Academic Bulimia

Disturbing bulimia photo from lecture

Our final in Metabolism and Nutrition was today; it covered an interesting span of topics ranging from endocrinology, metabolic pathways (glycolysis, TCA, beta oxidation, ketogenesis, LDL, VLDL, etc.), diabetes mellitus, and obesity/weight management issues. Although I complained continually at first that these topics were completely unrelated to each other, there are links between each area (mainly insulin or lack thereof) that actually tie the curriculum together in a rather enlightened manner.

One of our later lectures on the theme of weight management involved discussions on eating disorders like anorexia nervosa and bulimia nervosa. Although nutrition has never interested me (the food pyramid can eat itself), I am fascinated by disorders in which perfectly normal girls (sorry for the sexism) starve themselves to death in a land of plenty.

Although I have never had any eating disorders, the cycle of binging and purging associated with bulimia seemed awfully familiar even as I was cramming that syllabus chapter into the small space between my ears. Periods of intense binging...and then a subsequent purging? Yes, ladies and gentlemen, I realized that I have been a lifelong ACADEMIC bulimic since preschool. Like a circadian rhythm dictated by exam schedules, my life follows a regular cycle of compression (pain, stress, angst) and decompression (happiness, denial, sloth).

Here are some interesting posters on the medical consequences of anorexia and bulimia.

The Microcosm of the Library

Fourth floor lobby of the UCSF library

Awesome natural lighting, sometimes you can spy on the basic science laboratories in the medical sciences building across the street. The dark windows at night belong to tenured faculty, the lighted windows belong to non-tenured faculty, or so we hypothesize.

Fourth floor reading room (nook/cranny)

Never read in here, but the chairs look comfy.

Fifth floor "Annex"/Corner office view of San Francisco

Quiet study area, can get chilly due to A/C, awesome view of the sunset around 5-6 p.m. Beautiful vaulted roof, home of "Santa Claus."

All photos courtesy of Alice Prussin Lighting Design

In dire times, I begin studying at the beautiful UCSF library and I always forget how the library is an amazing little microcosm unto itself. On the outside, the library seems pretty basic and non-descript, especially compared to Widener library's imposing neoclassical marble columns, but its greatest strengths inside lie in its unbeatable views of San Francisco and roomy/elegant atmosphere. As a library aficionado, I would rate the UCSF library extremely highly on my list of medical school libraries (okay, you can stop barfing now).

There are some interesting things about the library that I wanted to point out:

1) I never call the UCSF library by its real name, maybe because its the main library

2) The windows are lined by red latticework, which looks so pretty against the green evergreens outside and reminded me one afternoon that the red windows resemble the pylons of the Golden Gate Bridge...inadvertently?

3) On the 3rd main floor, there is a beautiful large window that looks like a picture frame, containing the Golden Gate Bridge outside.

4) The library is built on the steep slope (like almost anything at UCSF and San Francisco), so the 3rd floor is the main floor and every floor has a fantastic and unique view.

5) The chairs have cushions and there are plenty of tables...most of the time

6) Anyone (the general public) is welcome at the UCSF library, which differs markedly from the library policy at Harvard, where they force you to swipe your ID card, walk through a security booth, register any outside guests in a logbook, and force you to unzip your backpack and reveal all of your belongings and possibly stolen library books upon exit. The Harvard libraries must be up to code Orange by now.

Anyway, at UCSF, everyone is welcome, but eccentric people (some of them homeless) will often infiltrate the library and make life more interesting. This afternoon, a homeless man who was snoring loudly on the 3rd floor had to be escorted out by library security because he was disturbing other people. It made me a little sad.

Albert, who spends far more time at the library than I do, swears that there are at least two men who LIVE at the library:

- a man with crazy white hair who looks eccentric, dubbed by Albert as "Demented Einstein"

- a man with white hair and a white beard, always wearing a red sweatshirt and living at the fifth floor annex reading newspapers and sleeping, dubbed by Albert as "Santa Claus," I argued that he also looked "Hemingway-esque."

In the past months, Albert has become more intrigued by these two characters.

He swears that the two men LIVE at the library, that they NEVER leave, and that it's so WEIRD. Is it possible that they're bums?

I looked at Albert and said, "Takes one to know one."

Amazing Grace

"Amazing Grace" by Philosophy

Someone once defined the difference between justice and mercy to me as:

justice = getting what you deserve (can be a good thing or a bad thing) and...

mercy/grace = NOT getting what you deserve (can be a good thing or a bad thing).

