Friday, February 29, 2008

Mosiac Culture Show

The AIDS week of action culminated with the Mosaic Culture Show, a showcase of performances that reveal UCSF's hidden talents. Sometimes you forget that your classmates have secrets talents that go beyond studying and developing patient rapport (and these are pretty amazing talents).

Last night's event revealed the diversity of skills and talents. The performances of the Mosaic Culture Show included everything from the beautiful songs to powerful spoken word to vibrant Bhangra dancing to gyrating belly dance to novel Brazilian Martial Arts to Hula dancing to our class hip hop act. I was able to visually capture the fluid motions of the performances through my camera (the dim lighting did make for a challenging photograph session).

After seeing the variation in creativity, I can't help but feel a little under-talented. I think it's time to take the salsa and belly dancing class I have been meaning to take since college started. I guess I have now discovered my summer time recreational activity...if time permits. And maybe I can find the time to perform next year (probably not...)

Proceeds from the show will benefit HIV clinics in Africa, as well as the UCSF student-run clinics.

Tuesday, February 26, 2008

Returning to Anatomy

The sight of a hemisected head in a tupperware container is not natural. Before starting medical school, I know I would have been taken aback by such a sight. But today felt no different than any other day in anatomy lab.

After a hiatus from anatomy lab (we had no anatomy in renal), we returned to the 13th floor for a two and half hour session of Gastrointestinal anatomy. There will be one more session of anatomy at the end of the week for M & N.

Four out of six group members came dressed in blue scrubs, reunited and assuming the same group roles we had in Prologue. We reviewed the gastrointestinal tract and associated organs, which had been dissected in Prologue. We also got a preview of the Brain, Mind, and Behavior Dissection as we examined the anatomy of a hemisected head and the space behind the esophagus in our cadaver (the head had been loosened from the neck for us).

When we got to examining the hemisected head, nothing felt unusual about anatomy lab, not even a flinch when the lid was peeled back. Is that normal? I suppose we are becoming sensitized to seeing human organs and body parts in isolation, akin to specimens that need to be studied to identify key anatomical landmarks.

Although I feel programmed to focus on the anatomy, I can't help but wonder how we can overlook the most obvious thing: we are studying the bodies of individuals--like me and you--whose lives we will never get to know.

Sunday, February 24, 2008

Returning for M & N

You know it's time to return to reality when you have exchange your comfortable and over sized sweats, slippers and t-shirt for jeans, a fitted sweatshirt and boots. It's all about being presentable when traveling and making the two-half hour train ride back to San Francisco--ending the four carefree days of interblock vacay.

Now, that I have returned and cracked open the Metabolism and Nutrition (M & N) syllabus, I can't help but notice the length of our syllabus has increased and the font size has decreased (definitely not a good sign). And I already see myself falling behind before we even start (one day really makes the difference).

I guess it is time to strap myself in for our next seven week block. I have a nice pair of running shoes (thanks mom) to carry me through the next few months. If only the rain would subside and the sun would come out, so I can break in my shoes properly.

I am blankly staring at the syllabus. The four day vacation vanished with a blink of an eye. I did enjoy the refreshing break. I've had my fill of home-cooked meals, dessert, conversations with the younger siblings, and time spent with my mom and the cats. It's hard to return after getting a taste of vacation. But given how fast this year has gone by, it will be in no time I will be returning.

Friday, February 22, 2008

Geneticist crossing the Tight Rope

"Are you a geneticist?" asked the lady working in the registrar's office.

"No, I am a medical student." I replied.

I finally picked up my diploma. I graduated in June 2007 with a Bachelor of Science in genetics. The piece of paper bearing the gold University of California seal sums up my four year education in a few black lines on a thick piece of paper with some signatures from people I will never meet in my life. Amazing how my diploma is the only official proof I have that I actually went to college for the last four years.

I remember studying genetics but I can't really recall what I studied. I do remember taking a myriad of classes that spanned the biological sciences, physical and molecular biology disciplines. And somehow this magical combination gives me the right to call myself a genetics graduate. For what it's worth- I'll take the title and run (since now I'm knee deep in an entirely different world where I have yet to figure out what I will end up with aside from the two letters at the end of my name in four years).

