Workaholic

You know that your life needs more balance when you get annoyed at the UCSF library for closing at 8 p.m. on Friday and Saturday nights.

The first BMB midterm is on Monday, but I have two side assignments that are due that same day...an interesting assignment for "Synapse" on a recently published study showing no association between induced abortions and breast cancer (super-interesting considering the recent Supreme Court decision and the suggestion that "an abortion procedure could be banned if it posed a risk to a woman's health" NYT 4/24/07) and an extensive literature search on prostate cancer and nutrition. I feel like there's not enough time to do a great job on these fascinating projects!

Dreaming of D.Lo

Dan Lowenstein

It finally happened: I had a dream last night involving our BMB course director, Dr. Dan Lowenstein. With all of this talk about brains and dreaming, I just knew that our brilliant academic leader would somehow find his way into my unconscious. It was a really weird dream, however, in which D. Lo was giving a lecture on the history of literature and he was so unbelievably articulate, insightful, and compelling...the lecture was somehow on the difference between the male and female narrative...or something like that...

I must be a lot smarter when I am asleep.

Crushing the Dreams of Budding Medical Scientists

A few months ago, my classmate Albert received a call from the UCSF MSTP office regarding a young student in middle school who was interested in writing a career report on being a "medical scientist." It was yet another reincarnation of that annoying report in junior high school that forces you to think of a random occupation and to interview a reluctant role model to get the "inside scoop" on being a puppeteer or a test pilot.

Anyway, it was obvious to Albert that the young boy was not particularly interested in being a medical scientist; he was probably encouraged by some well-meaning adults into contacting the MSTP office, which took pity on the boy and forwarded his information to Albert, a nice person. The boy asked Albert a few rote questions that were clearly being cribbed from a piece of paper, such as "What special skills are necessary for your job?" To which Albert responded, "JOB? I don't have a job, I'm a student." The boy asked a few more questions, and Albert later swore to me that for some reason, he received the impression that the boy was Asian. Later on, the boy sent Albert a "thank you" card, but Albert discarded it and forgot the boy's name.

Flash forward a few more months, until a few weeks ago when Albert received a message titled, "JohnnyIsAzn (name changed) has sent you a Hallmark eCard." Of course, Albert thought that it was spam and automatically sent it to the trash box, but since he rarely receives junk mail, he decided to risk the safety and security of his computer by opening the card. A colorful website popped out with the following message:

"Thank you for your time and cooperation during my interview with you, i have learned a lot more than i expected. Due to your knowledge of this career, i have earned a B- on my project."

Several minutes passed before Albert could figure out what this card was referring to, but by then the damage was done.

Our conclusions:
The boy is either...

a) genuinely happy with his project grade, it was well-deserved and an improvement over his previous work. We entertained the remote possibility that he may not be "the sharpest stick in the pile."

b) a junior high school genius with a refined literary wit to rival Jane Austen, whose nuanced expression of sarcasm and irony seeks to rebuke Albert for his lackluster interview.

Whatever the case, this short e-mail message is a masterpiece in its own right. The short, obligatory pleasantries, leading up to the witty and caustic phrase, "DUE TO YOUR KNOWLEDGE OF THIS CAREER," which seems to emphatically place the credit/blame on Albert's shoulders, collides at just the right moment with "earned a B-" The deliberate ambiguity of this boy's gratitude and satisfaction is the greatest punchline to a story that has spanned months.

What also makes me laugh is Albert's exceptional mentoring capabilities and his memory of the whole incident. It's heart-warming to consider that Albert's inspirational interview may have launched the academic career of yet another budding "medical scientist" at UCSF (class of 2034).

A Grape-Sized Tumor Called "Sonoma"

Visited Sonoma Valley last Saturday with Albert and Joyce, his friend from Amherst College. We had a late start, eating lunch at In'n'Out (Joyce has never been to the West Coast), before proceeding to Benziger Winery. Took a $10 tour at Benziger even though it was a rainy day, saw the beautiful vineyard, rolling hills, agrarian hillsides. Proceeded to the presses, wine caves, and the nice tasting room. Overall, we came away with half a case among the three of us (4 muscats, 1 buttery chardonnay, 1 port). The muscat tastes faintly of honey. :-)

Proceeded to Kenwood Winery, free tastings, the wine was okay but the prices were great. I bought a gurwertztraminer ($14) and a sparkling brut ($10) to make bellini or something fun later. Last stop was St. Francis Winery, a tasting menu heavy on the dry whites and reds. The best wine was the cabernet franc varietal, but at $45/bottle, I happily settled for the claret ($22). For dinner, we ate at the Red Grape in downtown Sonoma.

One of the best things about living in San Francisco and attending UCSF is the opportunity to visit Napa and Sonoma Valley. Wine country is good for the soul -- the beautiful landscapes, the peaceful vineyards, the delightful wine, the tasty foods.

It's a great idea that the UCSF MSTP admit weekend in early May will include a sojourn to Sonoma Valley. Sonoma is much less busy, commercial, and expensive than neighboring Napa Valley -- it's an interesting contrast and a fun place to visit if you like nature, plants, wine, fine food, and a dash of pretentiousness. Someday, I will write an essay on why I like wine so much, but for now, I just wanted to tell readers to ignore snooty wine drinkers and things like prices and ratings. The best rule of thumb is: "If the wine tastes good to you, then it's good." As in fine art, taste is always an individual and subjective luxury.

