Saturday, November 15, 2008

Surgery. 'Nuff Said.

Sorry for the lack of posts...I fell off the blogging bandwagon for a few weeks.  

Currently, I just finished week 3/8 of Surgery at Mt. Zion/Parnassus.  MZ is UCSF's cancer center, and I love being on the surgical oncology White service (the Gold service at MZ does colorectal cases).  White surgeries include GI malignancies (whipple's, etc), liver resections, and melanoma.  

Surgical oncology seems like a great field, there's a lot of satisfaction to be gained from whacking out a tumor.  

P.S. It seems like a bad did Prop 8 AND Prop 2 BOTH pass?  Since when do chickens enjoy advances in rights...while humans do not?

Tuesday, October 28, 2008


San Francisco voters, please vote YES on Prop A to make San Francisco General Hospital earthquake-friendly.

SELECT trial halted!

As a prostate cancer/oncology geek, I have to let you know that the huge trial examining whether selenium + Vitamin E prevents prostate cancer (results were due in 2013) was closed permanently yesterday!

Researchers found that there was a small but significant increase among vitamin E users to develop prostate cancer, and a small but significant increase in the incidence of diabetes among selenium users.

Juicy oncology gossip!


Tuesday, October 21, 2008

Intersession 2 and a Really Nice Weekend

Big Sur from the Lucia Lodge restaurant porch
best fish and chips ever
The MS3's are midway through Intersession 2, a week-long break between 3rd and 4th block. It's interesting that even though I had more free time during Family Medicine, I actually ended up blogging less. During Intersession, the students engage in a variety of touchy-feely small groups and lectures about medical ethics and professionalism. It's actually a good time to unwind and reflect on how we are changing on our journey to becoming doctors.
Last weekend after the Family Medicine exam was also extremely nice. To start, I spent an hour walking around Lake Merced by myself before sunset, which is something that I wanted to do for six weeks after glimpsing the beautiful lake through a window at the Janet Pomeroy Center (a fantastic center for children and adults with disabilities that FCM introduced me to via a community project). Lake Merced is beautiful; there are so many areas of the city that I haven't explored yet (the SF Zoo is nearby too).

Tuesday, October 07, 2008


I diagnosed my first case of gingivostomatitis this morning in a 2-year-old girl who had reported to the ED 5 days ago with a fever of 104 degrees. The ED thought thought that she had OM, and gave her amoxicillin. The next day, the patient presented with mouth sores and continued running a fever. Her gums were swollen and purplish, and she had oral lesions in her buccal mucosa, on her tongue, and soft palate.

After checking her normal TM's b/l and ruling out HFMD (oh, Coxsackie, I know you well after catching you during my peds rotation) and chicken pox (vaccinations UTD, no rash), the leading diagnosis was herpetic stomatitis caused by HSV-1.

Even though it was a relatively simple case, it feels good to have a solid differential and coming up with a diagnosis. One of the things that I enjoy most about the outpatient clinic is seeing new patients with fresh eyes, being the first person to examine a patient and figure out what's going on. For instance, last week, I saw a 3 y/o boy with a 6 cm cervical LN. I find myself enjoying acute/urgent care more than routine physicals/WCC/healthcare maintenance (but predictably enjoy the Pap smears, FOBT, PSA, and other cancer screenings).

In family medicine, I have also found myself having an irrational fear of pregnant women (having not yet done OB-GYN, pregnant women are a black box to me), and an extreme fondness for taking care of children who are acutely ill.

Tuesday, September 16, 2008

Wish List: paJAMAs

When they start making flannel JAMA PAJAMAS, please tell me so I can get me one'a'those. Brillz.

Thursday, September 11, 2008

Welcome, MS1's!

Orientation for the youngsters started last week, but I just wanted to say "HI" on my blog to the fresh-faced med students who will be having their white coat ceremony tomorrow. Sorry for being a deadbeat MS3, you will probably never see me unless you like to shadow doctors at Moffitt (you eager beaver you).

Ironically, as a first year, I always wondered why we didn't meet any MS3's or MS4's, apparently they were too busy to mingle with the first and second years. Also, we never get to attend any UCSF graduations, so there is a particular divide between MS1/2 and MS 3/4, that UCSF could probably remedy to some degree. Anyway, it's just funny that now I AM the shadowy MS3 whom you will never meet, and therefore assume that I am aloof and a little bit eccentric (ah, first non-impressions).

Enjoy medical school, and for goodness' sake, HAVE FUN this year and next year. Enjoy the pass/fail system and relax (you won't listen to me, but i'll say it anyway). Try to go to class. Eat the hashbrowns in the Moffiteria. Avoid the hospital. Do what you love. Hang out with friends and family. Don't worry about the Boards until perhaps Nov.-Dec. of your second year. Be nice to the MSP teachers and don't be (too) mean to the small group leaders. DON'T BUY ANY OF THE TEXTBOOKS ON THE LIST!! (except for Netter's and Blumenfeld, which you can buy in May). YOU NEVER USE THE TEXTBOOKS.

Good luck, medlings!

Tuesday, September 09, 2008

Family Medicine

My family medicine rotation started yesterday, and it's been nice so far. The rotation is entirely outpatient, with no call nights and every weekend free...which is great because i never had a "golden weekend" for 8 weeks on medicine. In many ways, the family medicine rotation is different from other rotations, and not just because it's entirely outpatient, but also in terms of philosophy and mindset. There's an emphasis on continuity of care, being the medical "home" for a patient, and doctors can care for entire families throughout the generations. The "bread and butter" conditions for family medicine are chronic -- HTN, COPD/asthma, HL, CAD, DM. Psychosocial issues like substance abuse, domestic violence, or homelessness -- which can be swept under the rug by time constraints in an inpatient ward -- become more important during family medicine.

During orientation, the clerkship director asked us how patients have already been affected medically even before we see them during the first new patient visit. It was a confusing question, but it's not just past surgeries or vaccinations, etc. that affect a patient...other factors such as environmental pollution, McDonald's, and rising gas prices can affect someone's health. I never appreciated how family medicine can be a vehicle for advocacy for many different things in the "real world" that impact health and well-being.

On another (non med) note, the media has exploded recently with the debut of Sarah Palin -- i've never seen so much press on one person in one week. She has made the news interesting lately, to say the least.

Thursday, September 04, 2008

Home Conversations

Home in Arcadia before starting Family Medicine.

After passing by Jeremy's old preschool, my siblings and I started talking about how we used to eat dirt, grass, and insects when we were in preschool.

"My friends and I ate ants," Jeremy said, "They were spicy."

"At least you ate them with friends," Samantha retorted, "I ate grass ALONE."

Love my family. :)

Wednesday, August 13, 2008

the case of the bloody poo

Mike and I were trading stories about medical cases that we've seen recently. My fault, really, since I'm obsessed with medicine and can't stop talking about work (since that's all I do anymore, anyway). After I told Mike about my current patient with weight loss of unknown origin and a recent case of Q fever endocarditis, Mike told me the following pediatrics case that he saw today:

"Six-year-old boy, the story is that he took a dump this morning and it was bright red. No stomach pain, might have had a similar poop last night, no vomiting, heart rate is stable, no signs of dehydration or shock, kid is in no apparent distress."


"No. So the resident does a digital rectal exam, and his glove comes out bright red and covered in poo. The resident smears his glove on a FOBT (a strip of paper that turns color when poo with blood gets smeared on it, even if the blood is not visible to the naked eye), and the strip never changes color."

"The strip should change color," I said, "so either the strip is defective or it's not really blood."

"Right, but what is it?"

"Meckel's?" I said.

"No. Then we asked the boy to pee in a cup. Why?"

"To check for hematuria or proteinuria?"

"No, even simpler."

"To see if his pee is red too?"

"Yes! Because eating too many beets can color your poop and your pee."

"Was it red?" I asked.

"No, his urine was not red."

"GI bleed?" I said, "he doesn't seem to be in distress. He's too young for colon cancer, diverticulitis, or ulcers.

"No. Give up?" Mike asked.


"So the resident is totally clueless. We talk to the attending, and the attending laughs. He says that a couple years ago, when RED HOT CHEETOS hit the market, there was a huge outbreak of kids with bright red poo. And this was the case."

Friday, August 08, 2008

"that's all i can do"

Mr. D suffered from the lung disease that killed Evel Knievel -- idiopathic pulmonary fibrosis (IPF). The word "idiopathic" in medicine is a code word that means "doctors have no clue what the cause of the disease can be." As a result, Mr. D couldn't breathe anymore -- his lungs were like a pair of old dishwashing sponges left in the sun to dry. Needless to say, there wasn't much oxygen exchange happening. So Mr. D got a lung transplant -- just one lung because organs are in short supply and that's actually sufficient for someone to live. When you have a new organ, you have to take lots of drugs to keep your immune system down so that it doesn't reject the new heart/lung/kidney, but that also renders you susceptible to millions of germs and bacteria that would otherwise be harmless. So Mr. D came down with a fungal infection -- Aspergillus -- and a bacterial infection -- Pseudomonas.

When Mr. D came to the hospital for a short procedure, he seemed okay. It was interesting listening to his lungs, because his right lung (the "native" one with IPF), sounded like tissue paper crackling. His left lung had normal breath sounds. It was listening to two different lungs in one person. I was immediately struck by how equanimous Mr. D was, especially when I asked him if it was okay for a group of medical students to come by and listen to his interesting physical exam. He was a quiet, scholarly guy in his 50s with graying hair -- the type of patient with glasses and a copy of the New York Times on his bed.