As I think back to my experiences as a pre-med genetics major, I remember the stress of school and the pleasure of everything that was non-school. It was like a being in a circus, where you are constantly balancing 10 things while walking on a tight rope surrounded by hundreds of others. Every moment you look around just to make sure you are inching forward and making progress to this destination that is so far from reach. There are times when you plummet and there are times when you want to jump and escape. And somehow you keep getting closer and closer, your balance improves, and before you know it- you've arrived (only to start the balancing act all over again in medical school).

When I was an undergraduate, I was surrounded by science majors and pre-meds. There is something about the pre-med culture that is quite odd; it's culture that lends itself to bringing out the best and worst in people. You see deep kindness for society and a competitive edge in some, especially at a UC, where it's all about the survival of the fittest with a large student body and limited resources. Arguably, most disciplines foster similar tendencies, when there are so few coveted spots and such high demand. It's the idea of supply and demand- applied.

Having been a pre-med peer advisor during my last year, I have seen it all and I spent a few hours yesterday addressing questions from pre-med students in the same room that I used to hold workshops and advising sessions. It was like walking down memory lane; I felt so much older (or maybe the students just looked so much younger).

The tables have turned; I am no longer a pre-med student; I am a medical student that is supposed to have the answers to all those burning questions: "what do medical schools look for in an applicant, how do you set yourself apart from other pre-meds, what does it take to get into UCSF, what do they want, is research necessary, etc." And I had forgeten about all of it, until I got the same battery of questions.

I am just eight monthes removed from college, and now students seek answers from me (as if I somehow know anymore than what I knew as a pre-med student). I still shudder when I get the questions about "what are they looking for?" when I have no idea who "they" really are? I do have an insider's perspective (being a medical student) and I do have the battle scars from my pre-med journey. And it's worth sharing to help others during their formative pre-med years. I remember learning from other medical students and it's my turn to give back.

I have my opinions and I have my theories, but in the end- we must make our own decisions (and my opinion is only an opinion). In the end, we must all walk the tight rope on our own.

Thursday, February 21, 2008

The end of the Renal Era!

For some reason, post-exam workouts are the best, perhaps the optimal therapeutic way to release tension and anxiety. We spend so much time talking about the sympathetic nervous system, which is responsible for activating the “fight or flight” physiological response. We got more of this in renal since there is an intricate interplay between low and high volume states and renal compensation through a sympathetic system mediated response. We learn all the gory details about this carefully controlled mechanism, including what activates the sympathetic nervous system and how your body responds to the signals. I am still amazed when I get to purposefully activate my sympathetic nervous system every time I work out and get my muscles working, heart pumping and lungs ventilating.
Renal is officially over. Grades have not been officially released, but we work under the assumption that if you failed you would have known by now (via e-mail). I guess no news is good news. So, if you have not heard anything, it probably means you are in the clear. These past few days were like being sucked into an abyss of endless renal exam preparation—reviewing (or learning) everything from nephron physiology to modes of drug action to the electrolyte disorders to kidney diseases and their respective pathologies to treatment of kidney disease to the drugs for hypertension to all the specific nuances of how the kidney functions under volume depletion and volume overloaded states (and this just a short list of things we learned over the last three weeks). Needless to say, it felt like I was eating, breathing, and dreaming everything renal. Now it’s over and I can’t help but feel relieved and exhausted. What a way to culminate our organs block (saving the hardest for last)!
Despite the challenges associated with decoding the cryptic renal language, learning renal is pivotal to assess patients with chronic conditions. You need to have a basal comprehension of kidney function markers, signs and symptoms when you are assessing patients with hypertension, diabetes, hyperlipidemia and the other chronic conditions we will see in our patients. Before renal, it was difficult to read a set of lab results and understand the significance of important markers such as creatinine, BUN, electrolytes, UA, and CBC . Now I feel like I am equipped with the knowledge to decode these numerical values and see where they fit in painting a picture of a patient’s condition. We have come a long way, haven’t we?It was odd. After I turned my exam in on Wednesday, I was running through my mental planner looking for the next thing “to do” and the next place I needed to be. And to my surprise, I really had nowhere to be. The feeling of having nothing to do is a rare sensation in medical school since we are so used to a rigid and structured schedule. It was so nice to actually be free, even if it is only for a few moments.
I finally got to reconnect with my classmates outside of class. Lunch was spent sipping green tea and venting about renal with classmates at The Vegetarian. Dinner was another exciting reconnection time with my advisory college at a local Ethiopian restaurant followed by celebrating a classmate’s birthday.
With the end of renal, we have been graciously given the rest of this week off—our first interblock break. It’s nice to get some time for ourselves. A big chunk of our class will be spending the four days braving the snow, skiing and snowboarding in Tahoe. Others will be staying in the city or heading out to visit family and friends. I am en route to Davis to spend time with family and friends. I think it will be actually nice to get out of the city and enjoy the company of the people closest to me, before lunging back into the seven-week Metabolism and Nutrition Block that starts bright and early on Monday morning.
With these four days, I am going to work on being more spontaneous with my time (although I do have my share of pre-planned adventures laid out: writing a review of the Diving Bell and Butterfly for the San Francisco Medicine Magazine, contacting professors to find a lab home for the summer, advising pre-med students at my alma mater, and most importantly- spending time with my family and friends). Aside from these events, I look forward to a semi-productive and non-eventful four day vacay!