Is It Any Wonder?

Rat cerebellum from Nikon Microscopy U

Although Brain, Mind, and Behavior (BMB) has only started, this course already seems like it will be one of the most incredible courses of my academic career. At UCSF, we tend to study the body as organ systems, and for the longest time, our cadavers in lab seemed to reflect that piecewise academic philosphy. Our cadavers have always had their heads and hands wrapped tightly in white gauze, perhaps to obscure the most poignant and human aspects of the body until we medical students were more accustomed to working with dissection. Similarly, our courses on the heart, lungs, kidneys, and GI system have always shied away from the brain, the nervous system, and anything existing above the neck. Therefore, in my mind, the brain has existed as this black box throughout the first year of medical school, a topic that "we'll learn later in BMB."

BMB has already given me several mind-blowing experiences, but I will focus on two of them and they both occurred in the anatomy lab. The first one occurred when my anatomy group and I were inspecting the gross specimens of the brain, floating in buckets of formaldehyde. One of the brains was cut lengthwise, allowing us to see the cross-section. The cerebrum was interesting, but it was the intricate, leaf-like pattern of the cerebellum that caught my breath. Like parents amazed at how a little baby has dainty, perfectly formed fingers and toes...I was amazed at the precision and detail present on the inside surface of the cerebellum, patterns of loops and ridges that looked like perfectly sculpted branches of ocean coral or vivid fern leaves. Since I could not find a photo of a gross pathology specimen that could convey the beauty of the cerebellum, I had to settle for a fluorescent confocal microscopy image. In neurohistology today, we learned that early scientists called the cerebellum "the tree of life," and this reverence has also captured me in the same way.

The human body reminds me of the earth in many ways. A few months ago when we looked at the spinal cord, we cut a piece out and saw the nerve endings exiting the spine like little white roots (in fact the nerves are called rootlets). The white axons sprouting out of the brown, cakey flesh reminded me of seeing roots coming out of the dirt, and serves to remind me that we all return to the earth eventually.

My second epiphany occurred when I was watching the anatomy video in preparation for the second lab. It was 8 a.m. and I was sitting in my room at my desk wearing scrubs and eating breakfast and watching our professor pointing out different anatomical landmarks on a cadaver on my lap top. When I least expected it, the anatomy professor lifted away the skull cap and revealed a curtain-like dura mater. It was a whitish film. Then, the professor lifted away the dura to show us the BRAIN, and seeing that reddish, pinkish, purplish mass safely ensconced within the skull, finally exposed and radiant in all its brainy glory, made my whole mind stop in wonder for 10 seconds and I exhaled a long, breathy, "Wow." It was a moment of wonder, and I realized again medicine is the right choice for me. When we uncovered the skulls of our own cadaver during anatomy lab later that day, I was prepared to witness the brain's exposure, but it was still exciting to use a "brain knife" (ours looked like an oversized pate knife or butter knife) to cut our cadaver's brain in separate cross-sections. It was the best anatomy lab this year so far.

However, it was also the first lab in which we finally got a good view of the cadaver's face, which was a sobering moment because it makes me realize that every patient whom we interact with is a person with their own thoughts, emotions, and souls. Sometimes it bothers me that we have patient interviews with a "diabetes patient" or "mentally ill patient," because it restricts that person to the one dimension of their disease. Hence my internal battle between utilizing the utmost clinical concentration and the utmost compassion continues on.

Update on this Week

Monday - finished my application for the Dean's Summer Research Fellowship, did laundry.

Tuesday - watched as a classmate interviewed a patient with sarcoidosis in Foundations of Patient Care (FPC). the patient mentioned how she felt very isolated in the patient community by this rare disease, as though she were "in the chicken coop, and in the chicken family, but not exactly like every other chicken."

Wednesday - co-hosted a wednesday night dinner with 2 hosts and 12 guests (paella, banana cream pie from scratch, seared tuna/salmon with reduction sauce, virgin margaritas, apple spice cake from scratch, faux chicken, salad, mushrooms with avocado spread)

Thursday - completed a home visit for FPC with a wonderful elderly lady, took my first kickboxing class with my roommate at the UCSF gym

Studying has not yet begun for me, but Brain, Mind, and Behavior (BMB) started on Monday and it has been an intense ride ALREADY. My study habits are so ingrained in my behavior that I can't even bring myself to begin reading, I've become one of those ne'er-do-well kids in the back of the medical school bus. Actually, I think that I've always been in the back of the school bus.

However, someone joked to me that BMB is obviously coordinated by a group of men, because the competition is heating up. Now we have a daily "Case of the Day" at 8 a.m. sharp in the morning (we're technically not required to begin lecture until 8:10 a.m.) and we get to answer questions and email them to a special yahoo account until the 8 a.m. deadline the next day. Each case has a certain number of points assigned to it, and the student with the most points at the end of the course gets a T-shirt that says, "I am a HUGE NERD among nerds who likes to wake up early." Not really, the T-shirt says, "I won Case of the Day." But it means the same thing.

Another competition starting in BMB is to find typos or content errors in the BMB syllabus and have them posted on the online forum. The winner with the most corrections submitted will get a T-shirt that says, "I have OCD," and a dinner for two at a restaurant. If the class finds over 500 errors in the syllabus, the winner will receive a fancy dinner. If not, then the winner will get a meal at McDonald's, or something to that effect.

