tag:blogger.com,1999:blog-377245142024-03-21T19:46:10.282-07:00UCSF Synapse Med1The Life of a Fourth-Year UCSF Medical StudentStephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.comBlogger356125tag:blogger.com,1999:blog-37724514.post-22938122146046309262010-05-15T20:16:00.000-07:002010-05-15T20:40:18.634-07:00UCSF GraduationYesterday, members of the UCSF Class of 2010 received their medical degrees. Families cheered. Students breathed a sigh of relief and excitement. Unlike college graduations, there's a greater sense of commitment and responsibility, and an emotional ending akin to finishing one leg of a marathon. Medical school is difficult in many senses...it is difficult to apply to medical school, accept more loans, and journey through the clinical years before applying to residencies. This difficulty underscores the fact that none of the students graduating yesterday could have accomplished anything without the support of family, friends, and teachers.<br /><br />Thank you to everyone, especially my mom and dad.Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com6tag:blogger.com,1999:blog-37724514.post-55510710019247946692010-03-18T15:30:00.001-07:002010-03-18T15:31:09.366-07:00Matched!Match Results:<div><br /></div><div>Preliminary Medicine at Kaiser Oakland!!!</div><div><br /></div><div>Radiology at Mallinckrodt (Washington University in St. Louis)!!!</div><div><br /></div><div>So HAPPY! :)</div>Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com1tag:blogger.com,1999:blog-37724514.post-51723117197147352552010-03-11T18:13:00.000-08:002010-03-11T18:19:22.106-08:00Infectious DiseaseFinishing my rotation on infectious disease at SFGH...it's AWESOME! :) I am on service with fellow med student Elaine, whom I love very much. Our fellow, Sarah, is amazing and very nice to us. The cases are fascinating and the learning is plentiful. Today, we had a nice bread and butter case of C. difficile in the afternoon.Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com1tag:blogger.com,1999:blog-37724514.post-376549364884150812010-03-08T18:36:00.000-08:002010-03-08T20:12:26.260-08:00WendyThe hospital equipment in her room surrounds her like a safety net or a fortification. She sits in her bed at home wearing a nasal cannula and a face mask, the continuous flow of oxygen and periodic puffs of extra O2 streaming from clear tubes like invisible life lines.<br /><br />A strange phenomenon surrounds Wendy -- she never seems to change. Four years have passed so quickly, and when I first met Wendy in the winter of my first year in medical school, she was 14 and recovering from a bone marrow transplant. She is my PedPal, and I have followed her through numerous hospitalizations. This fall, the medical team determined that Wendy would not be a good candidate for a lung transplant, and she went home with arrangements for home hospice.<br /><br />When I saw Wendy yesterday at home, she had not changed. Her days are simple -- sleeping 12 hours per day, occasional trips to the bathroom, continuous oxygen (12 L), she is breathing relatively comfortably and experiencing no pain. The static nature of her routine belies a well-hidden unrest; she continuously roams the internet and watches anime from her bed. Her round cheeks-- vestige of prednisone -- has not changed much in the last few years, and she has always been extremely shy. I have always struggled to understand Wendy's development as a person caught somewhere between childhood and adulthood -- she fell ill at the age of 12 and has not attended much school since then, she loves Hannah Montana, and she recently celebrated her 17th birthday.<br /><br />Like a fairy or a sprite, she appears ageless, frozen in time, forever innocent and forever young. What hurts the most is the realization that this illusion of eternal youth is cruel. As I pondered all of the things that Wendy might not have the opportunity to do, it surprised me to realize that of all the missed opportunities, it pained me the most to realize that Wendy might never have the chance to grow up and meet someone and fall in love.<br /><br /><br /><br /><br />.Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com1tag:blogger.com,1999:blog-37724514.post-51711435581702540032010-02-28T23:10:00.000-08:002010-02-28T23:17:06.962-08:00Back to the GeneralStarting an infectious disease rotation at SFGH tomorrow. Even though I had neurosurgery a few weeks ago, I am feeling a slight feeling of dread about going back to the hospital! <br /><br />Yesterday, Paul and I used a Groupon to visit Cuvaison in Napa, it was a very good deal. We also picked up a wine shipment at Beringer (tried both tasting rooms) and enjoyed Hill Family Vineyards in downtown Yountville. I fell in love with Thomas Keller's Bouchon Bakery (especially the TKO!).Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com1tag:blogger.com,1999:blog-37724514.post-35002754202490126582010-02-26T16:24:00.000-08:002010-02-26T16:27:22.445-08:00Baking CookiesThe rain in San Francisco was pretty intense this afternoon, but it seems to be easing up. In honor of the poor weather, I baked some chocolate chip cookies from scratch.<br /><br />Will be starting a two-week infectious disease rotation at SFGH next Monday with Elaine! Yay! :)Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com0tag:blogger.com,1999:blog-37724514.post-60621731482868925932010-02-24T22:04:00.001-08:002010-02-24T22:10:30.881-08:00Needlestick Update 2Six months passed by more quickly than anticipated, and i scheduled a follow-up appointment for the <a href="http://ucsfsynapsemed1.blogspot.com/2009/07/stuck-in-ed.html">needlestick incident </a>that happened last July in the SFGH ED. The source patient was negative, but since I had time, it seemed like the prudent thing to do. (Thanks, Iris!)<br /><br />Occupational hazard of being a healthcare provider...or a student one!Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com0tag:blogger.com,1999:blog-37724514.post-78126714632273619002010-02-12T15:34:00.000-08:002010-02-12T15:44:01.932-08:00Inspiration is like the Brain, "You have to go after it with a club" (Jack London and Me)Today is my last day of neurosurgery at the VA, it was a good rotation and nice to be back in the hospital and in the OR. The VA service has A LOT of spine surgeries, which was fun except that the main reason that I wanted to experience neurosurgery was to see the living brain in situ. After an inspiring anatomy lab experience during the spring of my first year of medical school (almost three years ago! still <a href="http://ucsfsynapsemed1.blogspot.com/2007/04/is-it-any-wonder.html">my favorite blog entry</a>), I didn't want to finish medical school without seeing that elusive brain! Alas, I will have to continue looking for opportunities at Moffitt in my spare time...Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com0tag:blogger.com,1999:blog-37724514.post-16434755732898843142009-12-24T16:50:00.000-08:002009-12-26T14:54:34.199-08:00Santa in ChinaHappy holidays! Best wishes for a warm and joyous new year. :)<br /><br />-StephanieStephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com0tag:blogger.com,1999:blog-37724514.post-39234176509546592862009-12-21T20:29:00.000-08:002009-12-21T23:22:22.718-08:00New Paper!Recently published in the Journal of Translational Medicine:<br /><br /><a href="http://www.translational-medicine.com/content/7/1/105">http://www.translational-medicine.com/content/7/1/105</a><br /><br />A big THANK YOU to my PI and mentor, Dr. Albert Koong.<br />And Congratulations to Albert on his recent promotion at Stanford! :)Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com1tag:blogger.com,1999:blog-37724514.post-82395644046383352382009-10-29T13:12:00.000-07:002009-10-29T13:17:43.618-07:00Quick UpdateCurrently home in Los Angeles preparing for Step 2 CS (the exam that is offered in only a handful of U.S. cities, costs $1500 to register, and uses actors as patients). <br /><br />Currently recovering from a flu-like illness, ironically not contracted while in the hospital. <br /><br />Currently excited about Halloween!Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com2tag:blogger.com,1999:blog-37724514.post-38545299652270571672009-10-23T17:49:00.000-07:002009-10-23T17:51:03.710-07:00essential = unknown"Essential mixed cryoglobulinemia: A condition in which cryoglobulin proteins which are a mixture of various antibody types form for unknown (<a href="http://www.medterms.com/script/main/art.asp?articlekey=3332">essential</a>) reasons."