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 process...like putting all your preferences into a magical Sorting Hat and seeing what comes out.

OSCE

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!

Mittelschmerz

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 synapse@ucsf.edu by March 3, 2008. THANKS! :)

Lunar Eclipse

From the SF Chronicle (photo by Fredric Larson)

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.

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. http://www.sfstation.com/valentines/ 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.

Synapse Valentine's Dedications

SUBMIT A VALENTINE'S DEDICATION TO SYNAPSE

Remember those elementary school days when you wrote Valentine messages to your friends in the school newspaper? This year, Synapse is hitting the stands on Thursday, February 14th, and we want to publish YOUR special Valentine's wishes for FREE.

Send a short message (50 word limit) to synapse@ucsf.edu by the deadline on Tuesday, February 12th, by 12 pm. Look for your dedications on Valentine's Day, February 14th!!

Disclaimer: Synapse does not guarantee that all dedications will be printed as requested. All dedications submitted will be used at the discretion of Synapse.

Lantern and Rope Riddles

A posting over the summer about riddles was warmly received by a few people who talked to me, so I am posting another set of riddles given to me by Paul, who passes them out like hard candies. Answers are written in light blue, so please highlight the text with your mouse to see the text more clearly.


LANTERN RIDDLE

A great pharoah of Egypt wanted to send 100 lanterns down the Nile River, and he set 100 servants to do a certain task. The lanterns would be floated down, and the first servant would light each one. The second servant would extinguish the 2nd, 4th, 6th (every even-numbered) lantern, while a third servant would find a lantern either "on"/"off" and then extinguish/relight every 3rd lantern. The fourth servant would look at every 4th lantern and also extinguish/relight the lantern depending on its present state...and so on until the 100th servant either extinguishes or relights the 100th lantern.

By the end of the ceremony, which lanterns are lit and which ones are extinguished?

ANSWER: There's an easy way and a hard way. The hard way is to make a chart and map out the pattern of the first 10 or so lanterns as they progress down the Nile. After the 10th servant has made his move, none of the succeedingly servants will touch the first 10 lanterns and you can determine their final state. You will find that lanterns 1, 4, and 9 will remain lit...and then find since 1+3 = 4, and 4+5 = 9, then why not add 9+7 = 16? By using this pattern, you will find that lanterns 1, 4, 9, 16, and 25 will remain lit. What is the pattern? All the lanterns are squares!

"But WHY?" you ask. The easy solution is to realize that, say, for lantern 20, that it will be touched by servants 1, 2, 4, 5, 10, and 20 (factors of 20, as Paul reminds), which is an even number of servants, and hence the lantern will be ultimately extinguished. However, for lantern 25, which is a square, the lantern will be touched by servants 1, 5, and 25, which will always be an ODD number since squares will always have an odd number of factors -- and thus lantern 25 will remain lit. Therefore, by the end of the ceremony, only lanterns which are square numbers will be lit!


PAUL'S TRICKY LANTERN RIDDLE

Paul made up this variation of the lantern riddle himself in half a second.
Pretend the same scenario of 100 lanterns and 100 servants. The first servant lights each lantern as usual, but this time EACH SERVANT will meddle with the first lantern and continue his pattern. So the 2nd servant would extinguish lamps 1, 3, 5, etc. The third servant would light/extinguish lamps 1, 4, 7, etc. And the fourth servant would light/extinguish lamps 1, 5, 9, etc.

By the end of the ceremony, which lanterns are lit and which ones are extinguished?

ANSWER: The hard way is to make another chart and determine which lanterns are lit and extinguished, as before, which will allow you to find that lanterns 2, 5, and 10 will be lit by the end of the ceremony. This pattern is square numbers + 1, so all lanterns that are a square number + 1 will be lit by the end.

BUT WHY? Since every servant touches the first lantern, regard the first lantern as LANTERN zero. The pattern of lighting has been shifted over 1 position, so that it will always be square+1.


ROPE RIDDLE

A semi-easier question supposedly asked by interviewers at JP Morgan. Pretend that you have TWO ropes which do NOT burn at a constant rate throughout the rope, but are cut to ensure that they will burn for exactly 1 hour each. Using only these two ropes, how do you measure out 45 minutes?

