It's almost a month into the New Year. Glancing back at my previous entry, I realize I've already broke one of my resolutions (write more). I've been making tons of mental notes about interesting topics to write about in my blog, but have been struggling to find the time to transform all my mental post-its into actual entries.
Since the start of Life Cycle, we have learned about the complexities of development and embryology, taking a whirlwind tour of development from fertilization to the development of the fetus. We attended our last anatomy lab (forever) and histology lab (no more of those microscope slides). I presented my research poster at the UCSF Research Symposium and taught the mechanics of breathing during the pulmonary MSP session. I've also been busy getting the Surgical Skills elective rolling. I am preparing to teach my last MSP lesson in February and will be teaching suturing at the next surgical skills session.
It's been a busy. Time has become a scant commodity. I always find myself thinking- there are just not enough hours in a day. Right now, the time pinch is even more palpable. The second years have starting to slowly go into hibernation. By that, I mean they are becoming preoccupied with preparing for the boards and revisiting all those topics of medicine, we have since forgotten.
The exam looms on the horizon, an unwelcome presence all the time- in the library (in the form of First Aid books and other prep books), in our day-to-day conversations, in the lectures (with lecturers dropping the "B" word so much more), and in our tired faces. It's boards fever! And it's spreading, sucking the life and energy out of MS2's. I can feel it.
I've been trying to maintain balance. But balance has become more of predictable routine- school, study, exercise, eat, study, sleep and repeat all over again. Sounds fun, doesn't it? I have found time for friends and running, which has made all the difference.
I am trying to live by my motto: there will always be things that have to be done, but there is also a life to be lived.
As they say, every cloud has a silver lining. In our case, that sliver lining is in the form of thinking of the road ahead- clerkships. We are in the process of planning our third year rotation schedules, including making decisions about enrolling in either a structured or traditional program. And we also must start thinking about how to order our core rotations, which inclide family community medicine, internal medicine, surgery, pediatrics, neurology & psychiatry and OB/Gyn.
It's a matter of getting through the next months and then moving on to an even more exciting chapter of our medical training. When I start thinking about actually seeing patients, I am reminded of the reasons why I came to medical school.
The test shall pass. Life will go on.
Tuesday, January 27, 2009
Saturday, January 3, 2009
New Year's Resolution
I have had some time to think. The last three weeks of vacation were a welcome hiatus. I thoroughly enjoyed spending time with my family, running in the bitter cold, resting and eating three meals a day. It was such a blessing to catch up with my family and pet cats.
As far as a New Year's Resolution, I'm old enough to know the cardinal rule of making resolutions: it's probably better not to make resolutions, since you are likely to set yourself up for failure. OK, I admit it is a defeatist attitude- but it is true.
In actuality, I can think of a couple things (in no particular order):
1. Stay in good health (physical and mental)- train for a half-marathon
2. Try to use the phone more often when communicating with friends
3. Broaden my experiences outside the medical bubble
4. Find time for family and friends
5. Write and reflect more
6. Photograph more
7. Explore SF and beyond (which means actually going to museums and restaurants outside the sunset)
8. Study hard for the Boards and do well (without going crazy)
9. Avoid making endless lists of things "to do" (I'm already breaking this resolution with this list)
Break was a welcome change. I felt recharged when I arrived in SF on Sunday. Three days into the first week of life cycle, I'm settling back into the groove of school and my lists of things "to do."
It's hard to believe Life Cycle/Epilogue brings us to our last pre-clinical block. The boards exams are sandwiched between Lifecycle and our clinical clerkships.
"You're in your homestretch," said our course director on the first day of course.
It's so bittersweet. On one hand, we are culminating our preclinical years, attending our last lectures and labs and gearing for the transition to clerkships. We had our last official anatomy lab on Tuesday- male and female pelvic anatomy (what a way to end). On the other hand, we are also facing the biggest barrier to moving forward- the BOARDS exam (believe me, you'll hear more about this with subsequent essays). And the realization that we don't know anything. OK, a little bit of an overstatement.
