Every few years, Harvard's dedicated class secretaries will send emails. Most of the time, these contain some form of panhandling, but today I received an email from the class of 2005 about submitting essays for the Class Report. One of the amusing things about Harvard is that the Institution loves its obscure, time-honored rituals and idiosyncrasies (the old incompatible 16-point grading system which was abolished sophomore year comes to mind), most of which are unknown to me until someone tells me that it's time to do it.
Today, I received an email about the November deadline for the Class Report. I have never heard of this "Red Book," a collection of updates on the lives of my classmates to be written, published, and disseminated every five years until at least the 50th reunion. As the article suggests, it does seem to function as a "collective personal diary" or glorified class reunion paper bound in red leather (very dark ages, charming).
http://harvardmagazine.com/2007/05/red-books-raw-gems.html
Several things came to mind:
1) i have a writing assignment from a school that i already graduated from?
2) is it almost 2010 already?
3) good thing that i changed my alum status to class of 2006 so that i can worry about it next year!
Wednesday, September 30, 2009
Friday, September 18, 2009
Valuable Teaching
Currently on neurovascular ICU at Moffitt and enjoying it. The residents are amazing, the faculty are wonderful and the teaching is impressive and inspiring. In fact, everything about the neurology program at UCSF is inspiring. Tomorrow will be my third day off in 3 weeks, but neuro has been a very formative experience that will help me be a better doctor.
Valuable teaching:
1) from neurovasc fellow: stop using algorithms to treat patients, use them as guides but remember that every patient is different with different treatment plans. being able to manage complex patients and make complex decision-making is the difference between a great doctor and a mediocre one.
2) a good history and physical is the foundation of any good management plan
3) stop giving patients multivitamins, it's just one more pill (again, see rule number 1)
4) always localize the lesion first
5) learning how to sift through information is more important than coming up with the diagnosis when you are learning
6) diagnosing patients early can still help them plan their lives, even if there is no treatment
7) enjoy your life
8) Find your platform
Valuable teaching:
1) from neurovasc fellow: stop using algorithms to treat patients, use them as guides but remember that every patient is different with different treatment plans. being able to manage complex patients and make complex decision-making is the difference between a great doctor and a mediocre one.
2) a good history and physical is the foundation of any good management plan
3) stop giving patients multivitamins, it's just one more pill (again, see rule number 1)
4) always localize the lesion first
5) learning how to sift through information is more important than coming up with the diagnosis when you are learning
6) diagnosing patients early can still help them plan their lives, even if there is no treatment
7) enjoy your life
8) Find your platform
Tuesday, September 01, 2009
evolution lite
ironically, from the NYT
"The results underscore the importance of avoiding the breezy generalities of what might be called Evolution Lite, an enterprise too often devoted to proclaiming universal truths about deep human nature based on how college students respond to their professors’ questionnaires."
"The results underscore the importance of avoiding the breezy generalities of what might be called Evolution Lite, an enterprise too often devoted to proclaiming universal truths about deep human nature based on how college students respond to their professors’ questionnaires."
Friday, August 28, 2009
Mission Bay
See article below about the newest neighborhood in SF, Mission Bay. I recently moved into UCSF housing at mission bay and have been enjoying the location. Not only is the weather warmer and sunnier, but the UCSF campus is in close proximity to the Giants ballpark and Philz coffee (albeit not as tasty as the Philz in the Mission). Also, MB is close to the freeways and the Bay Bridge for easy access to south bay and Napa. One downside of Mission Bay is the lack of restaurants and relatively higher levels of crime compared to the inner sunset. However, Mission Bay will be growing very rapidly in the next few years, especially as UCSF pumps more cash into the area and the new women's/children's/cancer (not quite sure how those are related) hospital becomes completed.
Mission Bay becoming a real neighborhood
Meredith May, Chronicle Staff Writer
Wednesday, August 26, 2009
It's a Wednesday morning in San Francisco's newest neighborhood.
As construction workers raise steel into place on emerging high-rises, a man blasts a serve on the beach volleyball court under the Interstate 280 overpass.
Biotech workers and suited professionals crowd the bar at Philz Coffee, where tattooed baristas place mint leaves on steaming cups of individually filtered coffee.
Retiree Toby Levine surveys the Mission Bay morning from her high-rise terrace, where signs of a community are finally starting to emerge.
It's taken four mayors and three planning directors to create what is now the last swath of San Francisco land where planners can create a neighborhood from scratch. So far, 3,000 people have moved into the 300-acre rail yard south of the Giants baseball park. The neighborhood is 35 percent built, and 15 years from now, it's expected to have 11,000 residents.
