I Heart Kids

The third pediatric preceptor session took place this afternoon, and even though the community clinic is located in Oakland and I have to take the Muni, Bart, and bus to get there...I actually don't mind that much because 1) I really like my preceptor 2) I really like the site and 3) 4 sessions is totally do-able. Today, we focused on developmental stages and learning how to use the Denver II charts for well-child visits, etc. What amazes me is that I didn't see a single English-speaking patient/family today! Through a combination of Spanish, Mandarin, and Cantonese (this one with an interpreter), my preceptor and I interviewed the parents of a 2 month-old, 17-month-old, 2-year-old, 6-year-old, and 3-year-old. It really is gratifying to work at a community clinic, especially with little kids!

Speaking of tweens, I learned that my PedPAL is still in the hospital after a month. She had aplastic anemia and a bone marrow transplant about 18 months ago, but she seems to be at the hospital more often lately. Since she can't go back to school or have much contact with the outside world, it feels to me like much of her life has been postponed or put on hold until she's more healthy, but as a result most of the time she seems very bored (at home and at the hospital). I'm not quite sure how to alleviate her boredom, I wonder if she's read Harry Potter yet.

Thoughts on Cancer

Cancer has always fascinated me on both a scientific and non-scientific level. As a deranged cellular process, the disease reveals an intricate system of checks and balances and underscores how little we actually know about the maddeningly complex “cross-talk” that Bruce Alberts compared to cell “thinking.”

Until last year, I considered cancer to be an isolated biological process. It was easy to see how the cell cycle can be sabotaged, how certain checkpoints can be bypassed and normal cellular proliferation permitted to run amok. In my head, there was a solid cadre of proteins automatically associated with cancer…p53, Bcl-2, Rb.

However, a syllabus chapter on neoplasms last year changed my view of cancer cells by pulling together information in a suggestive fashion. In normal tissue like the gut or skin, we have stem cells that continually divide into daughter stem cells and cells destined to terminally differentiate and die. Only these stem cells enjoy limitless replicative potential, and differentiation means that the cell has a one-way ticket to dying without any heirs. The syllabus also talked about how cancers can be pathologically graded based on differentiation, and that less differentiated cancers are fiercer adversaries – as though the degree to which a cell has regressed back from its terminally differentiated state reflects how feral and uncontrollable the cell has become.

And then I wondered if cancer cells had achieved the impossible…did they manage to somehow reverse the laws of nature and learn how to de-differentiate in a misguided bid for “stem cell-hood” and immortality?

In another tangent, I had never been interested in the links between inflammation and cancer until an analysis from a pilot project at Stanford showed that the only proteins associated with survival were two cytokines, IL-1 and IL-7. Suddenly, I was interested in how inflammation can affect cancer survival. The connection had never been vitally interesting before, even though it was also mentioned in the syllabus in passing. Another event that sparked my interest in the connection between immunity and cancer was writing about an ongoing UCSF brain tumor vaccine trial for Synapse, which described harvesting the tumor cells and cultivating protein complexes to boost immune response to the tumor. Although it still seems unclear to me how the whole immune system vs. cancer situation exactly works, I really like the connections.

No one else will agree with me, but the most outstanding lectures in Cancer block so far were given by Dr. Doug Hanahan on the topics of angiogenesis and metastasis. For some reason, his lectures really seemed to address where my thoughts on cancer biology have been turning to. There was an interesting mention of an “angiogenic switch” and the idea that there are “bad” inflammatory cells, fibroblasts, etc. that somehow aid cancer cells. In the metastasis lecture, I was intrigued by the notion that metastasis resembles a “re-awakening” of the far-flung migratory habits of cells during embryonic development. Re-reading Hanahan’s syllabus chapters made me intellectually excited. In the end, these two processes – angiogenesis and metastasis – are two of the keys to fully understanding cancer and how to cure it.

