Wednesday, October 31, 2007


Halloween. Oh yes, I remember those days. Growing up, I remember Halloween as my favorite Holiday because of the excessive amount of tooth-decaying glucose and fat packets wrapped in those shiny wrappers.

Candy, how I miss thee.

Every year I was an Indian Princess. There was no shortage of those outfits at home.

Today I really wish I would have dressed up. I would fit in nicely with my classmates who dressed up as pirates (one Johny Depp look alike), Harry Potter, John Travolta, the Incredible, Teenage Mutant Ninja turtles complete with April, Dumbledore, Penguins, Clifford the Red Dog, cowgirl (and these are just a few of the things I remember).

"The Flamingo is staring at me. The eyeball is looking at me,” said our Professor after seeing the Pink Flamingo hat.

My favorite costume was the Dr. Teresi--our anatomy professor--the costume was complete with the mustache, v-neck sweater, and goggles.

If I were to dress up, I would be a character from Harry Potter; I would do the whole bit: the black robes, the wand, the Griffyndor crest, the scarlet and yellow tie, and the broomstick. I would not be Harry, Ron, nor Hermoine.

If people asked me who I was I would respond with- "Hi. I am Parvati, the lesser know Indian character. I'm representing. See the resemblance?"


Some of my classmates will be doing a variation of the theme; something like "Trick or Drinking." We have a progressive Trick-or-Treating scheduled at different individual's house, with each host featuring a special drink: Mystery Punch, Russian Roulette, Bloody Sangria, Voodoo Vodka, Spooky Concoctions, anyone?

Think I'll sit this one out....maybe find some candy to rekindle those good old childhood days of guiltless sugar consumption.

Speaking of candy, here is some candy for thought (pulled straight out of a NYT headline):
"The candy lobby also played a significant role in pushing Halloween into daylight saving time, believing that extra hour of trick-or-treating in daylight would spur more candy sales but arguing that it would decrease deaths." The Candy Lobby is sweet and powerful, but they have got the kids best interest in mind.
It should be good times for all.

Tuesday, October 30, 2007

Baby A and Baby B

The baby boy was tugging his ear today. When Jane*, my U-teach mom, looked into the ultrasound monitor, she began to smile. "Last time, he was covering his face," she said.

The baby boy had been showing off earlier, as if he knew all eyes were on him during the ultrasound exam, an exam that makes use of high frequency sound waves to image a developing fetus.

"The baby girl is lazy, like me." Jane said.

The Baby girl is not nearly as big, nor as active, as the Baby Boy. Jane thinks the boy is taking her food.

During the exam, a technician placed gel on Jane's abdomen and moved a transducer (it looks like a white wand with a widened tip) over her stomach, slowly stopping to type codes and freeze images of Baby A and Baby B, one at a time. I forget which was one is the girl and which one is the boy.

Note to self: Ask Jane who is Baby A and who is Baby B at next visit.

From where I was sitting, I mostly saw black, white, and shades of gray. As he moved the transducer, I began to orient myself and place my limited radiology understanding to use. What I got was a glimpse of the marvels of life.

I could make out the four chambers of each baby's heart, represented by a little black bulge that was pulsing. I saw the amniotic sac (the source of nutrients and life for the baby), the five little fingers and toes, the brain (via a cross section), some of the organs, and the head with a little nose.

This was my first ultrasound in real-time. And to share in Jane's excitement as she saw her twins was truly a wonderful opportunity. She got two pictures to take home, one of the boy and one of the boy (Baby A and Baby B).
After the exam, we went to Panda Express to satisfy her appetite for some Orange Chicken. Over our meal, we exchanged stories and I learned more about her family and the struggles she faces as she progresses through this pregnancy. The due date will be in March; she has entered the trimester.

My fortune cookie revealed an interesting message: "Great Adventures are about to come your way."

Really? I think my adventures have already begun...and being part of this pregnancy is one of them.
Image: "Ultrasound Twins" (an image produced from a google-search):
*All names have been changed*

Monday, October 29, 2007

Thought I'd share

There is nothing quite like seeing your face staring at back you. When my classmate told me I was on the UCSF website, I was surprised. It is exciting to see that my blog has been mentioned on the UCSF main website- (See above image and direct your attention to "that's my blog."). That's me to the right of the pregnant woman's stomach.

Just thought I'd share...

Milk, it does a body good

"This is a recurrent theme. People that like to be active don't like to be inactive," said Dr. V, the orthopedic surgeon I was following in the Arthritis clinic today. Dr. V has a good point; individuals are not seeking surgery unless they really need it to control pain, or improve quality of life.

Sailing, soccer, cycling, climbing sand dunes, running, swimming, traveling, hiking--just a few examples of activities affected by hip and knee pain in the patients we saw today. I can not even begin to think what I would do if I had to give up my active lifestyle (running, spinning, kickboxing, dancing, weightlifting, tennis) because of pain.

Today, we saw around 10 patients in the afternoon, from 1:30 PM to 4:45 PM. Most cases were related to problems with joints--either the ball and socket joint of the hip, or the knee joint. During each exam, Dr. V attentively listened to each patient, responded to questions, and tested range of motion at the joint.

If there is one thing I need to improve; it is my ability to power-walk. I always feel like I'm jogging to keep up.

Note to self: Start increasing stride length when walking

I was lucky to spend an afternoon with Dr. V. He is extremely busy and multitasks very well. Dr. V wears many different hats; he is a father of two, chair of Orthopedic surgery at UCSF, surgeon, clinician, inventor of a particular hip replacement part, and overall- a nice man.

He answered a few of my burning questions. For all the ladies out there, wearing high heels will not necessarily cause limb or back problems. But tripping and falling will.

Note to self: Be careful when wearing heels (try to avoid clumsy moments).

Patients from all over the nation, including Florida, North Carolina, Washington (just a few of states I remember from today) follow Dr V for his expert opinion and services.

He opens his interview with a greeting and by asking "What are the state of affairs?"

Shadowing in clinic is so different from an OR; there was no sterile field or standing on my feet in one place for long procedures. I simply followed Dr. V from room to room. And at least this time, I got to meet the patient after Dr. V introduced me. It was nice to learn a little about each patent's story and to see patients return post-surgery with signs of improvement.