"So have you hit the board books?" (A question I have been asked a couple of times already). Answer- No, but I probably should. Thanks.
We are realizing the testing has only began. Step 1 is numbered one, because it is the first of a series of tests we'll take. Hooray.
$495.00 equals the amount to take the Step 1 exam. I submitted my application for this 336-question, 8 hour test a couple of days. I guess the time has come to develop a study game plan.
Other than the looming boards, I have returned to my MSP obligations, which involve teaching sessions in the Pulmonary and Renal blocks. I also have been tying some last odds and ends as one of the coordinators of the Surgical Skills elective, which provides students with an opportunity to learn basic surgical techniques (knot tying and suturing). I am also organizing a poster to highlight my summer research that examined in-utero stem cell transplantation for an upcoming research symposium next week.
It's a busy week and a busier quarter. I'm calm. I wish I could say I'm ready, but I figure I'll take it one day at a time, one step at a time (no pun intended).
Stay tuned for the adventures.
As far as a New Year's Resolution, I'm old enough to know the cardinal rule of making resolutions: it's probably better not to make resolutions, since you are likely to set yourself up for failure. OK, I admit it is a defeatist attitude- but it is true.
In actuality, I can think of a couple things (in no particular order):
1. Stay in good health (physical and mental)- train for a half-marathon
2. Try to use the phone more often when communicating with friends
3. Broaden my experiences outside the medical bubble
4. Find time for family and friends
5. Write and reflect more
6. Photograph more
7. Explore SF and beyond (which means actually going to museums and restaurants outside the sunset)
8. Study hard for the Boards and do well (without going crazy)
9. Avoid making endless lists of things "to do" (I'm already breaking this resolution with this list)
Break was a welcome change. I felt recharged when I arrived in SF on Sunday. Three days into the first week of life cycle, I'm settling back into the groove of school and my lists of things "to do."
It's hard to believe Life Cycle/Epilogue brings us to our last pre-clinical block. The boards exams are sandwiched between Lifecycle and our clinical clerkships.
"You're in your homestretch," said our course director on the first day of course.
It's so bittersweet. On one hand, we are culminating our preclinical years, attending our last lectures and labs and gearing for the transition to clerkships. We had our last official anatomy lab on Tuesday- male and female pelvic anatomy (what a way to end). On the other hand, we are also facing the biggest barrier to moving forward- the BOARDS exam (believe me, you'll hear more about this with subsequent essays). And the realization that we don't know anything. OK, a little bit of an overstatement.
"So have you hit the board books?" (A question I have been asked a couple of times already). Answer- No, but I probably should. Thanks.
We are realizing the testing has only began. Step 1 is numbered one, because it is the first of a series of tests we'll take. Hooray.
$495.00 equals the amount to take the Step 1 exam. I submitted my application for this 336-question, 8 hour test a couple of days. I guess the time has come to develop a study game plan.
Other than the looming boards, I have returned to my MSP obligations, which involve teaching sessions in the Pulmonary and Renal blocks. I also have been tying some last odds and ends as one of the coordinators of the Surgical Skills elective, which provides students with an opportunity to learn basic surgical techniques (knot tying and suturing). I am also organizing a poster to highlight my summer research that examined in-utero stem cell transplantation for an upcoming research symposium next week.
It's a busy week and a busier quarter. I'm calm. I wish I could say I'm ready, but I figure I'll take it one day at a time, one step at a time (no pun intended).
Stay tuned for the adventures.
Monday, December 22, 2008
33.5 Degrees of Hope
Last week, I visited UCSF's Neuro-Intensive Care Nursery. I had the opportunity to learn more about the Nursery and photograph the nursery for a feature article for the UCSF School of Medicine's website. Visiting the nursery with my camera was truly a unique opportunity. My essay and some photographs are included below. It can also be viewed at the following site: http://medschool.ucsf.edu/news/features/patient_care/20081222_NICN.aspx
Teddy bear wallpaper lines the top of the room. Large machines beep, and tubes are covering most of the crib that holds Baby E. Her small body is covered in plastic. Her face is just visible underneath the breathing tube. Her head is covered with white gauze, holding a series of green and red wires in place, which are connected to an EEG machine to monitor her brain wave activity. A camera records her movements. Despite the loud noises of the Neuro-Intensive Care Nursery (NICN), her eyes remain closed as if she were completely oblivious to her critical state of health.