Justice makes the most sense to me...because it posits that whatever you do, there is an appropriate repercussion or reward for it. Mercy has always intrigued me because it makes no logical sense...why do people who work hard never receive their rewards? Or why do people who do bad things receive forgiveness? Interestingly, it is with mercy that we see the greatest tragedies and miracles; it throws a wrench into the whole logical order of the world and seems to paradoxically argue for both the absence and presence of God himself.

The best definition of grace for me has been derived from a best-selling bath product by Philosophy (by the way, it is sad to me that the first site to pop up on Google when I search "philosophy" is a bath and cosmetics company...and even sadder to me that it was exactly what I was looking for):

philosophy®: life is a classroom. we are both student and teacher. each day is a test. and each day we receive a passing or failing grade in one particular subject: grace. grace is compassion, gratitude, surrender, faith, forgiveness, good manners, reverence, and the list goes on. it's something money can't buy and credentials rarely produce. being the smartest, the prettiest, the most talented, the richest, or even the poorest, can't help. being a humble person and being a helpful person can guide you through your days with grace and gratitude

I only mention the topic of amazing grace today because I messed up this morning and overslept something important, but sometimes in life you receive these unexpected mercies and it's important for me to remember how to behave with grace and pass on this gift to others in the future. I am so thankful for my classmates.

To bring this topic back to the medical field, it's important for doctors to behave with grace and you can see examples of grace/mercy at every turn. As a medical student learning about so many diseases and complications, you wonder why so many people are suffering and ponder how no one deserves it. On the other side, medical school emphasizes how we should give every patient the benefit of the doubt -- their home situation, homelessness, IV drug use, addictions, social support, and family history -- in order to render him/her better treatment and how to treat patients with the utmost compassion.

Mercy is an interesting topic to think about in the setting of ethical dilemmas surrounding liver transplantations, etc. Does a man who destroyed his liver through alcohol deserve a new organ? According to the chief of transplant surgery at UCSF, yes, it's very common as long as the patient demonstrates a commitment to sobriety for a set amount of time prior to the transplant. On the UCSF main website, there is an interesting article about whether addiction should be considered a biological and psychological disease and questions why we punish alcoholics and other addicts (see website on right hand bar on this page).

Edit: Our apartment building held an informal multi-level potluck on Friday night and it was a lot of fun. :-) While talking to a classmate in the elevator at school, I mentioned how although I was miserably behind in the syllabus, I would study as soon as the potluck was over. A bystander, a middle-aged woman, looked at me in the elevator and snorted, "Dream on." Thanks, ma'am, for the reality check.

Typical Wednesday: Diabetes, Fourth Graders, and PCR

Autobiography cover from the Kary Mullis website

8 a.m. - 9 a.m. Lecture on nutrition for critically ill patients

9 a.m. -10 a.m. Lecture on the ethics of tube feeding

10 a.m.-12 p.m. Lecture on the management of Type I diabetes

12 p.m. - 1 p.m. Basic Science Journal Club on glycosylation (or lack thereof) and its effect on diabetes...because there wasn't enough talk about diabetes in the morning...haha...

1 p.m. - 2 p.m. Bumming

2 p.m. - 4:30 p.m. MedTeach meeting, planning lessons for fourth and fifth grade students in a local SF elementary school on the basics of the heart/circulatory system and lungs/respiratory system. A team of 3 med students (including me) walked over to a resource center located in the middle of the wilderness behind UCSF and reserved some gross pathology specimens, posters, etc.

4:30 - 5:30 p.m. Writing emails and chillin' like a villain

5:30-7 p.m. Informal session on the methods of polymerase chain reaction (PCR) held by the invariably humble and intelligent MSTP's in our class. When I first learned about PCR in college, the professor had a slide with the above image (the cover of Kary Mullis' autobiography) and spent 5 minutes talking about how this Nobel Prize winner is a nut job. However, Mullis knew what he was doing; his book cover did make in impact on me, because now whenever I think about PCR, I think about Kary Mullis and this image of him as a crazy surfer comes up in my brain. His title, "Dancing Naked in the Mind Field," is equally unintelligible...and probably reflects the spirit of a free thinker...or a mad man. Genius is a fine line to walk, I suppose.

Geez, will I ever be able to open the syllabus and start reading?

T-minus 7 days until the GI final exam. Where the hell does all of my time go?