Sometimes it is the small gestures that make the biggest difference, everything from helping a patient get driving directions, or giving his e-mail to patients to follow-up, or just being honest with patients. Dr V has a way of listening and explaining complex anatomical concepts using X-ray images in a language that makes sense to his patients. He is kind, patient, and warm.

At 4:45 PM, he saw his last patient and we parted; he went to his office to dictate his notes for each visit and I went to the gym.

Interacting with patients that experience joint pain, made me aware of how delicate the body is (after it's been broken, or because of wear and tear). Most of all, I felt lucky to have the ability to run and work on increasing my stride length for future years that I will spend racing in the clinic or hospital.

Image: "Hip Replacement"

Saturday, October 27, 2007


I love coming home. Nothing much happening here. Lots of eating, mostly...

Just enjoying time in Davis. It's so quiet here, a nice, albeit short, change from life as a medical student and always rushing to get from Point A to B to Z and everywhere in between.

There is nothing like eating hot, spicy, savory authentic Indian/Pakistani food. And the desserts my mom makes are amazing--pure sweetness!
There is galab jaman (the friend dough balls covered in a sugar syrup), ras gulai (milky cheese balls), and barfi (blocks of buttery and milky sweetness). My descriptions do not do these desserts justice.

Oh I can't forget Baklava (see picture above); it's the best--my Achilles Heel.

I have probably consumed a zillion calories today, but it's worth every morsel of dessert. Since we start the Cardiovascular Block on Monday, it's probably best to eat the buttery, artery-clogging, sugar-saturated, packets of pure goodness now before I am fully aware of the irreparable vascular damage I am doing to my body. After that there may be less sweetness.
I guess there's always the gym...


Friday, October 26, 2007

Part 1 of 16

I am officially 1/16th of a doctor. Today was our final, marking the end of Prologue, an introductory block to medicine. The playing field has been leveled, the foundation has been laid. Now we venture into the “real medicine.”

The exam was alright. No curveballs, just the standard exam that tests how well you can cram, synthesize concepts, and recognize the correct answer from four possible choices while avoiding the ever so seductive answer that calls you, only to pull you into the incorrect answer trap.

There was more Anatomy this time around, more complex questions, and a lot more complaining medical students. But at the end of the day, it really does not matter what percentage we get on the test. We just need to pass under out beautiful, life-saving, Pass/Fail curriculum.

As one classmate put it, “pass now or pass later.”

The way I see it, we are all bound to make mistakes, misunderstand lectures, misidentify nerves and muscles, etc. Why not get all those jitters out now. We should strive to understand and limit the mistakes, but be comfortable making those inevitable mistakes now rather than when we will be taking care of patients. Just my thoughts….


October has flown by. Being sucked into the vortex of medical school sometimes makes me forget about the outside world. It dawned on me yesterday that next week is Halloween. How I miss Trick-or-Treating, costumes, and candy.
Speaking of Halloween, our Anatomy Lab practical was like a scene straight out some sort of awful horror movie; there were limbs everywhere with legs in bizarre positions, withering feet, hands with the skin peeled back, and skeletons. Some skeletons donned “rest stops,” and smiled at you while you waited to proceed to the next station.
Truly an appropriate Halloween scene.
With the end of Prologue, I must bid farewell to a few things.
-Goodbye to Mr. Danovich (our first patient case that was strung into our curriculum from Day 1)
-Goodbye to Anatomy Lab and smelly scrubs (We will still have a small bit of Anatomy in the Organs block, but not nearly anything close to 2 afternoons per week).
I am also hoping I can welcome some changes in my life.
-Hello to Friday afternoons to explore and play in the city.
-Hello to spending more time with friends and classmates.
-Hello to learning more about the other specialties and spending more time in the real medical world.
-Hello to moving on to the next phase of our training in medical school.
It’s time to start Part 2 of Part 16. Are you ready? I will be after this weekend. Stay tuned…

Thursday, October 25, 2007

Our First Meeting

Why do they keep the OB/GYN reception room so cold and dimly lit? I was thinking about this yesterday while I waited to meet Jane*. The big blue eyes of a baby from Baby Magazine looked up at me, while expecting mothers of all sizes paced back and forth or made their way to the restroom.

Learning is a two-way street. We all know the doctor teaches the patient. But how about the patient? I bet they have a lot to say and could give us a lesson, or two?

U-TEACH is a program that pairs a pregnant mom with a medical student, who follows her through the pregnancy from clinic visits to the actual birth. By participating in the longitudinal care of an expecting mother, I hope I can learn from my mother and gain a better sense of what pregnancy is like for an expecting mother and her family.

After fifteen minutes of reading a handout about "Expecting Twins," I met Jane, my pregnant mother.

When she had her first ultrasound to determine the sex of her baby, she crossed her fingers and hoped for a girl. She was in for a surprise.

"God made my wish come true," she said. She is expecting twins, one boy and one girl. She is five months along in her pregnancy and will be giving birth in March.

Note to self- If I have kids, I want twins (a boy and a girl)...

When I first met her, I would have never guessed she was that far along; the only sign is the slight outward bulge in her stomach. She is young (a few years older than me) with black hair and kind face.

From listening to her, I got one message: pregnancy is all about change. While we waited, she talked about how pregnancy has affected her body, her life, her relationship with her husband and her emotions. She had a lot to say and I was happy to by her side, so that I could listen and offer any support.

Her husband, John*, later joined us. During her exam, I sat at her side; she held my hand, squeezing tightly during an uncomfortable pelvic exam.

I am extremely fortunate to have this opportunity. I am grateful to Jane and John for allowing me to enter their lives. And at the same time, I feel a little strange; my role in this pregnancy is not well-defined. It will be up to me to define this role...

In 2 hours, I learned so much about Jane, who was a complete stranger just previously. After the visit, I already started thinking about the presents I planned to get for her and her babies. Maybe something from Victoria's Secret or Bath and Body for Jane, and some cute matching (boy and girl) outfits for the babies. Pink and blue are her favorite colors.

It's exciting to be a part of this pregnancy. I hope over the next few months our relationship can transform, so that I can become more than just the medical student participating in U-TEACH.

We'll see...I'll be with Jane at her next Ultrasound appointment.