The UCSF Neuro-Intensive Care Nursery (NICN) is located on the 15th floor of Moffitt Hospital. The front windows show a panoramic view of the city, from the ocean to downtown. Family members mill in and out of the nursery.
Dr. Tom Shimotake, Co-Director of the UCSF Neuro-Intensive Care Nursery, had given me a tour and introduced me to Baby E. Baby E had been transferred from another hospital and admitted to the NICN the previous night. Though being born full-term, she was in critical condition.
Since opening in April of 2008, the NICN has seen referrals of this type quadruple. UCSF's NICN represents one of the first nurseries in the United States that specializes in treating infants who have experienced brain damage during birth because of asphyxia, which prevents oxygen flow to a newborn’s brain and can lead to irreversible injury of neurons.
The NICN integrates multiple technological and treatment modalities along with clinical trials, to optimize the monitoring and care of critically ill infants who are at high risk for developing cerebral palsy, mental retardation and other cognitive problems later in life.
We were joined by Deidre Jarrell, Baby E's nurse, who has been with the NICN since its inception. She has specialized training to care for infants like Baby E who have suffered brain damage at birth. She works 12-hour shifts, attends to Baby E and provides updates to family members, who can call anytime for information about the baby's status.
As we surround Baby E's crib, the infant would periodically stir or kick her tiny feet. Bags of fluid were perched above her, dripping clear liquid into her system. She was sedated, and a machine was breathing for her. She was lying on top of a blue blanket that was set to maintain her temperature close to 33.5 degrees Celsius.
Baby E is receiving cooling therapy, which involves inducing a hypothermic state for 72 hours. According to Dr. Shimotake, the cooling therapy prevents further brain injury in babies born in a hypoxic (oxygen-deprived) state. Cooling needs to be started within the first six hours of birth after asphyxiation to have a benefit, and this therapy is only for babies born full-term.
After 72 hours of the cooling therapy, Baby E's body temperature will be slowly increased (0.5 degrees Celsius per hour) to her normal temperature. Her brain will then be imaged with an MRI to assess the primary injury, including the location and severity, to help develop a prognosis and determine the next steps in her long-term treatment.
Infants will spend an average of 10-14 days in the NICN. While in the NICN, they receive specialized care from a multidisciplinary team that includes neonatologists, pediatric neurologists, epileptologists, specialized NICN nurses, neuroradiologists and occupational and physical therapists. Social services, another integral component of the NICN services, are available to families and healthcare providers to help cope with the emotional stress that comes with caring for critically ill infants.
Dr. Shimotake believes families play a central role in making decisions, and healthcare providers must remain sensitive and open to each family's desires. "We deal with very sick babies here, so we participate in some of the most emotionally intense moments in these families' lives. In addition to specialized care for the babies, we provide important information to families that they may need to make difficult decisions. We don't make decisions alone."
In working with critically ill infants, healthcare providers are sometimes faced with the delicate balance between prolonging life and making decisions about palliative care. Some infants arrive at the NICN and are monitored, treated and discharged. Some will develop long-term neurological abnormalities, requiring lifelong specialized care. And some will have life support withdrawn due to an irreversible brain injury that shows no sign of recovery.
Those infants who are discharged from the NICN will visit their regular pediatrician and undergo ongoing physical therapy and follow-up with physicians at the high-risk neonatology clinic. They and their parents meet with a number of specialists, including neonatologists, developmental psychologists, physical therapists and nutritionists.