Mission Bay feels as if it escaped the economic downturn - stores are opening, buildings are going up, and young professionals are zipping out of $700,000 condos to get to work. Most live in a six-block area north of Mission Bay Creek. These pioneers say it's now starting to feel like a place worth staying in on the weekends.
"It's changed a lot. It's way more crowded now," said Claudia Arrenberg, 27, who shopped for pasta and fruit with her 2-year-old daughter at the new Mission Bay Farmers' Market.
She moved into UCSF student housing with her husband in 2005 so he could study neuroscience. But it was such a ghost town that they moved to Alamo Square, even though it was more expensive. They returned in 2008.
There's a public library, senior housing, a Safeway beneath the offices of the California stem cell research headquarters.
Half of UCSF's 12 buildings are completed, and dog walkers and parents are beginning to draw battle lines over the patches of park.
"We got more families than we expected, many couples with kids who commute to the South Bay on Caltrain," said Kelley Kahn, who manages the Mission Bay project for the San Francisco Redevelopment Agency.
"We thought we'd see more people in their late 20s, but it's older parents starting families and retirees wanting to leave the hassle of owning a house."
Levine is one of those retirees, who, after 40 years in the Mission District moved to a Mission Bay apartment in 2007 with her husband.
She began pushing for a tot lot after she discovered that there are 300 children in Mission Bay, but there's no playground.
"I like the adventurousness of starting something new at my age, and being in the middle of a tremendously important development for the future of the city," said Levine, 75.
Mission Bay is expected to create 31,000 new permanent jobs that range from retailers to biomedical researchers.
Levine has found it difficult to create community in Mission Bay, and she figures that's because the young professionals who work so hard to afford to live there just want to close their doors and relax at the end of the workday.
It's an investment to move to Mission Bay - condos start at $600,000 and go up to more than $1 million.
Nearly one-third of Mission Bay's homes will be reserved for low-income families, more than is required by law, Kahn said.
Below-market rate
Mission Walk - a two-building development with the first below-market-rate homes in the neighborhood - is set to open in September. Nearly 650 people applied for one of the 131 townhomes and condos, which were priced from $149,000 to $302,000.
The Mission Bay of the future will have 6,000 homes, a 43-acre UCSF campus that includes a 550-bed hospital, 41 acres of new parkland, 4.4 million square feet of biotech and lab space, and 500,000 square feet of retail shops. It will have a 500-room hotel and a public school.
Residential construction south of the creek has slowed, Kahn said, because developers can't get financing.
"If the economy is worse than we thought, and it stays this way for five or seven more years, we'll be in trouble, but right now we are OK. We have money in the bank," she said.
Mission Bay becoming a real neighborhood
Meredith May, Chronicle Staff Writer
Wednesday, August 26, 2009
It's a Wednesday morning in San Francisco's newest neighborhood.
As construction workers raise steel into place on emerging high-rises, a man blasts a serve on the beach volleyball court under the Interstate 280 overpass.
Biotech workers and suited professionals crowd the bar at Philz Coffee, where tattooed baristas place mint leaves on steaming cups of individually filtered coffee.
Retiree Toby Levine surveys the Mission Bay morning from her high-rise terrace, where signs of a community are finally starting to emerge.
It's taken four mayors and three planning directors to create what is now the last swath of San Francisco land where planners can create a neighborhood from scratch. So far, 3,000 people have moved into the 300-acre rail yard south of the Giants baseball park. The neighborhood is 35 percent built, and 15 years from now, it's expected to have 11,000 residents.
Mission Bay feels as if it escaped the economic downturn - stores are opening, buildings are going up, and young professionals are zipping out of $700,000 condos to get to work. Most live in a six-block area north of Mission Bay Creek. These pioneers say it's now starting to feel like a place worth staying in on the weekends.
"It's changed a lot. It's way more crowded now," said Claudia Arrenberg, 27, who shopped for pasta and fruit with her 2-year-old daughter at the new Mission Bay Farmers' Market.
She moved into UCSF student housing with her husband in 2005 so he could study neuroscience. But it was such a ghost town that they moved to Alamo Square, even though it was more expensive. They returned in 2008.
There's a public library, senior housing, a Safeway beneath the offices of the California stem cell research headquarters.
Half of UCSF's 12 buildings are completed, and dog walkers and parents are beginning to draw battle lines over the patches of park.
"We got more families than we expected, many couples with kids who commute to the South Bay on Caltrain," said Kelley Kahn, who manages the Mission Bay project for the San Francisco Redevelopment Agency.
"We thought we'd see more people in their late 20s, but it's older parents starting families and retirees wanting to leave the hassle of owning a house."
Levine is one of those retirees, who, after 40 years in the Mission District moved to a Mission Bay apartment in 2007 with her husband.
She began pushing for a tot lot after she discovered that there are 300 children in Mission Bay, but there's no playground.