Even though I am not working too hard, I am getting anxious about being late in the morning, because D. Lo will stand at the door and give you disappointed/dirty looks and it makes me so scared! I respect D. Lo, and the incredible effort that he and his colleagues put into the course to make it phenomenal, so it's only fair that he ask for the same total dedication and fanaticism among his students. However, another part of me is also skeptical and wary of his mind games and unnecessarily complex competitions designed to whip us into an academic frenzy. That's just the paranoid conspiracy theorist in me.

Overall, however, BMB lectures have been AMAZING. On our first day of class, we witnessed an interview with a stroke patient and how he is physically affected...it was very powerful and moving. We have had TWO anatomy labs in TWO days. On the first day, we looked at brains in buckets. On the second day, we opened up the skull of our cadaver and removed the brain in sections. It was mind-blowing. Today, we had another patient interview with a psychiatric patient to described to us how her life unravelled when she began hearing voices and seeing faces and eyes. She described with perfect detail how this neutral voice would say "No" and hiss when she did something the voice did not approve of, and how it said "beautiful" on the rare occasions when she did something it did approve of. And she believed that her internal turmoil was responsible for external events in the real world, like tornados, and that if she moved the salt and pepper shakers a certain way, it would affect the state of the universe. This incredible insight into the experiences of this patient, who is now fairly recovered and living a normal life, was a precious opportunity. Everything in BMB leaves me speechless and astounded, because the human mind itself is so amazing.

Structured Procrastination

Procrastinator Mousepad

Paraphernalia from Structuredprocrastination.com

Read an entertaining essay on "Stuctured Procrastination" written by John Perry at Stanford. Please refer to the link to see the whole essay, but I will paste the gist of it here:

"This is the essence of what I call structured procrastination, an amazing strategy I have discovered that converts procrastinators into effective human beings, respected and admired for all that they can accomplish and the good use they make of time. All procrastinators put off things they have to do. Structured procrastination is the art of making this bad trait work for you. The key idea is that procrastinating does not mean doing absolutely nothing. Procrastinators seldom do absolutely nothing; they do marginally useful things, like gardening or sharpening pencils or making a diagram of how they will reorganize their files when they get around to it...

The list of tasks one has in mind will be ordered by importance. Tasks that seem most urgent and important are on top. But there are also worthwhile tasks to perform lower down on the list. Doing these tasks becomes a way of not doing the things higher up on the list. With this sort of appropriate task structure, the procrastinator becomes a useful citizen. Indeed, the procrastinator can even acquire, as I have, a reputation for getting a lot done."

Ah-HA. I must revise my earlier self-diagnosis...I am NOT an academic bulimic...I am a STRUCTURED PROCRASTINATOR/ACADEMIC BULIMIC. Because it is true that studying...like closet space...will expand to fill the space allotted to it. And so it is much easier to get things done and out of the way earlier in the academic cycle before school rears its head. Unfortunately for me, the important thing at the top of my list is always "studying."

A Game of Chess

From Winding Roads Visual Art

Dr. Daniel Lowenstein (D.Lo) told our class a story yesterday during our first day of Brain, Mind, and Behavior (BMB):

"Once upon a time, there was once a traveler searching for the meaning of life, and he heard that there was a great Zen master who possessed an especially deep understanding of the essential. So the traveler journeyed up the mountain and stayed at the monastery where the Zen master lived, and spent many years enjoying life there and learning. Many of the people at the monastery had never lived anywhere else, and the traveler was delighted to learn that one of the favorite pasttimes at the monastery was playing chess. Since the traveler himself was quite good at chess, he spent many days playing with the monks.

One day, the traveler finally meets the great Zen master. The Zen master invites the traveler to play a game of chess, but warns the traveler that whomever loses the game will be exiled from the monastery forever. The traveler agrees and the two begin playing. At first, the traveler finds himself with the upper hand, and realizes that he is very close to defeating the Zen master. However, he soon becomes lost in thought, wondering why the Zen master would agree to this game, how much the monastery must mean to him after all these years, and how the Zen master would live in exile. Before the traveler could finish these thoughts, he looked down at the chess board and realized that he was now losing. The traveler refocused his attention to the game and barely brought himself back from the brink of defeat, before those intrusive, worrisome thoughts again clouded his mind and he found himself losing again. However, the traveler was able to turn the tide of the game once again with enough concentration, and this cycle continued for several more hours before the Zen master used his stick to knock the chess board off of the table with a mighty "thwack."

'That,' said the Zen master, 'is the secret to living life with the greatest meaning...by living with both the greatest concentration and the greatest compassion.'"

D. Lo continued by saying that as doctors, we must live life with the greatest concentration and the greatest compassion. The dichotomy between science and the humanities has always fascinated me, because medicine is truly the intersection between science and society.

When people asked me why I wanted to be a doctor (usually during an interview), I said that it was the personal stories of patients that fascinated me and the idea that I could somehow intervene and change that story for the better.

An NG Tube, Fancy Soaps, and a Mash-Up...Not Your Typical Three-Day Weekend

Hydra soap from the SF neighborhood collection: Sunset

Hydra soap from the SF neighborhood collection: Golden Gate

I actually believed that the three-day weekend following the Metabolism and Nutrition final exam was going to be extremely boring. Since Paul and Albert fled to Canada after the exam (I'd like to think that it was caused by something glamorous like tax evasion, a federal offense, but it was really more like food tourism in Paul's hometown), I planned for three days of absolute bliss and nothingness...like those lazy childhood afternoons that were blissfully wasted watching TV in a small windowless room.

