Motif of the Moving Van

Hi there,

The weekend is here! Boy, I am pretty screwed for this exam next week.

But that's not the purpose of this post...I was reading last week's issue of "Synapse" and there was this great article about a movie called "Two Weeks," a documentary on the last two weeks of a terminally ill patient's life. What struck me the most was an excerpt spoken by the director at the movie's Bay area premier, in which he describes his own personal experiences that led him to create this documentary (bolded). It seems that the director was also impressed with the image and memory of the white van taking away his mother's body at the end of an ordeal, and I am intrigued by this motif that seems to inadvertently reappear in life and in art. Since the article is short, I will repaste it here for archival purposes:

"Two Weeks: Touching Film About Death

By Catherine Dodd, Staff Writer

Many Bay Area End-of-Life practitioners attended the premiere of Two Weeks, a touching and surprisingly funny movie about four children caring for their mother during the last two weeks of her life. The premiere was a fundraiser for the Bay Area End of Life Network (www.sfeol.org) and for Final Choices (www.finalchoices.calhealth.org), the local and statewide organizations that encourages people to put plans in place should the “inevitable” (death) happen. The movie opened for the public on March 2. Film producer Steven Stockman spoke to the audience saying he hoped it would move people to talk about death and to plan for it.

Stockman says it happened like this: “My mother died at home, and the whole family was there. The mortuary guy came to pick up her body in an unmarked white van. He had one of those rolling stretchers where you flip a lever and the wheels pop down. My mom lived in a suburban neighborhood. It was about five in the morning, the sun was just starting to brighten the sky. The guy wheeled my mother’s body out of the house, and loaded it into the truck. I’d just had this excruciating night-long ordeal with my family and I stood there, watching from the top of the driveway as the truck pulled away. Just then, a car came up the street, dropping newspapers one at a time in the driveways of the sleeping houses. And I thought, I wake up every morning on my own street, in my own neighborhood. And somewhere, this is going on. It happens all the time, and I didn’t even know. This is part of everyday life. How come it’s hidden? Why don’t we talk about it?”

This film stars two-time Academy Award winner Sally Field who plays Anita, the mother, who is living her final Two Weeks of life. What amazed me is that while we see people die on television all the time, some violently, some quickly, never have I seen a character on television or in movies, that actually resembled what death looks like for real.

Anita’s children, played by Ben Chaplin, Tom Cavanagh, Julianne Nicholson, Glenn Howerton and Clea Duvall, experience the struggles that many families go through as a loved one dies. While the hospice nurse Carol played by Michael Hyatt is wonderful, the siblings provide the day-to-day physical care and administer pain medications. There are moving goodbyes and funny scenes that make the movie very watchable. The segment about forging their mother’s signature in order to close her bank accounts before she dies is a reminder that even patients whose death is not sudden, forget to take care of important business issues.

I highly recommend the movie and I highly recommend planning for the “big event” by consulting the Web sites mentioned in the first paragraph. To see the trailer check out: http://www.twoweeksmovie.com/movie/."

Another Typical Day

Sorry, my camera is broken! No cool pictures of SF!

8 a.m.- 9:30 a.m. Liver physiology lecture
9:30 a.m. - 11 a.m. Liver histology lecture. I fell asleep.
12 p.m. - 1 p.m. Synapse lunch meeting!
1 p.m.- 6 p.m. Preceptorship at Kaiser SF with a medical oncologist whom I shadow every Thursday afternoon to practice my clinical skills in a real life setting. Every week, UCSF medical students travel to different clinics in the Bay area to work with physicians. I enjoy working with my preceptor and his patients and learning more about oncology. :-) I also fell asleep there today, too. Nothing personal.

I think that I have low-grade narcolepsy. Maybe study-induced attention deficit disorder (SIADD). Or maybe just "medical student syndrome," in which medical students convince themselves that they have every disease being studied. Lately, I've been catching myself thinking, "Hey, I think that I have that one!" So far, I've falsely diagnosed myself with anemia, celiac sprue, and peptic ulcer disease. Maybe irritable bowel syndrome (IBS), but we'll have to see about that one...when I read about it.

Wish me luck!

Payback

Paul (green striped shirt) and his adoring fan base/well-fed friends

Last Wednesday, Paul invited us over to his house for the most delicious homemade steaks ever tasted, he even made them to order (medium rare, etc.) and had side dishes! He does this for free, for fun, and for his friends. Of course, the steaks were the last straw in a big pile of meals that Paul has prepared for us every Wednesday for the last few months, so Jenny took it in her hands to make sure that Paul would NOT prepare dinner this week...but since none of us can cook that well...we took him to Korean BBQ instead. At first, Paul resisted. He refused. Then Jenny found out that he loves My Tofu House. When she suggested that we eat there tonight, Paul quickly gave in. :-) The food was good, but not as good as Paul's home cooking!

GORD? GERD!

In the United States, we call it gastroesophageal reflux disease (GERD).

In the UK, they spell the esophagus as "oesophagus"...

so they call it GORD instead of GERD!

*rolls eyes* GORD just sounds weird.

Action Is Eloquence

Today I was studying half-heartedly at the library when my mother called me in tears, because she was trying to decide what items to place inside the vault with my grandmother's ashes. Grief is a multi-layered creature, and I'm pretty sure that when you lose someone whom you love very much, the pain never entirely goes away, but rather grows to lie dormant inside a little nerve in your cheek until your mind dangerously lingers a little too long on a memory or until an object, sight, smell, sound triggers a flood of tears. My mom has been taking everything the hardest, and of course I worry about her.

Typical Day

A day in the life of a medical student:

8 a.m.-10 a.m. Class - we watched a radiologist, surgeon, and GI internist approach the hypothetical case of a 57-year-old woman with a sudden onset of nausea, vomiting, and abdominal pain. Most students really enjoy these 'simulations' that allow them to watch experienced clinicians in action (mentally, that is).

10 a.m.-11 a.m. Class - a lecture on how to approach geriatric patients and how we all have misconceptions about the elderly.

12-1 p.m. Meeting for PedPALS, an informational session on pediatric palliative care for pediatric oncology patients. I have never really thought about how to approach children with terminal illnesses, and this session was very interesting and memorable.

2-3 p.m. Practice clinical session with Carson, a fellow medical student, in which we interview a standardized patient (SP) (a standardized patient is a paid actor/actress who is playing a role). The SP had an abdominal complaint and we performed an interview and directed physical exam. Then she gave us feedback on our performance, which is very helpful. Once, again, I forgot to screen for depression and abuse history during the patient interview, which are two items that I am trying to consciously include in my work-up after attending the domestic violence conference and failing to pick up on depression in a previous (real) patient.

Today was a relatively light day in terms of content and hours, but I still feel pretty unmotivated to study. :-p The weather in San Francisco is fabulous!

Kitschy Kitchenware

The Ex 5-piece Knife Set with Unique Holder from Overstock.com

Ironically, this little treasure of a bargain ($60) was pointed out to me by my boyfriend. I think that this might qualify as the most disturbing commercial product since Clay Aiken.

The logo in the upper left hand corner is hilarious: The EX (knife crossed by a bar). "Got an Ex? Get the Ex!"