After I switched services, Mr. D was ready to go home when something nearly catastrophic happened. He developed a massive bleed into the space behind his back -- his retroperitoneal space. The bleed was idiopathic. Mr. D landed in the ICU and suffered from acute renal failure --- his kidneys were in trouble.

A few days ago, I saw Mr. D while walking through the ICU and dropped by to say hello. Mr. D looked pale and sick, his head was tilted to one side, but he was still conversant. I nervously eyed a length of tubing filled with blood emerging from his body -- he was on CVVH, which filters the blood and helps out by mimicking the kidney. The doctors were thinking that he might need to go on dialysis for the rest of his life.

"Hang in there, Mr. D," I chirped.

He looked at me with tired eyes filled with weary, stubborn resignation.

"That's all I can do," he said softly.

satire on intellectual pretension

NYT yesterday, the most amusing, hilarious, mockingly pseudo-intellectual satire that I've read in a while. There are some valid points...have we become a society that values the aggregator over the creator? Is the mode of information delivery more important or prestigious than the information itself?

Lord of the Memes

Published: August 7, 2008

Dear Dr. Kierkegaard,

All my life I’ve been a successful pseudo-intellectual, sprinkling quotations from Kafka, Epictetus and Derrida into my conversations, impressing dates and making my friends feel mentally inferior. But over the last few years, it’s stopped working. People just look at me blankly. My artificially inflated self-esteem is on the wane. What happened?

Existential in Exeter

Dear Existential,

It pains me to see so many people being pseudo-intellectual in the wrong way. It desecrates the memory of the great poseurs of the past. And it is all the more frustrating because your error is so simple and yet so fundamental.

You have failed to keep pace with the current code of intellectual one-upsmanship. You have failed to appreciate that over the past few years, there has been a tectonic shift in the basis of good taste.

You must remember that there have been three epochs of intellectual affectation. The first, lasting from approximately 1400 to 1965, was the great age of snobbery. Cultural artifacts existed in a hierarchy, with opera and fine art at the top, and stripping at the bottom. The social climbing pseud merely had to familiarize himself with the forms at the top of the hierarchy and febrile acolytes would perch at his feet.

In 1960, for example, he merely had to follow the code of high modernism. He would master some impenetrably difficult work of art from T.S. Eliot or Ezra Pound and then brood contemplatively at parties about Lionel Trilling’s misinterpretation of it. A successful date might consist of going to a reading of “The Waste Land,” contemplating the hollowness of the human condition and then going home to drink Russian vodka and suck on the gas pipe.

This code died sometime in the late 1960s and was replaced by the code of the Higher Eclectica. The old hierarchy of the arts was dismissed as hopelessly reactionary. Instead, any cultural artifact produced by a member of a colonially oppressed out-group was deemed artistically and intellectually superior.

During this period, status rewards went to the ostentatious cultural omnivores — those who could publicly savor an infinite range of historically hegemonized cultural products. It was necessary to have a record collection that contained “a little bit of everything” (except heavy metal): bluegrass, rap, world music, salsa and Gregorian chant. It was useful to decorate one’s living room with African or Thai religious totems — any religion so long as it was one you could not conceivably believe in.

But on or about June 29, 2007, human character changed. That, of course, was the release date of the first iPhone.

On that date, media displaced culture. As commenters on The American Scene blog have pointed out, the means of transmission replaced the content of culture as the center of historical excitement and as the marker of social status.

Now the global thought-leader is defined less by what culture he enjoys than by the smartphone, social bookmarking site, social network and e-mail provider he uses to store and transmit it. (In this era, MySpace is the new leisure suit and an AOL e-mail address is a scarlet letter of techno-shame.)

Today, Kindle can change the world, but nobody expects much from a mere novel. The brain overshadows the mind. Design overshadows art.

This transition has produced some new status rules. In the first place, prestige has shifted from the producer of art to the aggregator and the appraiser. Inventors, artists and writers come and go, but buzz is forever. Maximum status goes to the Gladwellian heroes who occupy the convergence points of the Internet infosystem — Web sites like Pitchfork for music, Gizmodo for gadgets, Bookforum for ideas, etc.

These tastemakers surf the obscure niches of the culture market bringing back fashion-forward nuggets of coolness for their throngs of grateful disciples.

Second, in order to cement your status in the cultural elite, you want to be already sick of everything no one else has even heard of.

When you first come across some obscure cultural artifact — an unknown indie band, organic skate sneakers or wireless headphones from Finland — you will want to erupt with ecstatic enthusiasm. This will highlight the importance of your cultural discovery, the fineness of your discerning taste, and your early adopter insiderness for having found it before anyone else.
Then, a few weeks later, after the object is slightly better known, you will dismiss all the hype with a gesture of putrid disgust. This will demonstrate your lofty superiority to the sluggish masses. It will show how far ahead of the crowd you are and how distantly you have already ventured into the future.

If you can do this, becoming not only an early adopter, but an early discarder, you will realize greater status rewards than you ever imagined. Remember, cultural epochs come and go, but one-upsmanship is forever.

Monday, August 04, 2008

Heart Attack? Do This Now.

Working on the cardiology service, here is my public service announcement on heart attacks adapted from,,20188758,00.html

"If you are having chest pain and you do not have nitroglycerin:
1) Call 911 or other emergency services now. Describe your symptoms, and say that you could be having a heart attack.
2) Stay on the phone. The emergency operator will tell you what to do.
3) After you call for help, chew one regular-strength uncoated aspirin. Aspirin helps keep blood from clotting, so it may help you survive a heart attack.

The best choice is to go to the hospital in an ambulance. The paramedics can begin lifesaving treatments even before you arrive at the hospital. If you cannot reach emergency services, have someone drive you to the hospital right away. Do not drive yourself unless you have absolutely no other choice."

Sunday, August 03, 2008


from BIDMC CEO Paul Levy's blog
Boston's Fenway Park on a bedroom mural! Can I get one for my future kid?? This mural is so awesome! You could get little sox player dolls and stick them on the bases -- too bad the Manny doll was lost. At least he went to my hometown Dodgers...

Thursday, July 31, 2008

garp quote

just started reading for fun, from irving's the world according to garp:

"She felt if she ever had children she would love them no less when they were twenty than when they were two; they might need you more at twenty, she thought. What do you really need when you're two?

In the hospital, the babies were the easiest patients. The older they got, the more they needed; and the less anyone wanted or loved them."

Sunday, July 27, 2008

q2 and randy pausch

Post-call from medicine service, starting cardiology tomorrow and guess what? I'm on call! I'm going to sit and vegetate at home today.

In other news, Randy Pausch passed away on Friday, 7/25. Sad sad news. :(

Friday, July 25, 2008

Med Culture: Phrases I Hate

Phrases That Annoy Me (used by med folks among themselves):
- "touch base" with med onc/neuro/etc.
- "teaching point"
- "common things being common"

Phrases I Like:
- "our service"
- "patient census"

"only at Moffitt"

Since my first two blocks have been at Moffitt -- UCSF's fancy shmancy ivory tower tertiary medical center -- I'm starting to realize that my view of medicine can be a bit skewed. Someone observed that yes, we can get regular bread-and-butter medical cases like pneumonia or heart disease, but there's usually some exotic past medical history (a transplant, a rare genetic disorder) or some unusual aspect of the case (patient has PCP pneumonia). We see patients that can be very sick, and an attending warned us that it is not uncommon for a fair number of patients to pass away at Moffitt.

Some people have jokingly dubbed Moffitt "the Death Star," partly because of the complexity/severity of the cases, but also because there appears to be this consensus that the medical culture at Moffitt is highly intense, demanding, and academic.

From my perspective, there appears to be some truth to the rumors, but I wouldn't have ranked Moffitt so highly on my list if I wasn't interested in seeing rare medical cases (nicknamed "zebras" in medical slang, as opposed to the more common afflictions called "horses" ). I have always had a soft spot for academic medicine, and it's interesting seeing how different specialists work together to unravel or treat challenging medical conditions. Later this year, I will be doing family medicine in the Bay area, ob-gyn in "rural" Fresno, and neuro-psych at the General (SFGH), so there will be an interesting mixture of sites and practices to experience.

However, I am enjoying my time at the medical Ivory Tower with the aforementioned zebra folks. In pediatrics, I saw a patient with a disorder so rare that it affects 1 in 2 million people and there are only 230 cases in the U.S. It was also fairly common to see kids with fetal or neonatal abdominal surgeries, 2 babies with short gut syndrome who are on Hospital Day #301, kids with rare genetic mitochondrial disorders, a 14-year-old with a stroke who left AMA, a teenage boy with lupus (SLE), and a 12-year-old boy with anorexia. Kawasaki syndrome was not an outrageous differential when a child had a fever for over 3 days.

Adult medicine at Moffitt has been similarly intense and interesting. During our last intersession, Dr. Don Ganem told us anecdotes from his days as an infectious disease fellow at UCSF in the 1980s during the HIV/AIDS era, and how bizarre infections like PCP pneumonia, cryptococcal meningitis, and Kaposi's sarcoma became "bread and butter" cases at SF General Hospital and Moffitt. When he asked a third-year med student what the most common cause of community-acquired pneumonia was, the MS3 answered, "PCP." Dr. Ganem continued by saying, "I was going to whale on the student, until I realized that that was really all that he ever actually saw in the hospital." Sometimes, I can sympathize with the situation of Dr. Ganem's hapless student -- all zebras and no horses.