Busy Busy

The last week has been hectic:

Nov. 16 - gave a presentation on summer research for a shot at the Dean's Prize
Nov. 16 - flew to JFK and hurried to New Haven, CT for the Harvard-Yale game
Nov. 19 - spent 12 hours getting back from Yale to San Francisco
Nov. 20 - studied and took a Cancer midterm (plain crazy), then stayed up until 3:30 am finishing the last problem set for Biostatistics 183 (an imaginary grad course that I am auditing for no reason, sheer insanity). Found out that my project won the Dean's Prize! (there were 4 recipients this year!)
Nov. 21 - flew home to LA in the early morn
Nov. 21-24 - saw family, ate lots of food, shopped

Harvard-Yale 07

Yale Med Tailgate
Blockies!
"Rushing" the field after a 37-6 victory over Yale

Thanks for a fabulous weekend, Kim!

Class Play Videos

For your viewing pleasure...http://www.youtube.com/user/ucsf2010

Let the Trash Talk Begin

Harvard-Yale 2005

So...it seems strange that even when you leave Harvard...you can't really leave it behind. :)

No matter how much I might roll my eyes or moan and groan about undergrad, it's important to point out that my spine stiffens a little when a med classmate mentions Harvard basketball's recent...how do i put this delicately...total spanking at the hands of Stanford (111-56) last friday. Even being generously endowed can't seem to help Harvard basketball players. But at least we're well-endowed.

Anyway, I only mention this because I am flying into New Haven this Friday evening for a blockmate reunion at the Harvard-Yale football game (better known as the Game, which is sort of pretentious for two really mediocre football teams duking it out in subzero weather while everyone else is tailgating). Harvard-Yale is only marginally about football and bragging rights to the victor...it's more like Woodstock for the Ivy League...a reason to reunite with friends, drink beer, and take part in a time-honored ritual of pretentious aping and snooty trash talk against the Pepsi of the Ivy League...that annoying younger school, Yale. Boy, I wouldn't miss it for the world.

Here is an Op/Ed from today's Harvard Crimson, not sure that it's entirely correct:

The Real Difference
All universities are equal, but some are more equal than others

Published On Tuesday, November 13, 2007 12:50 AM
By ALEXANDRA A. PETRI
Contributing Writer

Every November, Harvard and Yale attempt to set up the impending Game as an epic battle of Good vs. Evil, Luke Skywalker vs. Darth Vader, or Plucky Underdogs vs. Bulldogs. But every year the actual struggle seems more like Hatfield vs. McCoy, Montague vs. Capulet, or Luke vs. That Masked Vader-Like Figure in Empire Strikes Back That Actually Turns Out to Be Luke’s Psyche (Or Something). Are we just fighting ourselves? Or is this indeed an epic smackdown between the representatives of two vitally different ideals?

Even those who liken Harvard and Yale to twins have to admit that no twins are truly identical. For instance, some twins have different genders or different personalities. Other twins are separated at birth and then reunited in Shakespearean comedies. So, what makes John Harvard different from Eli Yale? Personality? Gender? Or something else altogether, like Eli’s birth defect?

According to Facebook’s Network Top Ten statistics, there are some subtle but meaningful distinctions between the average Harvardian and the average Yalie. On a typical day, Joe “Eli” Yale relaxes to the music of his favorite artists, U2 (Yale’s #1, Harvard’s #2), The Beatles (#3 and #5, respectively), and, of course, Beethoven (Yale’s #7; not on Harvard’s list). He engages in his favorite activities—reading, politics, and music, in that order—as well as some other treasured pastimes—perhaps a little cooking (#7), history (#9) or philosophy (#8). Clearly, he is in no way a pretentious asshole. And just to drive this point home, he pops in his favorite DVD, “Amelie.” (Yale’s #1, Harvard’s #6). He flips listlessly through his favorite book— “Harry Potter,” also Harvard’s #1—and his second-favorite book, “Pride and Prejudice” (Harvard’s #4), and thinks about how much he enjoyed reading “Lolita,” “Crime and Punishment,” and “Lord of the Rings” (none of which made Harvard’s list). He is 20 percent liberal, three percent conservative, and 17 percent of him is in a relationship, a statistic that has been hard to explain to the other person involved. He goes to his computer, where he has been actively following Yale’s top news story of an “Eight-Limbed Toddler Believed to Be Vishnu Reincarnation.”

