New Year's!

"Musa, what is your New Year's resolution?"

"Let's see, number 1- do not tell others my resolutions." Musa is a smart kid.

It's hard to believe that 2007 will end in a matter of hours and we will soon ring 2008. With the New Year also comes the deluge of resolutions. There is also the challenge of reprogramming our pens/pencils/brains that it is 2008.

***Note to self: remember to write 2008.

As we bring in the New Year, we take with us memories of 2007 and hope that 2008 will be even more amazing (at least this is my wish). I really can not complain. 2007 has been unforgettable.

I graduated from college, started medical school, moved to SF, and started my new life as a medical student. Most importantly, I have been so lucky to be surrounded by my family and some wonderful friends, old and new.

I have no idea what 2008 will bring.

In the Spirit of the New Year's I will lay out my resolutions in a nicely organized list for my reference. By no means do I expect my resolutions to dictate my life; it will just offer some guidance.

Ok, here goes (in no special order):

1. Spend more time with family and friends.
*There will always be an endless list of "stuff to do" (as demonstrated by this resolution list), but as I get older I am realizing the importance of the individuals who make the moments of my life memorable and meaningful.

2. Discover and better define my spiritual self
*Let's leave at this. This is an evolving and personal quest requiring lots of introspection and inquiry.

3. Maintain a balanced life
*As a medical student, it is so easy to get bogged down by the details, stress, and studying. But as the old saying goes: "work hard and play hard." Life is always a balancing act and it is time to learn how to gracefully do this.

4. Stay Healthy
*As a future physician, I would like to be an example so that I can truly practice what I preach. So, this year I aim to eat 5 servings of vegetables and fruit per day and excercise every day. This will be difficult. But honestly, I exercise to live and I live to eat. I would like diversify my workouts, spend more time outdoors, and one-day run a marathon. I will start by training for a 10K or...5K. Baby steps.

5. Explore SF
*Everyday I feel so lucky to be surrounded by a city that is bustling with life and culture. I have yet to imbibe the essence of the city. I'll start with more regular runs through Golden Gate Park (see how I can multi-task and accomplish goal 4 and 5).

6. Give back to the community
*I look forward to teaching elementary school students about science and continuing my work at the student-run free clinics in SF and Sacramento. I hope I can incorporate my photography into service work and find new ways to impact the lives of others. Any ideas?

7. Be more creative
*Spend more time behind the lens of my camera and writing about anything and everything.

8. Become informed about current events and health care issues

9. Solve the health care crisis
*Ok, this is highly ambitious. But I'd like to be involved somehow.

10. Learn outside the box
*Lectures and textbooks can only teach me so much. There has to be a more effective way to retain information.

11. Master languages: Punjabi, Urdu, and Spanish

12. Cook more and cook for the people I like

13. Learn more about my classmates and their stories

14. Travel somewhere outside California (and possibly outside the United States)

15. Figure out what "kind" of doctor I want to be so that I can give a response to every person that asks me what "kind of doctor I want to be."

16. Enjoy Life. Stay Happy. Stay Calm. Stay Free.

Happy New Year's everyone. I look forward to celebrating the first few moments of 2008 with my dearest friends. Best wishes with your resolutions and enjoy the last hours of 2007.

Cheers!

***

Image: http://www.fitnessmatters.com/WP/wp-content/uploads/2007/01/happy%20new%20year%20fireworks.jpg

Little Brother Always Know Best

Musa and I are finally in agreement about something: more time off leads to more ineffectiveness. Little brothers always know best.

I also love that Musa will go out of his way to make you happy with expensive gifts or ridiculous jokes. Not to mention, Musa definitely gives amazing fashion advice (whether you like it or not); he will be first to point out an ugly sweater or color clash when he see its.

So, when I tell Musa that he is my favorite little brother, I really mean it. (He is my only younger brother, but I still mean it)

It is hard to believe that I will be returning to school in five days. And there is so much unfinished business. 15 days ago, I was just thinking how I would have all this time to do all those things I put off during the busy hours of medical school: reading, cooking, writing, exercising, reunited with friends, learning how to sew a loose button, etc...