Our medicine service had 11 patients, three of which were double-lung transplants. We usually have at least 1 lung transplant patient, sometimes a kidney transplant or a patient with a rare cancer (adult rhabdomyosarcoma of the cervix, primary CNS lymphoma and HIV negative, a metastatic paraganglioma presenting like pheochromocytoma). Many of our patients have serious bacterial infections, and some have end-stage liver or renal disease.

Whenever a resident or attending hears a fantastically unusual medical case -- say, a 22-year-old with a STEMI, intermittent fevers, acute renal failure, bilateral PE's, and a violaceous vesicular rash on the left side of the body -- there is a classic reaction: the doctor's eyes widen slightly, the eyes roll up to the ceiling, there is a deep sigh, and finally exhalation of the ritualistic phrase, "Only at Moffitt."

Lunchtime conversation with a fellow med student at Moffitt:
A: "My vision has been blurry and my head hurts lately...I think I have a brain tumor."
B: "Are you sure it's not a vasculitis...or a demyelinating disorder?"

Friday, July 18, 2008

Troponin Leak?!?

Doctors keep throwing around the phrase "troponin leak," and I came across this doozy paper while reading up on the mysterious term:


Cardiac Troponin I Elevation After Orogenital Sex During Pregnancy

José Mauricio Sánchez, MD1, Michael R. Milam, MD, MPH2, Tracy M. Tomlinson, MD3 and Michael A. Beardslee, MD1

From 1Washington University School of Medicine, Division of Cardiology, St. Louis, Missouri; 2Department of Gynecologic Oncology, M. D. Anderson Cancer Center, Houston, Texas; 3Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.


BACKGROUND: Venous air embolism due to orogenital sex in pregnancy is an uncommon clinical event.

CASE: A previously healthy, 29-week pregnant woman presented to the emergency room unconscious 1 hour after engaging in orogenital sex with her partner. The cardiology service was consulted due to troponin elevation. Assessment was that the patient had likely suffered an air embolism with associated troponin leak.

CONCLUSION: Although a rare clinical event, air embolism from air insufflation of the vagina can result in troponin elevation and should be considered in the differential diagnosis in pregnant patients with a history of orogenital sex.

Obstetrics & Gynecology 2008;111:487-489 © 2008 by The American College of Obstetricians and Gynecologists

Thursday, July 17, 2008

edward hopper in vietnam

Sent to me by Kim, traveler/dreamer/medical student extraordinaire. Recalling my love of Hopper's paintings, she took this photos that looks strikingly Hopperesque with solid blocks of light, neutral color, stark shadows, and straight lines. Her poetic emails remind me that there is life and literature and adventure outside of the medical ivory tower -- I can't help feeling a bit like a pale imitation of Rapunzel or the Lady of Shalott.

a leaf falls

Medicine has been great so far, it is almost the end of my third week and we are on-call tomorrow. What impresses me is that almost everything can fall within the umbrella of internal medicine -- the heart, the lung, the brain, the GI tract, and infections of every kind.

What also impresses me is how the doctors at UCSF in the dept. of medicine are so devoted to educating the medical students and taking the extra time to teach us when they could easily ignore us or make us do scutwork (KIDDING). in fact, the culture of the medicine dept. at Moffitt has been so welcoming and comfortable. As a third year medical student, it's easy to feel like the smallest kid in the medicine family, and the residents and attendings recognize this and take the time to truly nurture us.

Medicine has also been extremely busy, and 8 weeks of inpatient care with call every 4 days (we don't usually stay overnight, but sometimes we can be home from 3-6 a.m.) can be a marathon. One thing that I've noticed and somewhat expected (now that there's time to be contemplative and write long blog entries) is that third year can feel rather isolating. There's not much time to do things beyond shower, eat dinner, and maybe clean the kitchen and I've been trying unsuccessfully to sleep at 10 pm. Although it's nice to see my classmates in the hospital and build relationships with patients and my team, I miss feeling connected to people outside of the hospital and having leisure time without all the weekends blurring away into a 4-day cycle of work-work-work-sleep. Watching my interns and residents, it seems like there will be at least several more years of sleepless, blurry weeks before I can be a craggy old attending who doesn't carry a pager and makes tennis dates with his colleagues (for reals).

Tuesday, July 15, 2008

Bad Puns

Resident: "IR can be very picky (PICCy)"

Me: "I don't have any patients (patience)!"

No pun intended (really):

Intern: "She's radioactive....and disobedient."
Day float: "I don't like disobedient radioactive patients...[looks down at paper]...who have anxiety."

Friday, July 11, 2008

Things Learned in Medicine (so far)

1) 80% of the time, when a doctor asks you how to initially treat a patient's condition, "IV fluids" is correct. This does not work for CHF. It does work for pancreatitis.

2) Our attending teaches us to -- above all -- "do what's right for the patient." I have found that this mantra can rarely lead you astray.

3) In terms of H&P presentations, accuracy > speed > thoroughness.

4) Food is good for the soul

Wednesday, July 09, 2008

Lost in Medicine Land

Sorry for the paucity of postings...I've been spending 70% of my time at the hospital learning how to think about sick grown-ups. Medicine has been great so far; the culture is definitely different from peds, but I feel more comfortable in medicine than expected. In peds, the residents almost never wore white coats and had silly colorful toys. In medicine, everyone wears a white coat and the whole setting is slightly more formal, but still comfortable and very dedicated towards nurturing the med students. :-)

This morning, I got a numeric page on the 14th floor of Moffitt, so I called back saying, "this is Stephanie returning a page."

"Stephanie? Stephanie Chang?" the voice said on the other line.


"This is the ICU attending," the voice continued, "and I have to say that I am very disappointed..."

at that point I started experiencing dyspnea...

..."your progress note this morning was horrible..." vitals were HR 99, BP 150/90, RR 22


It was a classmate of mine playing a prank on me. In the hospital.

If I wasn't the victim, I would say that it was genius....

Monday, June 30, 2008

Great Weekend

One of my best friends from high school came to visit me in SF last weekend, and we drove to check out Stanford Business School for him before going to an 80s cover band concert on Friday night. The next morning, we biked around the perimeter of Angel Island, which was reachable by ferry and surprisingly lovely. The bike ride took about 1.5 hours, and the best part was how you could get a 360 degree view of San Francisco bay and how each part of the path gave you a slightly different by no less breathtaking view of the colorful houses, blue water, and white sailboats. I liked how the scenic view changed as you labored around the island, the changing nature was perhaps one of my favorite parts. It's weird, I told Leo, how after we visited Alcatraz 2 years ago, that I would not visit Alcatraz more than once, but I would definitely visit Angel Island again.
On Sunday, we visited Napa and tasted wine at Freemark Abbey, Louis Martini (hands down the best cabs in terms of taste & value, all 5 wines were amazing and I couldn't dump a single drop), V Sattui, Mondavi, and Opus One (ridiculous and excellent $30 tasting of one extremely hyped- up wine). We also saw the view from Artesa.
Today in medicine, it made me happy to think that only yesterday I was in Napa. :-)

Thursday, June 26, 2008

Gone Baby Gone II

Learned from a fellow medical student that the baby from my first delivery ever died a few weeks ago. It was a huge jolt, because I never expected the baby to die, even though his Apgars (assigned by me after some review with the peds team) were 3, 4, and 6. I assumed that he was going to make it after watching him for almost 10 hours after he was born, and now he has become my first peds patient to pass away.

Peds vs. Surgery

Notable quotes

...from peds: a boy in clinic with penis pain says that his "peanuts" hurts...Awww!

...from a friend in surgery: a resident who barks, "THERE'S NO TIME FOR TEACHING, ONLY LEARNING."

Saturday, June 14, 2008

Pausch's Last Lecture

Four days of fever, 1 day of sore throat, and 1 day of recovery (6 days total) and I'm back to, that took way longer than expected. :( I'm a little bummed that my 2-week summer vacation was cut in half by a pediatric viral illness, but I'm glad that it happened at a "convenient" time (so to speak) when there was not much going on and no patients to see.

Talking to my roommate made me realize that there are different senses of the word "sick," there's the conversational "sick" when you have sniffles or a mild URI. Then there's the second-level "sick," when you can't get out of bed and feel truly miserable and incapacitated for a short while and remember how much it sucks to not be healthy. There's also "sick" in the sense of mental illness, which is chronic and difficult to describe and quantify, and there's also the profound sense of "sick," usually earning you that "coveted" admission to the hospital because one of your organs is failing, or you need surgery with dorky UC med students watching, or sometimes because you are dying.

Most people on the web have heard of Randy Pausch, PhD, the professor at Carnegie Mellon University dying from pancreatic cancer who gave a stirring "Last Lecture" about life lessons. A few months ago, I learned about him from an interview in Time magazine, but didn't bother to Google his lecture until a friend in pharmacy school told me about it in the laundry room today. You can watch it on Google videos, it's a bit long (76 minutes), but worth the investment.

Naturally, I was interested because Randy is a pancreatic cancer patient, and if you don't read my blog that often, I am interested in pancreatic cancer research. Different cancers have different mortality rates, but pancreatic cancer remains a fearsome predator among cancers with a median survival of 6 months depending on how far the tumor spreads.

Oncology keeps drawing me closer, but still no idea. I told my friend in the laundry room that I'm interested in oncology because it's work that continually reminds me by its very nature why I am working and what really matters in this life. Somehow, by working with pancreatic cancer patients who continually face this duel with death, I feel like oncology motivates me to work even harder and with more purpose. Paradoxically and more importantly, oncology also simultaneously inspires me to appreciate everything non-work related in life -- family, friends, food, food, creature comforts, beautiful moments, holidays, and the ease of health. How can anything else teach me so elegantly to value both work and everything non-work?