*All names have been changed to protect privacy*
Image: Exam Room (Photographed on 10/24/07)

Monday, October 22, 2007

Yellow, Red and Blue (No Gray)- The Colors of the OR

Fat is yellow. When Frank Netter, famous anatomist and illustrator of Netter's Anatomy, drew fascia (fat), he accurately colored it yellow--the color I saw today in the OR during an abdominoplasty (waist reduction surgery) and breast reduction Mammoplasty surgery.

"Vertical belly buttons are youthful and horizontal belly buttons are aged," according the plastic surgeon I was shadowing Monday afternoon. I never knew belly buttons had some sort of identity. Swedish belly buttons were the trademark of a successful Salt Lake Plastic surgeon, according to the surgical tech I stood next too during the first 3 hour procedure.

Although we have our FINAL this Friday, I was in the OR from 12:30 PM to 7:30 PM (it was the earliest date I could be penciled into, given such a busy plastic surgery schedule).

I decided to venture into the OR after mingling with some surgeons earlier this year during the Surgery Interest Group's Annual Meet and Greet. I had no idea what surgery was about, aside from all the comments and rumors graciously provided by other medical students.

I was really interested in learning the truth. What is the OR like? What are surgeons like? Is it anything like Grey's Anatomy (we all know this answer- NO)? Is it true that surgeons eat medical students for lunch? And what better way to find out, than to set my own eyes on the scene and place myself directly into the pit.

The OR is bound by four white walls. Overhead, nine gold eyes look down; these are the adjustable lights that place a spotlight on the patient, actually the patient's body since the face is draped away from view. There is one main surgeon, a surgical resident, a medical student, a few scrub nurses, a surgical tech, and an anesthesiologist.

The only two colors I have come to know are red and blue: red for blood and tissues and blue for scrubs and the sterile field.

As a shadowing medical student (I did not scrub in, since I was simply observing), there is one simple rule to abide by: Stay away from anything blue to avoid contamination. So, I obey. I stand and watch.

The whole surgical team was extremely supportive and patient; they explained each step of the procedure and technique. The plastic surgeon I shadowed encouraged me to take the OR Access course taught in the spring to learn sterile technique and suturing basics. And after that, she mentioned in the future that I would get to sew (suture).

It's remarkable how plastic surgeons are masters of reconstruction. During both surgeries, there was lots of removing yellow fat, fine suturing, tissue repairing, and reconstructing.

They are artists of the body, transforming the body's landscape into something completely new at the patient's request. The process is unbelievable- the before and after-the in between. Wow!

At least I know the truth about the OR (it's nothing like Grey's Anatomy). I think I'll have to return...

Saturday, October 20, 2007

Tom Dick and Nervous Harry

"What does the dick stand for? Penis?" asked my anatomy lab mate (jokingly).

"No. It stands for 'flexor digitorum longus.' See, it goes 'Tom, dick, and nervous Harry.' These are the tendons that go through the tarsal tunnel. By that order, from anterior to posterior around the medial malleolus, it goes tibialis posterior (T in Tom), flexor digitorum longus (D in Dick), posterior tibial artery (A in And), tibial nerve (N in Nervous), and Flexor Hallicucus Longus (H in Harry)." I said during our last Prologue anatomy lab on Friday afternoon.

Anatomy probably involves the most memorization and comprehension I have come to know. Students and anatomists will develop all sorts of mnemonics, sayings, and dances to remember the order of tendons, the components in a fossa (space), the purpose of nerves, and anything else that requires memorization. Oftentimes, I'm trying to figure out which mnemonic goes with which anatomical concept.

FYI- "C3-C4-C5- keeps the diaphragm alive."

And there is the X-rated cranial nerve saying, which I will omit.

With our Anatomy Final coming up on Friday, I am feeling the pressure and time crunch. I never new the limbs could be some complicated.

Overall, anatomy has been an interesting experience. Friday ended with an eruption of applause to acknowledge our amazing anatomy family of instructors and PT students, who have been with us since Day 1--orienting us with the body in lecture and teaching us during lab.

Friday was Anatomy Lab 9, the last three hour lab for Prologue, an 8 week introductory crash-course of anatomy, pharmacology, histology, biopsychosocialogy, physical exam skills, and so forth. There is the final this Friday, so we're not really quite done yet and I am obviously too distracted right now to study anatomy.

We spend the most time in the Anatomy Lab during Prologue, oftentimes 6 hrs per week (in 2 three hour chunks on Wednesdays and Friday afternoons, times when my attention span wanes considerably and the view is the best with the sun shining through our 13th floor lab). Also, we may spend additional open time to review the structures glossed over during lab.

So for Prologue, we spent 27 hours (minimum) in lab. For most people it was way more time.
When most people probably think about medical school, they probably think about scrubs, anatomy, dissection, and other descriptors. And yes, there is plenty of that at first. There was the initial trepidation involved with actually cutting another human body; there was the inevitable smell (a mix of formaldehyde and rotting tissue); there was a crowded table, there was cutting (and negotiating shared scalpel time) and there was spending time navigating the body looking for structures (some very obvious and some not so obvious).
And yes, the prospective surgeons get called out by lab mates.

Anatomy is a transforming process. We all start with our fresh blue scrubs and wide-eyes ready to visualize the human body from outside to inside. Some of us more ready than others. We learn fast to detach the human identity from the body that looks up at us from a metal table. We quickly dissect, cut away, looking to uncover the particular artery or nerve or muscle, dirtying our scrubs and getting our gloved covered in body juices.

I have my feelings about the human side of things. I have lots to say but don't really know how to articulate my response to anatomy. I really enjoyed anatomy; I walk away with a deeper appreciation for the human body and fragility of life. Most importantly, I am deeply embedded to the family that donated perhaps the ultimate gift for the sake of our learning; I can't even begin to express my gratitude for what I have been bestowed from complete strangers.

At the same time, it's really easy to forget the human story of the individual, when you have three-hours, a list of objectives and bold-terms to plow through. I know nothing about the individual, aside from the cause of death and gender (female). And maybe it's better I don't know anything...

But I know about the intricate structures of her anatomy; I have touched her heart (literally), seen her lungs, felt her uterus, traced the blood supply though her arteries and veins, observed her muscles move, seen her abdominal viscera, and so much more. It's remarkable and yet so sad.