Although, I am not nearly close to marking things off my rather ambitious list, I know I have been having an unforgettable vacation. Sure, I have not traveled farther than Sacramento (definitely no European getaway), but I have spent the days doing the most important things: enjoying the company of my dear family and friends.

Coming from a family of six kids- it is always challenging to work around six different busy schedules. Even though we spend months away from each other, when we come together- it feels just like "old times."

Change is inevitable and it does become more and more difficult to get the people you truly care about in one place at the same time increasingly challenging. Working out the logistics will remain an eternal struggle (and I dear say it does not become easier).

As a friend puts it, logistics can become the bane of your existence. I agree. But when details are workout out, schedules arranged, and we can finally get together with the people we care about (even for a short time), it makes it all worth it.

How I will miss these blissful days of nothingness, endless jokes, spontaneous adventures with my closest friends, pointless car trips, movie nights with sibling commentary, and family dinners. I suppose I'll just have to make the most of the dwindling days of vacation...

Merry Christmas!

You know it's Christmas time, when the familiar red and white suit, black boots, and white beard becomes ubiquitous, which usually happens right after Thanksgiving.

I am a little concerned about Santa's diet- cookies and milk-- along with his risk factors for heart disease. I certainly hope that Santa makes lifestyle modifications during the off-season.

I know Santa makes a list and checks it twice to find out who is naughty or nice. I hope to make the "nice" list. By now, I am really hoping Santa has made it to my name (which I doubt since I'm at the very bottom, with a last name that starts with "Z").

Santa, if you are still checking your list, here is my wish:

*Can you please help us fix the health care crisis and give health care to over 45 million uninsured? So many individuals are denied basic sersvices for so long that by the time they seek health care they must deal with life-crushing injuries or chronic conditions that could have been prevented with earlier detection or treatment.

In a society that places such high value of freedom and life, why is health care a privilege rather than a right? I am not the first to ask this question, and yet the question has gone unanswered for too long.

If not, that's alright; I understand that even Santa has limitations. Health care seems to be the buzz word in the upcoming election. So, maybe between the democrats (and maybe the republicans), we might have a possible solution (probably not).

We'll just have to see what Santa brings.

Merry Christmas and Happy Holidays everyone! I hope Santa delivers everything on your wish lists.

Are you really breaking a sweat?

The thing I love about the gym, aside from the climate-controlled environment, has to be consistency in calorie counting. Any machine has the ability to magically deduce the exact number of calories you burn during any workout. Today I burned 298 calories during a 2 mile run.

Machines are consistent with numbers. For the last five years, the treadmill has always registered the same number when I run at a certain speed for a certain amount of time.

And I would think, after years of conditioning, my body's ability to burn calories would have changed by now. (It actually should and the calorie count should be different).

In a recent NY Times Fitness and Nutrition Article, Gina Kolata raises a similar question. The title appropriately captures the central message: "Putting Very Little Weight in Calorie Counting Methods."

Honestly, how much weight can we place in those calorie counts, when the counts are determined for the "average" person? Who exactly is this person? And how can you account for gender, muscle mass, age, diet, resting heart rate, an individual's typical activity level, among other factors that would further vary and complicate the big red number that displays on the dash?

In a quantitative society that measures everything from waistlines to portion sizes to bust sizes- I suppose we need a number to measure fitness. But we must not take the number to mean everything, it's just a baseline.

I am guilty of using the number to gauge how effective my workout is. But I have become more attuned to using my heart and sweat rate to assess if my gym time was used effectively. So, if I am drenched and my heart is really beating, I know it's a good day in the gym. And it does not take a fancy computer to determine that.

So, next time you think of rationalizing the 300-calorie scrumptious artery-clogging cookie because you burned 350 calories on the elliptical or treadmill, you may want to think twice (or just cut the cookie in half)- your heart will thank you later.

***
Image: "Treadmill." http://www.exe-direct.co.uk/images/Running_Machine_Fan.jpg

Farewell to Dean

Last Thursday, I received an e-mail from a classmate that was forwarded by a second year; it was a message from our Dean, announcing that he was being dismissed from his position as the Dean of UCSF School of Medicine.

My initial reaction was pure shock. I think the first year students, by virtue of being at the bottom of the food chain, learn about things last. But apparently the news was just seeping out to faculty, other classes, and the UCSF community. Did I mention the press?