See, I am so not studying.

SF MoMA

Picasso, "Seated Woman," 1927

from the SF MoMA

I visited the SF Museum of Modern Art today with some med school classmates to see an exhibit on Picasso and his influence on American art. The weather was so lovely today, a balmy 60 degrees with warm sunshine. It was as close to summer as SF will ever get!

PedPALS

"The Dance Examination," Degas, c. 1880

from the awesome Artchive

Yesterday, I met my mentee for PedPALS in the hospital for the first time. She is a teenager who had a bone marrow transplant last year for apastic anemia and she's currently spent an entire year at home due to her immunosuppressed state. It must be so hard to go through an ordeal like this when you are just beginning to learn more about yourself and as you enter puberty and adulthood. Since she was at the hospital and the social worker warned me that she was painfully shy, I bought a "paint by numbers" kit from the UCSF bookstore at the last minute so that we could paint something together. The canvases were actually much more complex than I anticipated, it was obviously for adults, but she chose to start on a canvas with a ballerina dancing in front of what looks like ancient ruins and shrubbery (ah, monty python, how you've ruined the mundane quality of that word for me). This would probably be consistent with the fact that her favorite color is pink, and she likes to drink boba too. That is very exciting to me. =)

We spent three hours together at the hospital, and I was surprised by how many hospital people came in and out within that period of time. Nurses, dieticians, child life therapists, doctors, social workers, me. It was also striking how busy the doctors were, and how genuinely nice everyone is. A nice nurse wanted my mentee to swallow some medication, even though she had already swallowed 8 pills that morning. After 15 minutes of cajoling, my mentee agreed to take the medication. I know that it must be hard for the nurse, when you know that the patient should take the medication, but you also feel sorry for the patient because you know that she's just plain sick of pills. When my mentee couldn't swallow a pill, and ended up throwing everything up onto the blanket, the nurse told her it was okay, brought her a new blanket, and said not to worry about it and that they could try again tomorrow.

It touched me because that ability to relent, I think, would qualify as grace.

Clinical Sciences Journal Club

H2 Receptor Antagonist

Today I presented a paper for clinical sciences journal club on how taking gastric acid-suppressive drugs like proton pump inhibitors and Histamine-2 receptor antagonists increases your risk of developing community-acquired pneumonia (Laheij et al., JAMA 2004). It was a fairly good paper, but the best part was being among so many fellow MS1's who come every week so faithfully for the FREE friday lunch and the lively discussion. Seriously, there is such a sense of community at UCSF and I grow to appreciate it more each day.

Last night, I went over the first part of my presentation with my roommate and her friends from the school of pharmacy, and they asked me why I was presenting and what I would get out of it. Albert, who kindly stopped by to give me some last-minute critiques, bluntly pointed out that you gain absolutely no benefit from presenting at the journal club...the speakers are strictly voluntary, you get no credit and no record of ever attending journal club much less presenting at a session, and you spend hours and hours angsting over a stupid powerpoint file and reading background papers to cram yourself full of facts and knowledge so that you can sound semi-authoritative when people ask you about confounders.

But really, I would beg to differ. There is a tangible benefit to volunteering and putting yourself out there. You get to research an area extremely thoroughly which I admit is really intellectually satisfying (and painfully nerdy) and you get to practice your presentation skills and learn to think on your feet. If I had to give myself a grade for my presentation today, I would rate it as a B or B- (grade inflation is a way of life at Harvard you know...just KIDDING!). The biggest problem wasn't fielding questions or my foundation of knowledge, but the fact that my public speaking skills are pretty shitty and out of practice right now. My voice wobbled more than Britney Spears' career and it cracked on several occasions. One audience member commented on that fact that it sounded constantly like I was going to cry, which wasn't the case at all but it was like I couldn't speak because my airway felt like it was closing and that I was going into anaphylactic shock.

When I look back on this in a few years, this entry is going to be a very funny read.

Anyway, I just wanted to say that presenting at CSJC was probably one of my best learning experiences thus far at UCSF. To a lesser extent, it is because I learned in great detail about the specific controversy between proton pump inhibitors and the risk of pneumonia, I learned that you are allowed to statistically compare incidence rates using a chi square test (pretty nifty trick comparing cases/person-years), and I learned from Albert that you can find old journal articles from the 1960's, 70's, and 80's in the basement of the UCSF library that are not available on PubMed (I am very satisfied with the library resources at UCSF by the way). To a greater extent, presenting was a great learning experience because I feel like I'm learning how to do public speaking all over again. Sure, my public speaking skills suck more than a vacuum and I sound like I'm going to cry, but at least I said, "screw it!" and went ahead and did it anyway. Next time, I will be better and maybe it'll be an oncology paper. :-)

Easy, Breezy, Beautiful Cover Boy (for Cell)

Our very own Alex Fay from the UCSF med class of 2010 has a first-author paper in Cell (February 2007). Not only that -- he's a cover boy! Congrats! Our class is so proud of him...if we ever have a question about gap junctions...we'll remember to ask.

I would talk more about our current block, Metabolism and Nutrition (abbreviated as M&N, which reminds me of M&M's or Eminem), but frankly I haven't been in class for a while and I haven't really started studying. Most of the last two weeks of February were spent at home in Los Angeles, and then last weekend I flew to Boston to pseudo-surprise my boyfriend on his birthday. Boston was wonderful...we saw a little play called "Almost, Maine," took advantage of restaurant week by eating lunch at Ruth's Chris (steaks fried in butter taste so sinfully good), and explored little shops and new businesses (to me). I visited my first Best Cellars (the people who supply wine to JetBlue), a very clever business that makes affordable wine more appealing and accessible to the average consumer. Bravo. Another new business that caught my eye: Johnny Cupcakes...a small shop that opened on Newbury St. specializing in punk-style printed t-shirts.

BlaH! So much work!

The Multi-Dimensional Experience of My Grandmother's Death.