"I like the adventurousness of starting something new at my age, and being in the middle of a tremendously important development for the future of the city," said Levine, 75.
Mission Bay is expected to create 31,000 new permanent jobs that range from retailers to biomedical researchers.
Levine has found it difficult to create community in Mission Bay, and she figures that's because the young professionals who work so hard to afford to live there just want to close their doors and relax at the end of the workday.
It's an investment to move to Mission Bay - condos start at $600,000 and go up to more than $1 million.
Nearly one-third of Mission Bay's homes will be reserved for low-income families, more than is required by law, Kahn said.
Below-market rate
Mission Walk - a two-building development with the first below-market-rate homes in the neighborhood - is set to open in September. Nearly 650 people applied for one of the 131 townhomes and condos, which were priced from $149,000 to $302,000.
The Mission Bay of the future will have 6,000 homes, a 43-acre UCSF campus that includes a 550-bed hospital, 41 acres of new parkland, 4.4 million square feet of biotech and lab space, and 500,000 square feet of retail shops. It will have a 500-room hotel and a public school.
Residential construction south of the creek has slowed, Kahn said, because developers can't get financing.
"If the economy is worse than we thought, and it stays this way for five or seven more years, we'll be in trouble, but right now we are OK. We have money in the bank," she said.
Monday, August 24, 2009
mmm, steak!
"I have to read your blog to find out what you're doing." - my mom
today was relatively quiet in IR, we had vietnamese sandwiches for lunch and they were great. for dinner, my lovely roommate christine and her boyfriend jason made filet mignon from costco, and it was DELICIOUS.
man, i really have to work on my ERAS application. :P
today was relatively quiet in IR, we had vietnamese sandwiches for lunch and they were great. for dinner, my lovely roommate christine and her boyfriend jason made filet mignon from costco, and it was DELICIOUS.
man, i really have to work on my ERAS application. :P
Thursday, August 20, 2009
IR
currently loving IR, just got back from the longest work day (12 hrs). We had six cases (a PEG tube, a central line and feeding tube for an ICU patient with an infected vascular graft, two aortograms and angiograms of the legs, and then two emergency cases involving an HIV+ man in acute renal failure and AMS requiring an emergent dialysis cathether and a man presenting to the E&A with a large perirectal abscess communicating with his bladder).
i am enjoying the demographic at the VA -- generally salty men with a good sense of humor and high tolerance for pain. On the carpet in front of the main entrance, there is a rug printed with the words, "the price of freedom is visible here." not quite sure yet how i feel about that.
wisest words today from a patient/former carpenter:
"one thing i've learned...leave good enough alone."
resident replied, "yes, the enemy of good is better."
i am enjoying the demographic at the VA -- generally salty men with a good sense of humor and high tolerance for pain. On the carpet in front of the main entrance, there is a rug printed with the words, "the price of freedom is visible here." not quite sure yet how i feel about that.
wisest words today from a patient/former carpenter:
"one thing i've learned...leave good enough alone."
resident replied, "yes, the enemy of good is better."
Thursday, August 06, 2009
A WhIRl of Activity
Finished my ED rotation last week and started my IR rotation at the VA this week...during the weekend I managed to complete two ED shifts while moving into a new apartment at Mission Bay!
Since this is my first time at the SF VA, there are a few observations:
- veterans tend to belong to a specific demographic
- veterans tend to pretty stoic about their medical conditions (example 1: "does this hurt?" [jab a needle] "Nope." example 2: "any medical problems?" "Nope." the note says he has HCV. These are two different veterans).
- the oceanside view is sublime
- the commute along the Great Highway is also pretty uplifting
Overhead, just heard a funny announcement over the loudspeaker:
"Mr. H. Mr. H, please return to your room, Room 1A."
Since this is my first time at the SF VA, there are a few observations:
- veterans tend to belong to a specific demographic
- veterans tend to pretty stoic about their medical conditions (example 1: "does this hurt?" [jab a needle] "Nope." example 2: "any medical problems?" "Nope." the note says he has HCV. These are two different veterans).
- the oceanside view is sublime
- the commute along the Great Highway is also pretty uplifting
Overhead, just heard a funny announcement over the loudspeaker:
"Mr. H. Mr. H, please return to your room, Room 1A."
Sunday, July 19, 2009
funniest quote of the day
from a nyt article on the booming college admissions consulting business:
“It’s annoying when people complain about the money,” the Vermont-based counselor, Michele Hernandez, said. “I’m at the top of my field. Do people economize when they have a brain tumor and are looking for a neurosurgeon? If you want to go with someone cheaper, or chance it, don’t hire me.”
couldn't stop laughing.