God, I was so wrong. But in a good way...

So here is a blow-by-blow recap of an action-packed weekend:

THURSDAY (3 hours of sleep)

8 a.m.-12 p.m. Metabolism and Nutrition Exam

- Visited my PedPAL at the hospital, she is 14 years old, but she weighs only 60 lbs. because her mouth hurts from Graft-versus-Host disease (GVHD) and she has been unable to eat on her own. When I came to visit her today, bringing fresh irises and a teenage magazine called CosmoGirl (which I carefully screened before purchasing), she was sporting a new nasogastric (NG) feeding tube. It made me really sad, and she's getting a more permanent PEG tube in a few days.

- Took a shuttle to Mt. Zion to pick up a letter of support, then decided to walk to Fillmore St. to see the boutiques. The walk was longer than expected, but the weather was nice and it was fun to roam the city. The best new find on Fillmore was a fancy soap shop called "Hydra," which specializes in custom designs and scents. The gimmick that really won me over was their SF Neighborhood Collection, which has soaps named after each SF neighborhood and a corresponding scent (e.g. the Marina soap smells like the ocean, the North Beach soap smells like coffee, the Haight-Ashbury soap smells like incense, there's also soaps for Sunset, Castro, Twin Peaks, Fisherman's Wharf, Mission, SoMa, etc.).

- Came home, napped for 1 hour, before attending a merry medical school class get-together in the evening, went to bed at 1 a.m.

- Did I mention that this is a UCSF sponsored blog?

FRIDAY

- Woke up around 8:20 a.m. to the call of my classmate Craig and Sarah, fellow MedTeach volunteers. We traveled to Alamo Elementary School in the Richmond District (hmm, no Hydra soap for Richmond!) to teach 4th and 5th grade students about the cardiovascular and respiratory system. We brought real pathology specimens and taught them about heart attacks, listening to heart sounds with stethoscopes, looking at red blood cells in microscopes, the dangers of smoking, and how breathing through a hollow licorice tube is analogous to asthma. The lessons were so fun, and the kids were really smart.

Here are some of my favorite quotes:

Me: "What is a heart attack?"

Kid: "When something attacks your heart."

Me: "Almost."

Me: "The heart has a big room where it pumps out blood."

Kid: "You mean the ventricle?"

Me: "Uhhh, yeah."

Me: "Do you know what's inside a cigarette?"

Kid: "Marijuana!"

Me: "No. Where did you hear that?"

So we ended at 3 p.m., and after teaching 16 separate lessons to little groups of eager elementary school children, I decided that being a teacher or pediatrician is too demanding. It's not that I don't like kids, in fact, I LOVE kids, but the amount of patience, dedication, and hard work that goes into raising 33 kids simultaneously is something that gives me the heebie jeebies right now.

After MedTeach, I went home to change and nap for 30 minutes before going to a $20 dinner at Palomino's on the Embarcadero with my roommate and her friends. It was a delicious dinner. Then I went to get gelato at Holy Gelato on 9th and Parnassus with my college roommate, Kim. We met at 9:30 p.m. and decided to head back to my place after a proposed bonfire at Ocean Beach was postponed to a later date. We talked for FIVE straight hours, until 2:30 a.m. about EVERYTHING...I can't even begin to summarize the crazy ideas passing between us. We talked about life after death, the dichotamous nature of the world (why is it always good/evil, man/woman, life/death? Would our conceptual framework be different if there were three sexes necessary for reproduction...say, man, woman, and fox?), Maslow's pyramid of needs and the value of high art. Then we got creeped out by talking about souls and decided to watch the Top 20 VH1 countdown. One thing that was strange was that Kim has been reading the same news articles that I have been reading...the Post article on Josh Bell, the NYT article on perfect high school girls, another article on the Flaw-O-Matic...we didn't share any articles between us, promise.

SATURDAY

I fell asleep around 3:30 a.m. -- Woke up at 3:30 p.m. on Saturday.

Checked my email, ate some lunch.

Fell back asleep from 5-9 p.m.

Attended a mash-up called Bootie SF with some friends from medical school. A few weeks ago in Vegas, a girl accidentally burned my right index finger with her cigarette while clubbing at TAO. It was an accident, but it was bizarre. Saturday night, while dancing at Bootie SF, DJ Axel from LA was throwing copies of his new album into the crowd. I raised my arm to get one, and he threw one at me, but the CD hit me in the face and cut my left cheek. And I STILL didn't get the CD. Yet another entertaining nighttime injury. I'm going to be like one of those biker pirates with a leather eyepatch and a story behind every scar. Chicks dig scars, right?

Fell asleep at 4:30 a.m.

SUNDAY

- Woke up at 11 a.m.

- Visited my PedPAL again and we continued working on our Paint-by-Numbers project of a ballerina painting. We're running out of white pigment, but the painting is turning out nicely.

- Shopped in Union Square with Irene and Elaine.

Wow, so that was my weekend.

Academic Bulimia

Disturbing bulimia photo from lecture

Our final in Metabolism and Nutrition was today; it covered an interesting span of topics ranging from endocrinology, metabolic pathways (glycolysis, TCA, beta oxidation, ketogenesis, LDL, VLDL, etc.), diabetes mellitus, and obesity/weight management issues. Although I complained continually at first that these topics were completely unrelated to each other, there are links between each area (mainly insulin or lack thereof) that actually tie the curriculum together in a rather enlightened manner.