The details are quite fuzzy. The University has published a release that outlines the reasons for his dismissal; the primary reason stemming from discrepancies in financial reports (and it's a two-way argument, with no way to know who is actually correct).

The story has also been picked up by major news journals, such as the US News Today, SF Chronicle, and NY Times. Interestingly enough, the description of Dean on wikipedia was modified last Thursday to include the recent firing.

The headline for the Chronicle says it all: "UCSF medical school fires dean in dispute over finances." Until more details are released, I have no idea what to believe since both parties seem to be in disagreement...

***

It's odd. I can still vividly remember our college dinner with Dean not so long ago. We all went around the table, introduced ourselves, and mentioned an interesting talent. He was an avid spinner and Springstein fan. This was my first interaction with him, aside from seeing him at our White Coat Ceremony.

During the White Coat Ceremony, he opened his speech, by pointing to the door and asking any student who wanted to leave, to leave now (and no one would look).

And by the looks of it, he seemed content working at UCSF. There was no way of knowing about all the turmoil happening behind the scenes. It goes to show how well buffered medical students from the truth. I really wish we were more in the loop about things.

It will be interesting to learn more (if they plan to share anything else with the medical students) when we return to school in the New Year's.

Whatever the case may be, we have been reassured by our administration that the resources that sustain us (medical students) are still in place. And the global search for his replacement is well underway. Interested?

Rain, Kitten, and Spicy Indian Food

The rain was falling today. The wet weather dampened more than the roads; it also dampened my desire for an outdoor run. So, I made my way to the gym for a quick cardio and ab workout.

*
There is something odd about going to a new gym. I was actually returning to my undergraduate gym, so it was not entirely new. It was just different. There were new treadmills with TV sets in the display that would be great replacements for the current treadmills in the UCSF gym. I think it's all about adjusting to an new gym habitat.
*
The rain did not just confine me to the indoors; I had company- my parent's new kitten, Paloo, that is as gray as the clouds on a rainy day. I spent my afternoon in the kitchen alongside my mother who was cooking up a storm (no pun intended). I would also periodically entertain the kitten with an orange ball. The kitten is like a ball of energy and I wonder when (and if) he sleeps.

I'd like to think cooking is simple. But I always disprove my theory when I'm with my mother, who demonstrates that there is an artistic quality to conjuring tasty and delicious food. There is a certain amount of knowledge, experience, and skill that goes into any pot of spicy chicken curry, or keema kaboobs, or chappatis. My mother makes the best cook and teacher.

Today we prepared kuftas (meatballs), chicken and beef kaboobs, tandoori chicken, and zerda (a sweet yellow rice). There is no recipe book or protocol. My mother just knows the correct proportions of red pepper, garlic, and spices. It is pure skill.

The aroma of masala, caramelizing onions, and boiling rice filled our home as we cooked. It's these smells and my mother's company that I miss when I am hurriedly preparing dinner during evenings in San Francisco.

So, while I'm here- I'm taking it all in--the sound of rain tapping on the windows, the playful kitten and all his antics, the aroma of nostalgia, the unique cooking lessons, and the taste of spicy Indian Food. Want some? Maybe I'll cook for you if I'm in the mood.

Sicko, How sick are we?

Vacation has begun. I've made my way home and am experiencing the beauty of spare time so far different from the busy days of lectures, clinical interlude, preceptorship, and general day-to-day activities of a medical student.

There is so much I want to do-- all those things I've been telling myself I will accomplish once I have the time: cooking, mastering Punjabi (the language my parent's speak), cooking (which I have begun), running, reading, writing, traveling, etc. Everything just seems so attractive when you are in school.

Now that I have the time, I find sitting around and doing nothing even more attractive.
There is a novelty to relaxing (or as my little brother says, "chillaxing"). It's the best feeling. What concerns me is that these days are numbered. Vacations become more and more rare as you get older and starting working in the real world.


Today was spent so far from the real world. A nice shopping trip that culminated with my first (and a momentous) visit to a local IKEA. What a world! And to think I have missed out on this splendid collection of interior decor with unpronounceable Swedish names when I was furnishing my small apartment in San Francisco.