***
As I watch Baby E, I wonder about her prognosis and life after the NICN. Will she be among the patients that gets life support withdrawn? Or will she regain her strength and go home to her family? How is her family coping, not being able to hold their baby, who is covered in tubes and connected to so many machines? How are they processing the endless amount medical information presented by Baby E's medical team?
Teddy bear wallpaper lines the top of the room. Large machines beep, and tubes are covering most of the crib that holds Baby E. Her small body is covered in plastic. Her face is just visible underneath the breathing tube. Her head is covered with white gauze, holding a series of green and red wires in place, which are connected to an EEG machine to monitor her brain wave activity. A camera records her movements. Despite the loud noises of the Neuro-Intensive Care Nursery (NICN), her eyes remain closed as if she were completely oblivious to her critical state of health.
The UCSF Neuro-Intensive Care Nursery (NICN) is located on the 15th floor of Moffitt Hospital. The front windows show a panoramic view of the city, from the ocean to downtown. Family members mill in and out of the nursery.
Dr. Tom Shimotake, Co-Director of the UCSF Neuro-Intensive Care Nursery, had given me a tour and introduced me to Baby E. Baby E had been transferred from another hospital and admitted to the NICN the previous night. Though being born full-term, she was in critical condition.
Since opening in April of 2008, the NICN has seen referrals of this type quadruple. UCSF's NICN represents one of the first nurseries in the United States that specializes in treating infants who have experienced brain damage during birth because of asphyxia, which prevents oxygen flow to a newborn’s brain and can lead to irreversible injury of neurons.
The NICN integrates multiple technological and treatment modalities along with clinical trials, to optimize the monitoring and care of critically ill infants who are at high risk for developing cerebral palsy, mental retardation and other cognitive problems later in life.
We were joined by Deidre Jarrell, Baby E's nurse, who has been with the NICN since its inception. She has specialized training to care for infants like Baby E who have suffered brain damage at birth. She works 12-hour shifts, attends to Baby E and provides updates to family members, who can call anytime for information about the baby's status.
As we surround Baby E's crib, the infant would periodically stir or kick her tiny feet. Bags of fluid were perched above her, dripping clear liquid into her system. She was sedated, and a machine was breathing for her. She was lying on top of a blue blanket that was set to maintain her temperature close to 33.5 degrees Celsius.
Baby E is receiving cooling therapy, which involves inducing a hypothermic state for 72 hours. According to Dr. Shimotake, the cooling therapy prevents further brain injury in babies born in a hypoxic (oxygen-deprived) state. Cooling needs to be started within the first six hours of birth after asphyxiation to have a benefit, and this therapy is only for babies born full-term.
After 72 hours of the cooling therapy, Baby E's body temperature will be slowly increased (0.5 degrees Celsius per hour) to her normal temperature. Her brain will then be imaged with an MRI to assess the primary injury, including the location and severity, to help develop a prognosis and determine the next steps in her long-term treatment.
Infants will spend an average of 10-14 days in the NICN. While in the NICN, they receive specialized care from a multidisciplinary team that includes neonatologists, pediatric neurologists, epileptologists, specialized NICN nurses, neuroradiologists and occupational and physical therapists. Social services, another integral component of the NICN services, are available to families and healthcare providers to help cope with the emotional stress that comes with caring for critically ill infants.
Dr. Shimotake believes families play a central role in making decisions, and healthcare providers must remain sensitive and open to each family's desires. "We deal with very sick babies here, so we participate in some of the most emotionally intense moments in these families' lives. In addition to specialized care for the babies, we provide important information to families that they may need to make difficult decisions. We don't make decisions alone."
In working with critically ill infants, healthcare providers are sometimes faced with the delicate balance between prolonging life and making decisions about palliative care. Some infants arrive at the NICN and are monitored, treated and discharged. Some will develop long-term neurological abnormalities, requiring lifelong specialized care. And some will have life support withdrawn due to an irreversible brain injury that shows no sign of recovery.
Those infants who are discharged from the NICN will visit their regular pediatrician and undergo ongoing physical therapy and follow-up with physicians at the high-risk neonatology clinic. They and their parents meet with a number of specialists, including neonatologists, developmental psychologists, physical therapists and nutritionists.