Dr. Pausch's video:
Dr. Pausch's homepage:

Friday, June 13, 2008

Happy Graduation, Matthew!

My little brother Matthew is graduating from Arcadia High School today!
Congratulations, Matthew!
Pictured with his prom date, but don't worry ladies, he's single! (as far as we know)

Wednesday, June 11, 2008


Did you know...?

From Wiki: "The Coxsackie viruses were discovered in 1948-49 by Gilbert Dalldorf, a scientist working at the New York State Department of Health in Albany, New York. Dr. Dalldorf, in collaboration with Grace Sickles, had been searching for a cure for the dreaded disease polio. Earlier work Dalldorf had done in monkeys suggested that fluid collected from a non-polio virus preparation could protect against the crippling effects of polio. Using newborn mice as a vehicle, Dalldorf attempted to isolate such protective viruses from the feces of polio patients. In carrying out these experiments, he discovered viruses that often mimicked mild or nonparalytic polio. The virus family he discovered was eventually given the name Coxsackie, for the town of Coxsackie, New York, a small town on the Hudson River where Dalldorf had obtained the first fecal specimens."

There's also a good Wiki clinical description:
"The most well known Coxsackie A disease is hand, foot and mouth disease (unrelated to foot and mouth disease), a common childhood illness which affect mostly children aged 10 or under[1], often produced by Coxsackie A16. In most cases infection is asymptomatic or causes only mild symptoms. In others, infection produces short-lived (7-10 days) fever and painful blisters in the mouth (a condition known as herpangina), on the palms and fingers of the hand, or on the soles of the feet. There can also be blisters in the throat, or on or above the tonsils. Adults can also be affected. The rash, which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet."

It should really be called Coxsuckie!!

Tuesday, June 10, 2008

The Other Foot-in-Mouth Disease

First day of my 2-week vacation and I come down with a 101.8 degree fever, mouth sore, and sore throat.

Today I woke up hoping it would be better, but I'm still sweating enough to fill a small swimming pool, must have caught something from the kiddos in pediatrics. Couldn't make it to my longitudinal clerkship in radiation oncology, but it's probably better not to give a virus to cancer patients getting chemotherapy. Stumbled into Student Health Services (SHS) this afternoon with a fever of 102.6 F, sore throat, apthous ulcer, and slightly bleeding gums. Since I just completed my pediatrics clerkship, my differential included strep throat and hand-foot-and-mouth disease (Coxsackie virus A).

As a kid, I remember getting HFMD with my siblings, and how I thought that it was called "Foot in Mouth Disease," and felt confused because that was supposed to mean something else...

Rapid strep test was negative (but you would still order a culture if your suspicions were strong), and the doctor said it was probably HFMD. The disease lasts 7-10 days (good use of vacation, eh?), and includes fever, sore throat, oral ulcers, and itchy vesicles on your hands and feet. Not all presentations have the full hand-foot-mouth thing.

My fever has been running pretty high these past 3 days, and i've been doing some reading on the internet to see if tylenol vs. motrin (ibuprofen) is better as a fever reducers. Some studies say ibuprofen, some say alternating both drugs works best.

Monday, June 09, 2008

Heal Thyself

Came down with a 101.7 F fever last night...must have caught something from the kiddos. I sat on the couch for a good 20 minutes before I realized, "Hey, I could be taking an antipyretic right now." So I took Tylenol, but at the clinic we always give feverish kids ibuprofen, I wonder which one works better for fevers. Another useful thing that I learned in peds is that fevers burn off a lot of water, so you have to rehydrate mucho -- and that dehydrated kids will decompensate a lot faster and with less warning than adults do.

Woke up this morning with a fever of 101.8 F...Arghhh.

Wednesday, June 04, 2008

My First Peds Patient in WBN

Baby Sierra (with permission)

Tuesday, June 03, 2008

Cancer Stem Cell Symposium

Recently found out that I missed a cancer stem cell symposium at UCSF...bummer.

Monday, June 02, 2008

Education > Contraception

On adolescents: "An increase in the number of years of schooling for a woman delays the age at which a woman marries and has her first child."


What about men?


Attendings throw around the word "smegma" occasionally in clinic, and I assumed that it was a slang term for secretory accumulations of "schtuff," but apparently it's an actual scientific term. Mmm, gross!

From Wikipedia:
"Smegma, a transliteration of the Greek word σμήγμα for sebum, is a combination of exfoliated (shed) epithelial cells, transudated skin oils, and moisture, and can accumulate under the foreskin of males and within the vulva of females. It has a characteristic strong odor. Smegma is common to all mammals, male and female. Mycobacterium smegmatis is the characteristic bacterium involved in smegma production, and is generally thought to form smegma from epidermal secretions."

Sunday, June 01, 2008


Intern: "Baby M and Baby M2 are the anti-babies...don't put them together or they'll explode."

Saturday, May 31, 2008

Bye Bye Baby

Babies are born into this world into different situations, and while most babies are born into loving families, the range of parents is amazing. Some parents have special "birth plans" and pediatrician appointments already established before the baby even leaves the hospital, while other babies need Child Protective Services (CPS) because the mom's living situation is unsafe or unstable.

Baby M was a small baby girl born during my second day of service in the newborn nursery, the daughter of a mom who told Jim, the intern, that she had used drugs, smoked a pack a day, and injected an IV "speedball" (cocaine and heroine) during her pregnancy. The situation was not unusual, but it naturally made the hospital staff a little concerned. Dad was in prison, mom was acting a little strange, and it was unclear whether mom would be able to take care of Baby M.

CPS offered to check mom into a residential rehab facility so that she could live with her baby, but mom was upset about not being able to take care of a dog at home. Since mom's urine tox tested positive for methamphetamines, and so did Baby M's, the staff decided to keep the baby in the nursery until mom detoxed a little. Usually, babies stay with their moms in the hospital rooms in order to promote bonding. Gone are the days when u see babies lined up in little rows behind a glass window, the newborn nursery is usually a quiet place when no circumcisions are occurring (just kidding).

Jim, the compassionate intern, urged that Baby M stay with mom to encourage bonding. Maybe spending time with her baby would convince mom to take CPS's offer of a second chance. Disappointingly, mom didn't seem to be interested in taking care of Baby M...who spent the same amount of time in the nursery as before.

Whenever we saw Baby M -- small, quiet, with a rounded nose -- sleeping in her crib alone in the newborn nursery -- I would look at Jim with a funny expression and he would shrug his shoulders at me with an air of disappointment. Jim really cared about Baby M.

On Friday, Baby M's mom was discharged from the hospital. CPS informed her that Baby M was going to be taken into foster care, but the full impact of the news seemed to escape her and she left.

It was quiet in the nursery that Friday afternoon. It was getting late -- 5 p.m. -- and people were leaving for home and the weekend. The sun was growing dimmer over a spectacular 15th floor view of San Francisco and the only occupant in the newborn nursery was quiet little Baby M waiting to be picked up by the foster care program at 6 p.m. Her eyes were open, but she was silent, so I picked her up and rocked Baby M in my arms for a few minutes to say good-bye. As I thought about how all of the other babies in the ward had gone home with happy families and all of the love and opportunity that awaited these other babies -- tears started coming to my eyes thinking about how Baby M was left behind in the hands of strangers.

When Baby M's mom dramatically returned to the newborn nursery the next afternoon -- glassy tears streaming down her face because she couldn't find her baby in the Well Baby Nursery or anywhere in the hospital -- it was hard not to feel sorry for a mom wearing dirty tennis shoes with rolled down socks and a red sweatshirt who didn't realize -- like many of us -- what she had lost until it was truly gone.

My First C-Section (as a med student)

The pager beeped and we dropped everything and ran to the labor and delivery room.

After a week of waiting, I finally witnessed my first newborn delivery. The mom was Rh negative and sensitized to Rh factor (which is sort of like seeing an ivory-billed woodpecker because everyone has read about it, but few people have seen such a case in the U.S. now that we are so meticulous about managing pregnant moms), and the baby was Rh positive.

The Ob-Gyn docs tried to pull the baby out using forceps, but baby wasn't coming they took mom to the OR to do a C-section. I saw my first C-section, which was eerily how I imagined it. Save your romantic notions that surgery is a delicate scientific process...they made a transverse incision across mom's lower belly and reached in to grab the baby. There was a fair amount of blood, but it was fascinating how much of the blood was collected by a plastic bag around the incision (will learn more about this later, hopefully), and the tough Ob-Gyn ladies were pulling and rummaging around mom's belly looking for the blue baby. The pediatrics team generously allowed me to hold a blue sterile towel so that I could "catch" the baby. Soon we could see the head, and the Ob-Gyn attending reached in and pulled the baby out of the womb by its head. I held my arms outstretched, holding the blue cloth, ready to receive the baby from the Ob-Gyn docs, and the baby landed in my arms, newly severed from mom -- a big blue baby that was sort of floppy and doll-like. I carried the baby 3 feet to a warmer and we began warming, drying, and vigorously stimulating the baby with towels...he had Apgar scores of 3, 4, and 6.

The baby was taken to the ICN and I watched as the residents put in a central line. I mentioned that it was my first delivery, and one of the residents asked if I was keeping a journal of my third year of medical school. I told him no, but I do keep a blog...