I know now where I will be buying future furniture. What I find to be most odd (and really wonderful) is that IKEA also sells food. My siblings really savored the ooey-gooey Cinnamon rolls that pack a whooping 400 calories per roll.

Speaking of health, I finally got to watch Michael Moore's Critically acclaimed "Sicko," a documentary that critically examines the deteriorating American health care system.

He leaves no stone unturned when criticizing a system that has left over 40 million Americans uninsured. He delves into the corrupt profit-generating HMOs, who will go through great lengths to deny any patient that would be a high cost to the company. He exposes government officials and highlights inherent fallacies in our approach to taking care of the sick.

He raises some good points. Interestingly, Americans spends one of the highest amounts on health care and yet we rank so low (just above Slovenia). In addition, he compares the US health care system to that of socialized systems, such as the NHS in Great Britain and the systems in Canada, France, and Cuba. At all these places, healthcare is essentially FREE!

Ironically, he closes the movie by taking 9/11 Rescue workers out of the United States to seek health care since they were denied services in the US. And of all places he chooses, he goes to Cuba: first to Guantanamo Bay and then to a hospital on the island.

I am saddened by the central message Moore delivers. How sick are we? And why are so many people denied a fundamental right?

The American health care system appears to be in shambles. We seem to be patching up a hemorrhaging system that really may need to be completely reconstructed from the base. How we go about this- I wonder? Should we move to a socialized (government-run) health care system? A completely privatized system?A hybrid system of sorts?

I do not have the answer and neither does Michael Moore. If you do, please post a comment; I am interested in learning.

I just know this will not be the last time this issue will appear in my blog. I am curious to learn about ways to solve our problems. I'll report back once I can get the facts. For now, I recommend watching the film "Sicko" to anyone curious to learn about how bad the health care system really is.

Image: "Sicko" http://sicko-movie.com/wp-content/themes/sicko/images/sicko-poster.jpg

Day 2 of Scoping in Clinical Interlude

"I would not give that liquid to my dog. I just want to eat," said Mr. B during rounds. He was referring to the liquid diet that is given to patients about to undergo a GI procedure, such as an upper endoscopy to explore for any evidence of ulcers that are bleeding.

When we spoke with our last patient today, he was frustrated and unable to comprehend why the doctors had to keep him in the hospital and keep performing test after test to explain why his lab tests were indicating he had lost half his blood volume.

In our last day of interlude, we started with grand rounds at 8 AM. Sitting in a lecture hall, we listened to a talk about celiac disease for the first hour followed by another lecture about the liver and genetics (the content completely surpassed my comprehension).

Once we arrived at the VAMC, we joined Dr. M. We met our first patient to get his consent for the colonoscopy. There are a few risks involved with any procedure. The major risks include bleeding, perforation, and anesthesia-related complications on the heart and lungs.

After consenting two patients, we observed a colonscopy and an upper endoscopy. We also observed an ERCP (Endoscopic Retrograde Cholangiopancreatography), which uses a combination of X-rays and endoscopy to visualize the pancreas and gallbladder, along with the biliary duct system. Before entering the patient room, we were given these heavy leaded vests to protect us from the X-rays.

In our second day of interlude, we felt a bit more at ease. When we walked with Dr. M from the GI unit to the ICU, I felt like I was actually jogging to keep up with him. But we felt like we were part of the team when we rounded on the in-patient consults. And today, I also listened to our patent's lungs and hearts, and got to learn about their histories and stories.

I walk away from interlude with a picture of what my third year rotation (and subsequent years in medicine) will look like. Dr. M was a fantastic mentor. He included us on his team and made an effort to teach us. I look forward to wait awaits us in the years to come.

Image: "ERCP." http://www.gehealthcare.com/usen/xr/surgery/images/ercp2_500.jpg

Scoping and Medical Anthropolgy: Day 1 of Interlude

Image: "Polyp"

The endoscope looks like a black hose that is as thick as a finger. A camera sticks out from the end. The scope is snaked either up through the mouth or from below during a colonoscopy (a very uncomfortable procedure).