Oh, right, see above (and below and this very site).

Seder

Matzah Cartoon from DryBonesProject

Enjoyed a lovely potluck Seder dinner from 7-10 p.m. tonight hosted by classmates. It was delicious and wonderful. Great food and great company really make me happy. It was my first Seder dinner and my first taste of Matzah ball soup! Mmmm, good.

Here are the 15 Steps of Seder which I learned about tonight from my classmates (information below from Seder.org):

1. KADESH:
A) SIMPLE DESCRIPTION: Drink wine.
B) SLIGHTLY MORE: A special blessing is recited over a glass of wine that speaks of the role all holidays play in Jewish life. Recite the following blessings (the second blessing on the first night only), then drink the first glass of wine.

Baruch attah Adonai, eloheynu melech ha-olam, boray p'ri ha-gafen.
Blessed are You, our God, King of the Universe, Who creates the fruit of the vine.
Baruch attah Adonai, eloheynu melech ha-olam, she-he-he-yanu, ve-kiy'manu, ve-higi-anu la-z'man ha-zeh.

Blessed are You, our God, King of the Universe, Who has kept us alive, sustained us and brought us to this specific time.

2. URECHATZ:
A) SIMPLE DESCRIPTION: Wash hands.
B) SLIGHTLY MORE: Fill a large cup with water. Pour twice on right hand and twice on left hand. Dry hands.

3. KARPAS:
A) SIMPLE DESCRIPTION: Dip veggie in salt water and eat.
B) SLIGHTLY MORE: Dip veggie in salt water. The veggies represent the Spring, rebirth and a flourishing existence. The salt water represents the tears of our forefathers. Recite the following blessing and eat:

Baruch attah Adonai, elohaynu melech ha-olam, boray p'ri ha-adamah.

Blessed are You, our God, King of the Universe, who creates the fruit of the ground.

4. YACHATZ:
A) SIMPLE DESCRIPTION: Break middle matzah (see "SET UP")
B) SLIGHTLY MORE: The middle matzah (see "SET UP") is broken in half to remind us that as slaves in

5. MAGGID:
A) SIMPLE DESCRIPTION: Read the Haggadah. Tell the story of Passover. Drink second glass of wine.
B) SLIGHTLY MORE: Read the Haggadah (which literally means "to tell), tell the story of the exodus from Egypt and explore the origins of our people and the meaning of our Jewish identity. Spend time reflecting on what freedom means to you personally. Include...
...the "Four Questions" of why this night is different from all other nights:
Q1) On all other nights we eat leavened bread AND matzah, on this night, why ONLY matzah?
A1) Matzah reminds us that when the Jews left Egypt they had no time to bake their bread. They took the dough on their journey and baked it in the hot desert sun into hard crackers called matzah.
Q2) On all other nights we eat VARIOUS veggies and herbs, on this night, why only BITTER ones?
A2) Bitter herbs remind us of the cruelty the Jewish people endured during their slavery in Egypt.
Q3) On all other nights we do not dip one food into another even ONCE, on this night, why dip TWICE?
A3)We dip bitter herbs into charoset to remind us of how hard the Jews were forced to work as slaves in Egypt. The chopped apples and nuts of the charoset represent the bricks and mortar they used to build the Pharoah's city. When we dip veggies in salt water, the veggies remind us that spring is here and new life will grow while the salt water reminds us of the tears of the Jewish slaves.
Q4) On all other nights we either sit OR recline, on this night, why ONLY recline?
A4) We lean on a pillow to be comfortable so that we are reminded that while once we were slaves, now we are free.
...the 10 plagues that ultimately led to our freedom:
1. blood
2. frogs
3. lice
4. wild beasts
5. pestilence
6. boils
7. hail
8. locusts
9. darkness
10. death of firstborn
...and finally, recite the following blessing, then drink the second glass of wine:

Baruch attah Adonai, eloheynu melech ha-olam, boray p'ri ha-gafen.

Blessed are You, our God, King of the Universe, Who creates the fruit of the vine.
(For information about the other elements of the Passover story, view www.kosher4passover.com)

6. RACHTZAH:
A) SIMPLE DESCRIPTION: Wash hands.
B) SLIGHTLY MORE: Wash hands and recite the following:

Baruch attah Adonai, eloheynu melech ha-olam, asher kid-shanu b'mitzvo-tav, ve-tzivanu al ne-tilat yada-yim.