At times its like you are navigating an unknown area, looking to understand the anatomical landmarks and intricacies and all those details. And yet, we are all human and really can't disconnect ourselves completely from the human we are studying.

We all have those moments of human realization. None of us saw the faces of our bodies. The gauze will be removed during the Brain-Mind-Behavior Block, when we dissect the brain. But some of caught glimpses and for some that was an unpleasant experience. I can still remember hearing screams from a neigboring table when the face was accidentally uncovered. Others had adverse reactions to the hand and toes, perhaps because these structures are remind us about the truth that we all sometimes forget...

Since Friday will be here soon, I think it's time to return to the lower and upper limbs. And this may require an anatomy lab revisit...

Thursday, October 18, 2007

Navigating the Labyrinth and the Medical School Tour

It feels like just yesterday I was pressing my pink collar shirt and black suit, polishing my three-inch black stilettos, telling my life story to strangers and criss-crossing the nation during my medical school interviews.

Let's rewind for a second. October 24, 2006, 8 AM- I find myself test-driving my new black suit and heels during a one-hour walking tour in rain and up hills at the University of Pittsburgh. Oh, it was my first interview. After surviving the tour marathon in heels, I knew I could make it through any walking tour (and those shoes were definitely keepers). And later there was the UCSF interview...more on this later.

When I think of medical school interviews, I think about black suits, long walking tours in three inch heels, sleepless nights, red-eye flights, traveling for endless hours, returning to school to take midterms, unappetizing hospital cafeteria sandwiches, nerves, repeating my life story for every interviewer, and waiting for weeks to month to hear a decision from the admission gods.
Today I was reminded of the entire interview process as I guided my first UCSF medical school tour. During the forty-five minute tour, I led a group of interviewees (all male and all in black suits) through the UCSF Parnassus Campus, taking them everywhere I could think of from the student lounge to the anatomy lab to Milberry Union to the Gym (including the downstairs weight room) to the library. Along the way, I answered questions and learned a little about each of the interviewees.

It's interesting how after seven weeks of medical school, I am looked to as a UCSF medical student representative and resident expert. I am supposed to have the answers to the questions, know the way, and speak about my experiences. Such high expectations for someone that still gets lost trying to navigate the labyrinth of connected buildings that is UCSF. And the funny thing is, I had no trouble talking during the entire tour and we did not get lost (not even once).

It's amazing how fast we transform. Just a year ago, I was looking at the tour guides similar to how the interviewees were looking at me--asking questions, seeking my opinion, and looking to me for answers.

I guess it's time to go beyond thinking that I am "just a first year medical student that just got accepted." That excuse won't fly anymore. It's time to put the entire application process and interview process behind me, and move forward.

I am officially a "first year medical student," who can lead a medical school tour. And I can definitely sell the school (it's really not hard, given the amazing views from the Anatomy Lab and library; among other amazing things abour UCSF).

I look forward to leading my next medical school tour (probably not for some time given the popularity of serving as a tour guide among my classmates). In the meantime, I will have to work on figuring how to navigate the Parnassus labyrinth....

Tuesday, October 16, 2007

Purple Bags

"You know you could have allergies or hay fever. That's why you have those purple bags under your eyes," according to the rheumatology and immunology internist I followed as part of my preceptorship.

Hay fever is unlikely (I'm sure). Hay fever is typically causes by allergens and pollens that induce an overactive immune response, typically causing itchy eyes, a runny nose, and sneezing. Allergies-- maybe.

I did not go to my preceptorship expecting to be diagnosed with something or gain some explanation for why I have bags under my eyes (which I have assumed may be due to a lack of sleep). It comes as a bonus learning point, I suppose.

While my classmate and I were walking to our first day at our preceptor's office, we passed an Armani Exchange, BeBe, and a number of upscale restaurants and other fashion boutiques.

His sixth floor office overlooks the SF Marena. On one side of the room, his wall shines with frames documenting his professional achievements and affiliations. The other side of the room has a wall dedicated to framed and signed photographs of 49ers from their heyday in the 1980's and early 1990's.

Football memorabilia, including a few signed footballs and figurines, fill the corner of his office. The plush red carpet matches nicely with all the visible 49er uniforms. Wooden mallard models sit on the front of his desk, surrounding his name plate. His name is adorned with 2 stars, one on each side, for his military service.

Our preceptor has an extremely dynamic career; he has a doctorate in immunology, has served as a General in the military for decades, as well as the allergy doctor for the 49ers, and the current allergist for the SF Giants. He has worked for most of his lifetime in medicine and continues to work in private practice three times a week in his office and also spends time in the hospital. On some days, Poncho, his dog comes to the office. At the time he graduated from medical school, he was married with four children.

In opening his practice to my classmate and I, our preceptor has introduced us to his world. A world concerned with allergens, antibodies, inflammation, immune disorders, pain, and unusual diagnoses. Today, we saw four patients, with variable chief complaints, everything from leg pain to congestion to asthma to wrist pain.

"Look at this nose and notice how it's inflamed on the inside. This is a good example of an allergic nose." (Our preceptor's instructions to us as he passed us a scope)

Today, we primarily shadowed our preceptor, following him and his cues during patient visits. When instructed, we placed our stethoscopes on a patent's lung or chest, listened to their breathing or heart beat, or looked into their nose, or observed their sinuses.

For the patient, it must have been strange to have 3 white coats in the room, 3 sets of eyes up their nose, and 3 cold stethoscopes on their back. And to be discussed like a case of allergies or pain, when still present in the room, must have been odd for the patient.

"What does that mean?" (a common patient question when their condition was being discussed openly)

And to be frank, I really don't know. The language of immunology is completely new to me.

Our preceptor is very friendly and receptive to our needs, asking us what we are interested in learning and what we hope to gain from our experiences. He always meets with his patients in his office after the initial exam. He even showed us the fridge, where we could find "soda-pops" if we ever got thirsty. How nice.

For now, I will expand my vocabulary with the assigned terms: Asthma, tendonitis, inflammation, fibromyalgia, rhinitis, allergies, hay fever etc. Our next preceptor meeting will be in November. And before then, I will either determine what causes these dark bags under my eyes, or maybe I'll just catch up on some sleep (and they may just magically disappear). Right?

Monday, October 15, 2007

Getting Cootie Shots

"Circle, Circle, Dot, Dot- now I have my cootie shot."