*

To visualize the internal geography in the digestive tract, an endoscope was used today during our clinical interlude in the GI/Endoscopy Department at the VAMC. Colonoscopies are performed to visualize the colon and bowels, primarily to screen for colon cancer. If you are male and over fifty (or have a family history of colon cancer), you will probably have to endure this procedure. Rest assured, the procedure is typically performed under anesthesia.
*

The stomach and colon should have nice regular folds on the mucous membrane. Any unexpected outpouches that form on the walls are bad. They are called polyps and can become cancerous if left to grow uncontrollably.

*

These polyps are "mean-looking," as the attending put it and need to be nipped. Once identified, a blue dye is injected to outline the submucosal layer. Using a plier-like instrument, the GI internist can return to the site, open the mouth of the pliers, and clip away the polyp. Once removed, the polyp is sent for biopsy and a tatoo (carbon-based blue ink) is left at the site to assess any future growth.

During interlude, 2 other classmates and I, stood alongside the GI fellow and observed how this exam is done. Two screens projected the live footage from the scope that was advanced through digestive system. We were protected by an oversized yellow smock (that reminded me of those smocks you were in kindergarten when finger painting). How I miss finger-painting...


When we first arrived on site after traversing the labyrinth of white buildings that is the VA, we were a bit anxious and confused about our role. It was like we were picked up and thrown into a completely different world.

The goal of interlude (as stated on the index card they gave us) was "designed to introduce 1st year medical students to the inpatient setting early in their careers. Similar to a medical anthropologist, the student will observe, study and discuss the cultures of inpatient units..."

Is medical anthropology a fancy term for shadowing?

While most of our classmates were spending the day in in-patient settings, we were in an out-patient setting. "They cheated you from an internal medicine team experience," said one of the GI fellows.

In all honesty, everything is new to me and I was just interested in learning about GI and what a typical day is like for individuals on the service by interacting with health care providers and patients. We did make a trip to the ICU, where we observed scoping from the mouth in a patient with COPD. We also saw how dialysis is performed in a patient with kidney failure.

When our attending, the "liver guy" arrived, we spent the afternoon with him. He specializes in disorders that affect the liver, such as cirrhosis and portal hypertension. The patient we saw had an uncanny resemblance to Leonardo Da Vinci, except our patient was pale and had a distended abdomen. I look forward to learning more about his story tomorrow, when my classmates and I will interview him.

After making our journey back to campus (it takes 2 buses to get home), we culminated our evening with a UCSF Advisory College Holiday Party, where we enjoyed good food and wonderful company, while exchanging stories of the day's adventures. I definitely had my share of scoping stories to share. And there will be more to come tomorrow during Day 2 of Interlude.

***

Images:

"Polyps." http://www.med.nyu.edu/virtualcolonoscopy/images/VC1.jpg

Interlude

Marnee Thai is by far one of the best Thai restaurants in SF. The vegetarian Pad Thai is my personal favorite. Savoring every morself of food was well worth the half-hour wait we endured.

What started as a lunch with a few classmates, turned into a party of 15 or so classmates. I absolutely love the cohesiveness that bonds us. We got together to celebrate the end of Cardio and the beginning of new friendships and the approaching Holidays.

It's hard to believe how fast the year is going. Before we know it, it will 2008!

And speaking of the Holidays, a second trip to Union Square was in order. There is nothing quite like kittens and puppies in the Macy's window that are up for adoption, strolling around the square, coming face to face with pencil-thin mannequins and being overcome with the consumerism that accompanies holidays.

Although today was our Cardio Final, we are not quite done, yet.

For the next two days, we start Clinical Interlude as a part of our Foundations of Patient Care. We are scattered all over the spectrum of medical specialities. Each of us will spend two days in different worlds, everywhere from the ED to the OR to internal medicine to psychiatry to Pediatrics to OB/GYN.

I will be spending my interlude in Internal Medicine at the UCSF Veteran Affairs Medical Center. The objectives have been laid out for us, but I have a very nebulous idea of what I will actually be doing.

I am excited and I look forward to spending my time as a part of a medical team in an in-patient setting. Hopefully, I can contribute with my new-found cardio knowledge. Well, we'll see. I just know I will have to be up extra early for the one-hour commute to to the VAMC.

Cheers to the end of Cardio!

Tabula

The weekend continues to unroll with no fun in sight. The sun was shining. I could feel the heat on my skin while I studied from the fifth floor of the library. The whole city was shining and bright.