One of our later lectures on the theme of weight management involved discussions on eating disorders like anorexia nervosa and bulimia nervosa. Although nutrition has never interested me (the food pyramid can eat itself), I am fascinated by disorders in which perfectly normal girls (sorry for the sexism) starve themselves to death in a land of plenty.

Although I have never had any eating disorders, the cycle of binging and purging associated with bulimia seemed awfully familiar even as I was cramming that syllabus chapter into the small space between my ears. Periods of intense binging...and then a subsequent purging? Yes, ladies and gentlemen, I realized that I have been a lifelong ACADEMIC bulimic since preschool. Like a circadian rhythm dictated by exam schedules, my life follows a regular cycle of compression (pain, stress, angst) and decompression (happiness, denial, sloth).

Here are some interesting posters on the medical consequences of anorexia and bulimia.

The Microcosm of the Library

Fourth floor lobby of the UCSF library

Awesome natural lighting, sometimes you can spy on the basic science laboratories in the medical sciences building across the street. The dark windows at night belong to tenured faculty, the lighted windows belong to non-tenured faculty, or so we hypothesize.

Fourth floor reading room (nook/cranny)

Never read in here, but the chairs look comfy.

Fifth floor "Annex"/Corner office view of San Francisco

Quiet study area, can get chilly due to A/C, awesome view of the sunset around 5-6 p.m. Beautiful vaulted roof, home of "Santa Claus."

All photos courtesy of Alice Prussin Lighting Design

In dire times, I begin studying at the beautiful UCSF library and I always forget how the library is an amazing little microcosm unto itself. On the outside, the library seems pretty basic and non-descript, especially compared to Widener library's imposing neoclassical marble columns, but its greatest strengths inside lie in its unbeatable views of San Francisco and roomy/elegant atmosphere. As a library aficionado, I would rate the UCSF library extremely highly on my list of medical school libraries (okay, you can stop barfing now).

There are some interesting things about the library that I wanted to point out:

1) I never call the UCSF library by its real name, maybe because its the main library

2) The windows are lined by red latticework, which looks so pretty against the green evergreens outside and reminded me one afternoon that the red windows resemble the pylons of the Golden Gate Bridge...inadvertently?

3) On the 3rd main floor, there is a beautiful large window that looks like a picture frame, containing the Golden Gate Bridge outside.

4) The library is built on the steep slope (like almost anything at UCSF and San Francisco), so the 3rd floor is the main floor and every floor has a fantastic and unique view.

5) The chairs have cushions and there are plenty of tables...most of the time

6) Anyone (the general public) is welcome at the UCSF library, which differs markedly from the library policy at Harvard, where they force you to swipe your ID card, walk through a security booth, register any outside guests in a logbook, and force you to unzip your backpack and reveal all of your belongings and possibly stolen library books upon exit. The Harvard libraries must be up to code Orange by now.

Anyway, at UCSF, everyone is welcome, but eccentric people (some of them homeless) will often infiltrate the library and make life more interesting. This afternoon, a homeless man who was snoring loudly on the 3rd floor had to be escorted out by library security because he was disturbing other people. It made me a little sad.

Albert, who spends far more time at the library than I do, swears that there are at least two men who LIVE at the library:

- a man with crazy white hair who looks eccentric, dubbed by Albert as "Demented Einstein"

- a man with white hair and a white beard, always wearing a red sweatshirt and living at the fifth floor annex reading newspapers and sleeping, dubbed by Albert as "Santa Claus," I argued that he also looked "Hemingway-esque."

In the past months, Albert has become more intrigued by these two characters.

He swears that the two men LIVE at the library, that they NEVER leave, and that it's so WEIRD. Is it possible that they're bums?

I looked at Albert and said, "Takes one to know one."

Amazing Grace

"Amazing Grace" by Philosophy

Someone once defined the difference between justice and mercy to me as:

justice = getting what you deserve (can be a good thing or a bad thing) and...

mercy/grace = NOT getting what you deserve (can be a good thing or a bad thing).

Justice makes the most sense to me...because it posits that whatever you do, there is an appropriate repercussion or reward for it. Mercy has always intrigued me because it makes no logical sense...why do people who work hard never receive their rewards? Or why do people who do bad things receive forgiveness? Interestingly, it is with mercy that we see the greatest tragedies and miracles; it throws a wrench into the whole logical order of the world and seems to paradoxically argue for both the absence and presence of God himself.

The best definition of grace for me has been derived from a best-selling bath product by Philosophy (by the way, it is sad to me that the first site to pop up on Google when I search "philosophy" is a bath and cosmetics company...and even sadder to me that it was exactly what I was looking for):

philosophy®: life is a classroom. we are both student and teacher. each day is a test. and each day we receive a passing or failing grade in one particular subject: grace. grace is compassion, gratitude, surrender, faith, forgiveness, good manners, reverence, and the list goes on. it's something money can't buy and credentials rarely produce. being the smartest, the prettiest, the most talented, the richest, or even the poorest, can't help. being a humble person and being a helpful person can guide you through your days with grace and gratitude

I only mention the topic of amazing grace today because I messed up this morning and overslept something important, but sometimes in life you receive these unexpected mercies and it's important for me to remember how to behave with grace and pass on this gift to others in the future. I am so thankful for my classmates.