Remember this juvenile saying kids would bounce off each other? I definitely remember this and still cringe just thinking about it.
I'm still unclear as to what a "cootie" is and how a "circle and dot" can remove "cooties." Kids are quite creative when it comes to developing solutions to imaginary problems.

Real shots are not fun. With the upcoming influenza (flu) season, health care providers are gearing up for the endless fevers, chills, sneezing, runny noses, and rampant spread of the virus.

Today I got my flu shot. The medical science lobby in front of the Nobel Laureate Wall was transformed into vaccine central. After filling out the green form reserved for students, I went to the S-room, waited in line, and got my flu shoot.
Kids were on to something, There was a circle (the band aid), a dot (the injection point), and a shot (a needle stabbed into my left shoulder). But that still leaves me unclear about how to define "cootie." Any thoughts?

Saturday, October 13, 2007

Visiting Home

Brachial plexus. Ectopic Pregnancy. Forarm Flexors. Appendicitis. Forearm Extensors. Muscles of the Anterior and Posterior compartment of the Arm. Pharmacokinetics. Physical Exam Skills.

These are a few of the many things going through my mind. I probably should be studying these subjects among other things, but I can't get myself to open up my syllabus or my Netter's anatomy atlas right now.

I'm spending my weekend in Davis at home with my family. This is my first time returning to my hometown in over a month since starting medical school. It is so nice to return to a place that really does not change much.

Everything seems the same. Home remains home--a place of serenity, loaded with lots of ready-made food and free laundry. It's great to just spend time around my parents and younger siblings. We also spent Saturday morning making samosas- a potatoe filled oily packet of sheer goodness (see above picture).

I exhausted my conversation topics within the first hour of my visit once I got all the updates about life, school, events, etc. And now I'm just enjoying my family's company and the comforts of home, including seeing my old cat, eating my mother's legendary Pakistani khannas (food) and coming face to face with Baloo, a new kitten that has made residence in my parents backyard shed.

I spent Saturday brunch with my mother's friends, which primarily consists of Pakistani and Indian families. I don't know if it's me or if I'm just a giant, but I felt like I was really towering at 6 feet in my gold heels and in a blue-violet shelwar kameez ensemble, a traditional outfit worn in Pakistan and India, that resembles a fitted tunic (or mu-mu) on top of MC hammer pants.

To celebrate Eid, the end of Ramadan, the women wear shinning in all the colors of the rainbow, the orange lines of henna designs were visible on some women's hands, and their arms were decked in glimmering gold and colorful glass bangles that complemented their beautiful jewelry sets. And there was no shortage of sequins, fake diamonds, or glitter to complete a scene that really could have been taken right out of a low budget Indian film.

Being reunited with friends is one of my favorite things. We really enjoyed each other's company, in conversation and in hand decorating. And to be honest, we spent a good chunk of our time taking pictures of each other. I brought my digital camera (point and shoot) and I was interested in trying different angles to get the most flattering shot (from everybody's point of view).

One friend described our scene, as something close to a "circus in town." I think she may have been referring to the fact that one, we were dressed in all colors of the rainbow, and two, we really must have been catching everyone's attention with our endless camera flashing and inability to sit still. We seemed to keep taking pictures; I'm dreading posting the pictures on the facebook because it involves endless tagging. But that's the fun of seeing each other--creating memories and having those pictures.

Along with indulging in a smorgasbord of Pakistani food items, including samosa (pictured above), chunnea, halwa, poori, and dai; we also satisfied our sweet tooth with jalabi, triple chocolate cake, and baklava. Food never tasted so good. And with no restrictions in place, we really devoured the food. The inevitable guilt that results from consuming 10,000 calories in one meal can be easily justified with "We've fasted for one month and should be allowed to eat for one day (with no regrets or guilt)!" This is actually my rationalization and I stick by it,perhaps a little beyond the days after Ramadan.

I probably over packed my backpack for this little weekend adventure. I leave for San Francisco tomorrow, heading first for a short dinner at my brother's place in Oakland. But before I leave, I'm going to pull out my stethoscope and blood pressure cuff and practice the physical exam, including HEENT (head, ear, eyes, nose, and throat), abdomen, heart and lungs, and musculoskeltal exams. Now, all what I have to do is round up some volunteers from my family and get started. Well, maybe I'll just suspend that thought until tommorrow.

Thursday, October 11, 2007

A sun-rise spin

I finally got to disable my 5:00 AM alarm tonight. Word just got out that tomorrow is Eid-ul-Fitr, the end of Ramadan (a month of fasting).

I am so excited for celebrating, going home to visit family, eating food, eating more food, and being reunited with some of my good friends (you know exactly who you are).
I have to get through tomorrow (a case presentation tomorrow morning followed by a tour guide training at noon and anatomy lab from 1-4 PM). And I have yet to read about the anatomy of the hand and forearm (tomorrow's subject). A busy day, but at least I can eat to keep my spirits high. My celebrating will be suspended until Saturday when I return home.

But I'm thinking a sun-rise spinning or jogging session at 6 AM will definitely be a welcome change from the 5 AM wake-up calls. We'll see if I can get up.

To everyone- Eid Mubarak! May you find peace and joy in your lives and take some time tomorrow (and Saturday) to reflect on the blessings in your life and CELEBRATE.

Image: "Eid Mubarak."

It's official- I'm going global!

It's so awesome when you can look down, and see your photograph staring back at you (a photo you took, not a head shot) published in a newspaper. Since starting as a photographer for the Synapse, the UCSF student Newspaper, I always get excited on Thursday--print day!

Pictured above is Connie, an Aztec Dancer, I photographed from last week's edition of the Synapse.

It's the ultimate joy for a budding photographer. And what adds to the cake (the proverbial cherry on top) is when individuals personally compliment the photo. I get happy to one, see my work in print. And two, to see that my photos can evoke some sort of emotion.

To that end, writing has become my new outlet. Actually, it's blogging that gives me a chance to connect with the different segments of my world, everyone from old friends to new friends and complete strangers. And I truly appreciate the feedback I've been receiving thus far; it keeps me coming back to share the details of my life.

And now I'm going global (well kind of); my blog has been pinned to the UCSF Synapse website: (and soon a head shot will be added, which is interesting since I wonder how readers respond when they know who is writing to them). Will I attract more readers or just scare readers off?