<br /><a href="http://www.medterms.com/script/main/art.asp?articlekey=14265">http://www.medterms.com/script/main/art.asp?articlekey=14265</a><br /><br /><br />Ironic and somehow apt -- how we use the word "essential" to mean "unknown."Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com0tag:blogger.com,1999:blog-37724514.post-49129198762666005092009-10-08T15:34:00.001-07:002010-01-22T20:45:00.619-08:00flashbackfrom some written thoughts during the first year of medical school (2/2007):<br /><br />"I guess what I'm trying to say is that there are a lot of things in my life that still make me happy. I am grateful to be at UCSF, and to have a lot of people in my life whom I respect, admire, and love. Being in medical school has changed my life for the better, I feel everyday like I have a purpose in life, the mysteries and quests and the prospect of making a real difference in the world."<br /><br />Now that I am a fourth-year student, it's funny that I still feel that way.Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com1tag:blogger.com,1999:blog-37724514.post-27828851253039422552009-10-06T12:15:00.000-07:002009-10-06T12:18:48.405-07:00How Science Publishing Works<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh61MwSS7wJJ2kx6IVLWjN8Xg5Af9UMMVlbP9uFwRtVuamgkEqUWR5FZplpeVu-WU-r-sisuv62cqUCdLxmlYAYBSjTWCQ-5s7MYVccDdd0-Z2en-lc0aD4O1hCm-QJzM20fJB8OQ/s1600-h/How+Research+Works+Comic.png"><img id="BLOGGER_PHOTO_ID_5389567934796705074" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 109px; CURSOR: hand; HEIGHT: 404px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh61MwSS7wJJ2kx6IVLWjN8Xg5Af9UMMVlbP9uFwRtVuamgkEqUWR5FZplpeVu-WU-r-sisuv62cqUCdLxmlYAYBSjTWCQ-5s7MYVccDdd0-Z2en-lc0aD4O1hCm-QJzM20fJB8OQ/s400/How+Research+Works+Comic.png" border="0" /></a>From <a href="http://www.smbc-comics.com/index.php?db=comics&id=1624#comic">SMBC</a>, "Saturday Morning Breakfast Cereal" by Zach Weiner, shown under fair use.<br /><div></div>Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com1tag:blogger.com,1999:blog-37724514.post-33515304284507671122009-10-01T08:41:00.001-07:002009-10-01T08:43:45.525-07:00By the No.My deep-body radiation dose for the month of August during my IR rotation: 350 mrem.<br />(range 50-800 mrem according to the radiation safety officer).Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com0tag:blogger.com,1999:blog-37724514.post-40955328668047045522009-09-30T13:03:00.001-07:002009-09-30T13:19:35.311-07:00Harvard Class ReportEvery few years, Harvard's dedicated class secretaries will send emails. Most of the time, these contain some form of panhandling, but today I received an email from the class of 2005 about submitting essays for the Class Report. One of the amusing things about Harvard is that the Institution loves its obscure, time-honored rituals and idiosyncrasies (the old incompatible 16-point grading system which was abolished sophomore year comes to mind), most of which are unknown to me until someone tells me that it's time to do it.<br /><br />Today, I received an email about the November deadline for the Class Report. I have never heard of this "Red Book," a collection of updates on the lives of my classmates to be written, published, and disseminated every five years until at least the 50th reunion. As the article suggests, it does seem to function as a "collective personal diary" or glorified class reunion paper bound in red leather (very dark ages, charming). <br /><a href="http://harvardmagazine.com/2007/05/red-books-raw-gems.html">http://harvardmagazine.com/2007/05/red-books-raw-gems.html</a><br /><br />Several things came to mind:<br />1) i have a writing assignment from a school that i already graduated from?<br />2) is it almost 2010 already?<br />3) good thing that i changed my alum status to class of 2006 so that i can worry about it next year!Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com0tag:blogger.com,1999:blog-37724514.post-8481269768567710982009-09-18T21:46:00.000-07:002009-09-18T21:58:35.655-07:00Valuable TeachingCurrently on neurovascular ICU at Moffitt and enjoying it. The residents are amazing, the faculty are wonderful and the teaching is impressive and inspiring. In fact, everything about the neurology program at UCSF is inspiring. Tomorrow will be my third day off in 3 weeks, but neuro has been a very formative experience that will help me be a better doctor.