Meanwhile, John Harvard flips on some Coldplay (#1 Harvard, #5 Yale) and sets about his favorite activity: Music. His room is decorated with posters of his favorite bands: Pink Floyd, The Red Hot Chili Peppers, and The Killers (none of whom make Eli’s top 10; he’s too busy listening to Beethoven), and favorite movies: “Little Miss Sunshine” (#1, Yale’s #5) and “Fight Club” (#2). Admittedly, he and Eli have similar taste in movies—six of the ten titles are the same. But unlike Eli, he enjoyed “Love Actually” and “The Shawshank Redemption,” and felt that “Crash” was edifying, but also thought-provoking. That’s how John likes his movies.

He is not a pretentious asshole either—as some of his favorite books attest: “1984,” “The Great Gatsby,” “Pride and Prejudice,” “To Kill a Mockingbird,” and “The Catcher in the Rye.” John just loved that AP English reading. Every single one of those books changed his life, as he wrote in his college essay. Some of them changed it multiple times. In his spare time, he reads modern classics with long, paradoxical titles like “The Unbearable Lightness of Being.” Also the Bible, although not quite as often as Eli does. He enjoys dancing, photography, and art. He is 17 percent liberal, three percent conservative, and 15 percent in a relationship. Another 15 percent of him is single. As they say, it’s complicated (one percent).

Yet all these comparisons hint at a more fundamental divergence. Yale students want you to know that they enjoy Beethoven. Harvard students want you to know that they enjoy Snow Patrol. Yale students sure love their long important novels by Dostoevsky, Nabokov, or Tolkien. Harvard students sure love their interesting modern novels by people with names like Milan Kundera and Jhumpa Lahiri. Yalies enjoy history and philosophy and put Tolkien books and movies on their profiles. Harvardians enjoy Dancing, Art, and Oscar-winning movies about race. Yale students want to impress you with what they’re doing. Harvard students want to impress you with how cool they look while doing it.

Someone wise once said, “Going to Harvard means you will have to spend the rest of your life proving to people that you’re an idiot.” Yale students don’t have that advantage. That’s why they need to tell us they’ve been reading “Crime and Punishment” and watching “Amelie” again. Everyone has heard of Harvard, and this makes a wider range of people want to come. It also means that your average Harvard student is more—dare I say?—normal than your average Yalie. Harvard’s sheer world fame draws excellent students from all countries and backgrounds while Yale, less-known, still feeds off more exclusive, east-coast-preppy sources. 46 percent of Yale’s freshman class came from private and parochial schools. Only 36 percent of Harvard’s did.

Some people say that by putting an end to early action, Harvard will open floodgates to people who are applying on a whim “because it’s Harvard.” But when these people get in—as they frequently do—it is because they deserve to do so. Everyone praises Harvard “for the students.” But what makes Harvard’s students so great is that they are in many ways a cross-section of the larger world. They are normal people who happen to be excellent, and this sets them apart. People who go to Yale go because they want to attend Yale. People who go to Harvard go because they can.

Alexandra A. Petri ’10 lives in Eliot House. Her column appears on alternate Tuesdays.

We Shall OverCome

Ovarian Cancer Support Bands

(youth sizes "for the petite ladies")

Last Friday, a classmate named Mike Frederick presented the best damn Clinical Sciences Journal Club in recent memory. It was a paper demonstrating the effectiveness of oophorectomies (surgical removal of ovaries) as prophylaxis against ovarian cancer in patients with BRCA1 and/or BRCA2 mutations.

The strength of Mike's presentation rested upon his courage to discuss how ovarian cancer has affected his life. He began the presentation with the sound a woman singing opera -- the voice belonged to be his sister, who passed away from ovarian cancer the summer before Mike started medical school at UCSF. Mike wove his own family history and his personal experiences together in a way that amused, touched, and educated the audience (a crowd of MS1's and MS2's, journal club has always been a proudly student-run affair). My eyes were constantly tearing up, and it was so memorable watching Mike onstage showing us videos of his family and photos of his sister...in between Kaplan-Meier curves and data tables of the patient population in the study.

What will really stay in memory is how the presentation was so quintessentially "Mike" -- a guy who is proud of his family, a down-to-earth, unapologetically opinionated farm boy from Nipomo, CA, who can bake banana cream pies from scratch and tell you the difference between a starfish and a sea star while he skin dives for abalone. A guy who formerly boasted tonsils the size of testicles (before he had them removed last year) and who has helped to make UCSF medical school an amazing place to be.