Saturday, February 16, 2008

The Weekend Looms on the Horizon

"I truly hope it rains and pours this weekend." So do I.

A classmate was telling me this yesterday as we discussed our weekend plans. The three-day weekend would be the best time to explore the city, take a brisk jog through Golden Gate Park, enjoy lunch at one of the million restaurants, or sip a cup of coffee with friends. All great activities. But the one activity most of us medical students are engaged in is even more exciting--studying for our upcoming Renal exam on Wednesday.

There is nothing quite like a sunny, fog-free day in San Francisco. I hate to miss out on it. But my attention has been diverted to mastering (or at least) understanding the cryptic filtering system that is the kidney and renal system.

Needless to say, my weekend will be spent staring at hundreds of pages of syllabus and a my computer screen, which will invariably have 10 windows open that may or may not include my e-mail, the NY times, wikipedia, facebook, med student portal, lecture powerpoints, and random distracting webpages. Ah yes, multi-tasking.

Such is the life of a medical student right before an exam. Eating, breathing, and sleeping the kidney. The prospects for a fun weekend look grim. But I will make sure to get some time in for physical activity.

The weekend does loom on the horizon as I dive (head first) into the abyss of renal review. I wish everyone else a happy weekend (with or without rain). And for all those confined to the library or study room- best of luck.

Let the studying! At least the library view is nice.

Friday, February 15, 2008

Med Teach

Today was the first day I was called Dr. Eisha. I know it's a little early to be called as such. And it makes sense the only individuals who would address me that way are five-year-olds.

Yesterday was the official day of the heart (Valentine's Day) and today was the day we got to teach about the cardiovascular system to kindergarteners at a local elementary school. Most students were surprised that a real heart looks nothing like the hearts of Valentines.

Med Teach is a UCSF program that partners UCSF medical and graduate students with local elementary school teachers to develop sessions about medicine, health, and science. I am part of a team of three medical students. We will be teaching a series of sessions about everything from the heart, lungs, muscles, bones, brain, senses, and digestive system.

As we walked into our classroom, I forgot how small children are. The tables are low to the ground and the chairs are tiny. Kids are masters of construction paper art; the black and white penguins that were drying outside the classroom looked identical to my kindergarten art creations.

There are a few challenges associated with capturing any five-year-old's attention. First, you have to get their attention. Then, you have to somehow keep their attention. If you can turn anything into a game, you are miles ahead and will be successful with kids. Teachers are brilliant; they have developed these "learning positions" that instantly bring students back. It works most of the time...