<br /><br />Valuable teaching:<br />1) from neurovasc fellow: stop using algorithms to treat patients, use them as guides but remember that every patient is different with different treatment plans. being able to manage complex patients and make complex decision-making is the difference between a great doctor and a mediocre one.<br />2) a good history and physical is the foundation of any good management plan<br />3) stop giving patients multivitamins, it's just one more pill (again, see rule number 1)<br />4) always localize the lesion first<br />5) learning how to sift through information is more important than coming up with the diagnosis when you are learning<br />6) diagnosing patients early can still help them plan their lives, even if there is no treatment<br />7) enjoy your life<br />8) Find your platformStephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com1tag:blogger.com,1999:blog-37724514.post-37956250908218094482009-09-01T17:56:00.001-07:002009-09-01T17:56:27.455-07:00evolution liteironically, from the NYT<br />"The results underscore the importance of avoiding the breezy generalities of what might be called Evolution Lite, an enterprise too often devoted to proclaiming universal truths about deep human nature based on how college students respond to their professors’ questionnaires."Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com0tag:blogger.com,1999:blog-37724514.post-15483969533744721152009-08-28T18:19:00.000-07:002009-08-28T18:25:42.414-07:00Mission BaySee article below about the newest neighborhood in SF, Mission Bay. I recently moved into UCSF housing at mission bay and have been enjoying the location. Not only is the weather warmer and sunnier, but the UCSF campus is in close proximity to the Giants ballpark and Philz coffee (albeit not as tasty as the Philz in the Mission). Also, MB is close to the freeways and the Bay Bridge for easy access to south bay and Napa. One downside of Mission Bay is the lack of restaurants and relatively higher levels of crime compared to the inner sunset. However, Mission Bay will be growing very rapidly in the next few years, especially as UCSF pumps more cash into the area and the new women's/children's/cancer (not quite sure how those are related) hospital becomes completed. <br /><br /><br />Mission Bay becoming a real neighborhood<br /><a href="mailto:mmay@sfchronicle.com">Meredith May, Chronicle Staff Writer</a><br />Wednesday, August 26, 2009<br /><a onmouseover="document.getElementById('printlink').style.textDecoration='underline';" onmouseout="document.getElementById('printlink').style.textDecoration='none';" href="http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/08/26/BAGK198O7F.DTL&type=printable"></a><br />It's a Wednesday morning in San Francisco's newest neighborhood.<br />As construction workers raise steel into place on emerging high-rises, a man blasts a serve on the beach volleyball court under the Interstate 280 overpass.<br /><br />Biotech workers and suited professionals crowd the bar at Philz Coffee, where tattooed baristas place mint leaves on steaming cups of individually filtered coffee.<br /><br />Retiree Toby Levine surveys the Mission Bay morning from her high-rise terrace, where signs of a community are finally starting to emerge.<br /><br />It's taken four mayors and three planning directors to create what is now the last swath of San Francisco land where planners can create a neighborhood from scratch. So far, 3,000 people have moved into the 300-acre rail yard south of the Giants baseball park. The neighborhood is 35 percent built, and 15 years from now, it's expected to have 11,000 residents.<br /><br />Mission Bay feels as if it escaped the economic downturn - stores are opening, buildings are going up, and young professionals are zipping out of $700,000 condos to get to work. Most live in a six-block area north of Mission Bay Creek. These pioneers say it's now starting to feel like a place worth staying in on the weekends.<br /><br />"It's changed a lot. It's way more crowded now," said Claudia Arrenberg, 27, who shopped for pasta and fruit with her 2-year-old daughter at the new Mission Bay Farmers' Market.