Busy Thursday

Today we had a Small Group from 8-10 am on molecular methods for detecting genetic mutations, focusing on Southern blotting and microarrays.

From 10-12 pm we had a lecture on cancer screening procedures for cervical cancer, colon cancer, breast cancer, and prostate cancer. It was interesting learning about the pros and cons of each screening test, and how there is a constant balance being weighing harms and benefits.

The Synapse lunch meeting from 12-1 pm featured a columnist from the San Francisco Chronicle, CW Nevius, who has been creating ripples in the community through his writing on the homeless in San Francisco.

Traveled from 1-2:15 pm to Oakland for my pediatric preceptorship. I really enjoy working in a community-based clinic with my preceptor, who is an Asian woman who speaks fluent Spanish. Not sure if this was intentional, but UCSF has arranged it so that I have been able to visit many different types of practices during my short time here...and each is different from the comfy, wonderful privileged academic medical centers where I have worked in the past! My first preceptor was a medical oncologist at Kaiser SF (HMO system); my second preceptor was a Cantonese doctor who divided his time between oncology and primary care in his private practice in Chinatown, and my current preceptor works in a community-based clinic as a pediatrician for the Cantonese/Hispanic community. Today, I got to practice my rusty Spanish skills by taking a short medical history and converse in Mandarin and listen to Cantonese. Undoubtedly, pediatrics has the cutest, most charming patient population. You can't help but smile when you see them.

The Ella Song

For the Class Play...

Shigella (from Rihanna’s “Umbrella”)

From the new album, “Good Tuna Gone Bad”

Voiceover: “It’s Shigella, bitch.”
OR: yeah, shigella, good tuna gone bad. Take 3. Action:

Got ‘crobes in your blood
Let them come, bacterial load on the rise
Comin’ up with a surprise
When infection comes we thrive, we all the “ellas”
You stay under the weather
And you never get better, you know ‘em
In anticipation, get a vaccinationfor inoculation. Stacked shots for the a sicker day.
D-LO, Brain Man is back with a gram stain
Ellas where you at?

(April - Rubella)
We have the shots
Give them 6 months apart
You know you need vaccines
And they won’t leave a scar
Baby cause in the dark
You can feel infection start
That's when you need me there
Cuz kids will always share
Because

[Chorus]
(Susan – Legionella)
When the drops spray, we’re there together
In your lungs I’ll be forever
Legionnaire is my name
Grow me up (and) see me with a silver stain
Now that you’re coughin’ more than ever
Know that we'll still have each other
You can call me Legionella
You can call me Legionella
(Ella ella eh eh eh)
Measles Mumps and Rubella
(Ella ella eh eh eh)
Call me Varicella
(Ella ella eh eh eh)
Salmonella and shigella
(Ella ella eh eh eh eh eh eh)

(Bianca – Varicella)
These vaccines, will never come in between
You’re part of my entity, here for Infinity
Just when the itching starts
That’s when the friends depart
If you don’t like someone,
You should just have some fun
Because

[Chorus]
(Melissa - Salmonella)
When you eat those eggs, we’re there together.
On the john you’ll be forever
Blame the fecal-oral spread
Don’t get scared when your stool turns wet and red
Now that you’re crapping more than ever
Know that we'll still have each other
My name is Salmonella
My name is Salmonella
(Ella ella eh eh eh)
Measles Mumps and Rubella
(Ella ella eh eh eh)
Call me Varicella
(Ella ella eh eh eh)
Legionella and shigella
(Ella ella eh eh eh eh eh eh)

(Climax)
Now you’ve met four of the five
Meet the Queen Bee of the hive
Give in to me
Ten of me…is all you need…to bleed
So go on and let the feces pour
I'll be all you need and more
Because

(Elaine – Shigella)
With your hands unwashed, we’re there together.
Diarrhea’s not forever
Shiga toxin – what a pain
After me, you’re never gonna be the same
Now that you’re crying cramping more than ever
Know that we'll still have each other
You can’t stand – no one fights Shigella
You can’t stand – no one fights Shigella
(Ella ella eh eh eh)
Measles Mumps and Rubella
(Ella ella eh eh eh)
Call me Varicella
(Ella ella eh eh eh)
Legionella and salmonella
(Ella ella eh eh eh eh eh eh)

[close up shot of clean toilet bowl flushing]
It's draining
Ooh baby it's draining
Baby give into me
Give into me
It's draining
Oh baby it's draining

Class Play

Just got back from the Class Play...it was AWESOME.