It is 10 p.m. on a Saturday night, and I am reading on my bed at home in Los Angeles while enjoying a short break from medical school. My grandmother enters the room dragging a plastic-encased acrylic blanket because she is afraid that I will get cold in the early morning.
Around midnight, my grandmother spies me getting ready to sleep.
“Go to bed,” she tells me.
It is the last time that I see her alive.
At 1:43 a.m., the sound of my little brother calling my name rouses me from a dreamless sleep. I hear the slap of my mom’s slippers flying down the hallway and I rush to the bedroom shared by my grandmother and my 11-year-old brother, Jeremy. Jeremy is sitting bolt-upright in bed, his eyes wide with fright, and I assume that he had a nightmare. Then I realize that my grandmother is missing from her bed; the sheets are untouched.
Nothing frightens me more than the memory of seeing my grandmother sitting on the carpet, slumped against the side of her bed. She sits in an upright position, but her head sags at an unnatural angle, so that her face is completely buried in her chest. Her limbs are tangled together like wet noodles, and there was an eerie stillness and silence surrounding her form. It was like someone had cut the strings to a marionette and dropped the plaything into a haphazard pile on the floor.
My mom begins to shake my grandmother, telling her to wake up, and her voice becomes increasingly shrill. We call 911 and try to perform CPR via directions over the phone, but I notice that my grandmother is not breathing at all and her pulse is impossible to tell. As I watch the stillness settled over her torso, I realize for the first time that seeing a chest rising and falling is a miracle that I will never take for granted ever again.
During those minutes, I feel the intense irony of being a medical student and seeing my grandmother’s life slip away. When she remains lifeless despite the CPR, I find it impossible to decide whether my grandmother is (in a sense) failing my mother and me by not responding to our rescue efforts…or whether we are failing my grandmother through our sheer inexperience.
For medical students, death is a familiar specter. Personally, death has become a multi-dimensional experience. Last year, I worked with terminally ill cancer patients under the knowledge that almost everyone would be dead within a year. It broke my heart. Last year, I was also excited to pass on my job working with cancer patients to my gifted friend from high school, but she passed away unexpectedly in a rafting accident in Peru before she could graduate from college. These professional and personal experiences show death as a sudden truncation, a disappearance from the world, a strange sort of disconnect between life and the void that follows. It was like looking inside a tube and seeing a barrier represented by death.
This year in medical school, working with cadavers has given me insight on death from the other side of the tube – a postmortem perspective. I can see nerves, muscles, organs, but my insight into the emotions, characters, and personal lives of these donors has been cut off by that same barrier.
As a medical student, I knew that someone would die in front of me eventually. I just never expected it to be my grandmother. She crossed that barrier between life and death in front of my eyes, and it was painful to remember her loving admonishment to go to sleep while also recalling how every angle, line, and shape of her form struck me as those of a cadaver almost two hours later.
When the paramedics arrive, they declare that my grandmother is already gone. The police make a brief appearance to rule out any foul play, but by 3 a.m. the authorities vacate the house and leave my grandmother’s body on the floor of her bedroom. We have no idea how to handle the body. It is a ludicrous moment. So we call a funeral home and they send a pick-up service van to recover her body at 4 a.m. in the morning. I remember watching the red tail lights of the van carrying my grandmother’s body turn a corner and disappear into the darkness.

A week later, in another ludicrous moment, I sit next to a stranger at the airport surrounded by a group of fans. The stranger whips out a gold statuette – an Oscar – which he earned the night before. Curiosity wins over potential embarrassment when I ask him, “Excuse me, what did you win an Oscar for?”
“Best Original Screenplay,” he responds.
This isn’t helpful; I didn’t watch the Oscars.
“Little Miss Sunshine,” he nudges.
We chat briefly, and for some reason I tell him about my grandmother and how the experience reminded me of a moment in Little Miss Sunshine when the grandfather unexpectedly passes away in a motel. The stranger tells me about how he watched a documentary depicting a terminally ill patient in life and in death, and how he was struck by how death can transform a human being into a lifeless object wheeled onto a van. It was really important to include in Little Miss Sunshine, the stranger says, a little scene showing Greg Kinnear’s character watching his father’s body being borne away in a van that turns a corner and then continues onto the open road.
“It’s strange how life imitates art or how art imitates life” I say, realizing that my grandmother’s death will gain more subtle dimensions as the years progress. An experience never remains static, but instead grows more complex with time.

Random Tidbits

Sorry for the shortage of postings...life has gotten overwhelming since going home for a short interblock break after the renal exam. Some very sad things happened. We started the gastrointestinal (GI) block last Thursday.

Some interesting tidbits gleaned from school and life:

- Saw Mandy Moore at the airport last week...that was random...but I was actually able to recognize a celebrity...

- A Cochrane Collaborative mug that reads: "What have I learned from the Cochrane Collaborative?" [turn mug around] "Answer: Life is full of trials."

- Human beings have "anal tonsils." What are they, you ask? Lymphatic tissue just like your oral tonsils, except that they line the other end of your GI tube...makes perfect sense in a gross kind of way. God thought of everything, he really did. The presence of anal tonsils may have increased or facilitated the transmission of HIV among homosexual men.

Your Kidney Is Smarter Than You Are

In a powerpoint lecture earlier this block, a phrase kept reoccuring: "Remember: Your Kidney Is Smarter Than You Are." After this block, I'm pretty sure that those cute little bean-shaped organs are much more cunning than they seem. The mantra seems both funny and demoralizing, because, yes, I am coming to believe that the kidney is smarter than me...it outsmarts me at every turn, adjusting, changing, filtering, secreting, excreting...and then we give it drugs and the whole delicate balance or imbalance of the system readjusts!

I get annoyed whenever they ask us to predict what would happen if X or Y were to occur...don't ask me...I'm a medical student...not a psychic. Even Miss Cleo would be hard-pressed to declare what that little critter called the kidney might do.

So I realize that this blog might benefit from more of a personal angle...what did I do last night, you ask? I spent Valentine's Day in the library, and it was actually a pretty calm, nice Valentine's Day. Half of our class was studying for the renal exam tomorrow, and we wished each other happy Valentine's and sighed over how romantic the whole situation was before sticking our heads back in the syllabus and crying over the kidney.

Then around 7 p.m., I went to a fantastic hot pot dinner at Paul's and watched the season finale of "Beauty and the Geek" with some special people. Even in the hard times, medical students can always make room for TV, food, and company. =)

Happy Valentine's Day

Meredith Grey

patron saint of romance drama

Valentine's Day is like Paris Hilton. Out of all of the holidays...Valentine's is the holiday that everyone loves to hate...but deep down most people also wish that they were part of that exclusive "in-crowd" of romantic lovers who couldn't give a damn about what other people think.

My love-hate relationship with Valentine's Day is pretty typical, but I would generally favor the philosophy "live and let live" (this includes Paris Hilton), and the holiday has some redeeming qualities. Today at UCSF, I saw at least a dozen men (hmm, no women) carrying fresh flowers for some special people and it was just nice seeing people in love and showing that they care. The anticipation of knowing that other people in the world would be happy made me happy.

This is no time for me to air my musings on love, but there was an interesting study conducted at Albert Einstein that took brain MRI's of college students who had recently fallen in love and who were looking at photos of their loved ones. Obviously, certain parts of the brain connected with pleasure lit up, but those parts were completely different from those that lit up in the brains of students looking at pornographic photos. Love and lust are different, science tells us. If you couldn't pick up on that dry sarcasm, it's okay. Even more interesting, the study looked at the brains of students who were recently rejected by their loved ones, and the parts of the brain that heightened in activity were parts associated with physical pain. Lesson here? Love hurts...like a kidney stone.

Syllabus Typo

In a chapter on acid-base disorders:

"Define academia and alkalemia."

I never realized how closely related the two words could be.

Tachypnea

tachypnea = breathing quickly (pronounced "Ta-kip-nee-ah")

Our small group discussion leader is an MD who helps us through the intricacies of nephrology. Today, he mentioned a funny sidenote:

"I had a friend in medical school who didn't go to class for the first two years because he preferred to study on his own [a fairly common thing in medical school]. It was fine, but when he got to the wards during his third year, he didn't know how to pronounce anything correctly. So he called [the word] "tacky-pee-nee.""

Bad Medical Jokes for Valentine's

Q: What did one red lacy Valentine heart say to the other Valentine heart?
A: "You're so tachy!"