ANSWER: Burning the rope at one end will measure out 1 hour, but burning a rope at both ends will measure out 30 minutes, despite the variable burn rates. Start by lighting Rope 1 at one end and Rope 2 at both ends. When Rope 2 burns out, 30 minutes have elapsed -- and then quickly light the other end of Rope 1 so that you will get half of the remaining 30 minutes. Since 30 + 15 = 45, you will measure out 45 minutes. :)

Imperfections

Matthew in Sacramento, State Capitol, February 2008

My brother Matthew visited the State Capitol this weekend for a high school competition, and the group found the infamous misplaced tile in the floor that generations of Arcadia High students have been excited about for decades.

Legend has it that the architect of the capitol building placed this tile incorrectly himself, to leave his personal mark on the building, yet it seems a little excessive since he designed the entire building (!).

The photo has me thinking about leaving behind legacies and the nature of imperfections. My favorite emotional philosopher, Kim, has often talked about the beauty of slight imperfections or maybe even gross imperfections -- and how they make people, places, and objects even more treasured, unique, and yea, vulnerable.

The quirky misplaced tile sets my thoughts in motion, because it is so different -- a misfit of geometric patterning. Why does it draw the eye to itself so irresistibly and why do I endow it with so much personality and vulnerability? After years of talking with Kim and college friends as we struggled and grew to love our own imperfections, there remains a continuous conflict between loving others for their flaws and yet not forgiving them in ourselves.

I love those imperfections that make people human -- the bald spots, the surgical scars, the absurdly long toe, or a hint of assymetry -- and I love those invisible imperfections that make people real -- a heightened sensitivity, a fiery temper, a secret sadness. It seems to me that we are ultimately composed entirely of irregularities and idiosyncracies like elaborate variations on the basic geometric pattern of humanity. By these unique flaws, we leave our mark on earth and on others.

What a Hoot!

My little MS1 sib, Scott, left me a furry present in my mailbox...an owl finger puppet! I love it!

My pediatric preceptor gave me a bright butterly finger puppet...my collection is growing!

I am 23, by the way. :)

Happy Chinese New Year

Year of the Rat - Rose Parade 2008

Paul hosted a hot pot dinner tonight with 12 guests in honor of Chinese New Year's Eve. It was lovely and wonderful and there was a cheery flame in the fireplace. Sat down and ate continuously for 2-3 hours. :) Thank you so much, Paul!

The night before Chinese New Year has new significance since my grandmother passed away last year on new year's eve. My grandmother took new year's seriously; it was the most important time of year for her. She would buy candy and decorations and make little pyramids of oranges and kumquats from our backyard. Before she went to bed the night she died, she set out 4 red envelopes on her dresser to give to the kids in our family so that they would be within easy reach the next morning when she would give us her little benediction.

We found those envelopes after she died, and I never told anyone this -- it has been my secret for a year -- but I took my own red envelope and the 2 red candies that she had placed on top and carried them with me back to San Francisco. The red envelope has been sitting in my bookshelf for almost a year now, and I have never opened it.

I Am Not Hitting on You

Anyone want to practice the physical exam for the OSCE?

Requirement: Must be alive.

Two Fake Pinkberries = Heaven

From http://www.tuttimelon.com/

Oh. My. Gosh.

Okay, I know that Pinkberry is overrated and that sugar-free, fat-free, food-free yogurt shouldn't be so addictive, but there's just something about Pinkberry that makes me buy into the hype. What also intrigues me is the phenomenon of so many FAKE Pinkberries -- so many unashamedly brash knock-offs of the cute, simple, yogurt enterprise that offer the same menu and decorations.

Yesterday, I tried the fake Pinkberry known as Jubili on Fillmore St. and it was actually not that great. The yogurt is more bland and it just didn't have the same addictive quality.

TODAY, boy, I am so excited, Paul and I stumbled upon a FAKE PINKBERRY on IRVING. ST. That's right, UCSF, there's a FAKE PINKBERRY ON IRVING ST. and you READ IT HERE FIRST! The store is called Tuttimelon and it just opened near the corner of 23rd Ave. and Irving St. last Saturday. They are having a special discount of 99 cents for a small, original yogurt, but toppings cost extra. The yogurt was better than Jubili and closer to that tart, sour cream-like taste of Pinkberry, but still not creamy enough.

By the way, the Synapse FOOD ISSUE is coming out this Thursday and it's a fantastic 20-page issue of all foodie goodness. Seriously, I am so stoked.