Blessed are You, our God, King of the Universe, who has sanctified us with His commandments, and commanded us with the washing of the hands.

7. MOTZI:
A) SIMPLE DESCRIPTION: Say blessing over matzah.
B) SLIGHTLY MORE: Recite the following blessing over the matzah:

Baruch attah Adonai, eloheynu melech ha-olam, ha-motzi lechen min ha-aretz.

Blessed are You, our God, King of the Universe, who brings forth bread from the ground.

8. MATZAH:
A) SIMPLE DESCRIPTION: Eat Matzah.
B) SLIGHTLY MORE: Recite the following blessing, then eat matzah, in accordance with the commandment to eat matzah on the night of Passover:

Baruch attah Adonai, eloheynu melech ha-olam, asher kid-shanu b'mitzvo-tav, ve-tzivanu al achilat matzah.

Blessed are You, our God, King of the Universe, who has sanctified us with his commandments, and has commanded us with the eating of matzah.

9. MAROR:
A) SIMPLE DESCRIPTION: Eat bitter herbs.
B) SLIGHTLY MORE: Recite the following blessing, then eat bitter herbs, which remind us of the bitterness of slavery:

Baruch attah Adonai, eloheynu melech ha-olam, asher kid-shanu b'mitzvo-tav, ve-tzivanu al achilat maror.

Blessed are You, our God, King of the Universe, who has sanctified us with his commandments, and commanded us with the eating of maror.

10. KORECH:
A) SIMPLE DESCRIPTION: Eat matzah, bitter herbs and charoset (sweet) together.
B) SLIGHTLY MORE: Having just eaten matzah and bitter herbs separately, now eat them together with charoset as a sandwich. This combines three important symbols of Passover – matzah, which is unleavened to remind us of the haste with which our forefathers fled Egypt, bitter herbs which remind us of the bitterness of slavery and charoset, the consistency of which represents the bricks and mortar used by Jewish slaves in Egypt and the sweetness of which represents freedom.

11. SHULCHAN ORECH:
A) SIMPLE DESCRIPTION: EAT!
B)SLIGHTLY MORE: EAT! But leave room for the after-dinner matzah, the afikomen.

12. TZAFON:
A) SIMPLE DESCRIPTION: Eat the remaining matzah.
B) SLIGHTLY MORE: The afikomen, which had been put away (or hidden) earlier, is now brought back and everyone eats a piece as his or her own personal afikomen.

13. BARECH:
A) SIMPLE DESCRIPTION: Meal is over. Drink third glass of wine.
B) SLIGHTLY MORE: The blessing after meals is recited expressing our gratitude to God. We recite the following blessing, then drink the third glass of wine:
Baruch attah Adonai, eloheynu melech ha-olam, boray p'ri ha-gafen.
Blessed are You, our God, King of the Universe, Who creates the fruit of the vine.
We also now pour an extra glass of wine for "Elijah, The Prophet" who represents the Messiah, and we open our front door, briefly, allowing him to enter.

14. HALLEL:
A) SIMPLE DESCRIPTION: Sing songs. Drink fourth glass of wine.
B) SLIGHTLY MORE: The "Songs of Praise," authored by King David, are recited. Recite the following blessing, then drink fourth glass of wine:
Baruch attah Adonai, eloheynu melech ha-olam, boray p'ri ha-gafen.
Blessed are You, our God, King of the Universe, Who creates the fruit of the vine.

15. NIRTZAH:
A) SIMPLE DESCRIPTION: Give thanks.
B) SLIGHTLY MORE: We pray that we have successfully fulfilled all the observances of the Seder. We seal our hopes for a brighter future with the words, "Next year in Jerusalem."

Ocean Beach Photos by Kim

The other sunset photo was from a Habitat in Humanity mission to Michigan in April 2005. Psych. This one is a real photo of the sunset seen last weekend at Ocean Beach (such a creative name for a beach; the name is just one step above Beach Beach, haha) If you come to UCSF, you can see the beach everyday...if you really really wanted to. The nice thing about sunsets is not the sun itself (which is setting in a glorious fiery finale), but the way that the sunset tranforms the whole sky into a symphony of colors.

The beautiful texture of the sand.

Albert: "You can take a macro picture of the sand ripples and tell people that you went to the Sahara!"

Kim: "Yeah, or I could just tell them that I went to the Sahara..."

Paul and I playing "wave chicken" with the tide.