<br />She moved into UCSF student housing with her husband in 2005 so he could study neuroscience. But it was such a ghost town that they moved to Alamo Square, even though it was more expensive. They returned in 2008.<br /><br />There's a public library, senior housing, a Safeway beneath the offices of the California stem cell research headquarters.<br /><br />Half of UCSF's 12 buildings are completed, and dog walkers and parents are beginning to draw battle lines over the patches of park.<br /><br />"We got more families than we expected, many couples with kids who commute to the South Bay on Caltrain," said Kelley Kahn, who manages the Mission Bay project for the San Francisco Redevelopment Agency.<br /><br />"We thought we'd see more people in their late 20s, but it's older parents starting families and retirees wanting to leave the hassle of owning a house."<br /><br />Levine is one of those retirees, who, after 40 years in the Mission District moved to a Mission Bay apartment in 2007 with her husband.<br /><br />She began pushing for a tot lot after she discovered that there are 300 children in Mission Bay, but there's no playground.<br /><br />"I like the adventurousness of starting something new at my age, and being in the middle of a tremendously important development for the future of the city," said Levine, 75.<br />Mission Bay is expected to create 31,000 new permanent jobs that range from retailers to biomedical researchers.<br /><br />Levine has found it difficult to create community in Mission Bay, and she figures that's because the young professionals who work so hard to afford to live there just want to close their doors and relax at the end of the workday.<br /><br />It's an investment to move to Mission Bay - condos start at $600,000 and go up to more than $1 million.<br /><br />Nearly one-third of Mission Bay's homes will be reserved for low-income families, more than is required by law, Kahn said.<br /><br />Below-market rate<br />Mission Walk - a two-building development with the first below-market-rate homes in the neighborhood - is set to open in September. Nearly 650 people applied for one of the 131 townhomes and condos, which were priced from $149,000 to $302,000.<br />The Mission Bay of the future will have 6,000 homes, a 43-acre UCSF campus that includes a 550-bed hospital, 41 acres of new parkland, 4.4 million square feet of biotech and lab space, and 500,000 square feet of retail shops. It will have a 500-room hotel and a public school.<br />Residential construction south of the creek has slowed, Kahn said, because developers can't get financing.<br /><br />"If the economy is worse than we thought, and it stays this way for five or seven more years, we'll be in trouble, but right now we are OK. We have money in the bank," she said.Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com1tag:blogger.com,1999:blog-37724514.post-2713611068975481572009-08-24T22:52:00.000-07:002009-08-24T22:54:18.088-07:00mmm, steak!"I have to read your blog to find out what you're doing." - my mom<br /><br />today was relatively quiet in IR, we had vietnamese sandwiches for lunch and they were great. for dinner, my lovely roommate christine and her boyfriend jason made filet mignon from costco, and it was DELICIOUS. <br /><br />man, i really have to work on my ERAS application. :PStephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com0tag:blogger.com,1999:blog-37724514.post-80628163202735226532009-08-20T21:04:00.000-07:002009-08-20T21:08:41.427-07:00IRcurrently loving IR, just got back from the longest work day (12 hrs). We had six cases (a PEG tube, a central line and feeding tube for an ICU patient with an infected vascular graft, two aortograms and angiograms of the legs, and then two emergency cases involving an HIV+ man in acute renal failure and AMS requiring an emergent dialysis cathether and a man presenting to the E&A with a large perirectal abscess communicating with his bladder). <br /><br />i am enjoying the demographic at the VA -- generally salty men with a good sense of humor and high tolerance for pain. On the carpet in front of the main entrance, there is a rug printed with the words, "the price of freedom is visible here." not quite sure yet how i feel about that. <br /><br />wisest words today from a patient/former carpenter:<br />"one thing i've learned...leave good enough alone."