So proud of UCSF Class of 2010 and the amazing talent, dedication, and energy. :)

My favorite skit remains the Office Parody, the Small Group. The pacing, the filming, the acting, the dialogue was so accurate and clever.

:)

Celebrity Look-Alikes

Above: Dr. Joe Derisi, Boy Genius

Doogie Howser, actor

L: Dr. Anthony DeFranco, course director for I3 (fall 2007)


R: Woody Allen, actor


Some Hollywood celebrities bear a striking resemblance to the academic superstars at UCSF.


This morning we had an awesome lecture on DNA microarrays from Dr. Joe Derisi, a 2004 recipient of the MacArthur grant. His other claim to fame is that he is the spitting image of Doogie Howser, boy genius!

Thanksgiving Should Be Everyday

Feeling blue today, but I found this email that I wrote to myself on 11/27/06 with the subject line, "Thanksgiving Should Be Everyday." It's actually an insightful time capsule into my life at that moment approximately one year ago.

"Thank you, God, for...
1) the health of my family, my friends, and myself this past year
2) nudging me to go to UCSF and to meet so many wonderful people
3) your grace and forgiveness
4) the wonder of taste -- from a 2004 Mondavi muscat to foie gras to hot salty french fries with ketchup -- which reminds me that I am alive and here on this earth for a short time
5) Jey
6) the sensation of falling in love
7) beauty in all things -- even the beauty of pain
8) knowing that ignorance is not bliss...it's the imperfections that make life worth living
9) allowing me to pass my cardiovascular exam
10) the respite of sleep
11) the warmth of love
12) letting me pretend that I'm Christopher Smart, but without the cat Geoffrey
13) my adorable brothers and sisters and wonderful family
14) my amazing friends who always give me an ear or a bed to sleep in
15) the 2004 Mondavi muscat
16) the opportunities that have been available to me since birth
17) giving me the chance to grow and develop emotionally
18) giving me an elevator to commute to school
19) my imperfect, humble, passionate, little soul."

Mailboxes

Don't want to sound alarmist, but I am annoyed that someone is stealing objects from the student mailboxes in the medical student lounge!

The Heroine on Heroin

From the SF Chronicle last year...

A homeless beauty and the beast, heroin
A slave to her addiction, young woman squanders her family and her potential
Kevin Fagan, Chronicle Staff Writer
Saturday, March 25, 2006

Rhonda Bye had a lot going for her -- brains, beauty, feisty strength.

Heroin and crack crushed it all.

The narcotics ruined her looks and attention span, snuffing out her potential both as a young clothing model for Nordstrom and as a computer whiz who could fix office network problems. Three years ago, a slave to her heroin addiction, Bye landed on San Francisco's streets as a homeless panhandler.

Still, she refused to give up, fighting her way through a frustrating maze of city social services to get into housing and drug rehabilitation. She shook off her addiction, and in the last couple months she had been talking about retraining to work with computers again.

But it was too late. Drug abuse and the ravages of street life had damaged her kidneys so badly that, in mid-February, doctors told her she would need dialysis for the rest of her life.
She missed her treatments three times in a row and went into a coma three weeks ago.

On Wednesday, she died. She was 39.

Bye leaves behind two sons and a daughter -- and a lifetime that her family hopes will be an example, in the harshest way possible, of how drugs and homelessness can destroy a person.

"She is an Exhibit A on what heroin and crack does to someone who is unbelievably beautiful, has the sweetest personality in the world, and is even smart," said Bye's brother, Robert Davis of Everett, Wash. "She could have done so much in life, so much. But drugs. ... It was drugs."
Bye lies in the San Francisco General Hospital morgue, the destination of all such indigents who die alone in the city from the ravages of drug abuse. But members of her family, many of whom haven't seen her in years, aren't focusing on that image. They choose to remember her in the days before everything went bad.