Working in the Well Baby Nursery this week (or Hell Baby Nursery according to some interns who dislike the loads of paperwork, the MS3's LOVE the nursery) was a lot of fun. It was very pleasurable playing with newborns, they are so different from any other patients and a pleasure to care for. The parents are always very excited and grateful, and the dads are amusingly awkward and sort of dazed and eager to help. I learned how to perform a newborn exam, and what things to look out for and what findings are normal in a newborn.

Thursday, May 22, 2008

Medicine and Domestic Violence

Sent by a JMP student today...

May 20, 2008

Screening for Abuse May Be Key to Ending It


The silver-haired woman greeted me at the clinic door, one arm suspended in a bright blue sling.
This wasn’t her first visit. In the preceding few months, she had come to the clinic twice with assorted aches and inexplicable pains. Now her husband had broken her arm, and the reason for those visits had become glaringly obvious: he had been hitting her.

And the domestic violence screening question I’d asked months before — nestled between queries about smoking and seat belts — seemed to have been spectacularly ineffective, since she’d answered “no.”

When I had asked about violence at home, I had been following guidelines set by the surgeon general and many professional groups, including the American Medical Association. Those who support routine questioning say domestic violence is as or more common in women than many diseases for which doctors regularly check, including breast and colon cancer, and its health risks are well documented.

Despite these recommendations, screening for domestic abuse in seemingly healthy women is nowhere near as widespread among doctors as testing for breast cancer or high cholesterol.
Some physicians see domestic violence primarily as a criminal justice issue, and take umbrage at being expected to delve into a difficult, messy topic when they already have to screen for many other conditions and diagnose complicated diseases in the span of an ever-shorter visit.
In a recent nationwide study of nearly 5,000 women, only 7 percent said a health professional had ever asked them about domestic or family violence. When surveyed, doctors often respond that they don’t ask such questions because of a lack of time, training and easy access to services that help these patients.

Some have reported that they worry about offending patients and believe asking won’t make any difference.

“Just like anybody else, doctors avoid things they may have discomfort doing,” said Dr. Michael Rodriguez, a researcher and family practitioner at the University of California, Los Angeles.

“There’s also an expectation on the part of some folks that once we identify abuse she should just walk away, and frustration when she doesn’t.”

Dr. Rodriguez and other experts say that urging an abused patient simply to leave may not be realistic or safe, for several reasons: The risk of being murdered is highest at the time one leaves, the woman may depend on her partner for food and shelter, and patients may not respond well to a doctor who dictates what to do.

They also say the best way to ask about such abuse is in a private place, with no family members present, as part of the routine patient history. If the patient says she has been battered or threatened at home, experts recommend that the doctor offer empathy, tell her what’s happening is wrong, document her story in the medical record and provide her with information on places to go or refer her to someone who may be able to help, like a social worker.
Barbara Gerbert, director of the Center for Health Improvement and Prevention Studies at the University of California, San Francisco, said that while some women might deny domestic violence at first, the question itself could have a profound effect: many women remember that their doctor asked and eventually, even years later, reveal their secret.

“Just by asking, you may be planting a seed for change,” she said.

Numerous studies indicate that doctors ask about domestic violence poorly, however, and don’t handle it well when they do get a yes answer.

Felicia M. Frezell, 34, an office manager in Omaha, told me recently that she visited her doctor’s office many times with her five children during the 15 years she lived with her ex-husband, who was convicted in 2005 of raping her. She said that even though she often had bruises, no one ever asked her why — until she asked her doctor to look at her swollen black eye and told him her husband had hit her.

“He just said, ‘You’d better get out of that situation’ and left it at that,” Ms. Frezell said, and added: “Looking back, I didn’t know the resources that were out there. The doctor’s office is a good place to go because it’s neutral and it’s confidential. It’s not like telling your husband you’re going to the police department.”

According to the Bureau of Justice Statistics, from 2001 to 2005 (the last year for which statistics are available) there was an annual average of nearly 511,000 violent assaults against women — and 105,000 against men — by a spouse or intimate partner, about half resulting in physical injury.

Despite such numbers, the United States Preventive Services Task Force concluded in 2004 that although clinicians should “be alert” for signs of violence, there was insufficient evidence to recommend for or against screening asymptomatic patients for domestic abuse — mainly because of a dearth of large-scale scientific studies looking at this question.
While many researchers say more money is needed to pay for such studies, some say the analogy to routine screening misses the point.

“Trying to equate it to a Pap smear is the wrong paradigm, and it’s just irrelevant,” said Dr. Christina Nicolaidis, a general internist and researcher at Oregon Health and Science University. “It’s not a test you can just check off.”

“The reasons to ask,” she continued, “are to educate a patient and to open the door so that the patient knows she can come to you. It’s part of developing a real relationship with your patient. Over time, you might be able to uncover the abuse and improve her safety, but you also might better understand why she’s having her symptoms and how to better approach her self-management of her illness.”

Abused women are at increased risk of chronic pain, depression, anxiety and alcohol and substance abuse, and they can have problems taking their medication correctly and getting to appointments. In one recent study, women who said they had been abused within the past year were more likely to have partners who interfered with their medical care.

Seven years ago, the Institute of Medicine, which advises the federal government, issued a major report on the training of health workers on family violence. The report concluded that such violence “was not a consistent priority” in health workers’ education and recommended that the Department of Health and Human Services establish education and research centers in family violence.

By unhappy coincidence, the report was unveiled at a news conference on Sept. 11, 2001, and has since “collected dust,” said one of the authors, Felicia Cohn, who now directs medical ethics at the University of California, Irvine.

“Certainly other issues took precedence at the time,” Dr. Cohn added, “but the continuing inattention is both inexcusable and embarrassing. This is a public health pandemic with immense health care implications.”

For my silver-haired patient — and other women I see at the clinic where I work — there have been no simple answers. I keep the telephone numbers for a local women’s shelter and the police department’s domestic violence unit in my lab coat pocket. And I keep asking the question, so my patients know there’s a place they can turn.

Erin N. Marcus is a general internist and associate medical director of the Institute for Women’s Health at the University of Miami Miller School of Medicine.

Monday, May 19, 2008

Finger to Nose

Just got back from the ED (for some reason, the med community calls it the ED, while the public calls it the ER or emergency room).

Pediatric urgent care was crazy busy today (everyone waits until Monday over the weekend), was there until 8 p.m. Then went over to the ED and saw the cutest 4 y/o boy with an eyelid laceration because his friend hit him in the eye with a rusty pole this afternoon (me: "it doesn't sound like he's a very good friend").

The cutest thing was when I was doing the neuro exam to make sure that his brain was intact after getting whacked in the head, and I asked him to do finger-to-nose to test his coordination.

Me: "Okay, I want you to touch your nose and then touch the tip of my finger."
Boy: [Sticks his index finger up his nostril to the first knuckle and withdraws a snot-covered finger]
Me: [Collective "Eew" arises from adults watching. Me pulling finger away quickly while parents burst out laughing] ", let's test your other finger..."

Wow, I never expected that from a pediatric finger-to-nose exam!

On another note, I am so far removed from current events...Robert Mondavi passed away and apparently there was this big earthquack in China. For a great blog posting on Anderson Cooper 360, please refer to a posting written by the sister of my former housemate:

Shit, did I just say "earthquack"?

Thursday, May 15, 2008

Thoughts on Parents

In college, I was most interested in pediatrics because a) I like kids; b) I have 3 younger siblings whose ages range over a 12-year span; and c) most of my community service in high school and college reflected working with little kids or mentoring adolescents.

Feeling comfortable with babies, toddlers, preteens, teenagers has helped me enjoy my pediatric rotation, so it's funny how by the end of my year finishing clinical research at Stanford, my career interests had changed course and my interest in oncology grew. As a patient population, I really enjoyed working with an older age group of patients who had pancreatic cancer -- they had diverse backgrounds, interests, and personalities tied together by an unfortunate and often tragic illness.

One thing that worried me about pediatrics was the hearsay that it's not just the patient whom you have to worry about...but often their neurotic and demanding parents who are understandably worried about their most precious charges. Hearing that argument, I was turned off by the idea that maybe I could not treat the patient directly, but would spend much of my time negotiating diagnoses and treatments by proxy. Another common argument one often hears is that pediatrics can sometimes be "veterinary medicine" (I don't like this phrase), since nonverbal children cannot articulate their symptoms or discomfort.

During my pediatrics rotation, I have found that my worries about Parents (with a capital P) have been exaggerated. Although some Parents can be bossy, demanding, and overly histrionic, I have more often found myself touched by the love, dedication, and sacrifice that each parent demonstrates for his or her child. An infant who received a liver transplant practically lives in our inpatient ward with his parents and older brother, who spend every hour with him, sleeping on chairs and air mattresses every night and never leaving his side for days without a word of complaint or resentment. A mom who cries because her son has anorexia and will not eat anything she offers. Another mom asking about the cognitive effects of whole brain irradiation on her 10 y/o son with Down's syndrome and ALL. Parents who take showers in the hospital, sleep on chairs every night, pour every ounce of energy into supporting their children, no matter how sick the child is or how hopeless the situation may be.

So now I find that Parents tug at my heartstrings as much as their children do, and everything that I have always loved about kids remains the same. Children perceive the world differently, they are more pure of heart and have cute miniature body parts.

Adolescents are an interesting age group, too, they have such a unique set of concerns, risk factors, and half-formed perceptions of the world and how it should be. At best, their preoccupations and insecurities amuse and touch me, at worst, their teenage angst and myopic, self-conscious and self-centered views of the world impede effective medical care.