<br /><br />resident replied, "yes, the enemy of good is better."Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com0tag:blogger.com,1999:blog-37724514.post-50281752467832001402009-08-06T17:56:00.000-07:002009-08-06T18:01:37.122-07:00A WhIRl of ActivityFinished my ED rotation last week and started my IR rotation at the VA this week...during the weekend I managed to complete two ED shifts while moving into a new apartment at Mission Bay! <br /><br />Since this is my first time at the SF VA, there are a few observations:<br />- veterans tend to belong to a specific demographic<br />- veterans tend to pretty stoic about their medical conditions (example 1: "does this hurt?" [jab a needle] "Nope." example 2: "any medical problems?" "Nope." the note says he has HCV. These are two different veterans).<br />- the oceanside view is sublime<br />- the commute along the Great Highway is also pretty uplifting<br /><br />Overhead, just heard a funny announcement over the loudspeaker:<br />"Mr. H. Mr. H, please return to your room, Room 1A."Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com0tag:blogger.com,1999:blog-37724514.post-5441513251845070662009-07-19T17:28:00.000-07:002009-07-19T17:29:33.017-07:00funniest quote of the dayfrom a nyt article on the booming college admissions consulting business:<br /><br />“It’s annoying when people complain about the money,” the Vermont-based counselor, <a title="Michele Hernandez biography." href="http://www.hernandezcollegeconsulting.com/about-michele-hernandez/">Michele Hernandez</a>, said. “I’m at the top of my field. Do people economize when they have a brain tumor and are looking for a neurosurgeon? If you want to go with someone cheaper, or chance it, don’t hire me.”<br /><br />couldn't stop laughing.Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com3tag:blogger.com,1999:blog-37724514.post-2266514786470266982009-07-12T17:10:00.000-07:002009-07-12T17:27:29.462-07:00zone 1/2finished my third shift in zone 1 at the SFGH ED, it was very busy (the way i like it) and full of new developments. one of the most surprising cases was a 55 F who came in c/o left flank pain, we thought that it was a UTI resistant to the ciprofloxacin that she was taking, but my ED attending suspected diverticulitis and the pt got an abdominal CT that revealed a right cystic ovarian mass concerning for ovarian cancer. after informing the patient of the CT results, I questioned the patient further and found that she has been experiencing abdominal bloating for two years and a sensation of abdominal fullness. she had never been pregnant. all of these symptoms (insidious and innocent as it seems) are all risk factors for ovarian cancer, and after the radiology results, things started clicking in place in a serious way. it was really sad.<div><br /></div><div>working in the ED is nice, I really enjoy the fast pace and being busy busy busy while i am at the hospital (downtime is not as fun for me, although i do need my coffee ritual in the morning). the other aspect that i am really relishing is the speed of test results (labs, CT, etc), the decision-making and diagnosis, as well as discussing the plan with nurses, consult teams, attendings. </div>Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com2tag:blogger.com,1999:blog-37724514.post-32697868642767692302009-07-10T20:42:00.001-07:002010-02-18T12:18:50.927-08:00Needlestick update 1Thanks everyone for the well wishes. :)<br /><br />I went to occupational health this morning to have baseline labs drawn and consented to have a "student phlebotomist" draw my blood. hey, we all gotta learn somehow (although most of the time in med school phlebotomy class, the learning is mutual). the student phlebotomist was nervous, but pretty fast. after the blood draw, the nurse supervising her growled, "you have to make sure that the whole needle is in the sharps bin." we looked at the table and realized that the entire butterfly needle was still hanging outside the bin. Hm. The sight of such a needlestick hazard made me wince (on the inside).Stephhttp://www.blogger.com/profile/08918230920210128668noreply@blogger.com2