Wednesday, October 31, 2007
Tuesday, October 30, 2007
Monday, October 29, 2007
Just thought I'd share...
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" http://upload.wikimedia.org/wikipedia/commons/thumb/8/8d/746px-Hip_replacement_Image_3684-PH.jpg/746px-746px-Hip_replacement_Image_3684-PH.jpg
Saturday, October 27, 2007
Friday, October 26, 2007
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.
-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).
-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.
Thursday, October 25, 2007
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*
Monday, October 22, 2007
Saturday, October 20, 2007
Thursday, October 18, 2007
Tuesday, October 16, 2007
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.
Monday, October 15, 2007
Saturday, October 13, 2007
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
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: http://www.ucsf.edu/synapse/blogs.html (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): http://www.ucsf.edu/synapse/articles/2007/Oct/11/schip.html
Well, off to another exciting day.
Wednesday, October 10, 2007
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." (http://en.wikipedia.org/wiki/Ramadan) 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).
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
How does one properly fill this chief complaint (CC) line?
“Mrs. Doe, a 33 y/o Caucasian female presents with A, B, and C….”
Monday, October 8, 2007
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
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.
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
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.
And San Francisco's Indian Summer really does not help....nope...not at all.
Tuesday, October 2, 2007
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
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).
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.