"She had such a great smile, back when she had teeth, and such a cute giggle," said her mother-in-law, Kay Vestre of Kent, Wash., who is raising Bye's three children and is a manager for the local child protective services office. "Back before she did drugs, they hired her at my workplace to work on the computer system, and oh, my, was she good. She became a trainer for other technicians."

But that -- like most of the promising things in Bye's life -- was before heroin seized her.
Bye was raised in Washington state, by a single mother who struggled on welfare or low-paying jobs for much of her childhood, her brother said, "but she always had the strength and brains to try to make something of herself."

Throughout middle school, she attended Bellevue Modeling Academy and walked the runway showing off clothes for Nordstrom. She pulled A's and B's in school, he said, "and by high school she was probably the most popular, cutest girl in class."

Then she met David Bye, whom as recently as this winter she called "the love of my life and the most interesting guy I ever met." By 17, she had dropped out of high school, and they were married, their first child on the way.

"The two of them just started doing cocaine a bit, and very slowly over the next bunch of years they lost what they had," Davis said. Jobs came and went, but about six years ago heroin had gripped them both, and they wound up on and off the streets. Vestre got custody of their three children -- and three years ago, things exploded out of control.

David Bye shot a man to death in Seattle in a fight over insurance money, and the couple fled toward Mexico. San Francisco police found them huddled in an alleyway, arrested David Bye and extradited him to Washington. His wife was left on the street -- and there she stayed.
Over the next year, she became a fixture at the Duboce Street off-ramp from Highway 101, the smiling, gentle woman with the ever-ready sign pleading for "just a little help." With her husband out of the picture for the first time since she was 17 -- he was convicted last year of second-degree murder and is serving 32 years in prison -- she was truly on her own for the first time in her life.

"This is not how I wanted to end up," she said one rainy day in 2004 as she begged in traffic. "I want to set a better example for my kids. All I need is a little more of a chance."

That chance came that year, when city Human Services Director Trent Rhorer struck up a conversation with her as she visited with a Chronicle reporter and photographer. He summoned an outreach worker, who signed her up for housing and rehab appointments.

It proved to be the one spark she needed. Bye followed up her many appointments diligently, and nearly three months later, she had a room in the Elm residential hotel and was firmly on methadone treatment to kick heroin.

"Rhonda struck me as someone who genuinely recognized her plight and really wanted to live a better life," Rhorer said. "She was no dummy. But sometimes the toll of drugs is just too much, and it catches up with you.

"What this tells me is that we have to work even harder to get the chronically homeless inside before this kind of damage sets in so deeply."

Her family hoped that she would learn so much from her street ordeals that she could become a counselor someday. Bye herself held that ambition.

"I know how the whole thing works now," she said one day last month in her hotel room, going over brochures of computer training classes. "Man, I could actually help people avoid the crap I've had to live through. Wouldn't that just be great?"

E-mail Kevin Fagan at kfagan@sfchronicle.com.

iClicker

iClicker

Dr. Bruce Alberts (science god, author of The Cell, ex-prez of the National Academy of Sciences, and UCSF faculty member) gave us a series of lecture on cancer biology this week. He was a fairly good speaker, and he introduced a new teaching device called the iClicker. It's a battery-powered remote control that allows people in the lecture to press ABCDE multiple choice answers and interact with the lecturer's pre-made multiple choice questions.

I think Harvard had a version of this in some science classes, but I've never used it before. At first, I viewed the iClicker as a tool of oppression... I felt like it was cheesy and coercive and not very instructive since multiple choice questions are generally reductionistic. However, I give kudos to Dr. Alberts for trying a new teaching tool and some of his questions were pretty interesting and challenging.

Britney Spears?

Despite reports that Amy Winehouse would be the most popular costume this year, no one knew what my costume was. As a side note, I thought of this costume idea on Sept 6th (see post)...way before Perez Hilton, et. al.! (sorry, must point that out).

Since I had a microphone, here are some guesses made by people at UCSF:

- Ashlee Simpson
- Sarah Silverman
- Christina Aguilera
- (Rehab!) Britney Spears
- Japanese pop princess
- random Halloween punkette

It's okay, it was fun dressing up!