Wednesday, January 31, 2007
So far, I have postponed discussing my secret obsession with oncology, but this news has prompted me to start reflecting again. Certain stages of pancreatic cancer have a median life expectancy of six months, and when I heard that a former patient had passed away, it flashed me back to the old feeling that another soldier has fallen.
And then I always start thinking about my former interactions with that patient...When did I first meet him? What did we talk about? What did he look like? Every death is like a small electrical shock to me, and it forces me to think about the mysterious void that we all seem to disappear into eventually. To flesh out this concept, I am attaching a piece of an essay that I wrote last year for medical school:
"Growing up, I felt haunted by the loss of a grandfather whom I would never meet. Tiptoeing around this void as a child was like trying to resist the gravitational force of a black hole. Since my grandfather died from colon cancer when my mother was seventeen years old, I never had the opportunity to meet this shadowy figure buried somewhere in a New York City cemetery. A passage from Tom Stoppard’s Rosencrantz and Guildenstern perfectly expresses that curious emptiness left by my grandfather: “Death is not anything...death is not...It's the absence of presence, nothing more...the endless time of never coming back...a gap you can’t see, and when the wind blows through it, it makes no sound.”
For the past seven months, I have worked at Stanford University Medical Center as the full-time clinical research coordinator, and the most compelling part of my job stems from my close interaction with terminally ill patients.
Of all these patients, I will never forget Mr. David Lee,* a seventy-five-old patient with metastatic gastric carcinoma whom I met during my first week. He was a cheerful, little old man with round glasses and a padded suit jacket that hid how emaciated he had become underneath. When Mr. Lee visited us last July, he was already dying. As he sat in the examination room with his wife and three grown children, the hardest thing that I have yet experienced was being present when Mr. Lee learned that he would likely die within six months.
After the doctor gently suggested that the family should consider “end of life” options, Mr. Lee’s daughter broke into uncontrollable sobs. I struggled to maintain eye contact with David Lee and his family in the cramped clinic room. It was difficult to breathe and remain objective in the midst of such grief. For the rest of the week, I could feel the blood pounding in my brain as my head ached with unshed tears. The greatest challenge in working with patients who have gastrointestinal cancers is learning to accept that some people will never quite recover from their illnesses and that no families will ever be the same. Two months later, Mr. Lee passed away.
Strangely, I cannot forget Mr. Lee. I remember his shuffling gait, his facial expressions, and his plastic frame glasses with remarkable clarity. What I marvel about death is its ability to take away someone so real and lifelike to me…to make him disappear into a void. That is the mystery of death that Guildenstern so eloquently described: how can Mr. Lee exist and yet not exist anymore? The more I pondered this, the more I realized that Mr. Lee represents to some degree an echo of my missing grandfather.
Working with terminally ill patients every day teaches me that I can be stronger, wiser, and more compassionate. But the deaths of patients like Mr. Lee also push me to realize that I am imperfect, that any clinical study is imperfect, and that our knowledge of cancer remains imperfect. Learning to recognize these imperfections and yet refusing to simply accept them motivates me to continue my research when I am a medical student and a physician to develop new treatment therapies against cancer in a never-ending quest to enhance a patient’s quality of life and chances for survival.
My reasons for pursuing a career in medicine stem from the people who have impressed me deeply, such as cancer patients like Mr. Lee. And yet, ironically, if I were to trace back the origin of my interest in healing and helping others, it would lead back to the void left by another person suffering from cancer whom I will never meet."
* Names are changed to protect patient privacy under HIPAA.
Tuesday, January 30, 2007
What I Want for Valentine's Day: An Oversized Novelty Kidney.
Wednesday, January 24, 2007
Once again, my blog has fallen silent because of an exam...it seems to be the only thing that can keep me away from updating compulsively! However, the exam has come and gone, and we are done with the lungs. Bye bye lungs. Welcome kidneys! The kidneys are rumored to be one of the hardest blocks in our first year at UCSF, so I should study more this month. We saw some beautiful slides today of the glomerulus (it took me ten minutes to figure out how to say it like a pro..."gloh-mare-ru-lus" as opposed to "gloh-mer-roo-lus"). Since I can't see anything in slides anyway (histology is not my bag, baby), I like to amuse myself by hallucinating and imagining what the image reminds me of. Aesthetically, some of these images are fantastic and I wouldn't mind hanging a few on my wall someday. The slides above remind me of stained glass windows; it's like I'm in a church! Yes, the kidneys are quite a religious experience.
Thursday, January 18, 2007
The hill near my home! Look at those lines of perspective!
Wednesday, January 17, 2007
Tuesday, January 16, 2007
Monday, January 15, 2007
Sunday, January 14, 2007
My fellow medical student blogger, Craig Chen, is a profound thinker and writer who will captivate you with his reflections on a myriad of medical ethical dilemmas, cool science facts, and funny quotes. Jeremy, our dental student blogger, possesses a hilarious and compelling "voice" that will give you an extremely vivid impression of dental school and educate you on a variety of political and intellectual contemporary issues. Although I do not know the two pharmacy students personally, ephempharm and Lux are also very worthy reads that promise to give you the inside scoop on pharmacy school.
Each of the bloggers has a unique perspective and writing style that reveals a different facet of UCSF. I would highly recommend that you sample each blog, that way you will discover that the UCSF experience offers way more than free plastic surgery, talking mannequins, off-color Harry Potter jokes and inadvertent cadaver eating. Wait -- scratch that -- there's NO free plastic surgery.
Friday, January 12, 2007
Wednesday, January 10, 2007
Tuesday, January 09, 2007
Three scenarios were available for the medical students to reenact:
1) Dick Cheney with angina (heart pain).