Overall, however, both pediatric patient groups demonstrate an acute vulnerability that makes me want to take care of them, and their little Parents too.

Wednesday, May 14, 2008

Pediatric Urgent Care

Today, I diagnosed a 16-month-old girl with acute otitis media. I am proud of this because a) the baby couldn't tell me what was hurting her and b) i've never seen an inflamed TM before. This makes me feel like maybe someday I can be a semi-competent doctor.

I also helped take care of a 10 y/o boy today who fell on his head and had a 2.5 cm. forehead laceration that was so deep it was down to the bone. It was a really wicked cool laceration, and the poor boy took it like a champ. Watching the suturing was so cool!

There was also a 4 y/o girl who also fell on the pavement, but she presented with waxing and waning mental status and 3 bouts of emesis in the exam room. We rushed her to the CT scanner in the emergency department to check her head.

Saturday, May 10, 2008

Random Peds Quotes

Intern: "Can't trust a four-year-old."

Intern: "Why don't we do pregnancy tests on all of our male adolescents, too? It would be more thorough and less discriminatory."

"The longer you stay...the longer you stay." (this makes so much more sense now that I'm in the hospital than it did before)

Senior: "She's afebrile and non-edematous, which is...weird."

Senior: "She's going to barf on you."

Tuesday, May 06, 2008


Moffiteer = pediatric patient who spends more than 50% of their time in the hospital

My service is the Blue team (adolescent med/eating disorders, GI, neurology) and I love our patient cases. We've had a incredibly busy service this week with over 20 patients this morning!

Other teams are Green (renal, psych, and endocrine) and Gold (pulmonary and gen. peds).

Friday, May 02, 2008

Only in Peds

Senior: "Cinderella is walking down the hallway!"
Me: "She is very convincing."

Woody from Toy Story was here too! :)

Thursday, May 01, 2008

What I Have Learned So Far on the Wards

Four days of working at the inpatient pediatric ward at Parnassus (someone who works here a lot would be called "Little Miss Moffitt"!) and it feels like I've been here for TWO months!

Lessons learned from the wards so far:

1) Medical school may possibly be detrimental to your own health. A classmate observed that doctors spend so much time obsessing about other people (the patients) by talking about them for hours, measuring every mL of fluid that enters and leaves their bodies, writing about them, visiting them, that it's ironic how healthcare workers forgo the basic building blocks of life: eat, sleep, exercise, go outside for fresh air and sunlight.

2) Abbreviations are extremely annoying and yet irresistibly convenient. New one: EOMI. Still don't know what c/c/r means.

3) Patients complain that they never see the doctor, but the doctor spends 10 hours everyday thinking about the patient, talking about the patient during rounds, making phone calls about the patient, writing orders for the patient, and writing progress notes for the patient...and then they spend 10 minutes interviewing and examining the patient!

4) Doctors can lose perspective by working the hospital everyday. Last night, we admitted a patient at 8 p.m., and after working for more than 12 didn't seem like anything new or exciting. But the family was really anxious because the patient was spending the night and it was all so unfamiliar and scary for them. Working in a hospital can give you a strange sort of myopia about what is normal and what is not...because everything normal at Moffitt is abnormal in the "real world."

I am loving my pediatrics rotation so far. Pediatricians are perhaps one of the nicest species of doctors, they are usually very happy and nurturing with a good sense of humor. I think it's impossible to be angry or bitter when you are surrounded by little children and adorable babies sitting in red plastic wagons pulled around the hallways or sitting at the nurses' station. Seriously, where else am I going to find a ward filled with red plastic wagons bearing adorable smiling kids (err...hooked up to IV's).

Yesterday, we had a talk on sickle cell anemia given by Dr. Mentzer (of Mentzer Index fame!). He is a professor emeritus at UCSF, and he talked about how he just grafted his pinot noir plants in the backyard.

Random Amusing Quotes:

Me: I don't even know how UCare works!
Intern: It barely does.

Me: [An 11 year-old boy] urinated on himself this morning and he became really embarassed and started to cry.
Attending: Happens to the best of us.

Monday, April 28, 2008

The First Day of a Long Year

I just wanted to commemorate my FIRST day in the wards with a special post. Today marks the first time that I have:

1) written an order
2) written an H&P that will actually go into a patient's file
3) been paged regarding an order

The transition from the classroom to the clinic is jarring no matter how wonderfully UCSF tries to soften the blow through FPC and Transitional Clerkship (which was excellent). I remember that right after a brief morning session, I began to follow Blue Team around on Rounds and they began discussing this baby with hyperbilirubinemia and debating things like hereditary spherocytosis, osmotic fragility test, Coombs test, etc. Suddenly, I had a moment of clarity lined slightly by surprise, delight, and terror. My first thought was, "Oh shit, this stuff actually matters." Two years of medical school have already passed, may they stand me in good stead.

Friday, April 25, 2008

Craig, you stole my post!

Lying awake this morning, I was thinking about writing the same thing as Craig....about the balance of power between nurses and doctors and how doctors can only write orders and are not allowed to touch the medications, while nurses are the only ones who can "push" the meds.

Moreover, nurses usually perform phlebotomies (blood draw from veins), but if the patient is a "hard stick," the butterfly needle may end up in the doctor's hands (MD's are also the least experienced phlebotomists!). What's even more interesting is that only doctors are allowed to draw blood from arteries...why is that?

Wednesday, April 23, 2008

if I don't return your calls

Third year is starting! Please forgive me if I don't return your calls/emails/smoke signals/pigeons...I will be in the hospital...a guppy in the healthcare ocean learning how to survive. This is your warning!

Block 1: Pediatrics
Block 2: Medicine
Block 3: Family Medicine
Block 4: Surgery
Block 5: Ob-Gyn
Block 6: Psych/Neurology

I will continue to blog, worry not. See you next May! =p


Funny thing: the closer we get to starting third year...the less sure I am about what I'm interested in. Suddenly everything feels more like an open book than ever before, and I don't know what I want to do or even where I'm going to live!

Boards Recap

USMLE Step 1 Tips:

1) Essential texts:
- BRS Pathology
- BRS Physiology
- First Aid (started at UCSF!)
- Microbiology Made Ridiculously Simple

2) Other great books:
- Basic Immunology (by Abbas, faculty at UCSF, he made us buy it)
- Neuroanatomy by Blumenfeld
- Neuroanatomy Made Ridiculously Simple
- For detailed biochemistry...Voet & Voet (from Paul)

There is an ocean of review books for pharmacology, gross anatomy, biochemistry, embryology from various series (First Aid has a review of the study resources), but I just relied on First Aid to tell me the important points.

3) Read BRS Pathology with Google Images and Wikipedia nearby...invaluable.

4) The age-old dilemma: Kaplan QBank or USMLE World? A classmate and I bought both qbanks and switched off taking tests on either as someone who has tried both...choose USMLE World because it's cheaper, has more realistic/harder questions, and the testing format looks EXACTLY like the real test with identical buttons, etc.

5) Goljan lectures are entertaining and enlightening and good for those few minutes of the day when you want to be productive without reading.

6) There is a free NBME Practice Test online.

7) Watching "House MD" on DVD as a "break" actually HELPED! Suddenly, tuberous sclerosis doesn't seem so foreign and you get to practice making differentials and seeing weird "zebras" dramatized onscreen.

8) Teaching MS1's (like in MSP) really helps you review material and remember it better.

Overall, I would agree with Craig's evaluation of Step 1...there were more behavioral science and experimental data analysis questions than I expected. Some questions were tricky...some were plain inscrutable (an oxymoron), and others were freebies. :)

Honestly, this might get me tarred and feathered, but I had a lot of fun studying for the boards. It was stimulating to learn new things (there's an ick factor tie between Google imaging STD's and various dermatological lesions) and having unstructured time to eat and play. I slept at 12, woke up at 9, studied for the most of the day in coffee shops, classrooms, or at home...went wine tasting, attended a mnemonics "party," ate meals at restaurants, and it was really only the last 4 days when I started freaking out (ehhh, probably not an endorsement, but there ya go).

Paul and I began studying in earnest around March 6 after formal classes ended, we finished BRS Pathology and Physiology in 9 days and then slowed down when we started reading First Aid in 5 days (read it several times, it's incredibly dense and every word is actually important). Then we started practice questions on Kaplan QBank and USMLE World while reviewing material in various sources.

Overall, I am fairly happy with my score, but of course it's my nature to entertain the nagging feeling that maybe I could have studied harder. Studying was a good experience, however, and I just have to admit that my brain and personality have mellowed with age. :)

Monday, April 21, 2008


Before today, I had never seen the effects of a gunshot wound before, much less a self-inflicted one. I was unsure that the bullet would be easily visualized on the x-ray, but the outline was clearer than a rabies virus capsule. It's true what they say about the identities white opaque things on CT: blood, bone, bullet, or "bontrast" (contrast).

Medicine loves acronyms and mnemonics. Give a poorly spelled and nonsensical acronym that serves as a mnemonic to any medical student and they will write it down and regurgitate it back to you like a highly trained machine. We like crazy sentences and mnemonics full of sexual innuendo. For example, for the brachial plexus, we have "SMI LPM MARMU" and "Randy Travis Drinks Cold Beers." Okay, there was no sexual innuendo. To the untrained eye.