During our session we talked about how the heart pumps blood to the body and how the lungs let air into your body. We even had these really awesome plastic heart and lungs along with models demonstrating how the heart pumps and how the diaphragm moves to allow for chest wall expansion (I wish they would have used these models when they taught about the cardiovascular and pulmonary systems).

Later in the session, the students got to listen to each other’s heart before and after exercise (we had them jump around for a bit) with stethoscopes.

I had so much fun teaching today. It is important to never underestimate how much a kid knows and how much they say (they really say the darnest things). It was so much fun to let my inner child speak for a change. I finally got to jump around, play games, teach a little medicine and learn from five years, who have yet to learn the truth (I am not a doctor yet, but on my way).

Thursday, February 14, 2008

Happy Single's Appreciation/Valentine's Day!

I have had my fill of choclate hearts and it's only 2 PM. It is definitely Valentine's Day when you are surrounded by anatomically inaccurate drawn hearts, red roses, and sanguine expressions of love packaged on cards.

I miss the days of making mailboxes with pink, red, and purple construction paper for the delivery of cards and candy from elementary school classmates. The Harry Potter Valentines were the best. And then there were those chocolates wrapped in red and pink thin foil and the hearts that conveyed messages.

I guess we have grown up. Now Valentine's is another hollow day, unless you are involved in a relationship and use this day as opportunity to ignite or rekindle romance with the roses, heart shaped boxes of choclates, candle-lit and overpriced dinner and expressions of love. Or you may participate in the Anti-Valentine's festivities to celebrate being single and free.

Medical students are somewhere in between the two extremes.

Tonight will probably be spent in the gym to release endorphins and numb the pain associated with spending this weekend understanding the renal system. And I need to reapply for financial aid. Oh, the complexity of the seemingly simple filter system and the increasing cost of attending a public medical school.

I am contemplating watching the Vagina Monologues if I make sufficient progress through this excessive material. And at this rate, it seems unlikely.

Oh well...Happy Valentine's Day everyone!
And Happy Studying to everyone else!

Monday, February 11, 2008

The First Incision

As I positioned my scalpel in my hand, I kept reciting in my head, "hold it like a pen." I moved the scapel along an imaginary vertical line. As the blade pierced the skin, making the incision took some effort. The skin was tough, pink, and leathery. There were some sparse gold hairs sticking out. Making the slit was not easy and once the blade slid through the layers of tissue, the skin openly nicely, revealing the white layers of fat and a dark pink band of muscle beneath. With the would open, I was ready to practice to throw my first suture into the pig's foot.
Suturing requires fine motor skill and hand eye coordination. You must learn how to correctly load your needle drivers with a crescent shaped needle, work with open incisions, position your hand and tie knots (among other things under the watchful eyes of skilled surgeons). Along with a basic familiarity with some core techniques, practice and repitition represent mainstays of this beautiful craft.

"It takes a lot more practice than you think. And when you think you have it, you realize you need more practice," said a first-year surgery intern, who was assisting us during our practice suturing session.

During the third session in our surgical skills elective, we applied what we learned over the last two weeks (knot tying, running sutures, instrument ties and other suture styles) to our first real set of tissues: pig feet. As I threaded the black suture through the incision I had cut, I could not help put think of Babe and Charlotte's Web. Poor pigs. I never knew suturing pig's feet require so much work. According to the surgeons in the room, working with human skin should not be as difficult (what a relief).

Along with repairing the incisions we made on the pig's feet, we also had a pig's liver to practice cautery. In cauterization, a current is applied to a tissue to stop bleeding or burn tissue. The Bovi, a type of cautery machine, has two buttons. When the yellow button is pressed, the tissue smokes and leaves a nice clean incision (this cuts tissues). The "coag" button is pressed to control bleeding (coagulation). The smell of burnt pig liver is unpleasant and left a lingering odor on my skin that took four good handwashings to remove.
There is a certain amount of thought that goes into each motion. You must think of your body's position relative to your patient, how your knots look, how your hands move, how your needle is loaded, how the wound is closing (and this is just a sample of some of the considerations made when suturing a pig's foot). I can not even begin to imagine the complex multi-tasking and list of things that must be considered when you operate on real patients.