Heart Failure is no fun. And obsessing about physiological abnormalities of the heart and trying to figure out why a bad heart just keeps getting worse in congestive heart failure does not make for an exciting weekend.

Seems like every time I study heart disease, I am more inclined to jump out of my chair and run to get some exercise. Studying (and sitting sedentary along with stressing) just seems so bad for my heart.

There is one thing I've accomplished this block: I have developed a semi-regular gym and exercise schedule. Exercise. It's a good thing.

Well, distracted-- I am. I'm thinking less about the heart as I write this and more about Tabula.

What is Tabula, you might ask?

Tabula reflects the creative side of UCSF students, staff, and faculty. It is a semi-annual literary supplement published in the Synapse, the UCSF student newspaper. It provides a forum for individual expression in images and words, including poems and short stories. It is simply beautiful.

And the website cover (of candles) is actually a photograph from my personal collection: "Timeless," an image of hope, inspiration, and guidance.

Please take the time to be inspired and check out Tabula: http://www.ucsf.edu/synapse/tabula/ (when you get to this site, just click on the candle picture and entry will be granted).

Back to studying...

Enjoy!

The Rain Starts to Fall

The rain has started to fall. Winter is officially here.

Rain always makes for a logistical nightmare. You have to remember the umbrella (which I always forget), a rain coat, and proper shoes. And forget about having a great hair day. It's static city around my long tresses of curly hair.


I guess I'm just distracting myself. We have our cardio final on Monday (hence the heart picture).

With rain and gray clouds, I might actually end up find myself studying (or not....)

A wet San Francisco has a novelty that I am just starting to take in.

So, I might just be staring out this large library window overlookin the city with a distant gaze.

Oh well...there is always the weekend (to get even more behind).

Bleeding Gums

Pregnancy does "funny things" to a woman's body. Jane was complaining of bleeding gums, which seems to be common with pregnancy. According to her physician, the condition will go away once the pregnancy is over. That seems like a simple solution.

Other women will complain about chills, edema (swelling), backaches, cravings, among other things. Pregnancy is an odd thing; the body's hormones, blood circulation, and metabolism are in overdrive.

Today was another one of Jane's prenatal appointments. It seems like March 2nd is far away. But it is really about 2 and half months, since twins usually deliver early or are delivered during a scheduled C-section.

While we waited for the nurse, a photographer from a baby resource website asked us if we were Middle-eastern (we are not). Jane and I have been mistaken for being sisters. He was looking for a face for the new Middle-eastern prenatal informational website.

I guess it would be kind of interesting for Jane (or for anyone expecting) to be a pregnant model.

*Note to self: bring camera to next visit

At our next visit, I have to remember bring my camera. Jane wants pictures to remember what she looked like during pregnancy. "This is the first and last time I will be pregnant," she said jokingly.

Everything is looking great. Baby A and Baby B are both growing. Jane placed my hand on her stomach, letting me feel the baby's heads. I really can't tell you what I was feeling. It was just harder than other areas of her stomach. The babies did not kick so much today, but later they will (and I can't wait to feel the kicks).

While we waited (today we were in the clinic for 2 and a half hours), I got my blood pressure measured: 115/54. I'm not the only one interested in blood pressure. All the husbands also get their blood pressures measured.

We did get to hear the baby's hearts beating. A normal heart rate for an adult is less than 100. For a developing baby, the normal heart rate is higher, between 120-160. Each Baby's heart was beating loud and fast; I could make out the lub-dub over the swooshing sound of the doppler.

It's hard to believe there are two babies growing inside the bulge of Jane's stomach. I wonder how much bigger the stomach will have to grow to support Baby A and Baby B. It's simply amazing how the body adapts to make a nice home for the growing babies, and watching Jane transform each time I see her.

It's Starting to Feel a Bit Like Winter

The calm before the storm. That is what this weekend is (the weekend before our Cardiovascular Final, next Monday). So, I decided to enjoy this weekend.

Food, friends, mentoring, photographs, Christmas trees, shopping-- just a few of my favorite things.

Saturday was all about Med-Link, a mentoring program that pairs medical students with high school students, who come to UCSF each month for a Saturday session that is filled with science, college, and clinical sessions. I met my mentee, MM, and learned more about her goals, family, and life.