“It’s annoying when people complain about the money,” the Vermont-based counselor, Michele Hernandez, said. “I’m at the top of my field. Do people economize when they have a brain tumor and are looking for a neurosurgeon? If you want to go with someone cheaper, or chance it, don’t hire me.”
couldn't stop laughing.
Sunday, July 12, 2009
zone 1/2
finished my third shift in zone 1 at the SFGH ED, it was very busy (the way i like it) and full of new developments. one of the most surprising cases was a 55 F who came in c/o left flank pain, we thought that it was a UTI resistant to the ciprofloxacin that she was taking, but my ED attending suspected diverticulitis and the pt got an abdominal CT that revealed a right cystic ovarian mass concerning for ovarian cancer. after informing the patient of the CT results, I questioned the patient further and found that she has been experiencing abdominal bloating for two years and a sensation of abdominal fullness. she had never been pregnant. all of these symptoms (insidious and innocent as it seems) are all risk factors for ovarian cancer, and after the radiology results, things started clicking in place in a serious way. it was really sad.
working in the ED is nice, I really enjoy the fast pace and being busy busy busy while i am at the hospital (downtime is not as fun for me, although i do need my coffee ritual in the morning). the other aspect that i am really relishing is the speed of test results (labs, CT, etc), the decision-making and diagnosis, as well as discussing the plan with nurses, consult teams, attendings.
Friday, July 10, 2009
Needlestick update 1
Thanks everyone for the well wishes. :)
I went to occupational health this morning to have baseline labs drawn and consented to have a "student phlebotomist" draw my blood. hey, we all gotta learn somehow (although most of the time in med school phlebotomy class, the learning is mutual). the student phlebotomist was nervous, but pretty fast. after the blood draw, the nurse supervising her growled, "you have to make sure that the whole needle is in the sharps bin." we looked at the table and realized that the entire butterfly needle was still hanging outside the bin. Hm. The sight of such a needlestick hazard made me wince (on the inside).
I went to occupational health this morning to have baseline labs drawn and consented to have a "student phlebotomist" draw my blood. hey, we all gotta learn somehow (although most of the time in med school phlebotomy class, the learning is mutual). the student phlebotomist was nervous, but pretty fast. after the blood draw, the nurse supervising her growled, "you have to make sure that the whole needle is in the sharps bin." we looked at the table and realized that the entire butterfly needle was still hanging outside the bin. Hm. The sight of such a needlestick hazard made me wince (on the inside).
Wednesday, July 08, 2009
"Stuck" in the ED
Yesterday was my first day in the SFGH ED as a sub-intern. I really enjoy the fast pace of the emergency room and the ability to triage and decide on preliminary tests for my patients. By the end of five hours, my head was pounding from the chaos and competing interests of different patients (next time, carry tylenol in my pocket).
Another nice thing about the ED is the number of procedures that you can do. By the end of my shift (7/7, 9:10 pm), I was attempting a lumbar puncture on a woman suspected to have meningitis. After inserting a 20-something gauge needle filled with lidocaine to anesthetize her back, I capped the needle using the one-handed scoop method. Then I tried to unscrew the needle to replace it with a longer needle in the LP kit. But the needle would not unscrew from the syringe. I made a twisting motion, which in retrospect only loosened the cap from the needle, and subsequently felt a familiar sting (after being phlebotomized by classmates so many times). I had stuck myself in the tip of my left index finger with a dirty needle.
"I think I stuck myself," I told the resident calmly, setting the syringe down and walking away from the patient while watching the blood welling underneath my glove tip. My first thought was, "Good thing we got a rapid HIV test before doing the LP." The resident was incredibly considerate and advised me to run my finger under running water for five minutes before calling the needlestick hotline (in retrospect, I would recommend washing with soap and water, running your wound under a faucet for 5 minutes, and maybe splashing some alcohol or betadine if you're extra paranoid).
While holding my finger under running water, I stared at the clock and began rapidly running through the patient's medical history again in my mind. 35 F c/o 3 days of fever and headache. 10/10 occipital headache with pain on neck flexion. no trauma. T 38.7 on arrival. What were her serologies? Is this an acute primary HIV infection? What is the NPV of a rapid HIV test in the SFGH ED? I felt unnaturally detached.
I was also extremely peeved at myself for making this mistake, because I usually pride myself on being careful during procedures. In fact, the smoldering annoyance has not faded today, and I still feel like an idiot. In retrospect, most needlestick injuries occur when you are recapping a needle (hence the scoop method) or disposing sharps, and the injury occured probably because I was attempting to unconsciously recap the needle before the needlepoint was exposed after seeing the cap slipping. Unfortunately, the lidocaine needle is a lot shorter than the IV needles that I have grown accustomed to using. When speaking to the ID fellow, he advised me that one of the most common needlestick injuries occur after screwing the needle too tightly into the syringe.