***
As I watch Baby E, I wonder about her prognosis and life after the NICN. Will she be among the patients that gets life support withdrawn? Or will she regain her strength and go home to her family? How is her family coping, not being able to hold their baby, who is covered in tubes and connected to so many machines? How are they processing the endless amount medical information presented by Baby E's medical team?
Vacation
One week of vacation has gone by in a blink of an eye.
I spent the first few days in San Francisco taking care of business, tying some loose ends. I finally made my way to Union Square last week for some aimless shopping. And then left SF.
I arrived at my parent's house on Thursday. Since arriving, I've been spending time with my family, catching up and eating some delicious traditional Indian meals. In between, I have braved the chilling cold to fit some runs in my day. It's cold, but so much flatter in Davis, a welcome change from the hills of SF (although I do miss the views). I have been reintroduced to a concept three complete meals and eight hours of sleep. This is the life.
To sum up- vacation has been relaxing so far. I'm working on writing something insightful. For now, I'll enjoying the simplicity of life and the smells of fresh food without thinking too much.
Monday, December 15, 2008
The Endless "To do" List
M3 Mania has ended. I turned in my final today, proceeded to take the lung and prostate practical (almost mechanically). By now, tests have become a part of norm. We learn how to program our minds to ingest voluminous amounts of information in such short periods of time to answer question after question (and then we repeat the process). It's a well-oiled process for the most part. Except one big problem- retention. In the end, after an exam, you feel numb, knowing well that most of the information you meticulously hand wrote on multiple pieces of paper to committed to short term memory, will dissipate to a foregone memory. The reality of medical school.
When I walked out, I felt relieved but also unsure about what to do with myself. I have become so school-centric; my long to-do lists revolves around getting through material for small group or lecture, planning electives, preparing MSP sessions, etc. I can now attend to the growing list of things, some school-related (odds and ends), as well as a plethora of life things, namely shopping and social engagements.
The end of M3, which included cancer, blood disorders (leukemia, lymphoma and anemias) and epidemiology takes us to Christmas break. I am looking forward to spending time with my family. Outside of the cancer block, I was able to spend time in the pediatric intensive care unit in Oakland, working with a diverse spectrum of critically ill patients. I also had the pleasure and pure enjoyment of teaching cardiac anatomy and ischemic heart disease to first years during MSP sessions.
When we return from break sometime in January (not sure what date exactly) we start our last preclinical block (Life Cycle). A couple of weeks ago, our course directors sat us down and gave us that unwelcome talk about the "B" word, we have tried so hard to suppress. THE BOARDS have come upon us, infiltrating our subconscious and libraries with board review books. Not exactly sure when studying begins, just know it's going to be long, hard and epic. Overall, I'm apathetic to the exam. More concerned with getting it over with to move on to a "watershed moment" in our educational training- the wards. Hopefully, in the process I'll relearn all those important facts that have escaped.
Although we have become programmed professional information memorizes and test takers, I still can not believe how fast time has gone by. It was a year ago, when I finished my cardio exam and was preparing for clinical interlude. Now, I'm moving into uncharted study territory.
For now, I'll bask in being done. And with time, after some distraction (time to go shopping), I might actually look at the oh so endless "to do" list. I am hoping to reflect and write to process second year, looking at how I have changed and how far I have come.
From my year of medical school, I have learned that no matter how many things you have to do, you must always remember that you also have to live your life.
When I walked out, I felt relieved but also unsure about what to do with myself. I have become so school-centric; my long to-do lists revolves around getting through material for small group or lecture, planning electives, preparing MSP sessions, etc. I can now attend to the growing list of things, some school-related (odds and ends), as well as a plethora of life things, namely shopping and social engagements.