Worst pick-up line: "Hey baby, you must be an alpha-1 agonist, because I can feel my blood pressure rising..."

The New President of Harvard

Rumors are flying thick that the new president of Harvard is set to be announced this weekend. Who is the top candidate? Drew Gilpin Faust, currently the Dean of the Radcliffe Institute for Advanced Study (formerly Radcliffe College).

It's useless for me to point out the inherent irony of hiring Harvard's first female president on the heels of comments made by the former president of Harvard concerning women in science, etc. Refer back to the "Female Brain" entry in December if you wish. However, it's interesting how circumstances aligned for this appointment to be possible, and how so many other well-qualified candidates were either not interested or unable to take the job.

Absolute Heroes

Dr. Frederick Kaplan and a Patient (from Newsweek)

Dr. Frederick Kaplan from orthopedics at the University of Pennsylvania gave a talk today on his 15-year research on a rare genetic disease known as Fibrodysplasia Ossificans Progressiva(FOP). FOP is a startling disease that episodically transforms skeletal muscles into bone, the ossification can be triggered by any trauma, immunization, viral infection, or it may occur spontaneously. Imagine getting whiplash in an automobile accident...and then having those muscles turn into bone and never being able to move your head. Then getting an injection in your thigh...and then being unable to bend your knee ever again. Instead of Galatea coming to life, it's like a child becoming a statue before your eyes.

Dr. Kaplan presented his research with the sensitivity and intelligence of a storyteller who has unraveled this disease over the course of 15 years. As an associate professor in the 1970s, he asked a medical student what "exons" and "introns" were, and was surprised to learn of the scientific revolution that occurred over the past decade. It's incredible to see how this physician's journey from taking classes on genetics led him to discover the gene responsible for FOP. Dr. Kaplan's passion for his work and his compassion for his patients made this presentation the best talk that I have seen this year thus far. His patience, dedication, and intelligence have led him on an incredible quest as well as show the marks of true genius, and I really feel that he will continue dedicating his life to finding a cure.

I can never forget how these awe-filled moments that occur at the intersection of science and humanity hit me about every other day at UCSF. Watching Dr. Kaplan from the audience, I realized that this slightly short, unremarkable-looking doctor wearing a navy blue blazer was saving the world in his own way. Strangely, in medical school, you often feel yourself in the presence of absolute heroes -- cleverly disguised as ordinary human beings.

DLo Quote

"The currency of academia is creativity." - Dan Lowenstein (DLo)

Oh February

Photo from CNN.com, I like their series "Offbeat Images"

In honor of Valentine's Day, here is an essay by David Sedaris entitled "Old Faithful" much beloved by my sweet college friend, Amy.

On a lighter note, I think that renal block is killing me slowly.

Happy SuperBowl Sunday!

I Love My Intellectual Mother

Being unable to study in the library today, I went home defeated and started doing laundry. I decided to call my mother and we talked about the New Yorker. Then she started talking about NPR and her recent fascination with Truman Capote, and how she plans to read "In Cold Blood" and "Breakfast at Tiffany's." This tickles me, because her last obsession with Jane Austen led her to reread most of Austen's classics and purchase box sets of the BBC series of "Pride and Prejudice" and the one with Keira Knightly.

It was only in recent years that I realized that my mother is not your typical immigrant Asian mom...even though she did make me take piano lessons.

Anyway, at the end of our conversation, she mentioned that a new book is coming out by a female doctor...here is a NYT review. Interestingly, it covers much of the themes included in this blog and it's written by a female Asian physician of Taiwanese heritage. I hate being a stereotype, and I say that only half-jokingly.

Without Music Life Would Not Be Fair

Postcard from Postsecret

After class and Clinical Sciences Journal Club today, I hung around a practice room at Millberry Union as four of my friends rehearsed for a concert. Jenny plays the piano like prodigy, Elaine and Paul play violin with amazing skill, and Albert plays violin (an understatement) while sensing music on an entirely higher level. What impresses me even more than their individual musical skills is that these four friends had enough initiative to get together on a Friday afternoon to practice for a concert that they are setting up themselves with funding acquired from UCSF.

In many ways, I am a musical dunce. As a lazy and unmotivated child, I never practiced the piano (even though I took lessons for an untold number of years) and my perception of tones, rhythm, and melodies is pretty much equal to that of a softly ripened tomato sitting quietly in the sun. Oftentimes, I marvel at how Albert can explain the meaning, emotions, and genius of certain musical pieces...allowing me to appreciate nuances in rhythm, musicianship, etc. that seem to have magically appeared within seconds. In a strange way, I feel as though Albert is actually translating the music for me so that I can understand what the violin is saying.

The idea of art being lost in translation has occurred to me in the past. As a person with many "pet-ideas," I once thought that although beauty can take an infinite number of forms, people themselves can only perceive beauty in a limited number of ways. Beauty is like white light, but we only see certain wavelengths as individuals. For instance, here is a poem:

The Forgotten Dialect Of The Heart

How astonishing it is that language can almost mean,

and frightening that it does not quite. Love, we say,

God, we say, Rome and Michiko, we write, and the words

get it all wrong. We say bread and it means according

to which nation. French has no word for home,

and we have no word for strict pleasure. A people

in northern India is dying out because their ancient

tongue has no words for endearment. I dream of lost

vocabularies that might express some of what

we no longer can. Maybe the Etruscan texts would

finally explain why the couples on their tombs

are smiling. And maybe not. When the thousands

of mysterious Sumerian tablets were translated,

they seemed to be business records. But what if they

are poems or psalms? My joy is the same as twelve

Ethiopian goats standing silent in the morning light.

O Lord, thou art slabs of salt and ingots of copper,

as grand as ripe barley lithe under the wind's labor.

Her breasts are six white oxen loaded with bolts

of long-fibered Egyptian cotton. My love is a hundred

pitchers of honey. Shiploads of thuya are what

my body wants to say to your body. Giraffes are this

desire in the dark. Perhaps the spiral Minoan script

is not language but a map. What we feel most has

no name but amber, archers, cinnamon, horses, and birds.

-Jack Gilbert

Look at the beauty of the end-stopped lines and the genius of his enjambment, the fantastical conceit of ancient Sumerian trade and timeless love. Makes your toes curl, doesn't it? When I was in middle or high school, one of my favorite books was a cheesy anthology from my wonderful mother called "Immortal Poems of the English Language" and I used to read all the emily dickinson poems. Once, when I tried to eagerly read the poem to my mother "Because I could not stop for death," or even better, "I died for beauty," I remember with distinct clarity how my lovely mother shook her head and said that the poem did not speak to her; she didn't understand its sublimity but she wasn't upset. It was like that Christmas story, where the little boy asks for a sleigh bell from Santa Claus and the adults could not hear the bell and assumed that it was broken. It was at that moment that i realized that there are special languages and senses in this world and certain arts -- visual, literary, musical, theatrical -- that touch people in certain ways, that bring those people to life and sensitize them in ways that are abnormal. This is all probably elitist harvard english crap, but what if there are a million different beautiful senses in the world and we are only privy to one or two of them? What if music is the same as poetry and poetry is the color aquamarine?