To bring this topic back to the medical field, it's important for doctors to behave with grace and you can see examples of grace/mercy at every turn. As a medical student learning about so many diseases and complications, you wonder why so many people are suffering and ponder how no one deserves it. On the other side, medical school emphasizes how we should give every patient the benefit of the doubt -- their home situation, homelessness, IV drug use, addictions, social support, and family history -- in order to render him/her better treatment and how to treat patients with the utmost compassion.

Mercy is an interesting topic to think about in the setting of ethical dilemmas surrounding liver transplantations, etc. Does a man who destroyed his liver through alcohol deserve a new organ? According to the chief of transplant surgery at UCSF, yes, it's very common as long as the patient demonstrates a commitment to sobriety for a set amount of time prior to the transplant. On the UCSF main website, there is an interesting article about whether addiction should be considered a biological and psychological disease and questions why we punish alcoholics and other addicts (see website on right hand bar on this page).

Edit: Our apartment building held an informal multi-level potluck on Friday night and it was a lot of fun. :-) While talking to a classmate in the elevator at school, I mentioned how although I was miserably behind in the syllabus, I would study as soon as the potluck was over. A bystander, a middle-aged woman, looked at me in the elevator and snorted, "Dream on." Thanks, ma'am, for the reality check.

Typical Wednesday: Diabetes, Fourth Graders, and PCR

Autobiography cover from the Kary Mullis website

8 a.m. - 9 a.m. Lecture on nutrition for critically ill patients

9 a.m. -10 a.m. Lecture on the ethics of tube feeding

10 a.m.-12 p.m. Lecture on the management of Type I diabetes

12 p.m. - 1 p.m. Basic Science Journal Club on glycosylation (or lack thereof) and its effect on diabetes...because there wasn't enough talk about diabetes in the morning...haha...

1 p.m. - 2 p.m. Bumming

2 p.m. - 4:30 p.m. MedTeach meeting, planning lessons for fourth and fifth grade students in a local SF elementary school on the basics of the heart/circulatory system and lungs/respiratory system. A team of 3 med students (including me) walked over to a resource center located in the middle of the wilderness behind UCSF and reserved some gross pathology specimens, posters, etc.

4:30 - 5:30 p.m. Writing emails and chillin' like a villain

5:30-7 p.m. Informal session on the methods of polymerase chain reaction (PCR) held by the invariably humble and intelligent MSTP's in our class. When I first learned about PCR in college, the professor had a slide with the above image (the cover of Kary Mullis' autobiography) and spent 5 minutes talking about how this Nobel Prize winner is a nut job. However, Mullis knew what he was doing; his book cover did make in impact on me, because now whenever I think about PCR, I think about Kary Mullis and this image of him as a crazy surfer comes up in my brain. His title, "Dancing Naked in the Mind Field," is equally unintelligible...and probably reflects the spirit of a free thinker...or a mad man. Genius is a fine line to walk, I suppose.

Geez, will I ever be able to open the syllabus and start reading?

T-minus 7 days until the GI final exam. Where the hell does all of my time go?

Oh, right, see above (and below and this very site).

Seder

Matzah Cartoon from DryBonesProject

Enjoyed a lovely potluck Seder dinner from 7-10 p.m. tonight hosted by classmates. It was delicious and wonderful. Great food and great company really make me happy. It was my first Seder dinner and my first taste of Matzah ball soup! Mmmm, good.

Here are the 15 Steps of Seder which I learned about tonight from my classmates (information below from Seder.org):

1. KADESH:
A) SIMPLE DESCRIPTION: Drink wine.
B) SLIGHTLY MORE: A special blessing is recited over a glass of wine that speaks of the role all holidays play in Jewish life. Recite the following blessings (the second blessing on the first night only), then drink the first glass of wine.

Baruch attah Adonai, eloheynu melech ha-olam, boray p'ri ha-gafen.
Blessed are You, our God, King of the Universe, Who creates the fruit of the vine.
Baruch attah Adonai, eloheynu melech ha-olam, she-he-he-yanu, ve-kiy'manu, ve-higi-anu la-z'man ha-zeh.

Blessed are You, our God, King of the Universe, Who has kept us alive, sustained us and brought us to this specific time.

2. URECHATZ:
A) SIMPLE DESCRIPTION: Wash hands.
B) SLIGHTLY MORE: Fill a large cup with water. Pour twice on right hand and twice on left hand. Dry hands.

3. KARPAS:
A) SIMPLE DESCRIPTION: Dip veggie in salt water and eat.
B) SLIGHTLY MORE: Dip veggie in salt water. The veggies represent the Spring, rebirth and a flourishing existence. The salt water represents the tears of our forefathers. Recite the following blessing and eat:

Baruch attah Adonai, elohaynu melech ha-olam, boray p'ri ha-adamah.

Blessed are You, our God, King of the Universe, who creates the fruit of the ground.