The end of M3, which included cancer, blood disorders (leukemia, lymphoma and anemias) and epidemiology takes us to Christmas break. I am looking forward to spending time with my family. Outside of the cancer block, I was able to spend time in the pediatric intensive care unit in Oakland, working with a diverse spectrum of critically ill patients. I also had the pleasure and pure enjoyment of teaching cardiac anatomy and ischemic heart disease to first years during MSP sessions.
When we return from break sometime in January (not sure what date exactly) we start our last preclinical block (Life Cycle). A couple of weeks ago, our course directors sat us down and gave us that unwelcome talk about the "B" word, we have tried so hard to suppress. THE BOARDS have come upon us, infiltrating our subconscious and libraries with board review books. Not exactly sure when studying begins, just know it's going to be long, hard and epic. Overall, I'm apathetic to the exam. More concerned with getting it over with to move on to a "watershed moment" in our educational training- the wards. Hopefully, in the process I'll relearn all those important facts that have escaped.
Although we have become programmed professional information memorizes and test takers, I still can not believe how fast time has gone by. It was a year ago, when I finished my cardio exam and was preparing for clinical interlude. Now, I'm moving into uncharted study territory.
For now, I'll bask in being done. And with time, after some distraction (time to go shopping), I might actually look at the oh so endless "to do" list. I am hoping to reflect and write to process second year, looking at how I have changed and how far I have come.
From my year of medical school, I have learned that no matter how many things you have to do, you must always remember that you also have to live your life.
Monday, December 1, 2008
World AIDS Today
1 in 10 San Franciscans living with AIDS does not receive primary care.
December 1st marks World AIDS Day, a day to raise awareness about the AIDS epidemic. Today was the 20th anniversary. AIDS sprung to our attention in the 1980's as a mysterious disease affecting predominately gay men. With the emergence of the disease came discrimination and mistreatment due to lack of understanding. Today, we know more about the AIDS and the virus (HIV) that is transmitted by blood, sex and breastfeeding, which can lead to the development of AIDS. And over the last two decades, we have seen the face of AIDS (it affects everyone).
Over 60 million people have been infected with HIV, a number that continues to grow. And the death toll continues to rises.
There is so much that has to be done to understand the virus, decrease transmission, fund treatment and support those living and dying with HIV and AIDS.
Today, we gathered together, each donning sign with a statistic. With our signs and red ribbons, we made our way to Parnassus Avenue (right in front of the main hospital), where we stood in solidarity, remembering those who have lost the fight and those that are continuing the battle the disease each day.
Wednesday, November 26, 2008
Chugging Gatorade
The weather has transformed into the cold, bitter gray that is winter. For the last couple of days, I've been under the weather, chugging Gatorade and lemon-lime flavored carbonated beverages, while curled up in a ball on the sofa, staring aimlessly at the coagulation cascade page of the syllabus.
It definitely does not help when you know a little about the differential for fever, fatigue, headache and myalgias. You just start thinking way too much about which bug it could be.
Thankfully, I'm feeling much better in time for Thanksgiving. By tomorrow, hopefully, I can eat my fill of home cooked food.
We'll see...
It definitely does not help when you know a little about the differential for fever, fatigue, headache and myalgias. You just start thinking way too much about which bug it could be.
Thankfully, I'm feeling much better in time for Thanksgiving. By tomorrow, hopefully, I can eat my fill of home cooked food.
We'll see...
Sunday, November 16, 2008
M3 Mania I
After today, we should now be able to complete a head to toe physical exam (theoretically). In our last patient education/physical exam session, we learned about how to complete a clinical breast exam, which involves a visual inspection (from four different views), lymph node palpation (in the axilla and near the collar bone) and the breast exam. Like the female and male pelvic exams, we were taught by patient educators who demonstrated the exams on themselves before walking us through each step of the exam, as well as teaching us important points about establishing rapport.
The breast exam is not just about the breast as we think of structures contained in the bra. In performing the breast exam, it helps to think of an imaginary rectangle drawn around the breast, starting from under the arm going up to the clavicle along the sternum and down just below the breast. Using a light, medium and deep palpation with the pads of our fingers, we feel the fatty and glandular tissue of the breast as we move our fingers in a cork-screw pattern vertically on the tissue.