Time will tell. For now, I am looking forward to reporting to my blog and to an extended community.

By the way, I also just published an article in this week's (released today) Synapse about the recent demonstration surrounding SCHIP and Bush's veto, which if implemented, will take health care from uninsured children (and I thought we had enough domestic problems):

Well, off to another exciting day.

Wednesday, October 10, 2007

I'm going to be here later today goes by slow

I have really come to hate the sound of my alarm. I mean who really likes their alarm? My alarm sounds like a chime/bell and its produced by my cell phone. Cell phones definitely know exact time, because I am pulled out of a semi-peaceful sleep everyday, same time. Lately (and for the last 27 days or so), my alarm has been waking me at 5 AM.

Waking up at 5 AM takes a great deal of force, effort, and strength. What actually takes more strength is fasting for the whole day (until 7 PMish).

During Ramadan, Muslims all over the world give up food, water, and sex (during fasting hours) for a month of sacrifice and spirituality. The word Ramadan is Arabic for "intense heat, scorched ground, and shortness of ration." ( And it is an appropriate name, since the multi-faceted definition reflects how one feels when fasting (well, that's how I feel and I'm not ashamed to admit it).

The most common response I get when I tell individuals I am fasting is- "How can you go an entire month without eating?"

Well, we eat in the morning during Sahur and again in the evening. It's basically fasting (no food or water) from sun up to sun down for an entire month until the end, which is celebrated during Eid-ul-Fitr. Makes sense.

In making one of the biggest sacrifices, you learn to discipline yourself. At least, that is the intended outcome. And I have been learning to appreciate all the blessings in my life: health, food, shelter, family, friends, etc. Celebrating the end of a fast during the Iftar dinner with friends and family is especially rewarding, because it feels like you have actually earned your food and your plate. And you never really realize how amazing food until you've gone without out (oh yes!).

At the same time, fasting can be challenging.

Giving up food is not really a problem. Waking up when it's still dark to the sound of irritating bells is fine. Being absentminded and distracted and tired after 2 PM is tolerable. Always being around food- totally cool. It's giving up water, which makes it difficult for someone (like me), who is accustomed to hitting the gym most days.

No running, no spinning, no weights, no crunches, no swimming, no fun. No going fast; time goes by slow.

But I've adjusted and when I get back to my routine (or better yet, ease my way back into the swing of things next week), I will appreciate my workout so much more, when I can have my water back and when I can experience the joy of a hard core workout.

Until then- Happy Ramadan (with 2 hours to go...for today)

Image- "Noor (Light)" from my collection

Tuesday, October 9, 2007

Can I Check the “Human” Box, please?

CC: ________________________________________________
How does one properly fill this chief complaint (CC) line?

Typically, you may hear something like:
“Mrs. Doe, a 33 y/o Caucasian female presents with A, B, and C….”

After seeing my first patient in homeless clinic,I was told the CC is akin to a teaser of the movie of a patient’s medical history. If that's the case, how much information about an individual should be included in the CC and what should be omitted?
“Knowing the ethnicity and race sets off red flags,” said a self-proclaimed doctor from the old generation during our lecture on race.

Genetically, we are 99.9% identical and yet we are so different. And yet there is no "human box" we can check to identify ourselves in this manner. We are diverse; especially when we think about race and ethnicity—two nebulous terms that evoke strong reactions.

After a two hour lecture and panel discussion of race in medicine, I am still unclear about how to define each term. I do know they are not synonymous and the significance of race and ethnicity as a medical identifier is up for debate.

I did get one central message. No matter how much we can recognize the existence of biases, the bottom line is that we all have our biases. I have mine and you have yours. And biases play a role in how we deliver health care to our patients.
I have been told repeatedly that I am being indoctrinated into a new culture. Ideally, we shed our biases when we put on our white coats and interact with our patients. But apparently, this new culture is not color-blind.

As such, we must ask if race and ethnicity belong in the tag-line of the chief complaint or should this information be tossed into the social history?

There are no studies that have actually proven that removing race and ethnicity from the chief complaint removes bias. But how can you really measure a bias (and the removal of a bias)? And to play devil’s advocate, if we are hesitant to include race, then why do we mention age and sex in the CC, since both topics are also polarized and notorious sources of generalizations and stereotypes.

UCSF has developed a new innovative approach to addressing how we describe and use race in delivering medical care. We have been instructed to omit race/ethnicity from the CC. In implementing a new approach to address the race/ethnicity question within a broader social context, UCSF is hoping to create a new norm for history taking and will start by educating us early in our training.
It seems simple enough, and yet we have opened Pandora’s Box based on today’s extensive discussion in lecture about the implications of this policy. There was no agreement; just a long discussion with varying perspectives that bounced high and low, side to side, and all over the place.

I have mixed feelings. I can see why it is important to look outside the racial box—we need to focus on the individual, rather than the disorder, race, or ethnicity (and the associated stereotypes).

At the same time, an individual’s race and ethnicity is an unavoidable subject that will come up later on in the interview and sometimes has medical significance especially in disorders that have a genetic component such as sickle cell anemia, Tay-Sachs, and cystic fibrosis. It will be interesting to see how this plays out during my clinical experiences. The discussion has got me thinking about race and asking, "so what now…” I think I can quote myself.

Here is something interesting I learned: South Asians are actually more closely related to Europeans than East Asians. And yet, South Asians are clumped under the “Asian” category. Interesting...
At least, I’ll think twice before I check the next racial box that asks me to identify myself. Instead, I will select “other” and pencil “human.”

My reasoning may just be an oversimplification (but at least I can identify with a group that we are all part of).


Monday, October 8, 2007

I see no evil, speak no evil

Did you know that "Peeking is traceable and is now illegal."

As a matter of fact, there is a $25,000 fine per infraction and repeat offenders may have to pay up to $250,000 or 10 years in prison.

When I say "peeking" I'm not talking about reading the headlines of the San Francisco Chronicle over a stranger's shoulder or catching a glimpse of the new Angelina Jolie pictures from someone else's People Magazine.

In the medical world, "peeking" refers to wrongfully scoping out a patent's medical history. The policy to protect patient privacy and records from prying eyes was enacted by the Health Insurance Portability and Accountability Act (HIPAA).