Needlesticks are extremely common in the hospital, but in the SFGH ED, it was especially scary. Most of my patients have HIV, HCV, or both, and this patient was a black box. It was also concerning for me to realize that we still had no idea what her diagnosis was.
Since today was my day off, I was able to read some personal accounts of other doctors and nurses who have joined the Private Misery Club and some of them are quite moving, funny, thoughtful, and some just depressing. Many talk about mortality, or the sensation of a lost future. Some of my first thoughts after the needlestick involved my future...what am i going to do now? can i practice medicine in the future? what about unprotected sex? and then maybe a few times I mentally uttered my favorite curse word of all time: fuck.
It is not a good time right now to wax philosophical about mortality or medicine; I have an appointment on Friday for some baseline labs. The patient's rapid oral HIV was negative, and I have been told today that her serologies were negative, but that doesn't ease my concern that this patient has acute primary HIV infection given her suspected meningitis (which can follow the prodromal flu-like illness) and considering our ED population enriched with blood-borne diseases. Argh. If there is one thing that I hate more than uncertainty or regret, it is having the patience and attention span required for surveillance serologies. The ED requires neither patience nor an attention span longer than 24 hours, which might still be ideal for me.
My favorite personal account of a needlestick injury is from Buckeye: http://ohiosurgery.blogspot.com/2008/10/needle-stick.html.
There's a nice one from an ED physician: http://gruntdoc.com/2005/05/needlestick.html
And a blithe one from an MS2: http://www.boston.com/yourlife/health/blog/2007/10/ill_have_what_s.html
Another nice thing about the ED is the number of procedures that you can do. By the end of my shift (7/7, 9:10 pm), I was attempting a lumbar puncture on a woman suspected to have meningitis. After inserting a 20-something gauge needle filled with lidocaine to anesthetize her back, I capped the needle using the one-handed scoop method. Then I tried to unscrew the needle to replace it with a longer needle in the LP kit. But the needle would not unscrew from the syringe. I made a twisting motion, which in retrospect only loosened the cap from the needle, and subsequently felt a familiar sting (after being phlebotomized by classmates so many times). I had stuck myself in the tip of my left index finger with a dirty needle.
"I think I stuck myself," I told the resident calmly, setting the syringe down and walking away from the patient while watching the blood welling underneath my glove tip. My first thought was, "Good thing we got a rapid HIV test before doing the LP." The resident was incredibly considerate and advised me to run my finger under running water for five minutes before calling the needlestick hotline (in retrospect, I would recommend washing with soap and water, running your wound under a faucet for 5 minutes, and maybe splashing some alcohol or betadine if you're extra paranoid).
While holding my finger under running water, I stared at the clock and began rapidly running through the patient's medical history again in my mind. 35 F c/o 3 days of fever and headache. 10/10 occipital headache with pain on neck flexion. no trauma. T 38.7 on arrival. What were her serologies? Is this an acute primary HIV infection? What is the NPV of a rapid HIV test in the SFGH ED? I felt unnaturally detached.
I was also extremely peeved at myself for making this mistake, because I usually pride myself on being careful during procedures. In fact, the smoldering annoyance has not faded today, and I still feel like an idiot. In retrospect, most needlestick injuries occur when you are recapping a needle (hence the scoop method) or disposing sharps, and the injury occured probably because I was attempting to unconsciously recap the needle before the needlepoint was exposed after seeing the cap slipping. Unfortunately, the lidocaine needle is a lot shorter than the IV needles that I have grown accustomed to using. When speaking to the ID fellow, he advised me that one of the most common needlestick injuries occur after screwing the needle too tightly into the syringe.
Needlesticks are extremely common in the hospital, but in the SFGH ED, it was especially scary. Most of my patients have HIV, HCV, or both, and this patient was a black box. It was also concerning for me to realize that we still had no idea what her diagnosis was.
Since today was my day off, I was able to read some personal accounts of other doctors and nurses who have joined the Private Misery Club and some of them are quite moving, funny, thoughtful, and some just depressing. Many talk about mortality, or the sensation of a lost future. Some of my first thoughts after the needlestick involved my future...what am i going to do now? can i practice medicine in the future? what about unprotected sex? and then maybe a few times I mentally uttered my favorite curse word of all time: fuck.
It is not a good time right now to wax philosophical about mortality or medicine; I have an appointment on Friday for some baseline labs. The patient's rapid oral HIV was negative, and I have been told today that her serologies were negative, but that doesn't ease my concern that this patient has acute primary HIV infection given her suspected meningitis (which can follow the prodromal flu-like illness) and considering our ED population enriched with blood-borne diseases. Argh. If there is one thing that I hate more than uncertainty or regret, it is having the patience and attention span required for surveillance serologies. The ED requires neither patience nor an attention span longer than 24 hours, which might still be ideal for me.