As individuals, we can sometimes see beauty in a landscape, a lovely poem, a powerful painting, a certain style of architecture, or a musical performance. In a less traditional sense, we can see beauty in the curve of a parabola or a mathematical equation, the elegance of an experimental design, or the smoothness of a chemical reaction. Beauty can be found in the way that a medical student comforts a sick patient or in the way that a doctor smoothly performs a a physical exam.

Back in the small windowless closet known as a practice room, I sat on the floor as Jenny and Albert continued playing their superb duet. If I concentrated hard enough, I could almost sense the beauty, the aching loveliness, inherent in the music and the way that the notes seemed to linger, float, twirl, and make complex arabesques. The music seemed to fluidly progress into an invisible maelstrom that pulled me, and I could just feel the edges of something else. I don't know how to explain it further, except that as first year medical students, we are taught to push our fingers underneath the rib cage to feel the edge of a patient's liver, and someone once explained that it feels like "the edge of a rubbery something quickly slipping away from your grasp."

I could almost feel the music's liver.

Voids and Memories

Today I went to class, dropped by the Basic Science Journal Club for some stimulating science, and visited the Mt. Zion UCSF cancer center for the first time. When I got home and opened up my e-mail this afternoon, I learned that a former patient whom I met at Stanford last year recently died from pancreatic cancer.

So far, I have postponed discussing my secret obsession with oncology, but this news has prompted me to start reflecting again. Certain stages of pancreatic cancer have a median life expectancy of six months, and when I heard that a former patient had passed away, it flashed me back to the old feeling that another soldier has fallen.

And then I always start thinking about my former interactions with that patient...When did I first meet him? What did we talk about? What did he look like? Every death is like a small electrical shock to me, and it forces me to think about the mysterious void that we all seem to disappear into eventually. To flesh out this concept, I am attaching a piece of an essay that I wrote last year for medical school:

"Growing up, I felt haunted by the loss of a grandfather whom I would never meet. Tiptoeing around this void as a child was like trying to resist the gravitational force of a black hole. Since my grandfather died from colon cancer when my mother was seventeen years old, I never had the opportunity to meet this shadowy figure buried somewhere in a New York City cemetery. A passage from Tom Stoppard’s Rosencrantz and Guildenstern perfectly expresses that curious emptiness left by my grandfather: “Death is not anything...death is not...It's the absence of presence, nothing more...the endless time of never coming back...a gap you can’t see, and when the wind blows through it, it makes no sound.”

For the past seven months, I have worked at Stanford University Medical Center as the full-time clinical research coordinator, and the most compelling part of my job stems from my close interaction with terminally ill patients.

Of all these patients, I will never forget Mr. David Lee,* a seventy-five-old patient with metastatic gastric carcinoma whom I met during my first week. He was a cheerful, little old man with round glasses and a padded suit jacket that hid how emaciated he had become underneath. When Mr. Lee visited us last July, he was already dying. As he sat in the examination room with his wife and three grown children, the hardest thing that I have yet experienced was being present when Mr. Lee learned that he would likely die within six months.

After the doctor gently suggested that the family should consider “end of life” options, Mr. Lee’s daughter broke into uncontrollable sobs. I struggled to maintain eye contact with David Lee and his family in the cramped clinic room. It was difficult to breathe and remain objective in the midst of such grief. For the rest of the week, I could feel the blood pounding in my brain as my head ached with unshed tears. The greatest challenge in working with patients who have gastrointestinal cancers is learning to accept that some people will never quite recover from their illnesses and that no families will ever be the same. Two months later, Mr. Lee passed away.

Strangely, I cannot forget Mr. Lee. I remember his shuffling gait, his facial expressions, and his plastic frame glasses with remarkable clarity. What I marvel about death is its ability to take away someone so real and lifelike to me…to make him disappear into a void. That is the mystery of death that Guildenstern so eloquently described: how can Mr. Lee exist and yet not exist anymore? The more I pondered this, the more I realized that Mr. Lee represents to some degree an echo of my missing grandfather.

Working with terminally ill patients every day teaches me that I can be stronger, wiser, and more compassionate. But the deaths of patients like Mr. Lee also push me to realize that I am imperfect, that any clinical study is imperfect, and that our knowledge of cancer remains imperfect. Learning to recognize these imperfections and yet refusing to simply accept them motivates me to continue my research when I am a medical student and a physician to develop new treatment therapies against cancer in a never-ending quest to enhance a patient’s quality of life and chances for survival.

My reasons for pursuing a career in medicine stem from the people who have impressed me deeply, such as cancer patients like Mr. Lee. And yet, ironically, if I were to trace back the origin of my interest in healing and helping others, it would lead back to the void left by another person suffering from cancer whom I will never meet."


* Names are changed to protect patient privacy under HIPAA.

The Kidney: How to Know When 'Urine' Too Deep

Adorable Kidney from I Heart Guts!

Unlike serious, stuffy organs like the heart, brain, and lungs...the kidneys, I have realized, are bodily organs with a sense of humor. It should have been obvious from the beginning because on gross pathology, the kidneys are cute, bean-shaped organs hiding underneath the fatty tissue slightly above the small of your back. Hence the term "kidney punch," the phrasing of which tickles my funny bone (it's so 'humerus') for some strange reason. One lecturer likes to say that some diseases involve "a good kidney in a bad world."

My penchant for anthropomorphism extends to all organs...the heart is a no-nonsense workhorse, while the lungs are spongy and passive. The kidneys never take themselves seriously and strangely remind me of myself: small, quirky, and complicated.

Maybe if I actually started studying the material regularly, this block will be more productive. I'm starting to realize that maybe passively absorbing information for three weeks and then cramming for the last 2.5 days before the exam is like eating a candy bar for breakfast...sure, it's a quick fix that can get me through the day...but it's not very soul-satisfying and the effects fade quickly.

Sorry for the dearth of entries lately, lots of things have happened in the meantime...such as a medical school formal or "prom" at the Hyatt Hotel at Fisherman's Wharf last Saturday and a fascinating case spanning several problem-based learning (PBL) sessions involving a fictional young man coughing up blood. Today, Dr. Stan Glantz gave a really interesting talk about the links between tobacco, restaurant economics, and heart attacks. This paragraph has no relation to the rest of the entry and the sentences have no relation to each other. Back to the kidneys.

There are A LOT of pathology/histology slides this block involving the kidneys. The lecturer who teaches us these slides likes to insert normal pictures of flowers, fruitstands, buildings, art work, and encourage us to interpret them as "glomeruli," "crescents," "humps," "necrosis," and "mesangial cells." At first, it was sort of interesting and novel...but now I feel like it's a little obsessive. She is extremely nice, however, and I appreciate her efforts to make histology more stimulating. Apparently, I have to the opposite problem: I like to look at histology slides and interpret the cells, staining, and shapes as everyday objects. Each slide is a Rorschach ink blot to me...sometimes I see a big slug, a happy face, two Picasso creatures mating, or a cylinder of red Cheerios. It was also nice of the lecturer to assert that pathology slides are like works of art...every interpretation is in the eye of the beholder. To synthesize these thoughts into a coherent ending, I'm going to post a picture that draws together art, interpretation, and the kidneys...it's a gorgeous sculpture in Chicago called "The Cloud Gate" that locals have dubbed "the Bean." Until recently, the only silver "bean" in my repertoire of free association involved expensive jewelry from Tiffany's, but now I look at this picture and see a big shiny glorious KIDNEY.

