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.