Wednesday, March 14, 2007

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.


Tuesday, March 13, 2007

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!

Sunday, March 11, 2007

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!

Saturday, March 10, 2007

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.

Friday, March 09, 2007

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. :-)

Wednesday, March 07, 2007

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.

Wednesday, February 28, 2007

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.

Thursday, February 15, 2007

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. =)

Wednesday, February 14, 2007

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.

Monday, February 12, 2007

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.""

Sunday, February 11, 2007

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..."

Saturday, February 10, 2007

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.

Friday, February 09, 2007

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.

Tuesday, February 06, 2007

DLo Quote

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

Sunday, February 04, 2007

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!

Saturday, February 03, 2007

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.

Friday, February 02, 2007

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.