Jubili
1515 Fillmore Street, San Francisco, CA 94115


Tuttimelon
2150 Irving Street, San Francisco, CA

Words Only Dead People Should Know

"Don't laugh at me, okay?" I said, "I made up a story to help us memorize the urea cycle."

"Okay," said Paul, sitting down.

"It's sort of a mythological story of origin, okay? In the beginning, there was only CO2 and NH4+, but 2 ATP were invested to create the first man, named Carl (carbamoyl phosphate). Carl mated with a bird goddess, named Ornithine, and together they had a daughter named Citrulline who was actually an orange fruit. Citrulline was all happy and innocent until one day she was bitten by an ASP (aspartate), which turned her bad and sucky (argininosuccinate). Since she changed names to reflect her new identity, like J.Lo, Argininosuccinate started smoking (release fumarate, "fumar" means to smoke in Spanish). She quit smoking, however, and reformed like Lindsay Lohan (haha), changing her name to plain Arginine. Then Arginine drank some magic water (H20) and peed (urea), transforming Arginine into her mother, Ornithine."

There was a short silence. Then Paul said, "So man screws a bird --"

"Bird GODDESS."

"And the bird lays an orange. Then a...what is an ASP?"

"It's a poisonous snake, can't you see the drawing?"

"It sounds more like ASS to me, so a DONKEY bites the orange and turns it evil."

"Fine," I said, "A DONKEY bites the orange. Geez, you don't know what an ASP is?"

"No," Paul said.

"It's the snake that bit Cleopatra," I said.

"That's a COBRA," Paul replied.

"NO, it was an ASP," I insisted.

Later that week, I referred to Wikipedia to resolve the COBRA/ASP issue, and found that ASP is an ARCHAIC term for several poisonous snakes, and that it has fallen out of common usage. In fact, many believe that the "asp" mentioned in ancient and Elizabethan literature as the snake that killed Cleopatra is the COBRA.

I had to apologize to Paul and then reevaluate my vocabulary -- am I using words that only dead people should know? Outdated and antiquated words are charming when you know that they are actually dead, but it's another thing to run around saying a person with TB has "consumption" and believing that you're using modern terminology.

Now I just feel like an idiot in a time capsule. I would blame Harvard for this, because certainly there are many people there who relish learning dead tongues and forgotten customs (some of them in the English Department). In fact, there are a fair number of people there who would probably be better equipped to live in 12th century society, but I never suspected myself to be one of them.

Aphasia

Strange when struggling with writer's block for over a year, and only just recovering, that you find a personal entry that captures something felt almost 2 years ago and now.

April 5, 2006
I haven’t written in this diary for a long time, but I just wanted to say that so much has happened within the past month, maybe even the whole year…I wish I had written more of my thoughts down so that I could read them again years later and be refreshed…reminded of myself when I have already forgotten. It’s too hard writing things down on my blog, because it’s public and I don’t want everyone to see what I really think or feel. So much thoughts clustered at the edges of my lips, I can’t let them out for fear of trying.

Free Hepatitis B Screening & Vaccination

Hepatitis B: Testing (No Fee) and Vaccination (Low Cost)

Mt Zion UCSF Medical Center
2330 Post Street(near Divisadero St)
San Francisco, CA 94115
(415) 885-3580

1st Saturday of each month (9 AM - 12 noon)
Mar 1, 2008
Apr 5, 2008
May 3, 2008
Jun 7, 2008


Hepatitis B: Testing (No Fee) and Vaccination (Low Cost)

Chinatown Public Health Center
1490 Mason Street (near Broadway St)
San Francisco, CA 94133
(415) 364-7910

2nd Saturday of each month (9 AM - 12 noon)
Feb 9, 2008
Mar 8, 2008
Apr 12, 2008
May 10, 2008
Jun 14, 2008

Be Hep B Free

Butterfly needle

This morning I volunteered at the new hepatitis B clinic at Mt. Zion, run by the San Francisco Hepatitis B Collaborative (SFHBC).