As I performed the exam, I said aloud "light, medium and deep" to help coordinate my actions. To completed a thorough exam, when you are learning, it takes some time (more than 2 minutes). And it's always hard to make sense of what you are feeling; everything feels kinda of lumpy and bumpy. "Like a bunch of grapes," said our patient educator. And every patients tissue will obviously feel different.
In explaining the exam to our patients, our patient educator made a good point- we perform a thorough exam to establish a baseline, which will serve to us detect any change (the other "C" word), not just for cancer.
In completing my first breast exam, I know it will take lots of practice to master the fine art of detecting subtle tissue changes that may come in the form of pea-sized lumps. "One day, you may be saving lives," our educator said as we closed the session. Maybe.
Other than performing a clinical breast exam on one of the nicest and warmest days in November, I spent my Sunday indoors preparing for our first M3 exam. We transitioned from Infectious diseases to the mechanisms, methods and malignancies block, formerly known as the cancer, bench to bedside, block.
Preparing for this exam has been partly a walk down undergraduate memory lane, taking me back to the days of when I majored in genetics and studied cancer as part of my research. Revisiting the genetic basis of cancer and the molecular biology of tumorigenesis has been interesting, especially as we learn the connection and see how the science relates to the clinical picture of a disease that impacts so many people.
Having been personally affected by cancer, it is sometimes difficult to read about the studies that predict five-year survival of patients on certain drugs, or learn about how cancer can recur or metastasize to other organs. It's hard to focus on the biology of a disease, when you can't help but see a face of someone you love who has suffered from the disease. And at the same time, it is promising to hear about the advances made in treatment and understanding the disease.
All in all, this has been a somber block. And Studying for the tomorrow's exam has been especially difficult (story of my medical school life).
M3 Mania continues...homestretch!
The breast exam is not just about the breast as we think of structures contained in the bra. In performing the breast exam, it helps to think of an imaginary rectangle drawn around the breast, starting from under the arm going up to the clavicle along the sternum and down just below the breast. Using a light, medium and deep palpation with the pads of our fingers, we feel the fatty and glandular tissue of the breast as we move our fingers in a cork-screw pattern vertically on the tissue.
As I performed the exam, I said aloud "light, medium and deep" to help coordinate my actions. To completed a thorough exam, when you are learning, it takes some time (more than 2 minutes). And it's always hard to make sense of what you are feeling; everything feels kinda of lumpy and bumpy. "Like a bunch of grapes," said our patient educator. And every patients tissue will obviously feel different.
In explaining the exam to our patients, our patient educator made a good point- we perform a thorough exam to establish a baseline, which will serve to us detect any change (the other "C" word), not just for cancer.
In completing my first breast exam, I know it will take lots of practice to master the fine art of detecting subtle tissue changes that may come in the form of pea-sized lumps. "One day, you may be saving lives," our educator said as we closed the session. Maybe.
Other than performing a clinical breast exam on one of the nicest and warmest days in November, I spent my Sunday indoors preparing for our first M3 exam. We transitioned from Infectious diseases to the mechanisms, methods and malignancies block, formerly known as the cancer, bench to bedside, block.
Preparing for this exam has been partly a walk down undergraduate memory lane, taking me back to the days of when I majored in genetics and studied cancer as part of my research. Revisiting the genetic basis of cancer and the molecular biology of tumorigenesis has been interesting, especially as we learn the connection and see how the science relates to the clinical picture of a disease that impacts so many people.
Having been personally affected by cancer, it is sometimes difficult to read about the studies that predict five-year survival of patients on certain drugs, or learn about how cancer can recur or metastasize to other organs. It's hard to focus on the biology of a disease, when you can't help but see a face of someone you love who has suffered from the disease. And at the same time, it is promising to hear about the advances made in treatment and understanding the disease.
All in all, this has been a somber block. And Studying for the tomorrow's exam has been especially difficult (story of my medical school life).