Aforementioned tide.

Paul and me playing at the edge of the water. I look like Cousin It and and it looks like the sun took a bite out of Paul's head, but it's a nice picture.

Tasty seafoam (isn't that supposed to be a green color?)

The sun setting.

Stephanie: "I'm curious about the ocean."

Paul: "It's only two blocks away..."

[we walk to Ocean Beach via Golden Gate Park]

Stephanie: "Is the sun down yet?? It's cold!!"

Meanwhile, the moonrise was happening on the other side of the sky.

New Beginnings

Figure 17: ‘Piece’ on a handball court, from left to right: “Daze,” “Cope,” “TKid.”
Peter Rosenstein, unknown title (c. 2006), in Tattooed Walls, Peter Rosenstein (Jackson: University Press of Mississippi, 2006)

A cool graffiti picture from Samantha's thesis. :-) It has inspired me to redo my blog page, more minimalist & edgy. Of course, my skill on the computer is on par with a gerbil's, but I tried my best.

Lately, I've been sort of a downer, so I'll try to be more upbeat in future posts and bring back that Stephanie humor that we all know and love.

The first goal is to pass medical school.

Sunday and Endings

The picture above was taken last summer in downtown Los Angeles to document random graffiti for my sister's art history thesis. She is writing an undergraduate thesis at the University of Chicago on the artistic value of illegal street art; and that baby is due tomorrow! Good luck, Samantha!

I woke up at noon today (surprise), worked a little bit on odds and ends before grabbing lunch at the Canvas Gallery with my favorite girl, Kim, around 1:30 p.m.

It was a meal that strangely focused on the theme of endings (at least for me it did)...the Canvas Gallery closing, a long weekend slowly ending, a year gone by in the blink of an eye. Kim (my favorite partner in the metaphysical journey known as life) mentioned how a year is both a long and a short amount of time, and how so many things can happen within the space of 12 months and yet how it's paradoxically not a very long time at all. We talked about daylight savings time and how Kim was upset about losing an hour to talk to her friend in Germany due to daylight savings. It makes me realize that time = love, even more than time = money.

This seemed especially poignant today, because it was the first anniversary of a friend's death, a gifted friend from high school who was preparing to take over my job at Stanford last year before passing away unexpectedly while whitewater rafting in Peru over spring break. Time is a strange beast, and it feels like the most precious thing in the world. We squander it.

After lunch, I went home to squander a bit more time before heading over to Paul's for a quiet dinner around 7 p.m. Did I mention how my life is a long sequence of eating delicious food? If you haven't noticed already, my life amounts to 40% eating, 30% class, 10% blogging, and 20% studying. I rarely talk about medicine because (a) I'm not studying and (b) it's boring to talk about studying.

We had a delicious dinner right after watching the sunset over the buildings of San Francisco. Albert, a sunset watching enthusiast (especially from the nerdy vantage point of the library), likes to say, "They don't call our neighborhood 'Inner Sunset' for nothing." Watching the sun go down reminded me that another day has gone by, and then I remembered how beautiful the sunset was yesterday over the Pacific Ocean...and how there is a certain special quality to seeing the sun go down over a salt water horizon without any man-made buildings in the way. An unadulterated sunset. Those kind of moments stick with you for a long time.

Orange-Colored Day

Woke up at 12 p.m. today when Kim called me from the Farmer's Market at the Embarcadero. We were going to grab lunch at the Canvas Gallery, when Albert and Paul contacted me about brunch at a Chinese restaurant on 20-something street. It occurred to me that we could join forces, and we had a big meal at the Chinese restaurant. We were so full of food that we had to rest, so we hung out at Paul's and watched "Amelie," a movie that Kim introduced me to during the first month of college and which I have always loved since. Then, we wanted to take advantage of the day and walk in Golden Gate Park...it was like a game of "If you give a mouse a cookie," because then we decided that we were very close to the ocean, and we wanted to walk through the park to the ocean. We walked most of the way, then took the muni a few blocks, and caught a view of the sunset over Ocean Beach. The sun was like a giant orange egg yolk moving behind the clouds, and we frolicked on the freezing cold sand. Then we took the Muni home, Kim went home to cook dinner for her brothers and her, and we ate at a Chinese vegetarian restaurant called Good Vegetarian Restaurant on 12th and Kirkham that was really really tasty. The tofu really tasted like meat...wow...it was so good.