For an assessment of a teenager's psychosocial history, we use HEADSSS (my pet peeve is when they add multiple "invisible" repeats of a letter in the mnemonic), which stands for "Home, Education, Activities, Drugs/Alcohol, Sexual History, Suicidality, and Safety." I underestimated how important HEADSSS can be as a "tool" to cover the basics until my patient was an adolescent with a self-inflicted gunshot wound. Suddenly, the mnemonic was a way to get inside his HEAD(SSS).

Tuesday, April 15, 2008


Today was the first day of Third Year (we're in a 2-week buffer known as Transitional Clerkship) and the rubber has clearly hit the road.

We had class 9-12 pm and then orientation at SFGH (for my group) in the afternoon. Around 10:30 am, the speaker asked if there were any questions and one student asked if we could take a break.

"A break?" the speaker asked blankly, as if to say, what's that?

It was a sign that we've become MS3' more touchy feely breaks or administrative coddling! Running down the hallway eating a salad at SFGH today also made me realize that life is going to be a lot more hectic.

Hopefully these 2 weeks will be productive and organizational for me...I've already experienced a few administrative snafu's mostly from being so distracted last month.

Coming back to UCSF for lecture makes me feel like a stranger...the lecture hall was repainted and recarpeted and there were new metal benches outside the nursing building. UCSF does seem to continually change. :)

Friday, April 11, 2008


Look, Ma, No Cisplatin!
Took Step 1 (gulp) the first week of April and then flew home to LA to take a family trip to Taiwan. The four kids in our family took the coolest picture with a DNA sculpture! Next week begins our orientation for the wards. :)

Tuesday, April 01, 2008

one year ago

Written exactly one year ago today on this blog:

"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."

Double Dog Dare You

Saturday, March 29, 2008


Hilarious article written by next year's Synapse editor, Arul, in honor of our yearly April Fool's issue (called Relapse). For some reason, UCSF has a reputation for being fiercely competitive and intense, but it's actually one of the most touchy-feely medical schools around. We just like to pretend that we're all business -- prickly demeanor on the outside....soft gooey caseating mush on the inside.

Note: this article is entirely fictional.

Grades: As Easy as A, B, C

By Arul Thangavel
Relapse Staff Writer

In a surprising move, UCSF School of Medicine has announced that it will switch from its current Pass/Fail grading system to a more traditional A/B/C grading system at the request of students. Many of the top medical schools in the country have had a Pass/Fail – or the even more friendly Pass/No Pass – system in place for many years now, at least during students’ pre-clinical education, to encourage a spirit of camaraderie and curiosity among students instead of fierce competition. But here at UCSF, many first-year medical students have complained that the current system has not allowed their competitive urges to fully blossom – and as a result, they pushed the administration hard for a change back to what many Deans call “the dark ages.”

Stories of “the dark ages” of medical education, which spanned much of the twentieth century, are severe. Students, graded on a strict curve against their peers, tried whatever they could to get the edge on their classmates, from hiding library books to grabbing group study room cards but not using them, to buying up entire stores of Netter’s Anatomy from the school bookstore to get the famed “restocking advantage” – other students squirmed for thirty days while the consortium of students who bought the multitude of Netter’s sat comfortably by. In one particularly ugly case, a student – not at UCSF – willfully got bitten by a werewolf so he could become a fearsome beast once a month on test day – scaring students and professors out of the room and securing a decided advantage for himself. Only a few students stayed in the room with the seemingly mythical creature, and they had their heads down while it bubbled its Scantron furiously.

First-year medical students at UCSF, though, believe that the pendulum has swung back the other way now. George Hulley, MS-I, laments, “Have you been to one of our small groups? It’s a love-fest. Everyone says, ‘Oh you’re right,’ and then ‘Oh no, you’re right.’ Come on people. You can’t both be right. Man.” Other students complain that tests are far too easy, citing the fact that every student passed the Pulmonary block exam. Michael Tseng, MS-I, suggests, “If everyone in the class is passing, we’re obviously doing something wrong. I have no idea whether I’m better than someone like, say, you, Arul. Without that knowledge, I don’t know if I’m really getting anything out of my medical education. I need to better someone else.” Tseng further displayed his competitive urge by challenging this reporter to a series of mock medical aptitude tests, “right here, right now.” Clearly, UCSF students needed an outlet for these fearful feelings.
UCSF administration says that they tried to provide an outlet to competitive feelings through non-scholarly activities such as intramural sports and extracurricular activities. Even these activities, though, have spiraled into fierce tete-a-tete’s, with one memorable moment involving water balloons, freezers and both Homeless Clinic and Clinica Martin-Baro. Intramural basketball games have ended in utter failure, with each individual student trying to outshine the other on her team, causing massive team losses. In response to these results and strong opinion from students, faculty finally succumbed and allowed grades – even with pluses and minuses – back for next year.

Emily Whichard, MS-I, is excited. “Finally! Now I can show people that I know more than them in a standardized way. Standardized is key. Normally I have to wait until a certain point in a conversation and then chime in the answer from afar. And then you don’t always get the credit. Now I will – the administrators have made the right decision.” Hugo Torres, MS-I, is also gleeful, “I can’t believe how great this is – grades are the best. They make me feel like I’m in high school all over again.”

It remains to be seen how this saga will unfold, but one thing’s for sure – the academic heat has been turned up a notch at UCSF School of Medicine.

Wednesday, March 26, 2008

Amusing Quote

Lily Tomlin - "The trouble with the rat race is that even if you win, you're still a rat."

Tuesday, March 25, 2008

it's sort of funny...after the hundredth time

P: "Leigh's disease
I have no idea what that is
it's not in first aid or BRS path
the explanation starts off w/.. "this disease is so rare that most physicians will never see it ever in their life"
"some sort of mitochondrial deficiency.. present w/ ataxia and other neural signs"
I hate them."

Sunday, March 23, 2008

in retrospect

My 24th birthday was really special, even though UCSF conspires to make every birthday slightly hectic (last year: M&N exam, this year: boards, next year: rotations, 4th year: Match Day).

Studying for the boards has helped me understand the medical conditions of the patients whom we have interviewed in the hospital for the past 1.5 years. In particular, I just wanted to jot something down right now about a woman in the neurology wards who I now realize had one of the defining illnesses of AIDS: HIV encephalitis. At the time, I didn't understand what that could be, or that she even exhibited signs of it. Talking to her about her life (she was in her 30s and a professional dog walker), she seemed normal but now I realize how much patients can preserve social graces in the face of debilitating mental conditions. She could talk about her life and her background, but she couldn't name simple objects and often mixed them up with similar sounding words. In retrospect, she was so young, and she was in bad shape...but she said to me, "Want to know something? HIV hasn't changed much, I've had a good life."

And for some reason right now, I want to believe her.

Friday, March 21, 2008


Lost my hearing and my voice at an awesome 80s cover band concert. It's all part of the normal aging process. So happy! :)

If medical students studying for the boards start talking about bizarre illnesses...just yell out the safety word: "PEANUT BUTTER AND JELLY SANDWICH!!!" To get them to stop.

Thursday, March 20, 2008

Caffeine Is the New Coke

Think about coffee and then think about the criteria for substance dependence (from First Aid 2008):

1. Tolerance - need more to achieve same effect
2. Withdrawal
3. Substance taken in larger amounts of over longer time than desired
4. Persistent desire or attempts to cut down
5. Significant energy spent obtaining, using, or recovering from substance
6. Important social, occupational, or recreational activities reduced because of substance use
7. Continued use in spite of knowing the problems that it causes


Monday, March 17, 2008

Signs of Mental Decline

The first sign of dementia is losing track of your surroundings...I am definitely not alert & oriented x 3. In fact, I'm not even sure what day it is, but it doesn't trouble me too much. It's funny how they say boards studying will fry your brain...I've definitely lost my short-term memory (hello, Alzheimer's) and I even think that I may have Broca's aphasia at this point....finding words is SO DIFFICULT. I can't speak normally all comes out in short words like...""

Friday, March 14, 2008

The Effects of Boards Studying

S: "Can you come up with a mnemonic for uremia (kidney failure)?

Signs of uremia:

P: "Hey, how about 'HAHAHA...pericarditis'?"

Boards Tip #1

Wikipedia is my best friend.

Google images is also incredibly useful.

Sunday, March 09, 2008

Boards Boot Camp

UCSF has given us 4 weeks to take the USLME Step 1. I am liking the unstructured time to study, but am currently starting to get worried and quickly losing track of time (what day is it? what time is it? when did I last eat?)...and it's only been day 2 post-life cycle final.

Will send periodic updates from the black hole that is boards studying.

Wednesday, March 05, 2008

Seminal Events

Yesterday: I ate lobster for the first time in my life (if you don't count the allergic reaction when I was 2 years old). Thanks to Paul for introducing crustaceans and clams into my diet.

Today: Studied in the sunshine for 4 hours.

Tomorrow: Last medical school test.

Tuesday, March 04, 2008

Last Day of Class

Today was our last day of formal lecture at quickly the time flies by! After the Life Cycle exam on Thursday, we will be on our own studying for the USMLE Step 1.

Today our small group had a small celebration with mimosas and home-baked muffins (courtesy of Char who woke up early to bake them) and peppermint bark (courtesy of DSL). After a fun patient interview with an elder, our class celebrated our transition from the classroom into the boards and wards with a raffle, a few words from the interim Dean, and a slideshow made by an MS4.

Tuesday, February 26, 2008

MSP, I Love Thee

The most valuable experience this year has been teaching for the Medical Scholars Program (MSP) at UCSF. MSP is a program consisting of 16 MS2's who run 30 minute review sessions of anatomy, cardiovascular, respiratory, and renal material to the MS1's from September through February 2008.

