now that is a privilege.

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.

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?

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!

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.

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...

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 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.

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.

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?

Ready Set Go: Winter Quarter of MS1

It's true, winter quarter is mighty. Neurobiology, neuroanatomy, head and neck anatomy, immunology, microbiology are incredibly fascinating courses, but also completely foreign to the vast majority of medical students, including me. I am very thankful for the 3 courses of neurobiology I took in college, but quickly I realize that I learned the tip of the iceberg. Long class hours and short days do make it difficult to get sunlight when all our lecture halls lack windows.

There is a shining light of this quarter, the physical exam. In one week I learned how to do a basic pulmonary exam and cardiovascular exam. While last quarter we practiced our medical history-taking skills, now we are beginning to breakdown a big transition that happens for all physicians, the transition from a normal person, to specialist of the human body. Someone who can read the external signs of health and disease, who uses their eyes, ears, hands, and some fun tools to inspect, palpate, percuss, and auscultate a patient to understand what it really is that brought them to see the doctor. I really enjoy this part of medicine, even though it is the  most challenging for me. I already know how to study -it's not always fun, but I know I will do well in my science classes, because there is a formula for studying that I think I've mastered. Learning how to practice medicine is totally new, how do you learn to quickly differentiate a normal lung resonance from disease? See the internal jugular vein undulating at the surface of the neck as you're staring at a real, live person who probably gets nervous, scared, annoyed, and angry just like I would if someone stared at my neck for too long. How do I learn to correctly identify normal heart sounds from irregular sounds? I am now beginning the process of developing my senses, touch, hearing, visual, and smell in order to help others. It is very cool. In our introduction to health and human disease class, Dr. Parsonnet and other physicians told us that the number one skill that medical students need to develop first is the skill of determining if someone looks sick or not, and now I begin to really hone and develop that skill. Very cool.

I miss winter break. After Christmas, I did so much wonderful hiking, running, and javelin throwing. I realized that I had not devoted a good enough time to doing things I loved last quarter, so I will be trying to be better this quarter. I found several incredibly gems of nature right in my backyard, including Purisma Redwoods Open Preserve, Skyline Ridge Open Preserve, and Big Basin State Park. These hikes were incredible, memorable times I spent with my family and I can't wait to explore more... Alas, time to review immunology. Thanks for listening.

Humans: Are we like differentiated cells or stem cells?

Disclosure: Yes, I'm studying over Thanksgiving Break. I must. I spent too much time working on cool projects rather than studying the last month and now my break is paying for it. At least what I'm learning is interesting!

Humans as differentiated cells
Do we start out all equal, capable of anything and everything? Then, over time, progressively restrict our goals, hopes, opportunities and dreams?  Does every little choice we make steer us towards our final destination, in sequential order? Meaning that if we didn't make choice A and B first, then we couldn't arrive at C?

Or...

Humans as stem cells
Not only do we start out with the world at our feet, but we have this ability throughout our lives. Are we constantly capable of reinventing ourselves? With the right mix of opportunity and timing, can we become anything we want to be? We can self-renew, be bold. But we need might need the right environment, the right parents, the right nurturing in order to have this ability.

I love biology metaphors. I think we might be something in between. Mostly differentiated cells, but under the right conditions we can be changed into stem cells, like inducible pluripotent stem cells!

PS. I shadowed Dr. Verghese today, it was pretty much totally awesome. Tomorrow I'm going on oncology rounds. So thankful for these learning opportunities...

Spilled Milk

I really liked this story, its written by Jack Canfield and was in the HuffingtonPost today...

"One of the best stories I've ever heard about "spilt milk" and the lessons of making a mess comes from a famous research scientist who made several very important medical breakthroughs. A newspaper reporter once asked him why he thought he was able to be so much more creative than the average person. What set him so far apart from others?
He responded that, in his opinion, it all came from an experience with his mother, which occurred when he was about two years old. He had been trying to remove a bottle of milk from the refrigerator, when he lost his grip on the slippery bottle and it fell, spilling its contents all over the kitchen floor--a veritable sea of milk! (Thankfully, no glass shattered, but the milk kept flowing out like a river.)
When his mother came into the kitchen, instead of yelling at him, giving him a lecture, or punishing him, she said, "Robert, what a great and wonderful mess you have made! I have rarely seen such a huge puddle of milk. Well, the damage has already been done. Would you like to get down and play in the milk for a few minutes before we clean it up?"
Indeed, he did. After a few minutes his mother said, "You know, Robert, whenever you make a mess like this, eventually you have to clean it up, and restore everything to its proper order. So, how would you like to do that? We could use a sponge, a towel or a mop. What do you prefer?" He chose the sponge and together they cleaned up the spilled milk.
His mother then said, "You know what we have here is a failed experiment in how to effectively carry a big milk bottle with two tiny hands. Let's go out in the back yard and fill the bottle with water and see if you can discover a way to carry it without dropping it." The little boy learned that if he grasped the bottle at the top near the lip with both hands, he could carry it without dropping it. What a wonderful lesson!
This renowned scientist then remarked that it was at that moment he knew he didn't need to be afraid to make mistakes. Instead he learned that mistakes were just opportunities for learning something new, which is, after all, what scientific experiments are all about. They are simply that--just experiments to see what happens. Even if the experiment "doesn't work," we usually learn something valuable from it."

Read more at: http://www.huffingtonpost.com/jack-canfield/raise-children-not-flower_b_268607.html

3 Things About Today

In my Healer's Art class, the class begins by asking 3 questions, and I thought I would share my responses with you today...What Inspired Me: In my CPR class, hearing Dr. Smith-Coggins talk about the Good Samaritan Laws in California and other states, and then subsequently sharing with us her own views, when she feels that she has a personal responsibility to help, and thinks there is a good chance she can help, she always does so.

What Moved Me: As I was running from the Student Lounge to CCSR, I saw a big, stunningly beautiful bluebird land and perch on a bike rack. I stopped running, admired, smiled, and had to run a little faster the rest of the way to be on time to my meeting.

What Motivated Me: I had an optional Anatomy midterm today, British Style, meaning that you have 15 minutes with a TA or professor and they quiz you. I had the pleasure of being quizzed by one of our professors, Dr. Whitmore, and did well, a "comfortable pass" as he declared, and I'm now happy with my study habits and motivated to learn more anatomy!