There is something satisfying to see a nice clean wound closure after so many efforts of threading and rethreading. My favorite suture is a continuous running stitch; it looks like baseball stitching on skin.
As I sutured to the end of the incision, I thought of what the seasoned surgeon's tell us about knots, "Remember to square your knots." Yes, square those knots.
I really found this surgical skills session to be the most valuable. It is satisfying to use my hands and learn the basic techniques, so that I will be prepared when I make first real incision.

Friday, February 8, 2008

Reflections on Journal Club

I decided the black suit was the outfit for today. Why do people take you more seriously when you are wearing your finest black suit? I remember ironing the same suit many times not so long ago during the medical interview season. And if there was a black suit, there had to be those nice thin black heels that make walking (more like wobbling) a challenge.

The presentation was in a larger size lecture hall that had auditorium seating. Today's lunch was Falafel (by request) and the food was virtually gone by the time I arrived to set-up my laptop (because of medical students and their food radars).

After some technical difficulties due to a projector that refused to turn on, I finally got my presentation on the screen and started my talk. I opened by asking anyone personally affected by breast cancer to raise their hand. A good majority of the hands shot up in the air.

The American Cancer Society reports that over 40,000 died of breast cancer in 2007; it is a disease that touches so many lives.

Although preparing and translating the clinical jargon into a language that made sense for my peers was a challenge, I enjoyed sharing the findings and addressing questions at the end. And I find a new purpose for the black suit that has been hanging in my closet since medical school started.

Thursday, February 7, 2008

Journal Club

I am putting the finishing touches on my presentation for tommorrow's Clinical Sciences Journal Club meeting, which is kind of like a book club, except we only talk about clinically relevant articles.

My friend, who is the coordinator of the club, recruited me after I was wobbling off the treadmill after a long, painful run. I was all sweaty and breathless and in no position to protest. Actually, I was planning to present one day and I am actually really looking forward to my presentation. Tommorrow will be my day.

My presentation will examine the following New England Journal of Medicine Article, "A Comparison of Letrozole and Tamoxifen in Postmenopausal Women with Early Breast Cancer."
Having been personally affected by breast cancer and researched the enigmatic disease for the last three years, I am very excited about sharing the research findings about breast cancer and new treatments with my peers.

I know I can expect an audience since a lunch is provided (medical students somehow have a radar for finding the places where free food is served). The challenge then becomes capturing everyone's interest...We'll see how it goes.

Tuesday, February 5, 2008

Summer Vacay

It's hard to believe that this summer will be our last vacation ever! How did this happen? Although our summer vacation does not start until the end of June, the preparations start now. We have started to structure the eight weeks to stretch out the time as much as possible.

What happended to the days of nothingness? Remember when you were a kid and you would spend your days watching cartoons, eating three meals and playing tag? How I miss those days. Now, we are deciding whether we want to spend our days pipetting in a lab, setting up public health projects in far away lands, developing new parts of our curriculum, or organizing a trip to travel the world. And did I mention figuring out the oh-so-dreaded logistics, including seeking the necessary funds for our summer adventures (whatever they may be...)

A panel of second year medical students spoke about their experiences during a dinner hosted by our medical school college. The panel follows a formal presentation provided by the directors of different summer programs that happened last week. The second years sat before us and divulged all the details about their summer, everything from the days spent in lab to the travels to the World Health Organization to the learning Spanish in Guatemala to just traveling the world (for fun).

As we start shopping for summer plans, many of us wonder about the importance of this summer. Does it really make a difference (to residency programs) what we did during the summer? The answer was a resounding "No" from the physicians. Rather than catering our application to any residency director, our advisors encourage us to enjoy our summer since we may not being seeing such protected vacation time for a long time.