My favorite personal account of a needlestick injury is from Buckeye: http://ohiosurgery.blogspot.com/2008/10/needle-stick.html.
There's a nice one from an ED physician: http://gruntdoc.com/2005/05/needlestick.html
And a blithe one from an MS2: http://www.boston.com/yourlife/health/blog/2007/10/ill_have_what_s.html
Monday, June 15, 2009
perfect weekend
i'm not sure yet what "living the dream" means in medicine jargon, but just finished a perfect weekend (thanks to paul and costco):
saturday: philz coffee, driving over golden gate bridge to napa (mondavi, stag's leap -- cask 23 is uhmazing), napa outlets, spicy dinner in berkeley
sunday: philz coffee, casual walk to SF Giants game for $10 seats in the view box behind home plate, 9-hole game of golf at Golden Gate Park, and watching the movie "Up" in 3D using $7.50 costco tickets.
saturday: philz coffee, driving over golden gate bridge to napa (mondavi, stag's leap -- cask 23 is uhmazing), napa outlets, spicy dinner in berkeley
sunday: philz coffee, casual walk to SF Giants game for $10 seats in the view box behind home plate, 9-hole game of golf at Golden Gate Park, and watching the movie "Up" in 3D using $7.50 costco tickets.
most people do not know where the heart is
recent study in BMC Family Practice showing that less than half of 722 Britons surveyed can identify where the heart is on a diagram.
http://www.cnn.com/2009/HEALTH/06/15/body.knowledge.survey/index.html
reminder to self: draw more pictures for patients
http://www.cnn.com/2009/HEALTH/06/15/body.knowledge.survey/index.html
reminder to self: draw more pictures for patients
Tuesday, June 09, 2009
Radiology
Currently on a didactic radiology rotation for the next month. Medicine at SFGH was great, and I look forward to working in the ED next month (read: avoid the ED next month).
Currently watching basketball.
Currently watching basketball.
Thursday, June 04, 2009
osborne wave!
Craig showed me the coooooolest EKG this morning of a 58 M "found down" in the tenderloin. rectal temp 24 degrees celsius. he had very large and distinct osborne waves!
It was very exciting to see real osborne waves for the first time, like reading someone's biography and then meeting them in person for the first time. Do people still read biographies?
Thanks, Craig!
It was very exciting to see real osborne waves for the first time, like reading someone's biography and then meeting them in person for the first time. Do people still read biographies?
Thanks, Craig!
Wednesday, June 03, 2009
reflections on a "stabbiversary"
extremely well-written reflection on near-death experiences from NYT blog. curiously, this author was stabbed in the neck with a stiletto 14 years ago...
"You can’t feel grateful to be alive your whole life any more than you can stay passionately in love forever — or grieve forever, for that matter. Time forces us all to betray ourselves and get back to the busywork of living in the world. Before a year had gone by the same dumb everyday anxieties and frustrations began creeping back. I’d be disgusted to catch myself yelling in traffic, pounding on my computer, lying awake at night wondering what was going to become of me."
http://happydays.blogs.nytimes.com/2009/06/02/reprieve/?em
"You can’t feel grateful to be alive your whole life any more than you can stay passionately in love forever — or grieve forever, for that matter. Time forces us all to betray ourselves and get back to the busywork of living in the world. Before a year had gone by the same dumb everyday anxieties and frustrations began creeping back. I’d be disgusted to catch myself yelling in traffic, pounding on my computer, lying awake at night wondering what was going to become of me."
http://happydays.blogs.nytimes.com/2009/06/02/reprieve/?em
Monday, June 01, 2009
"Winning the Game"
In medicine, "winning the game" means that a team or person has discharged all of their patients before the next call night, which means that they have no work until the next call. Clinical medicine is an interesting culture, with slang and neologisms that can roll off your tongue before you can think, "wait, that was incomprehensible to a normal person." For instance, you can say, "CBC q 6 hours, goal crit 30" or "cycle the trops" or "wean the nebs" and most people around you in the hospital will nod knowingly.
But i often digress. Medicine at el general has been great, I really enjoy working with my team and treating patients who are often underprivileged and have complex psychosocial situtations. The residents and attendings at SFGH are fantastic, and provide top notch care to patients who can easily fall between the cracks.
But i often digress. Medicine at el general has been great, I really enjoy working with my team and treating patients who are often underprivileged and have complex psychosocial situtations. The residents and attendings at SFGH are fantastic, and provide top notch care to patients who can easily fall between the cracks.
Monday, May 11, 2009
Medicine Sub-Internship
Currently a sub-I at SFGH, please don't get sick in the next month or you might see me.