Since the MS1's are currently applying for MSP, this is a great opportunity for me to list reasons to apply for MSP:

1) MSP gives you lots of practice about how to communicate lessons in different ways (visual, audio, kinetic) to your peers

2) You learn how to answer questions or handle questions that you don't know the answer to (very very valuable on wards I would imagine with both patients and attendings)

3) MSP is a lot of fun and the people are really energetic

4) There's a great MSP tradition and you feel like you're part of something special :)

5) GREAT review for boards, you relearn important things, the best preparation is teaching and everything you do actually helps you in the end

6) you earn a small stipend for being an MSP leader

The only drawback is that MSP does take up a lot of time (especially preparation) depending on the type of person you are. Some people take a few hours, while some people take days preparing. It was a little frustrating in the fall, because i was studying for I3, prologue, and taking a grad class in biostatistics at the same time, so it was like 2/3 of my studying wasn't even going towards "medical school." I did feel sometimes like i was studying for first year all over again but now the reviews are a lot less painful so i think it was worth it.

What do MSP coordinators look for? They want enthusiasm and great communicators. :)

Core Lottery

Our Core Lottery list was due this morning at 8 a.m. For great coverage of the lottery, please see Craig's blog on the right sidebar. I regret not spending more time obsessing about my rotation preferences, but suspect that it would have been sort of pointless. Results are due March 7 (after our Life Cycle final on March 6). It's sort of an interesting putting all your preferences into a magical Sorting Hat and seeing what comes out.

Sunday, February 24, 2008


The MS2's are spending this weekend taking the OSCE (Objective Structured Clinical Examination...just know that it's pronounced "oskey" and it means that we have a clinical skills exam). We need to pass the 4-hour OSCE to participate in our core rotations next year.

The OSCE was pretty enjoyable and fast-faced...we ran around to 6 stations with different scenarios and standardized patients. Some stations focused on a particular organ system (patient with lung problems, abdominal pain, sinus infection, actual neurological findings!) and others were focused on patient-doctor communication (delivering serious news, trying to explore sensitive issues). My only critique is that it was a little frustrating trying to decipher which patient tidbits we were supposed to notice and explore and which we should ignore because we are still practicing and playing an elaborate game of "make-believe." For example, a patient who complains of "shortness of breath," but who sits there calmly with a RR of 10 and lungs CTA. Or a standardized patient (SP) who glances at the clock twice and expects me to ask her why she seemed anxious. The OSCE can easily devolve into an elaborate game of "guess what I want you to do."

Overall, however, the OSCE was really valuable and we had to pass it to do clinical rotations next year. I am really glad that we did the OSCE with our Foundations of Patient Care (FPC) groups, because it was actually really comforting to see Carson, Rodney, Miguel, and Jason (my "POD," we are whales or peas) there. We're like a little family. :)

Today we had our final FPC dinner at Park Chow and ate ginger cake!

Friday, February 22, 2008


Some women experience pain during ovulation, which someone coined as "mittelschmerz." It is quite possibly one of the quirkiest terms and definitions in medicine. According to Wiki, the term is German for "middle pain," and I would have to say that life is definitely in that slightly uncomfortable "in-between" stage right now.

Last year, I never realized how the MS2's were suffering in semi-silence -- crunched with Life Cycle, finishing up activities, trying to study for boards a month away, and trying to decode the Core rotation lottery for next Tuesday. Ahh, so much to do right now and I still haven't worked on a manuscript that I wanted to draft by last December. :( Mittelschmerz.

*** On March 6, Synapse is publishing a Women's Issue, so please contribute any articles, photos, or women-inspired poetry and artwork to by March 3, 2008. THANKS! :)

Wednesday, February 20, 2008

Lunar Eclipse

We drove to a small hill near Twin Peaks to see the lunar eclipse tonight around 7 p.m. The next lunar eclipse will be in December 2010, and Paul joked that at least one of us would be doctors by then. Stepping out of the car, the eclipse had already happened and all we could see was a tiny round wisp of cloud that we presumed was the lunar eclipse...but perhaps it was an artifact. In the dark, we climbed a hill and found a group of strangers staring into a navy blue sky without a moon in sight, the city of San Francisco lying underneath our feet lit up like a giant circuit board and the "sun" and "moon" visible on either side of the bay.
A lunar eclipse, by definition, is the partial disappearance of something. And when the moon is totally eclipsed, we found that there is actually not that much to see. So we waited for about 30 minutes for the moon to reappear, standing on the hill in the darkness. Jon asked how far away the earth was from the sun, what the tilt of the earth's axis was, and how many miles it would be to the center of the earth. Paul and Jon made a few speculations to kill the time, and Collin teased us with a riddle about wrapping a string tightly around earth and asking us how far we could pull the string from the ground if the string were lengthened by 1 inch.
I tried to remember some poetry to recite or talk about, but my thoughts were as wispy as the clouds (cirrus? asked Jon). All I could remember was Romeo's "it is the East, and Juliet is the sun," and a poem by Langston Huges about the sharp crook of the moon, "Dover Beach," and most of all, a poem called "Sad Steps" by Phil Larkin...which itself was a reference to Sidney's "Astrophil and Stella." But maybe "Sad Steps" was more appropriate than I realized, since it is after all a poem about the passage of time, reverence tinged with irreverence, and most of all an awareness that we shall all grow old together with other strangers in the darkness.
Sad Steps
Groping back to bed after a piss
I part thick curtains, and am startled by
The rapid clouds, the moon's cleanliness.
Four o'clock: wedge-shadowed gardens lie
Under a cavernous, a wind-picked sky.
There's something laughable about this,
The way the moon dashes through clouds that blow
Loosely as cannon-smoke to stand apart
(Stone-coloured light sharpening the roofs below)
High and preposterous and separate -
Lozenge of love! Medallion of art!
O wolves of memory! Immensements! No,
One shivers slightly, looking up there.
The hardness and the brightness and the plain
Far-reaching singleness of that wide stare
Is a reminder of the strength and pain
Of being young; that it can't come again,
But is for others undiminished somewhere.
- Philip Larkin
Around 7:50 p.m., the eclipse ended and the moon returned faintly, shining on its rounded edge like a pure white crescent wrapped in clouds and city light.

Thursday, February 14, 2008

Happy Valentine's Day

From today's special Valentine's Synapse:

Top 10 Things to Do if You’re Single on Valentine’s Day

By Irene Kang and Stephanie Chang
Staff Writers

Valentine’s Day, known as Singles Awareness Day to some, can be a day in which a sickening amount of Hallmark cards, chocolate, red roses and overpriced dinners are bought. With more and more people revolting against the commercialized holiday, Valentine’s Day can be made into a reason to celebrate singledom; there are more and more things to do for a good time. Here are some of the best ways to spend February 14 if you’re lucky enough to be single:

1. Go to the gym. –What?!?! Get your endorphin fix…and if that cute guy or gal is also at the gym tonight, you’ll know he or she is probably available and single.

2. Channel Cupid and shoot stuff! Even an ounce of pent-up frustration won’t be able to stand up against some therapeutic paint-balling. Gather a group of friends and shoot away. Any couples silly enough to show up to the field will have it coming.

3. Watch a zombie movie because nothing says Valentine’s Day better than “Auuuuugh!!!” Actually, there are several movies opening on February the 14th. Jumper, an action flick by the makers of The Bourne Identity, promises to get your adrenaline running while Definitely, Maybe, a romantic comedy starring Ryan Reynolds, seems to be appropriate if you are in that sort of mood.

4. Un-Valentine’s Day clubbing is the new trend. Get awesome deals and even complimentary chocolates at your favorite clubs and bars. For example, the Dirty Martini has $2 drinks on Thursdays. Chances are other fun-loving singles will also be out and about this evening. has a list of Anti-Valentine’s Day parties for the night.

5. While couples are fretting over getting into that four-star restaurant for a prix-fixe meal, you can rest assured that your wallet will survive the day. Go somewhere unpretentious with friends, so you won’t be surrounded by couples. Another option is to invite friends over for dinner.

6. Make V-Day into Me day. Everyone needs love, and maybe you’re overdue.
Setting aside time for yourself is always a good idea and particularly appropriate on Valentine’s Day. Whether you’re single or not, this day is meant to be enjoyed, so go out and get that massage or eat your favorite flavor of ice cream.

7. The UCSF production of The Vagina Monologues is playing tonight. It makes for an awesome Valentine’s evening whether you’re with someone or not.
The Vagina Monologues will be Thursday, Feb. 14th and Friday, Feb. 15th at 7pm in Toland Hall. Tickets are $8.

8. No matter who you are, you already have a Valentine. Show your appreciation to someone you love whether it’s sending flowers to your mom, calling up your best friend from college or knitting a sweater for your Chihuahua.

9. Any thoughts of Valentine’s Day should be eclipsed by the fact that this weekend is President’s Day weekend.
That means that you can make plans for an awesome three-day weekend.
It’s the perfect time of year for Tahoe, and you can pack it in and get several days’ worth of fun on the slopes.

10. At the end of the day many of us are still students. We may have class or have to teach an elective. Does your Valentine’s Day look like this? Midterm Exam, Physical Exam Review at the Clinical Skills Center, MSP teaching session from 6-8 p.m. It’s okay… this too is a meaningful way to spend the day. Really, Stephanie. It is.

Irene Kang and Stephanie Chang are second-year medical students.