4. YACHATZ:
A) SIMPLE DESCRIPTION: Break middle matzah (see "SET UP")
B) SLIGHTLY MORE: The middle matzah (see "SET UP") is broken in half to remind us that as slaves in

5. MAGGID:
A) SIMPLE DESCRIPTION: Read the Haggadah. Tell the story of Passover. Drink second glass of wine.
B) SLIGHTLY MORE: Read the Haggadah (which literally means "to tell), tell the story of the exodus from Egypt and explore the origins of our people and the meaning of our Jewish identity. Spend time reflecting on what freedom means to you personally. Include...
...the "Four Questions" of why this night is different from all other nights:
Q1) On all other nights we eat leavened bread AND matzah, on this night, why ONLY matzah?
A1) Matzah reminds us that when the Jews left Egypt they had no time to bake their bread. They took the dough on their journey and baked it in the hot desert sun into hard crackers called matzah.
Q2) On all other nights we eat VARIOUS veggies and herbs, on this night, why only BITTER ones?
A2) Bitter herbs remind us of the cruelty the Jewish people endured during their slavery in Egypt.
Q3) On all other nights we do not dip one food into another even ONCE, on this night, why dip TWICE?
A3)We dip bitter herbs into charoset to remind us of how hard the Jews were forced to work as slaves in Egypt. The chopped apples and nuts of the charoset represent the bricks and mortar they used to build the Pharoah's city. When we dip veggies in salt water, the veggies remind us that spring is here and new life will grow while the salt water reminds us of the tears of the Jewish slaves.
Q4) On all other nights we either sit OR recline, on this night, why ONLY recline?
A4) We lean on a pillow to be comfortable so that we are reminded that while once we were slaves, now we are free.
...the 10 plagues that ultimately led to our freedom:
1. blood
2. frogs
3. lice
4. wild beasts
5. pestilence
6. boils
7. hail
8. locusts
9. darkness
10. death of firstborn
...and finally, recite the following blessing, then drink the second glass of wine:

Baruch attah Adonai, eloheynu melech ha-olam, boray p'ri ha-gafen.

Blessed are You, our God, King of the Universe, Who creates the fruit of the vine.
(For information about the other elements of the Passover story, view www.kosher4passover.com)

6. RACHTZAH:
A) SIMPLE DESCRIPTION: Wash hands.
B) SLIGHTLY MORE: Wash hands and recite the following:

Baruch attah Adonai, eloheynu melech ha-olam, asher kid-shanu b'mitzvo-tav, ve-tzivanu al ne-tilat yada-yim.

Blessed are You, our God, King of the Universe, who has sanctified us with His commandments, and commanded us with the washing of the hands.

7. MOTZI:
A) SIMPLE DESCRIPTION: Say blessing over matzah.
B) SLIGHTLY MORE: Recite the following blessing over the matzah:

Baruch attah Adonai, eloheynu melech ha-olam, ha-motzi lechen min ha-aretz.

Blessed are You, our God, King of the Universe, who brings forth bread from the ground.

8. MATZAH:
A) SIMPLE DESCRIPTION: Eat Matzah.
B) SLIGHTLY MORE: Recite the following blessing, then eat matzah, in accordance with the commandment to eat matzah on the night of Passover:

Baruch attah Adonai, eloheynu melech ha-olam, asher kid-shanu b'mitzvo-tav, ve-tzivanu al achilat matzah.

Blessed are You, our God, King of the Universe, who has sanctified us with his commandments, and has commanded us with the eating of matzah.

9. MAROR:
A) SIMPLE DESCRIPTION: Eat bitter herbs.
B) SLIGHTLY MORE: Recite the following blessing, then eat bitter herbs, which remind us of the bitterness of slavery:

Baruch attah Adonai, eloheynu melech ha-olam, asher kid-shanu b'mitzvo-tav, ve-tzivanu al achilat maror.

Blessed are You, our God, King of the Universe, who has sanctified us with his commandments, and commanded us with the eating of maror.

10. KORECH:
A) SIMPLE DESCRIPTION: Eat matzah, bitter herbs and charoset (sweet) together.
B) SLIGHTLY MORE: Having just eaten matzah and bitter herbs separately, now eat them together with charoset as a sandwich. This combines three important symbols of Passover – matzah, which is unleavened to remind us of the haste with which our forefathers fled Egypt, bitter herbs which remind us of the bitterness of slavery and charoset, the consistency of which represents the bricks and mortar used by Jewish slaves in Egypt and the sweetness of which represents freedom.

11. SHULCHAN ORECH:
A) SIMPLE DESCRIPTION: EAT!
B)SLIGHTLY MORE: EAT! But leave room for the after-dinner matzah, the afikomen.

12. TZAFON:
A) SIMPLE DESCRIPTION: Eat the remaining matzah.
B) SLIGHTLY MORE: The afikomen, which had been put away (or hidden) earlier, is now brought back and everyone eats a piece as his or her own personal afikomen.

13. BARECH:
A) SIMPLE DESCRIPTION: Meal is over. Drink third glass of wine.
B) SLIGHTLY MORE: The blessing after meals is recited expressing our gratitude to God. We recite the following blessing, then drink the third glass of wine:
Baruch attah Adonai, eloheynu melech ha-olam, boray p'ri ha-gafen.
Blessed are You, our God, King of the Universe, Who creates the fruit of the vine.
We also now pour an extra glass of wine for "Elijah, The Prophet" who represents the Messiah, and we open our front door, briefly, allowing him to enter.

14. HALLEL:
A) SIMPLE DESCRIPTION: Sing songs. Drink fourth glass of wine.
B) SLIGHTLY MORE: The "Songs of Praise," authored by King David, are recited. Recite the following blessing, then drink fourth glass of wine:
Baruch attah Adonai, eloheynu melech ha-olam, boray p'ri ha-gafen.
Blessed are You, our God, King of the Universe, Who creates the fruit of the vine.