We talked about pursuing our passions, my passion being medicine and hers being politics. MM definitely reminded me about the importance of challenging ourselves to achieve new goals and learn more about ourselves in the process. I mean you'll never know until you try, right?

***

Here are some photographs from good times on Sunday that are just reminders that it's winter (and Christmas is just around the corner), in case you have yet to brave the shopping centers.

Location: Union Square

This is one really big tree in the center of Union square. I love Christmas decorations. There is something so beautiful about red and green, glass ornaments on a pine tree, and shiny lights. I have yet to outgrow my fascination with Christmas lights and decorations lighting up a house on a dark, cold, night.

***

Well, the calm will soon evolve into a turbulent storm, as the studying really begins! Stay tuned for the never-ending excitement.

The Heart Exposed

The site of a beating heart glistening and pumping is like no other site I have ever seen. The heart is simply amazing. It's more than just a four-chambered pump; it is well-designed machine that keeps our blood flowing to our muscles and lungs, ensuring we receive oxygen and nutrients to sustain ourselves.

But when the heart becomes damaged, we compromise our ability to circulate our blood to our tissues. This is a bad thing. And sometimes, we must intervene to repair this amazing machine.

When I walked into the OR with Dr. N, an anesthesiologist, I was awe-stricken. There was the heart sitting snugly in the middle of the chest, completely exposed.

To gain access to the heart, the chest literally had to be cracked along the sternum. The middle flaps of skin, fat, and muscle were pulled to the side, opened with large scoop-like metal instruments. The result was a square window, where the heart was exposed, and the surgeons were busily working to the tune of the ECG and Blood monitor beeps.

I gained an interesting vantage point; I stood from behind the blue drape that covers the patient's face. From above the blue, I could see the red blood and heart. And behind me, the monitors beeped, flashed numbers, showed squiggly lines--revealing the overall state of the heart through each stage of the surgery.

Watching the surgeons work around the heart took me back to anatomy. I can still remember the day in anatomy lab, when we each passed the scalpel around to cut the heart out of our cadever. When I held the heart in my hand, I could only think- "this was some one's heart- wow!"

Performing an invasive open heart surgery is long and complicated. The surgeon's were performing a mitral valve replacement. Essentially, the valve that separates the left atria from the left ventricles in our patent's heart was no longer functioning properly. If left untreated, a broken valve can lead to heart failure or severe cardiac complications. So, surgical intervention is necessary.

To place a new valve into the heart, the heart has to stop beating and must be kept cold (to protect the heart). While the heart stops beating, the blood is pumped out of the body through a cardiopulmonary bypass machine, which adds oxygen. So, the machine effectively acts as the heart, while the real heart is being repaired.

The surgeon's gloved hands skillfully sutured the new valve into the heart, as well as other areas of the heart that had be cut earlier in the procedure. And when the heart was ready, it had be be shocked to start pumping again.

I left the OR at 5 PM. By then, the surgery that had started earlier that morning was still underway. Metal wires were loosely placed through the two sides of the opened chest. The heart was being closely monitored, suction was used to remove any remaining blood, the last sutures were being placed, and the heart was pumping with full force.

**Image: "Open Heart Surgery." http://images.jupiterimages.com/common/detail/46/71/23127146.jpg

The Special Man

"We are looking for the special man," said the a female OB/GYN faculty member during today's Men in Women's Health panel. This "special man" is encouraged to join the OB/GYN field, where the number of males are dwindling.

Normally, Wednesday lunch is reserved for U-TEACH, an elective that takes us through the prenatal care and the birthing process. The scheduled In-Vitro Fertilization lecture was replaced with a Men in Women's Health panel, featuring an intern in OB/GYN in his first year of training and a faculty member that has spent the last 17 years at UCSF in OB/GYN.

Some of the issues that were discussed included the challenges, rewards, societal taboo associated with being a male in a field that focuses on women's health, and the downsides to being a male in the field.

One of the biggest challenges occurs when female patients will only see female providers (I place myself in this group). In that case, there is not much to do aside for apologizing or offering an female provider (if one is on hand).