What I Want for Valentine's Day: An Oversized Novelty Kidney.

Kidney Church

Glomerulus of the kidney, silver stain, light microscopy

Once again, my blog has fallen silent because of an exam...it seems to be the only thing that can keep me away from updating compulsively! However, the exam has come and gone, and we are done with the lungs. Bye bye lungs. Welcome kidneys! The kidneys are rumored to be one of the hardest blocks in our first year at UCSF, so I should study more this month. We saw some beautiful slides today of the glomerulus (it took me ten minutes to figure out how to say it like a pro..."gloh-mare-ru-lus" as opposed to "gloh-mer-roo-lus"). Since I can't see anything in slides anyway (histology is not my bag, baby), I like to amuse myself by hallucinating and imagining what the image reminds me of. Aesthetically, some of these images are fantastic and I wouldn't mind hanging a few on my wall someday. The slides above remind me of stained glass windows; it's like I'm in a church! Yes, the kidneys are quite a religious experience.

Views of UCSF

UCSF sits atop a hill in San Francisco, which gives everyone a beautiful view of the city. Last year, someone mentioned that one of the things that they love is "beautiful views," which I thought was intriguing because I had never considered "views" as a commodity or interest, but rather something incidental or spontaneous.

Colorful, gaudy houses are a signature feature of San Francisco. Funky pastel is an architectural style in the city.

Strange column of black and white portraits located in front of the Medical Sciences building. No idea what it represents, but maybe something artsy.

Statue of mother bear in front of the UCSF library.

The hill near my home! Look at those lines of perspective!

UCSF Medical Center at Parnassus, where we get a lot of patient contact.

On clear days, you can always see the Golden Gate Bridge. Sometimes, I will find myself gazing outside looking for the red towers, and seem to derive a curious comfort from its presence.

Irving Street!

Where all the shops and restaurants can be found as seen from a balcony at UCSF

Downtown San Francisco as seen from the same balcony at UCSF.

The Best Free Food (Can Be Found Among Friends)

Rosemary Garlic Chicken

In medical school, free food can be found at almost every event and a poor struggling student can always survive any famine by finding a new talk or club meeting to find sustenance. There are some unofficial sayings at UCSF: "If you can't find free food, you're just not looking hard enough" and "hey, there IS such thing as a free lunch."

Today, I managed to make it through the day with not one, not two, but FOUR free meals. 1) During our small group discussion, one of the talented students in our lovely group baked a crumb cake and brought in cinnamon buns for breakfast. I would say that this was unusual...but it really wasn't! 2) free lunch was served at a basic science journal club presentation on how chaperone protein AHA1 affects the mutant CFTR protein in cystic fibrosis; 3) free dinner was served during a volunteer organization meeting, but I had to save this dinner for another time because 4) a friend was cooking dinner and hosting a highly anticipated (by me) "Beauty and the Geek" TV viewing.

The best free food by far was (4), the pasta and asparagus dinner cooked with loving care by Paul in honor of the TV event. Sure, free food is great on every occasion, but I realized tonight that the best free food tastes better and gives the most satisfaction when it is made by someone who really cared and enjoyed by a group of friends who happen to enjoy watching reality television. This is going to sound REALLY cheesy, but until now, I never believed it when cooks say that there is a special ingredient called "care and attention," maybe even "love" in a sense.

It tastes like the best thing in the world.

Michael Blumlein, MD

Last November, I went to UCSF Student Health Services (SHS) complaining of upper abdominal pain. The doctor at the time was kind enough to squeeze me into his schedule; his name was Dr. Blumlein. Overall, I was pretty satisfied with SHS and how the doctor gave me a full work-up. Several months have passed, and I havne't thought about SHS for a long time.

However, this afternoon, the cover of a book at the UCSF bookstore caught my eye.

"Blumlein," I thought, experiencing a tingling, uncomfortable feeling between my shoulder blades that usually signals that I should have read the class syllabus last night.

I took the book off of the shelf and did what any amateur browser does: I read the back of the book, the inside flap, and then the back inside flap...and there was a picture of my doctor at SHS!

Apparently, Dr. Blumlein is a physician at SHS by day and a well-respected science fiction writer by night. He has published several novels and dozens of short stories and has been nominated several times for prizes. It amazes me that everyone at UCSF seems to lead an exciting double life or to downplay interesting accomplishments. UCSF is like a box of chocolates...you never know who or what you're going to get...

From Ben: Choosing a Medical Specialty

Stolen from a friend.

Veysman, B. Physician, know thyself. BMJ 2005; 331:1529.

Fellow UCSF Bloggers

It would be a crime for me to not tip my top hat in tribute to the fellow UCSF Synapse bloggers working tirelessly every night to entertain, delight, dazzle, and inform our loyal readers (which number in the high twenties, I'd wager, not counting ourselves). We labor like monkeys chained to typewriters. Sort of. Their websites can be found in the nifty sidebar to the right, along with the website for our mothership, UCSF Synapse.

My fellow medical student blogger, Craig Chen, is a profound thinker and writer who will captivate you with his reflections on a myriad of medical ethical dilemmas, cool science facts, and funny quotes. Jeremy, our dental student blogger, possesses a hilarious and compelling "voice" that will give you an extremely vivid impression of dental school and educate you on a variety of political and intellectual contemporary issues. Although I do not know the two pharmacy students personally, ephempharm and Lux are also very worthy reads that promise to give you the inside scoop on pharmacy school.

Each of the bloggers has a unique perspective and writing style that reveals a different facet of UCSF. I would highly recommend that you sample each blog, that way you will discover that the UCSF experience offers way more than free plastic surgery, talking mannequins, off-color Harry Potter jokes and inadvertent cadaver eating. Wait -- scratch that -- there's NO free plastic surgery.

No Smoking

California Dept. of Health Services Campaign

The top three causes of death in the United States (in order of prevalence):

1) Heart Disease

2) Cancer

3) Stroke

Smoking significantly contributes to all three causes of death by various mechanisms, but (to be horribly unacademic) I remember from reading our class syllabus that a person exposed to second-hand smoke is 1/3 more likely to develop cardiovascular disease than a non-exposed person. Moreover, we learned that even a few hours of exposure to cigarette smoke led to increased platelet aggregation (or platelet aggression, as I prefer to call it) -- which I found pretty astounding. Smoking is a major health issue tackled by UCSF; please run a PubMed search on Dr. Stanton Glantz and review his amazing research in this area.

High Altitudes and a UCSF Bachelor

Hiking in the Himalayas

Medical school involves a heavy use of the imagination, and it seems to bring out the thespian in everyone. We constantly role-play, pretending to be doctors, patients, and competent medical students; we read fictitious case studies and hypothesize how we would treat the patient during problem-based learning (PBL) and small group discussions; we play with dummies and pretend to give them supplemental oxygen.