Recently registered for step 2 USMLE.
Warning: CS costs $1,055 alone to register and CK costs $495. That doesn't include the mandatory travel to LA or lodging.
Recently bought an i-pod touch to enjoy epocrates...my first apple product. Got absorbed in installing apps and was reading through Yelp, found out that there are many patient reviews of UCSF Medical Center. It's so interesting read those reviews, which are either 1 star or 5 star (max)...which makes sense since you only make the effort to type something if you are extremely satisfied or ridiculously angry.
Some observations of Yelp feedback: Interestingly, the polarized reviews had many themes in common. The 1-star patients usually are in general good health with minimal contact with healthcare, coming in with a musculoskeletal complaint (eg xray for foot/hand, sprain or acute flu with SOB) to Urgent Care (oohh, lots of ire). The main complaint is waiting time (up to 8 hrs) in the ED, brusque staff, lack of parking, billing, hospital food, etc. There were very few complaints about doctors' care (except for one woman who was turned away by an ED physician for SOB), and no complaints about residents or trainees (except one patient cited the lack of continuity with residents in clinic).
Patients who write 5-star reviews generally have serious/chronic/rare ongoing medical conditions. Some families will write on behalf of patients. One reviewer wrote on behalf of a friend who had heart surgery, another patient was grateful for the teaching program regarding kidney transplants, etc. One patient noted that the lab reports for rare diseases will be processed faster at UCSF than at other hospitals. Some patients who had life-threatening conditions praised the ED.
Reading that uncensored feedback might be a good exercise for our hospital administration to see what can be improved. We can score big points with patients if we make the logistics of getting healtcare more convenient -- making appointments online and keeping clinic wait times within 1-2 hrs (or the pizza is free!).
Recently registered for step 2 USMLE.
Warning: CS costs $1,055 alone to register and CK costs $495. That doesn't include the mandatory travel to LA or lodging.
Recently bought an i-pod touch to enjoy epocrates...my first apple product. Got absorbed in installing apps and was reading through Yelp, found out that there are many patient reviews of UCSF Medical Center. It's so interesting read those reviews, which are either 1 star or 5 star (max)...which makes sense since you only make the effort to type something if you are extremely satisfied or ridiculously angry.
Some observations of Yelp feedback: Interestingly, the polarized reviews had many themes in common. The 1-star patients usually are in general good health with minimal contact with healthcare, coming in with a musculoskeletal complaint (eg xray for foot/hand, sprain or acute flu with SOB) to Urgent Care (oohh, lots of ire). The main complaint is waiting time (up to 8 hrs) in the ED, brusque staff, lack of parking, billing, hospital food, etc. There were very few complaints about doctors' care (except for one woman who was turned away by an ED physician for SOB), and no complaints about residents or trainees (except one patient cited the lack of continuity with residents in clinic).
Patients who write 5-star reviews generally have serious/chronic/rare ongoing medical conditions. Some families will write on behalf of patients. One reviewer wrote on behalf of a friend who had heart surgery, another patient was grateful for the teaching program regarding kidney transplants, etc. One patient noted that the lab reports for rare diseases will be processed faster at UCSF than at other hospitals. Some patients who had life-threatening conditions praised the ED.
Reading that uncensored feedback might be a good exercise for our hospital administration to see what can be improved. We can score big points with patients if we make the logistics of getting healtcare more convenient -- making appointments online and keeping clinic wait times within 1-2 hrs (or the pizza is free!).
Sunday, May 10, 2009
Friendly PSA
Call your mother today!
Remember that the US postal service raises prices on stamps to 44 cents tomorrow!
Thursday, May 07, 2009
Reflections on Third Year
"So what should I know for third year?" someone asked me recently.
Whoa. Wow. Um. Where to begin?
Undoubtedly, the third year of medical school has been the most memorable experience thus far in my life, and even now when I reflect on all the crazy and outrageous and wonderful and awful things that I've seen, I can't even believe that it happened to me and not some 2D person on "Grey's Anatomy." In psychiatry, they might call that derealization.
Being a third year medical student is like being a guppy in the hospital ocean. You wander around helplessly, trying to learn how to coexist in a complex environment under some very talented and harried residents. It can be totally confusing and bewildering, but it also opens the door to levels of opportunity and privileged intimacy with strangers previously unheard of. Sometimes, third year feels like an apprenticeship where you learn things using your hands and watching others. Other times, it can feel like boot camp or pledging a fraternity. In many ways, you learn things about yourself and other people during your first year on the wards...and none of these lessons can be easily transmitted verbally...it's almost like everyone has to undergo a second awkward adolescent period as a rite of passage. Also, being a third year medical student was like regressing back into being a 4-year-old child, because the medical world is often alien to the newcomer and learning how to be a doctor is like learning how to be an adult all over again...how to speak medical jargon in surgery vs. psychiatry, how to be polite (pager etiquette), how to follow rules, how to learn what might be important (lab values, complaints) and what is unimportant when listening to a story -- simple things that seem obvious to the indoctrinated.