M3 Mania continues...homestretch!
Friday, November 7, 2008
What a Week!
This has been one amazingly busy week! Perhaps, one of the most epic weeks of medical school and history.
Tuesday was unbelievable. With the swipe of a magic black marker, I cast my vote early in the morning, braving the cold and lines. I proudly wore my "I voted" sticker all day, knowing that we may make history.
During pediatric preceptorship, I completed my first pediatric neuro exam on a one and half year old girl, who was fast asleep when I arrived. She did not like tracking my penlight, but she did like the fluffy teddy bear. Later, we listened to a presentation from a pediatric cardiac thoracic surgeon, who spoke about how to repair congenital deformities involved with babies born with large vessel switching.
We did make history on Tuesday! I was brought to tears, as I watched the election results unfold. After 8 PM, when it was announced we had elected Barack Obama, I was elated. I am excited this welcome change.
Wednesday we made medical school history with our annual class play- MDTV, which was remarkable. I don't think I have ever laughed that hard. The mix of music videos, live skits, performances and video skits (that featured classmates, faculty members and first years), was one awesome production. I made an appearance in a couple of the video skits, namely a video titled "Girls gone Mild." (I really hope it does not end up on youtube).
I was also part of the final dance number, which was set to the song "Bye Bye Bye," with rewritten lyrics. After rehearsing (for what seemed like forever), we finally performed to a crowd of screaming medical students and faculty members (and the stage lights are super bright). It was quite an experience...I would love to take a dance class (if only I had the time).
After the end of the dance, we stayed on stage for the Final song number- "Seasons of Gloves." It was so heartwarming be in the company of my classmates as we sung (a slideshow of our first year flashed behind us as we swayed). The final hurrah that is our class play was extremely memorable. Now the curse of topping our class play gets passed to the Class of 2012, who must now hit the drawing board to devise an even better play.
Thursday was another long day. I taught my first cardiac MSP session. We moved from the anatomy labs to the chalk boards in the classroom. I taught cardiac anatomy, one of my favorite topics. I truly hear the the heart (seriously).
Friday is here. And the weekend, which means catch-up time and learning the language of cancer. I'll be spending time with family this weekend, so we'll see how much gets done.
Cheers to an unforgettable week!
***
Bye Bye Bye - Lyrics by Ning
We're done with this tonight
It's time to turn on the lights
We hope you thought it was tight
Hey baby, come on
We worked on this endlessly
So that we could help you see
That you're not in this med school business alone
We know that you can't take no more
It ain't no lie
You laughed so hard your abs are sore
Baby, bye bye bye
Right now everything's so new
But before you now it you're an MS2
It seems crazy, but it ain't no lie
Baby, bye bye bye
We know that this med school's tough
You probably feel like you already had enough
But you'll all make it and it ain't no lie
Baby bye bye bye
Just hit you with the truth
Life's better as an MS 2
I'll give you some good reasons baby, come on
No more anatomy
Just Life Cycle and I3
We study, take the boards and then we're gone
Goodbye to the Essential Core
It all flew by
We'll see what third year has in store
Baby, bye bye bye
All of us were just like you
But we all made it, now we're MS2s
You'll all make it and it ain't no lie
Baby, bye bye bye
We know that this med school's tough
Learning how to use a blood pressure cuff
You'll all make it and it ain't no lie
Baby bye bye bye
Sunday, November 2, 2008
Being DNA Polymerase
One genetic degree and two years of medical school later, I am amazed at what I have become. For Halloween, I probably selected one the most nerdy costumes (of all time). I was DNA Polymerase, the enzyme that replicates DNA.
My costume was complete with a homemade sign, spandex, loop earings, a replication fork necklace and an oversized shirt that read "How do you express yourself?"
It was funny watching people reading my sign and trying to figure it all out. My costume only works on the UCSF campus or around my science/medical school friends. So, I did have the perfect daytime and nighttime outfit.
I know...look what I have become- pretty scary!
Happy Halloween!!!
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