We hear about this all the time: celebrity checks into hospital, press hear rumors, hospital location where celebrity checked in is discovered, celebrity health information leaked to the press, celebrity get outraged...and cycle starts all over again

No body wants their medical history broadcasted on Entertainment Tonight or on the local news, and yet sometimes patent's rights are violated.

* * *
Now that our first midterm has ended, we move onward in our training to become physicians. We received our formal HIPAA training today to prepare us for the next few steps in our training.

Starting next week, we'll be traversing San Francisco, the bay, and cities in between to make our way to our preceptor sites, where we have each been paired with seasoned physicians in fields such as internal medicine, primary care, and emergency medicine.

During our bi-monthly preceptorship dates, we are expected to experience medicine directly, put our physical and history-taking skills to good use and observe how medicine is practiced.

"There are standardized patients, but they are no standardized preceptors" according to our doctoring facilitator.

We will each have different experiences.

I really do not know what to expect and I'm a little bit uncertain as to what is to be expected of me.

Nonetheless, I know about a patent's rights (as described by HIPAA regulations), I know where to place my stethoscope, I can take blood pressure, percuss, and listen to some one's lungs and take a basic medical history.

With six weeks of medical school behind me, I have come a ways from where I started. I do have some skills to help patients.

Most of all, I have an interest in learning and I look forward to walking into my new classroom next week.

Saturday, October 6, 2007

The Mirror Girl

Mirrors are a beautiful thing. We look at mirrors in the morning to see our ourselves when we wake up and again in the evening before we go to sleep. Mirrors provide reflections. And when carefully positioned, mirrors provide a glimpse into the birthing process.
That was my job today- I was the mirror girl during my first medical shadowing experience spent in labor and delivery. As I held the mirror for mom and dad to produce the optimal view, I got to observe the whole birthing process and also provide positive feedback to mothers as they pushed, pushed, and pushed some more during contractions. It was simply amazing to watch mom (despite her initial trepidation) and dad look at the mirror, as if they were viewing a portal into a magical world.

In medical school, we will eventually complete a OB/GYN rotation sometime between our third and fourth years. But by then there will be responsibility, evaluations, and pressure involved. As a first year shadowing student, I decided to experience medicine a little earlier, when I can really observe. My knowledge is limited and there are no high expectations (yet), or case presentations to be made. Today was not about reciting physiological processes or pharmacological terms as they pertain to specific cases; it was more of a holistic learning experience and an opportunity to be by each patient in a supportive role.

And today I served as the mirror girl and helped mom during her contractions.

My day started at 8 AM. I was running to make it to the 15th floor in my over sized and unflattering blue scrubs. As I made my way to Labor and Delivery, I began to understand why the chief resident had instructed me to wear "comfy shoes." My Adidas sneakers definitely served the purpose, although it seems like clogs are the big thing in labor and delivery.

*Note to self- Maybe I should consider buying clogs for Clinic days, but I really can't see myself in them. I am really a high heel girl.

I arrived on time and joined an OB/GYN team for sign-out rounds in the small resident work-room right across from the Nurse's Station. The resident work room is the hub of activity. It' s equipped with computers and a dry erase board that chronicles each patient's condition and history in acronyms that I can't understand. When I arrived, a new team was getting all the updates through a series of case presentations provided by residents from the last team.

It took an hour and half to get the debriefing of the patients in labor, the new admits, the post-labor recovery, etc. Having just studied female pelvic anatomy, I could pick up words such as uterus, os, fundus, and umbilicus. Most other words or acronyms where a new language to me that flew over my head, just like the Blue Angels, who were out today for Fleet Week Celebrations.

Once notes were exchanged, I was paired with an intern and off. We started with assessing triage (newly admitted patients) and made our way to our first mom in labor.

The laboring rooms on the fifteenth floor have the best panoramic view of the city. When I first walked into our first mom's room, it was surprising how different the room looked from a typical hospital birthing room. It actually felt more comfortable; it was spacious with large windows and some home furnishings, such as a sofa and some wooden side tables and dressers. An incubator for the baby sat in the corner and mom's bed was right in the middle of the room.

I observed my first live birth within an hour of my shift and by the end of my shift, I saw a total of three deliveries (two girls and one boy), including one breach baby delivery in the Operating Room.
Delivering a baby involves a lot of pushing, contractions, coaching, screaming, blood, and patience. When the baby finally arrives through the birthing canal, it's amazing how much stretching can take place. After today, I know I passed my first test-I can stand the presence of blood and oozy stuff since I did not faint (a very good sign).

In each delivery, I got to meet a new set of parents, who were excited, anxious, and a bit scared. Some parents had the exact name selected for their baby, while others had a list of names and alternate names in mind.

From my experience today, I can really see how the arrival of a baby transforms individuals. Two of the couples I met were having their first child. When the baby arrived and was given to mom and dad, I could start to see a change. I followed one baby to the nursery, where it was given oxygen to assist with the transition (the point where the baby starts to completely breathe on its own). I was there, assisting the nurse administer oxygen, and watching the baby as it gained color and as her grunts diminished (a good sign). She began to respond to Dad as he called to her and spoke to her.

It's hard to explain; it's something that just happens between a newborn and its parents. It's natural. And it is beautiful to watch parents display affection for their child and for each other, as they welcome their new child into this world--one of the reasons that makes OB/GYN such a promising career.

I left the hospital at 5 PM, quite early since most residents will be in the hospital overnight attending to their patients. Having been on my feet all day, I was tired and ready for a power nap. I don't know how residents pull those long shifts.
Serving as the mirror girl was truly rewarding; I not only got to observe the birthing process; I got to see a reflection of a potential career.

The question now becomes- can I see myself as an Obstetrician?

Well, I might just need to look at the mirror a little more closely, now that I have some experience.


It's all over

It's done. And I feel just fine. Despite the all-day marathon, starting yesterday at 9 AM and ending at 6 PM, I'm relieved my first medical school midterm is over.

I survived what will be the first of a series of tests that will challenge me and my ability to learn this new medical language. In retrospect, I could imagine the test being 10 times worse, but it was fair, given the amount of information and number of topics we covered.