This morning we had a small group case study on a fictitious German tourist in the Himalayas suffering from high altitude sickness. After the small group session, we had a lecture given by Dr. Alan Gianotti (an emergency medicine doctor from Stanford), who has extensive experience treating patients in the Himalayas for the Himalayan Rescue Association (HRA) at 16,000 feet above sea level. Dr. Gianotti's presentation and photos were fascinating and based on real-life experiences that totally dazzled me. It was wonderful seeing the connection between hypothetical situations and true events.

This afternoon, we enjoyed our second patient s(t)imulator session with a mannequin, which was entertaining and instructive. Since other medical students are not going to experience this case until Friday, I will refrain from saying anything more. :)

Lastly, during our patient stimulator discussion, a medical student mentioned that the next bachelor for the reality TV series "The Bachelor" may be an ER physician who attended UCSF. At first, everyone seemed to find it pretty cool...UCSF deserves more exposure to the mainstream.

But then another medical student voiced a second, more troubling thought by asking, "Wait, why is he still a bachelor?"

Harry Potter's Greatest Fear

Today in our cross-cultural communication lecture, the speaker had the medical students engage in some role-playing to better see a patient's perspective. Some questions that we were encouraged to ask were "What do you feel is causing your illness?" "What treatment do you think you should receive to alleviate it?" and "What worries you the most?"

Three scenarios were available for the medical students to reenact:
1) Dick Cheney with angina (heart pain).
2) Jennifer Lopez, who feels that she may be pregnant yet is planning to spend the next 9 months working on a movie set.
3) Harry Potter with a lump on his groin.

After the students finished the doctor-patient dialogue in pairs, the speaker opened a lecture-wide discussion. The transcript was loosely thus:

Speaker: "What was your patient most worried about?"

Student #1: "Getting fat."

Speaker: "I assume that your patient was Jennifer Lopez."

Student #1: "Haha, yes."

Speaker: "But what about Harry Potter? What would he be most worried about?"

Student #2: "Not being able to practice his magic."

My Secret Crush on San Francisco

Crazy Cable Car

"San Francisco is a mad city inhabited by perfectly insane people whose women are of remarkable beauty." - Rudyard Kipling

The fabulous city of San Francisco has not received enough attention from me. UCSF is located in the heart of the city, and we are so privileged to live in one of the craziest, loveliest, most passionate places in the world.

If San Francisco were a woman, I would be in love with her. She has culture, but she's not snooty. She's stylish and classy, but also very natural, down-to-earth, and laid-back. She's equally at home drinking wine in Napa Valley and roughing it in the outdoors -- biking, kayaking, running, hiking, swimming. Her signature monument is a giant tomato red structure called the Golden Gate Bridge, which seems to simultaneously blend in and stand out from the stunning natural beauty that surrounds it. San Francisco (the woman) is definitely a free spirit and a champion of independent thinking and progressive social reform.

Of course, I can still objectively say that San Francisco has her faults, like all people. She's rather moody and mercurial -- unlike her flat and reliably sunny sister, Los Angeles, to the south. When I first came to San Francisco, I thought that the whole city suffered from a serious case of multiple personality disorder. Gorgeous Victorian houses are built on hills with 45 degree inclines; people are expected to parallel park on those hills; it's warm in the winter and freezing in the summer; there's thick fog everywhere!

"Nor is there any place like San Francisco itself -- much to the relief of conservative talk-show hosts...who often liken the place to Sodom and Gomorrah. Face it, the city has always been a haven for those who are a tad on the weird side by Presbyterian standards...If San Francisco had a Statue of Liberty, she would beckon, 'Send us your odd, your bizarre masses, your tired beatniks, ancient hippies, drag queens, poets, and artists, your tempermental opera singers and recalcitrant pastry chefs, your feminist firebugs and immortal quarterbacks, your transsexual tennis players yearning to breathe free.'"

- From "The Irreverent Guide to San Francisco," 4th edition.

However, now I understand that San Francisco's case of multiple personality disorder is her greatest strength and weakness. She can be anything and everything all at the same time, and you cannot help but love her for it.

"The irresistible beauty of San Francisco lies in its innate refusal to fit into any mold, beginning with the very ground upon which it is built -- steep hills and wide valleys dropping off suddenly at the edge of the continent."

- From "The Irreverent Guide to San Francisco," 4th edition.

A Diagram Worth the Entire Preceding Entry

Gr(a-e)y's Anatomy: TV vs. Life

Diagram of Dermatomes from the textbook "Gray's Anatomy" (2005)

Forgive me for my terrible memory of the specific details, but a fellow medical student mentioned an amusing story recently. A non-medical friend of this student walked into the student's room, spotted "Gray's Anatomy" on the student's bookshelf, and said, "Oh, my gosh, they made the TV show into a book?"

There is a classic medical textbook called "Gray's Anatomy" (with an 'a'), which has been used for many years by students in medical school. Also, there is a hit TV show called "Grey's Anatomy" (with an 'e'), which has nothing to do with the textbook. I'm inclined to cut the lay person some slack -- it's not like I have read "Gray's Anatomy" very religiously even though it's sitting on my bookshelf too.

The diagram posted is from "Gray's Anatomy," and it depicts how spinal nerves from each vertebra correspond to specific sections of skin on the human body, which are called dermatomes. In other words, nerves from your T4 vertebra are responsible for the feeling of sensations in a thin strip on your chest along your nipple line. During Halloween, I prayed that a brave soul would paint his body in different colors and call himself "Dermatome Man." Alas, no one stepped forward.

Dermatomes is a concept that we learned in the beginning of medical school, but it was hammered home to me in an unconventional fashion when I met a teenage girl in the hospital who had been hit by a car last October. The collision had shattered her T5 vertebra and paralyzed her. When the doctor lightly scratched along her chest in the hospital, the patient could feel nothing below her nipple line in one of the most dramatic demonstrations of dermatomes that I could ever imagine. The memory has vaguely haunted me for months. My college advisor, a pediatric orthopedic surgeon, performed spinal surgery on this patient the next morning to repair some damage...but it was clear that the girl would probably be paralyzed below her chest for the rest of her life.

Several months later, I wonder how this girl is doing, how her life has changed, and what happened to her and her family. Medical school is like the TV show, "Grey's Anatomy," in that you meet actual patients with dramatic stories and heart-wrenching injuries...and everything is real and what you do matters so much.

But, a huge difference between life and TV is that the patients do not cease to exist once the credits have rolled and the music begins playing...even though the lives of these patients and your own life have intersected for the space of 30 minutes to an hour...these patients follow their own paths and you move on with your own life. And I think that it's interesting how -- unlike television -- there is very little closure regarding the lives of many of these people in the hospital, the most dramatic theatre of humanity.

Cue blackout and dramatic white header: "Gray's Anatomy."

Cue music, probably from "The Fray."

Role credits.

Domestic Violence Conference

The lovely coordinators of the DV Conference

Today I attended an all-day Domestic Violence (DV) Conference held at UCSF. It's amazing to think that incredible conferences on topics ranging from cancer imaging to universal healthcare to domestic violence happen every weekend on campus. It blows my mind.