To take a quote from "Amelie,"

it was a beautiful orange-colored day.

Night at the Exploratorium

Stephen, Mary, Albert wearing special headphones at the Exploratorium

No school today (thank you, Caesar Chavez) for UCSF...so I spent most of it sleeping in (read: 14 hours). Tonight, UCSF students and staff members could get free admission to the Exploratorium in San Francisco from 6-9 p.m. So of course we visited! The museum was a blast; it was like a huge playground for budding scientists and congenital nerds alike. In fact, we were so enthusiastic about the whole museum that we felt that it may be wasted on children:

Albert: "These damn kids have no idea how amazing these exhibits are...they keep hogging the exhibits and getting in my way!"

Mary: "Yeah, some of them can't even reach the podium!"

Despite what you may believe from the following exchange, Mary and Albert are the sweetest medical students whom you will ever meet.

In other news, I've caught a little souvenir from Las Vegas (no, it's not an STD) and now I'm sick with an upper respiratory infection...obnoxious phlegmy cough, congestion, etc. At least all of my blockmates are sharing the same virus...it's a collective experience. Lovely.

Mary and me after we built a red rubber arch from scratch

Albert making sand designs on plates of metal using vibrations from a bow

Stephen and Mary playing with an infrared camera

Adios, Canvas Gallery

Image of Canvas Gallery from its website

I hate it when you fall in love with a person, place, or thing (e.g. a noun) and find out that your beloved noun is not long for this world. Hence, I've always walked past a cafe near UCSF (on 9th and Lincoln) called the Canvas Gallery, felt my interest piqued, and never walked inside until last Wednesday. The cafe is amazing with hip exhibits by local artists, ample space to rest and chill out, and an artsy fartsy atmosphere. Unfortunately, the cafe is closing on April 29th due to financial hardship. Ouch, it hurt a little to think of what might-have-been.

So even though I've already fallen in love with this newfound gem in my neighborhood, the taste of this brief encounter is one of my favorite flavors: bittersweet.

Typical Tuesday

8 a.m.-10 a.m. Histology lab on the thyroid

10 a.m.-12 p.m. Small Group discussion on endocrine disorders

12-1 p.m. Lunch elective ("Introduction to Clinical Research") on clinical studies observing how emergency contraception affects sexual behavior

2-3 p.m. Lecture on how to communicate complex things to patients

3-5 p.m. Problem Based Learning (PBL) session, continuing with the Standardized Patient (paid actress) whom we saw in our practice abdomen clinic a few weeks ago. It was a pretty complex medical case with some comorbidities and I was the lucky student who got to communicate to the patient in a second interview...we had to explain (a) the concept of autoimmunity (b) the physiology of pernicious anemia and primary adrenal insufficiency (c) the lifelong treatment regimen for these diseases...monthly injections, medication schedules, etc. (d) concerns that the patient had about the possibility of pancreatic cancer or being able to take care of her husband (who is suffering from Parkinson's and a recent stroke). Within 20 minutes. Yeah. It was a little challenging.

6-8 p.m. Meeting for the Medical Scholars Program (MSP), a student-run tutoring program for first-year medical students to help them with the material next year.

8 p.m.-now Letting my brain decompress.

Viva Las Vegas

Sin City 2007

The Metabolism and Nutrition midterm last Thursday was more difficult than previous exams because it involved a microscope histology/radiology/gross pathology component AND an anatomy lab practical. That translates into a written multiple choice exam from 8-12 p.m., identifying anatomy in cadavers in the lab from 1:30-2 p.m., and looking at slides/pictures of films/preserved specimens from 2-3 p.m. Although it was definitely more challenging, the exam was also more enjoyable because it tested our knowledge in different ways.

It wasn't all strawberry fields, though, here were some of the thoughts running through my head during the anatomy/histology practicals:

"Gee, I wonder what that thing is...the lesser omentum?" [Doh, the pancreas]

"I have no idea what this slide is showing...I'm going to just guess it's cancer."

"Cancer."

"Uh, cancer?"

"Oh, God, is that a kidney?!"

After the exam, I went to visit my PedPALS mentee at the bone marrow transplant unit, went running/exploring in Golden Gate Park, grabbed some pearl milk tea with Paul and Albert (two of the nicest people ever), and then ran home to shower and see my mentee again before grabbing dinner at Crepes on Cole for an informal birthday celebration. Cake was eaten at Albert's, but the highlight was watching a YouTube clip of the Japanese hot dog champion competing against a live Alaskan Grizzly bear in a hot dog eating contest. The bear won, regrettably, without even trying very hard. Dropped by another friend's birthday get-together, hung out at BarNone in the Marina for a little less than an hour, and then went home to fall into a deep coma.