The first part of the midterm was a three-hour extravaganza. It was nice to be interrupted by the second years, who streamed in bringing sources of ATP (cookies and brownies).
*Note to self- bring cookies for first years during their prologue midterm next year.

Then, there was waiting. I did learn about the conflict in Darfur from a physician's perspective during a noon-hour talk. I am left feeling saddened about the humanitarian crisis in Darfur. I will need to learn more.

My anatomy practical, including histology, wasn't until 4:45 PM. I would have been ecstatic if I had a 1 PM exam time, but no- I had the last possible practical slot.

In an ideal world, I should have been effectively making use of the time by studying and reviewing all those long Latin-derived anatomical terms.

Realistically, I just absent-mindedly stared at my syllabus and the anatomy dissection videos and color histology slides. It did not help being on the 5th floor of library overlooking the entire city. Not to mention, this weekend is Fleet Week. And yesterday, we were fortunate to get a glimpse of the Blue Angels as they flew by. Needless to say, I was distracted and anxious to just get this all over with.

If there is one thing I remember from the anatomy midterm- it is the 13th floor has one of the best views of SF. The "rest stops" that are embedded in the exam gave me an opportunity to stare out and map out the city and all the sites I have yet to explore. I also noticed I always get goosebumps when I walk into anatomy lab; it's just way too cold for blue (over sized) scrubs.

It's great to be done. Celebrating and spending time with classmates (post-exam) in the Haight was fantastic. Although I ended my celebrations early compared to others, who were just gearing up to spend an evening at Milk, a bar/club in the Haight for a night of bliss, I was happy to catch up with sleep. Sleep--it's a good thing.

I am looking forward to refreshing weekend and catching up with friends outside of my little medical school world. But before I do that, I'll be spending my day in the labor and delivery world. We'll see how that goes...maybe if I'm lucky I'll see a birth (or two).

Thursday, October 4, 2007

Passive Diffusion and the Exam...

Figure 1: Passive Diffusion

Do you know the feeling you get when you know you're about to walk into something scary and unfamiliar? Well, that is kind of how I feel right now, only I'm not really walking into anything except my first medical school midterm tomorrow morning at 9 AM (gasp!).

Maybe its the massive amount of information (over 568 pages of syllabus--pretty much all text with the occasional "cartoons," ) or maybe its being surrounded by so many talented and brilliant individuals, who are all stressing out, or maybe its simply taking a new type of test for the time. Whatever it is- it's got me feeling overwhelmed, wound up, jittery and distracted.

Here is just a side note: I have been staring at my massive syllabus and power point slides for way too long. It's odd how professors sometimes refer to those boring and/or complicated scientific diagrams and images as cartoons. For example, the image above is not a cartoon (but some scientists would disagree). When I think of cartoon, I think of Garfield or Sponge Bob Square Pants, not the binding site for Cox-2 or a picture of the Na+/K+ ATPase pump.

I suppose I should be studying and filling the last spaces of my brain, which has already exceeded its capacity, with more facts that will inevitably diffuse out of my brain (via passive transport) the moment I turn my exam in. See Figure 1 (above), which is not a cartoon. The image illustrates passive diffusion, in this case, the flow of information (the blue balls, disregard the oxygen label- this was the best google-generated image I could find) going from my brain out to the environment.

Despite the diffusion (its inevitable, since information will flow down the path of least resistance), I hope I can retain some of it. Ideally, I would like to remember most it. But I am up against the endless battle of learning more and more new facts and seeing more fun cartoons.

Hopefully, it will all come together for the test. But most importantly, I hope all this studying will form the foundation of the knowledge that I will draw on throughout my life as a practicing physician.

It's time to return to this fun task. Maybe if I'm productive (and chances are low), I might just see where I'm going tomorrow and prevent some of this passive diffusion.

And San Francisco's Indian Summer really does not help....nope...not at all.

Study time!!!!!


Tuesday, October 2, 2007

The Sign Says it All

Why are we even debating this topic? (All kids should have access to health care)

I was planning to simply observe this pediatric resident-led demonstration, but decided to bring my camera along. When I arrived on the scene, I had the opportunity to speak with the pediatric residents who are concerned about the state of SCHIP, a federal program that provides health care to uninsured children.

As I took photographs and learned about the gravity of President Bush's intention to veto the bill that would sustain the program, I realized what kind of force health care providers are up against.

In a way, the demonstrators are providing a voice for the children and families, who can not vote and who will not be heard. But what do we do when no one really see us, or validates our concerns? After all, we are the ones who are taking care of our patients, while policies are made by those who have limited (if any) exposure to our world.

So, what can be done to get the message across to policy-makers?

We can start with letter, a photograph, or a sign that really delivers an obvious message that seems to still get overlooked.

Monday, October 1, 2007

Marking ourselves

Why would anyone invent smelly markers for kids? You know- those colorful markers with a chemically synthesized scent, everything from red cherry to black licorice to yellow lemon to brown sugar. I mean, should children really be developing a habit of sniffing markers.

After today, a blueberry-smelling marker will never be the same.

During our surface anatomy session today, I got my body marked with a blue-berry smelling and brown crayola marker. The beautiful marks were visible on my chest. There was a line in the middle of my chest at my sternal angle (the place where manubrium meets the sternum) along with two blue-brown dots marking my second intercostal spaces (the space between my second and third ribs), one on the right and one on the left. There were also marks all on my back (I don't know what those look like for obvious reason).
In any other setting, having those marks might seem odd, but in medical school it seems perfectly normal.
It's kinda funny what my idea of normal has become. Before medical school, I would probably never have drawn on my skin or been comfortable with having my body poked (to be fair, it is technically palpation and percussion). But now I find it quite normal to have my classmates tap their fingers on me, feel for anatomic landmarks, and draw lines on my chest and back to outline my lungs, heart, and ribs. It's all in the name of medicine and learning.
I guess the whole experience of surface anatomy was not too bad. Performing the physical is a whole other story...(but I'll explore this topic more when I don't have a midterm).

Aside from the cold hands, fingers all over, and smell of scented-markers, I am really learning how to read the human body and notice key anatomical details. I know now where to place my stethoscope to listen for the heart and the lungs. I am beginning to see the body and what lies beneath.

Along with making sense of all the anatomical jargon, I am learning what it feels like to be a patient and how sometimes you just have trust others, even if they are people holding scented markers.