What also amazed me was how simply being a third year student opened doors in the hospital... From being a mere college graduate with an interest in medicine to someone invited to scrub in on surgeries, write notes, interview patients, perform IV insertions and intubations, and witness the miracle of birth...I learned halfway through third year that simply saying, "I'm a medical student, can I watch?" led me to opportunities beyond imagination.
Third year is hard, I definitely feel slightly burned out, but surprisingly my cynicism has not worsened. If anything, I've shed a little bit of my "beat around the bush" mentality. It was more difficult to blog about third year than anticipated, mostly because of time constraints but also because of privacy issues (HIPAA etc). If I had more time, I would write out paragraphs of my ten most memorable experiences this past year, but instead will list them in no particular order:
1) participating in a liver donor run to New Mexico over Thanksgiving
2) scrubbing in on liver transplants
3) befriending a boy with a giant retroperitoneal tumor in rad onc and crying outside the OR after hearing that it was wrapped around his aorta
4) taking care of little kids in peds urgent care
5) watching babies being born in fresno
6) inserting a 14-gauge IV into the dorsal hand vein of a patient under the curtain on anesthesia
7) chasing after a psychotic HIV+ transgendered patient at SF General on psychiatry
8) participating in my first code while scrubbed in on a vascular surgery in which the patient had an MI on the table...he was placed on ECMO
9) learning from medicine to "always do what's right for the patient" and to talk to unconscious patients as though they were awake, even though it seems strange, it's a sign of respect.
10) watching the work-up of a patient who turned out to have Q fever endocarditis
Whoa. Wow. Um. Where to begin?
Undoubtedly, the third year of medical school has been the most memorable experience thus far in my life, and even now when I reflect on all the crazy and outrageous and wonderful and awful things that I've seen, I can't even believe that it happened to me and not some 2D person on "Grey's Anatomy." In psychiatry, they might call that derealization.
Being a third year medical student is like being a guppy in the hospital ocean. You wander around helplessly, trying to learn how to coexist in a complex environment under some very talented and harried residents. It can be totally confusing and bewildering, but it also opens the door to levels of opportunity and privileged intimacy with strangers previously unheard of. Sometimes, third year feels like an apprenticeship where you learn things using your hands and watching others. Other times, it can feel like boot camp or pledging a fraternity. In many ways, you learn things about yourself and other people during your first year on the wards...and none of these lessons can be easily transmitted verbally...it's almost like everyone has to undergo a second awkward adolescent period as a rite of passage. Also, being a third year medical student was like regressing back into being a 4-year-old child, because the medical world is often alien to the newcomer and learning how to be a doctor is like learning how to be an adult all over again...how to speak medical jargon in surgery vs. psychiatry, how to be polite (pager etiquette), how to follow rules, how to learn what might be important (lab values, complaints) and what is unimportant when listening to a story -- simple things that seem obvious to the indoctrinated.
What also amazed me was how simply being a third year student opened doors in the hospital... From being a mere college graduate with an interest in medicine to someone invited to scrub in on surgeries, write notes, interview patients, perform IV insertions and intubations, and witness the miracle of birth...I learned halfway through third year that simply saying, "I'm a medical student, can I watch?" led me to opportunities beyond imagination.
Third year is hard, I definitely feel slightly burned out, but surprisingly my cynicism has not worsened. If anything, I've shed a little bit of my "beat around the bush" mentality. It was more difficult to blog about third year than anticipated, mostly because of time constraints but also because of privacy issues (HIPAA etc). If I had more time, I would write out paragraphs of my ten most memorable experiences this past year, but instead will list them in no particular order:
1) participating in a liver donor run to New Mexico over Thanksgiving
2) scrubbing in on liver transplants
3) befriending a boy with a giant retroperitoneal tumor in rad onc and crying outside the OR after hearing that it was wrapped around his aorta
4) taking care of little kids in peds urgent care
5) watching babies being born in fresno
6) inserting a 14-gauge IV into the dorsal hand vein of a patient under the curtain on anesthesia
7) chasing after a psychotic HIV+ transgendered patient at SF General on psychiatry
8) participating in my first code while scrubbed in on a vascular surgery in which the patient had an MI on the table...he was placed on ECMO
9) learning from medicine to "always do what's right for the patient" and to talk to unconscious patients as though they were awake, even though it seems strange, it's a sign of respect.
10) watching the work-up of a patient who turned out to have Q fever endocarditis
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