I have yet to decide what my summer plans will be. I just know I will be doing something and hopefully it will be fun, exciting and interesting. Hopefully, I can incorporate photography into my summer plans.
The search now begins for constructing an amazing summer. Any ideas?


Sunday, February 3, 2008

Zone 1

Getting to the San Francisco General Hospital on a Sunday requires taking one MUNI train followed by another bus transfer. The bus ride is quite long, especially the final ascent up this massive hill to get close to the hospital.

From the hill, you have to climb down and cross a foot path over some sort of highway and traverse a labyrinth of buildings to the hospital enterance. Getting to Zone 1 takes a little more work.

Once I got out of the rain and into the main hospital, I enlisted the assistance of a white coated resident. He politely guided me to the Zone 1. As I ventured forth, I could hear the seasoned resident say, "Wear gloves and have fun."

After making a few turns down a corridor, I finally made it to Zone 1, the area in the Emergency Room where all initial traumas are assessed. Today was my first day in the Emergency Room.

When I arrived, I was directed to the white board, where a group of doctors where quickly debriefing each other about the patients (it was time to switch shifts). I stood and listened and once the speaking was over, I introduced myself to the attending, who I would follow for the next few hours.

Within minutes, we had our first motor vehical accident patient. He was rushed to an exam room, where the initial assessement was made: he was connected to a monitor, his pulses were felt, lights were shined in his eyes, he was asked to move his legs, his lungs were checked, he was asked he if felt pain, etc. His presentation reminded me of Mr. Danovich, our first case in medical school. Very uncanny.

I assisted with moving the patient to his side. With one hand on his shoulder and one hand on his hip and on the count of three, we rotated him over to his side so the doctor could feel his back, while asking if he felt pain.

When the gel was squeezed on his abdomen for the ultrasound, the patient jokingly said through gritted teeth,"tell me if it's a girl or boy." Despite his humor, he was in severe pain and looked scared.

Today seemed like a slow day. Perhaps, it was the Superbowl. After we sent our patient off for further testing, my attending got reports about the patients on the floor from the residents. I stood and listened. After the second round of debriefing, we visited our patients.

The ER is an impersonal place; it is the first stop a patient makes before being transferred. My first experience gave me a better idea about what goes into admitting a patient into the ER and how the initial assessment is made. I will likely return to Zone 1 (and know I know the way).

Friday, February 1, 2008

Spending time with the Babies

A forrest can be seen through the window in Jane's postpartum room. Since the delivery of Baby A and Baby B, her room has become decorated with pink and red roses along with two big balloons in the shape of baby foots. One pink balloon says"It's a girl," and one one blue balloon saying "it's a boy."

I met Jane in the Neonative Intensive Care Unit. She had just finished feeding her two babies and was ready to return to her room. Baby A and Baby B are being closely monitored and are spending their first days in isolates, clear plastic cribs. They spend most of their time sleeping and are simply adorable. I could spend the whole day watching the babies as they open and close their eyes, modify their facial expressions, move their little hands, and stare at you with bewilderment.

At the request of the nurse, I wheeled Jane from the nursery passing through a pink hallway to her room, where we spent lunch together. She shared stories about her family and showed me pictures from her baby shower (I was invited but unable to attend). As she slowly ate her chow mein, strategically setting aside the broccoli and green beans, the door of her room would open and different people would walk in.

The nurses would walk in periodically check her blood pressure or give her medicine. Later, a clerk from the birth certificate would come in to finalize the forms; the names have now been selected. A social worker came to ask Jane if she had any questions. The social worker did share information about post-partum depression, a condition that affects new moms and leaves women feeling sad, unhappy, and not like their normal selves.

As I sat at Jane's side, I felt privileged to be a part of her life. It was not so long ago that we had our first meeting. I remember sitting in the waiting room waiting to meet my U-teach mom. "It was like it was your appointment. You were always early and I was always late," Jane said.

"You are a part of my family," she said. We have come along way. And I am happy to know that Jane views me more than just a medical student. She thinks of a me as a friend and a part of her family.

I look forward to stopping by tommorrow to spend time with my new extended family.
*All names have been changed to protect privacy