2) Jennifer Lopez, who feels that she may be pregnant yet is planning to spend the next 9 months working on a movie set.
3) Harry Potter with a lump on his groin.
After the students finished the doctor-patient dialogue in pairs, the speaker opened a lecture-wide discussion. The transcript was loosely thus:
Speaker: "What was your patient most worried about?"
Student #1: "Getting fat."
Speaker: "I assume that your patient was Jennifer Lopez."
Student #1: "Haha, yes."
Speaker: "But what about Harry Potter? What would he be most worried about?"
Student #2: "Not being able to practice his magic."
Monday, January 08, 2007
Sunday, January 07, 2007
Saturday, January 06, 2007
Today I attended an all-day Domestic Violence (DV) Conference held at UCSF. It's amazing to think that incredible conferences on topics ranging from cancer imaging to universal healthcare to domestic violence happen every weekend on campus. It blows my mind.
Domestic violence is a healthcare issue...here are some facts from the "Family Violence Prevention Fund" (FVPF), funded by the U.S. Department of Health and Human Services:
- "Nearly one-third (31%) of American women report being physically or sexually abused by a husband or boyfriend at some point in their lives.
- In 2000, 1,247 women, more than three per day, were killed by their intimate partners.
- In addition to injuries sustained during violent episodes, physical and psychological abuse are linked to a number of adverse physical health effects including arthritis, chronic neck or back pain, migraine and other frequent headaches, stammering, problems seeing, sexually transmitted infections, chronic pelvic pain, and stomach ulcers.
- Children who witness domestic violence are more likely to exhibit behavioral and physical health problems including depression, anxiety, and violence towards peers. They are also more likely to attempt suicide, abuse drugs and alcohol, run away from home, engage in teenage prostitution, and commit sexual assault crimes.
-Emerging research indicates that hospital-based domestic violence interventions will reduce health care costs by at least 20%.
- A recent study found that 44% of victims of domestic violence talked to someone about the abuse; 37% talked to their healthcare provider. Additionally, in four different studies of survivors of abuse, 70-81% of the patients studied reported that they would like their healthcare providers to ask them privately about intimate partner violence (IPV)."
So many issues are swirling around in my head, but what strikes me the most is how the concept of domestic violence and the issues surrounding it can have similarities to so many other ideas in healthcare:
- Like obesity or smoking, domestic violence is a multifactorial health problem that leads patients to suffer from physical injury, emotional trauma, and stress-related symptoms. Prevention of domestic violence at an early stage would not only save the lives of countless women, but would also save the healthcare industry a fair amount of money in the long run due to abolishment of the "revolving door" for abuse victims in the ER that currently exists in many places.
- Domestic violence is like "second-hand smoke" in that it not only harms the abuse victim, but also the children and family members living in the same household. These children also suffer from physical and emotional health problems and engage in behavior that may endanger their health.
- Pharmacists have a unique role because abuse often centers around issues of control, and medication and birth control becomes prime examples of how abusers can maintain power over their victims.
- Doctors, nurses, and other healthcare professionals also have to be aware of "compassion fatigue" and "secondary or vicarious trauma" that can result from helping victims of domestic violence. Burn-out is a common hazard. I feel that the issues of compassion fatigue and burn-out are also very pertinent issues in oncology and hospice care that are rarely addressed by the healthcare community.
As a medical student, the most important lesson that I learned today is to ALWAYS ask about domestic violence in a private and safe environment during the clinic appointment. It seems like a simple protocol, but doctors rarely screen their patients in this manner and it makes all the difference.
To draw another parallel to a similar health issue, doctors also rarely question patients about depression and thoughts of suicide. The general stance is that doctors should always always ask...but physicians and medical students rarely do. When interviewing a double-lung transplant patient during my Foundations of Patient Care class, I asked the female patient dozens of questions during a one-hour session. She answered in short sentences and rarely volunteered any information, and I felt frustrated and helpless and maddened by the fact that she expressed ignorance on every issue, including why she had the lung transplant in the first place. Later on, during my clinical interlude in psychiatry, I stumbled upon this patient's name and discovered that she was suffering from major depressive disorder. Did I detect this during my hour-long interview? Did I even ask her whether she was feeling depressed? No...and that has made all the difference in changing my attitude and approach.
Thursday, January 04, 2007
We haven't been in anatomy lab for a month, and at first it was nice getting reacquainted with our cadaver and seeing the familar organs and muscles. Dissection is always messy and anatomic structures are never usually easy to see without a little careful cleaning and expert recognition. The memory of the smell also returned -- every cadaver smells a bit differently, which surprised me.
Anyway, I was using a scapel to slit open the trachea (the airway) with my head approximately 12 inches above the body when a spray of yellowish gunk burst out. Some of it landed in my mouth and I jumped like a jackrabbit. If anyone is curious...it tastes like it smells. Then I ran to the bathroom and washed out my mouth and maybe my GI tract.
Lesson learned: never dissect with your mouth open.
Wednesday, January 03, 2007
Tuesday, January 02, 2007
Monday, January 01, 2007
Fear not, loyal readers, I did not keel over and die during my transcontinental flight back to Los Angeles. For the past week, I have been hiking, ice skating, going to museums, shopping, watching movies and TV, and gorging my little heart out on wonderful food at home. Also, I live near the street where the annual Rose Parade is held every January 1st...it brings back fond memories of volunteering for float decoration and nearly losing my hair in a tragic glue accident.
Very little of my vacation at home involved medicine...except when my sister sprained her ankle and I shouted, "That's your deltoid ligament!"
Then my brother hurt his arm and I yelled, "That's your biceps...wait, no...I mean your triceps. It has three heads, but I forget the names." After three months of medical school, I am surprised and appalled by how much human anatomy has been learned and how much has already been forgotten.