Last Friday, I flew to Las Vegas for a little reunion with my college friends (H translation: blockmates) and much fun was had by all. Our days were dominated by sinfully rich food (in both senses of the word...24-hour Korean BBQ, dinner at Spago's and brunch at the Wynn), searching for caged animals (flamingos at the Flamingo, MGM lions, Mirage tigers, Mandalay Bay Sharks), and a smattering of art (Ansel Adam's exhibit at the Bellagio, a failed attempt to see the mini Guggenheim at the Venetian, and the Cirque de Soleil show LOVE starring Beatles music at the Mirage). Our nights were dominated by caffeine and nightclubs (Jet, TAO, Pure).

Las Vegas is a unique American city...a town (the Strip) characterized by escapist excess and sensory overload....shameless consumerism and entertaining artifice. Built upon the foundations of the seven deadly sins (gluttony, greed, vanity, sloth, wrath, envy, lust); it's a curious mix of the finest material trappings that money can offer and the seediest places on earth coexisting side by side. As a fascinating mix of highs and lows, Las Vegas is a shape-shifter that has built its name upon replicating genuine articles and places to create a parallel universe -- a playground for adults. Nothing in Vegas (the Strip) is mundane or natural...but the very nature of its brazen artificiality enraptures any visitor. It is a self-absorbed microcosm that can be anything and everything except itself, a chameleon of a city ever-changing.

My friend Kim observed that Las Vegas is full of mirrors...I suggested that mirrors are shiny and attractive, suggestive of wealth and opulence, and able to give the illusion of infinity and amplified space. Kim suggested that mirrors allow vain people to look at themselves. But maybe the mirrors are there for both reasons; mirrors would be an apt symbol for Las Vegas. Secondly, there are no clocks in Las Vegas...especially in the casinos where the house intentionally obscures the time of day to encourage people to lose track of time...I think maybe clocks represent an intrusive reality in an otherwise self-absorbed fantasy world.

Sorry for the reflective post. Now I am back at UCSF and we are focusing on endocrinology, which will be a lot of fun once I start studying.

My Mom Forgot My Birthday

The following telephone conversation occurred at 9 p.m.:

S: Hello?
M: Happy Birthday, Stephanie!
S: It's 9 p.m. Mom, you forgot my birthday, didn't you?
M: I sent you a card last Monday, did you get it?
S: Not yet. How come you didn't call me until now?
M: I remembered on Monday...
S: I knew it! You forgot that my birthday was today.
M: No! I didn't forget per se --
S: Yes, you did!
M: Well, I was busy! March 21st was a big day for me, I had an audit.
S: And the date that kept cropping up, March 21st didn't ring any bells for you as -- gee, i dont know -- the date of birth of your firstborn child?
M: That was 23 years ago! I just forgot...
S: Yeah, mom, but you gave birth to me...I thought maybe it was a big deal for BOTH of us.
M: I sent you a card on Monday!
S: I can't believe that you forgot my birthday!
M: Ohh, here comes Dad. [Shouting to Dad]: Sam! Come wish your daughter a happy birthday!
Dad: [in the background, genuinely confused] Who?


By the way, my mom gave birth to me, and my dad delivered me. Or so they tell me.

My Birthday Present

Today is my birthday. A lady never reveals her age. Okay, fine, I'm 23.

This morning, I woke up at 9 and spent 2 hours in the anatomy lab reviewing some gastrointestinal material because...

I had the misfortune of being born the day before the Metabolism and Nutrition midterm exam...

which involves 4 hours of written testing and 2 hours of microscope/histology and gross anatomy testing...

blah!

Wish that I had a camera...studying has been semiproductive...blah!

B. Lewis Quote

My preceptor, Dr. Lewis, told me a story yesterday about his first lecture in pharmacology as a medical student at HMS. A venerable and crusty old German professor who had flown for Germany during WWII (just to give you an idea of how long ago this was) spoke with a heavy German accent, and he told the students that if they would remember ANYTHING from that day, it should be the following pearl of wisdom:

"All drugs are poisons."

And Dr. Lewis remembered that lesson for the next few decades as a medical oncologist.

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.