Some of my favorite classmates poured their hearts and souls this year into establishing outreach clinics to screen and vaccinate the San Francisco population against hepatitis B. Two clinics have been running once at month since last November, and today the clinic had a record of 59 people screened (read: phlebotomized) and about 20 people vaccinated. I am so impressed by the time, effort, organization, cooperation, and dedication exhibited by students from the school of medicine, pharmacy, and nursing. Building this clinic from the ground up was a labor of love and patience, and I could already see the impact of spreading awareness and administering vaccines to improve and prolong people's lives -- so incredibly inspirational. :)

As an educator in the morning, I was surprised by how many strangers come into clinic after hearing about the free screening from a friend or advertising with very little knowledge about hepatitis B. People were confused about the difference between hepatitis A and B, didn't know that there is a hepatitis C for which there is no vaccine, and did not know what damage hepatitis could inflict. For more information, visit the SFHBC SITE at http://www.ucsf.edu/sfhbc/hepb/. Talking to patients and teaching them about hep B was even more gratifying than I thought, because you got to spend some quality time with them and gave them some knowledge that would serve them indefinitely (until the next scientific breakthrough). Educating people about hep B is as important as drawing their blood or administering vaccines, because their knowledge dictates their autonomy.

As a phlebotomist later in the morning (we switch roles halfway), I partnered with a nursing student to draw blood for hep B testing and administered IM injections for the hep B vaccine. I lost count of how many phlebotomies I performed today, but I definitely gave 3 vaccine shots. Sorry to switch gears, but here's the story in vignette form:

A married couple entered the narrow exam room, ready to receive their first hep B vaccinations. S, the nursing student, had already administered the first injection to the husband and now it was the wife's turn to be stuck by...me. Watching S carefully screw the needle onto the syringe and drawing 1 cc of the refrigerated hep B vaccine, squirting a bit out to expel air, helped me prepare -- the last time I learned how to administer vaccines was in the fall of 2006 and we practiced injecting water into oranges. It saddened me because the oranges were inedible afterwards.

A friend of mine working for Teach for America mentioned how small children can sense fear and uncertainty in elementary school teachers, and now I realized that patients can also smell uncertainty. It makes them unhappy and nervous; and I've learned to never make sudden movements or giggle nervously. I smiled at the wife and said, "Have you had any problems with needles or blood before?"

She lifted her sleeve, exposing her petite deltoid muscle. I swabbed her arm with alcohol in a Starry Night pattern and hefted the syringe like a dart. To cause the least amount of pain, we're taught to stick the needle quickly. I held my breath and swung the needle into her muscle as fast as possible, pushed in 1 cc of vaccine, and held a piece of gauze against the point of entry while I withdrew the needle with my right hand at the same initial angle (for some reason, I convince myself that this causes less pain). The patient pressed the gauze against her wound and a band-aid was applied. She didn't seem perturbed at all, while I tried not to act too elated -- it was the first IM injection that I had ever administered to a live person. In medicine, we play it cool...like a cucumber wearing a white coat.

Administering vaccines turned out to be easier than drawing blood! After the first IM injection, it was like throwing darts but much more satisfying. My goal was the cause the least amount of discomfort, because I feel that poking needles as painlessly as possible is a valuable and admirable skill. But drawing blood requires more coordination and skill in selecting and coaxing the right vein to give up some sangre. Asian women are notorious for having no vasculature in the antecubital fossa (behind the elbow). One woman in our exam room seemed to have a promising vein, but it collapsed and S had to pull out. An MD tried to draw blood in the opposite arm, but to no avail. The woman was a bit upset at this point, because we had poked her twice without success, but a third try was the charm.

After the patient left, another Asian lady arrived and it was my turn to draw her blood. In front of a TV camera. For the first time, I tried chatting with the patient to distract her and we made small talk while I set up the supplies and searched for a good vein. I've become convinced that a sucessful phlebotomy depends less upon the skill of the health care provider and more upon the juiciness of the patient's veins -- big, blue, hydrated veins that feel spongy to the fingertip. I harbor a suspicion for veins that look too close to the surface, bright blue sirens that appear to be an easy mark, tempting you to puncture them, only to shipwreck you on a fruitless "stick." I was equally suspicious of a dark blue "Y" shaped vein on her right forearm, was it scarred down? Was it eager for a blood draw? The MD told me to go ahead, and I carefully slid the butterfly needle into the skin -- saw that ever-gratifying "FLASH" of blood in the butterfly needle and slid on the vacuum tube to pull blood into the container. There was a video camera pointed at the patient's arm less than 3 feet away, but the only mishap occurred when the vacuum tube lost suction and blood stopped pooling into the container. I nervously told the MD about the problem before tightening the syringe and seeing blood flow. Then I started breathing again.