15. NIRTZAH:
A) SIMPLE DESCRIPTION: Give thanks.
B) SLIGHTLY MORE: We pray that we have successfully fulfilled all the observances of the Seder. We seal our hopes for a brighter future with the words, "Next year in Jerusalem."

Ocean Beach Photos by Kim

The other sunset photo was from a Habitat in Humanity mission to Michigan in April 2005. Psych. This one is a real photo of the sunset seen last weekend at Ocean Beach (such a creative name for a beach; the name is just one step above Beach Beach, haha) If you come to UCSF, you can see the beach everyday...if you really really wanted to. The nice thing about sunsets is not the sun itself (which is setting in a glorious fiery finale), but the way that the sunset tranforms the whole sky into a symphony of colors.

The beautiful texture of the sand.

Albert: "You can take a macro picture of the sand ripples and tell people that you went to the Sahara!"

Kim: "Yeah, or I could just tell them that I went to the Sahara..."

Paul and I playing "wave chicken" with the tide.

Aforementioned tide.

Paul and me playing at the edge of the water. I look like Cousin It and and it looks like the sun took a bite out of Paul's head, but it's a nice picture.

Tasty seafoam (isn't that supposed to be a green color?)

The sun setting.

Stephanie: "I'm curious about the ocean."

Paul: "It's only two blocks away..."

[we walk to Ocean Beach via Golden Gate Park]

Stephanie: "Is the sun down yet?? It's cold!!"

Meanwhile, the moonrise was happening on the other side of the sky.

New Beginnings

Figure 17: ‘Piece’ on a handball court, from left to right: “Daze,” “Cope,” “TKid.”
Peter Rosenstein, unknown title (c. 2006), in Tattooed Walls, Peter Rosenstein (Jackson: University Press of Mississippi, 2006)

A cool graffiti picture from Samantha's thesis. :-) It has inspired me to redo my blog page, more minimalist & edgy. Of course, my skill on the computer is on par with a gerbil's, but I tried my best.

Lately, I've been sort of a downer, so I'll try to be more upbeat in future posts and bring back that Stephanie humor that we all know and love.

The first goal is to pass medical school.

Sunday and Endings

The picture above was taken last summer in downtown Los Angeles to document random graffiti for my sister's art history thesis. She is writing an undergraduate thesis at the University of Chicago on the artistic value of illegal street art; and that baby is due tomorrow! Good luck, Samantha!

I woke up at noon today (surprise), worked a little bit on odds and ends before grabbing lunch at the Canvas Gallery with my favorite girl, Kim, around 1:30 p.m.

It was a meal that strangely focused on the theme of endings (at least for me it did)...the Canvas Gallery closing, a long weekend slowly ending, a year gone by in the blink of an eye. Kim (my favorite partner in the metaphysical journey known as life) mentioned how a year is both a long and a short amount of time, and how so many things can happen within the space of 12 months and yet how it's paradoxically not a very long time at all. We talked about daylight savings time and how Kim was upset about losing an hour to talk to her friend in Germany due to daylight savings. It makes me realize that time = love, even more than time = money.

This seemed especially poignant today, because it was the first anniversary of a friend's death, a gifted friend from high school who was preparing to take over my job at Stanford last year before passing away unexpectedly while whitewater rafting in Peru over spring break. Time is a strange beast, and it feels like the most precious thing in the world. We squander it.

After lunch, I went home to squander a bit more time before heading over to Paul's for a quiet dinner around 7 p.m. Did I mention how my life is a long sequence of eating delicious food? If you haven't noticed already, my life amounts to 40% eating, 30% class, 10% blogging, and 20% studying. I rarely talk about medicine because (a) I'm not studying and (b) it's boring to talk about studying.

We had a delicious dinner right after watching the sunset over the buildings of San Francisco. Albert, a sunset watching enthusiast (especially from the nerdy vantage point of the library), likes to say, "They don't call our neighborhood 'Inner Sunset' for nothing." Watching the sun go down reminded me that another day has gone by, and then I remembered how beautiful the sunset was yesterday over the Pacific Ocean...and how there is a certain special quality to seeing the sun go down over a salt water horizon without any man-made buildings in the way. An unadulterated sunset. Those kind of moments stick with you for a long time.

Orange-Colored Day

Woke up at 12 p.m. today when Kim called me from the Farmer's Market at the Embarcadero. We were going to grab lunch at the Canvas Gallery, when Albert and Paul contacted me about brunch at a Chinese restaurant on 20-something street. It occurred to me that we could join forces, and we had a big meal at the Chinese restaurant. We were so full of food that we had to rest, so we hung out at Paul's and watched "Amelie," a movie that Kim introduced me to during the first month of college and which I have always loved since. Then, we wanted to take advantage of the day and walk in Golden Gate Park...it was like a game of "If you give a mouse a cookie," because then we decided that we were very close to the ocean, and we wanted to walk through the park to the ocean. We walked most of the way, then took the muni a few blocks, and caught a view of the sunset over Ocean Beach. The sun was like a giant orange egg yolk moving behind the clouds, and we frolicked on the freezing cold sand. Then we took the Muni home, Kim went home to cook dinner for her brothers and her, and we ate at a Chinese vegetarian restaurant called Good Vegetarian Restaurant on 12th and Kirkham that was really really tasty. The tofu really tasted like meat...wow...it was so good.

To take a quote from "Amelie,"

it was a beautiful orange-colored day.