Domestic violence is a healthcare issue...here are some facts from the "Family Violence Prevention Fund" (FVPF), funded by the U.S. Department of Health and Human Services:

- "Nearly one-third (31%) of American women report being physically or sexually abused by a husband or boyfriend at some point in their lives.
- In 2000, 1,247 women, more than three per day, were killed by their intimate partners.
- In addition to injuries sustained during violent episodes, physical and psychological abuse are linked to a number of adverse physical health effects including arthritis, chronic neck or back pain, migraine and other frequent headaches, stammering, problems seeing, sexually transmitted infections, chronic pelvic pain, and stomach ulcers.
- Children who witness domestic violence are more likely to exhibit behavioral and physical health problems including depression, anxiety, and violence towards peers. They are also more likely to attempt suicide, abuse drugs and alcohol, run away from home, engage in teenage prostitution, and commit sexual assault crimes.
-Emerging research indicates that hospital-based domestic violence interventions will reduce health care costs by at least 20%.
- A recent study found that 44% of victims of domestic violence talked to someone about the abuse; 37% talked to their healthcare provider. Additionally, in four different studies of survivors of abuse, 70-81% of the patients studied reported that they would like their healthcare providers to ask them privately about intimate partner violence (IPV)."


So many issues are swirling around in my head, but what strikes me the most is how the concept of domestic violence and the issues surrounding it can have similarities to so many other ideas in healthcare:
- Like obesity or smoking, domestic violence is a multifactorial health problem that leads patients to suffer from physical injury, emotional trauma, and stress-related symptoms. Prevention of domestic violence at an early stage would not only save the lives of countless women, but would also save the healthcare industry a fair amount of money in the long run due to abolishment of the "revolving door" for abuse victims in the ER that currently exists in many places.
- Domestic violence is like "second-hand smoke" in that it not only harms the abuse victim, but also the children and family members living in the same household. These children also suffer from physical and emotional health problems and engage in behavior that may endanger their health.
- Pharmacists have a unique role because abuse often centers around issues of control, and medication and birth control becomes prime examples of how abusers can maintain power over their victims.
- Doctors, nurses, and other healthcare professionals also have to be aware of "compassion fatigue" and "secondary or vicarious trauma" that can result from helping victims of domestic violence. Burn-out is a common hazard. I feel that the issues of compassion fatigue and burn-out are also very pertinent issues in oncology and hospice care that are rarely addressed by the healthcare community.

As a medical student, the most important lesson that I learned today is to ALWAYS ask about domestic violence in a private and safe environment during the clinic appointment. It seems like a simple protocol, but doctors rarely screen their patients in this manner and it makes all the difference.

To draw another parallel to a similar health issue, doctors also rarely question patients about depression and thoughts of suicide. The general stance is that doctors should always always ask...but physicians and medical students rarely do. When interviewing a double-lung transplant patient during my Foundations of Patient Care class, I asked the female patient dozens of questions during a one-hour session. She answered in short sentences and rarely volunteered any information, and I felt frustrated and helpless and maddened by the fact that she expressed ignorance on every issue, including why she had the lung transplant in the first place. Later on, during my clinical interlude in psychiatry, I stumbled upon this patient's name and discovered that she was suffering from major depressive disorder. Did I detect this during my hour-long interview? Did I even ask her whether she was feeling depressed? No...and that has made all the difference in changing my attitude and approach.

Lesson learned.

The Taste of Cadaver

A piece of cadaver flew into my mouth today during anatomy lab.

We haven't been in anatomy lab for a month, and at first it was nice getting reacquainted with our cadaver and seeing the familar organs and muscles. Dissection is always messy and anatomic structures are never usually easy to see without a little careful cleaning and expert recognition. The memory of the smell also returned -- every cadaver smells a bit differently, which surprised me.

Anyway, I was using a scapel to slit open the trachea (the airway) with my head approximately 12 inches above the body when a spray of yellowish gunk burst out. Some of it landed in my mouth and I jumped like a jackrabbit. If anyone is curious...it tastes like it smells. Then I ran to the bathroom and washed out my mouth and maybe my GI tract.

Lesson learned: never dissect with your mouth open.

Killing Two Birds with One Stone

While googling for studies done on new year's resolutions, I stumbled across a blog written by Dr. Greg Mankiw, an economics professor at Harvard who teaches Ec10 (http://gregmankiw.blogspot.com/). Dr. Mankiw's blog, in turn, led me to a fascinating New York Times article written today on the link between education and health.

It would seem that the most important indicator for health is the level of education attained by the patient. This correlation seems to be omnipresent and one of the most powerful indicators of lifespan, more than race or income. In fact, the more years that a child has spent in school, the more years that that child actually lives: "Three economists noted the correlation between education and health and gave some advice: If you want to improve health, you will get more return by investing in education than by investing in medical care."

The article digresses into the problems inherent in separating correlation from causation, but the idea of investing money into education for the sake of health struck me as particularly clever because it was like killing two birds with one stone (by birds...I mean education and public health, and by stone...I mean money).

NYT article: Kolata, Gina. "A Surprising Secret to a Long Life: Stay in School." New York Times, Jan. 3, 2007. http://www.nytimes.com/2007/01/03/health/03aging.html?pagewanted=2&_r=1 and http://www.nytimes.com/aging.

Organs Block, Lungs - Is that a Miro?

Electron Micrograph of Pulmonary Surfactant

Today begins our next Organs Block: the lungs! Class began with the anatomy of the airways and the lungs, then we had an introduction to gas exchange and a histology lecture on different parts of the respiratory system. The image above was breath-taking in lecture...the black rose shapes are pulmonary surfactant...a phospholipid-rich secretion that reduces the surface tension in alveoli. Science and art intersect in divine ways -- the results are elegant, beautiful, effortless. It really does look like an artistic museum piece to me...or maybe something my brother could draw on an Etch-a-Sketch.

Later in the day, we had our Foundations of Patient Care session in small groups of six students. We discussed our assignment completed over break concerning our family histories, our backgrounds and cultural influences that have shaped our development and views on medicine. We had to draw a family tree and write a 3-4 page essay on our personal histories. I am continually impressed with the personal stories shared by my classmates -- the struggles that they have overcome, the experiences that they have gathered, and the achievements that they are too humble to discuss. Although it's a hideous cliche -- the best part of UCSF truly is the quality of its students. How the heck did I get here?

Happy New Year!

Fear not, loyal readers, I did not keel over and die during my transcontinental flight back to Los Angeles. For the past week, I have been hiking, ice skating, going to museums, shopping, watching movies and TV, and gorging my little heart out on wonderful food at home. Also, I live near the street where the annual Rose Parade is held every January 1st...it brings back fond memories of volunteering for float decoration and nearly losing my hair in a tragic glue accident.

Very little of my vacation at home involved medicine...except when my sister sprained her ankle and I shouted, "That's your deltoid ligament!"

Then my brother hurt his arm and I yelled, "That's your biceps...wait, no...I mean your triceps. It has three heads, but I forget the names." After three months of medical school, I am surprised and appalled by how much human anatomy has been learned and how much has already been forgotten.