Both panelists expressed a deep interest in their fields. They agreed that it is difficult to empathize with woman, having not experienced the contractions of labor or the pain of menstruation. But at the same time, they feel listening and paying attention to their patients can help make up for this deficit.

Some of the more interesting discussions revolved around what it's like for a male OB/GYN to focus his attention "down there" all the time and those conversations with significant others or friends that emerge, or the awkward silence that comes after telling others what one does for a living.

Also, panelists touched on the role of becoming sensitized to women. I suppose if you are a male and you see female patients all day, there is a possibility that the novelty of the female body wears off.

But that's where you learn to keep professional life separate from clinical life.

Overall, an interesting panel. Hopefully, the panelists were able to reach out to this "special man."

On a Scale of 1 to 10

On a scale of 1 to 10, how would you describe your pain? This is a question that gets to the heart of assessing the severity of pain. And yet, how accurately can we quantify pain given everyone has a different pain threshold?

Pain perception varies from person to person, and can be affected by different conditions.

Patients with fibromyalgia experience a lower threshold of pain (they are more sensitive). There are certain trigger points where pain is most pronounced; patients will experience muscle, joint pain, and fatigue.

Today in preceptorship, we confronted the issue of pain management and fibromyalgia.

***

It was a nice sunny day walking to Dr. D's office. While walking, I pulled out my camera and snapped some photographs of the neighborhood. Emily and I performed intake and took patient histories today. Going into the room, we had little knowledge about what brought each patient to clinic. And we walked out, fully aware of not only the present medical illness, but each patients entire medical history.

***

In talking with patients, the issue of pain management came up over and over again. Patients living in chronic pain have to be concerned about the pain management, which is often complicated and requires medication that have side-effects, such as constipation and fatigue. Also, what happens when patients become dependent (or addicted) to their relief source?

"You do not hunt a rabbit with a cannon," said Dr. D.

Dr. D extended this analogy to pain management; you do not overuse opiates or pain killers when managing pain.

Image: Image from the Neighborhood (off Filmore Street)
Dr. D has a good point--but I wonder about how to adequately help patients in pain without making them dependent on medication. And we must remember pain sensation is subjective, with a different scale for each individual.

Jumping!

Yeah...not much going on here.

Giving Thanks!

If I had to choose a favorite Holiday, it would definitely be Thanksgiving! This holiday is shrouded in a great deal of historical controversy and I will not delve into any of that. But I appreciate the simplicity and beauty that comes from two of my favorite things: food, family, and giving thanks (OK, that is three things).

Tradition is big part of Thanksgiving. For most, it's all about turkey, stuffing, cranberry sauce, and pumpkin pie. In my family, we have our own traditions and they do not include any of the above. We had baked chicken instead of turkey and a fruit tart instead of pumpkin pie. We decided on the fruit tart to celebrate my Dad's Birthday, which happens to also fall on Thanksgiving.

Bottom line: I love Thanksgiving. I love food. I love family. And there is a lot to be thankful for.

I am thankful for my amazing family: my parents, siblings, and extended family (and my cat- Chitty, pronounced Chit-tee). These are individuals, who have made so many sacrifices for me. Their unconditional love, support, and concern is always with me. They make my life complete. I cannot begin to thank them for everything they do (and have done) for me.

I am thankful for my friends. My friends bring joy to my life, making me happy, spending time with, and being there for me. I hope to cultivate these life-long friendships.

I am thankful for my health, one of the biggest blessings of all. Every day I wake up, excited for another day. I am thankful for food, water, and shelter--basic amenities that are so essential that are sadly denied to individuals in the third world and in nations ravaged by war and instability.

I am thankful for being able to live my dream: medicine. As a medical student, every day is about learning about how to effectively serve my future patients and their families. It such an honor to learn the language of medicine and the stories of my patients, while standing alongside my amazing classmates. I am excited for the next steps and challenges that await me on my ongoing journey in medicine, as I continue navigating the complex mechanisms of human disease, fragility of human life, and as I understand what speciality I should pursue.

I am thankful for being a student at UCSF and for the endless opportunities to explore, learn, and serve.

I am thankful for San Francisco, the city with a soul. There is so much that I love about the city: the people, the diversity, the beauty, the individuality, the distinctive culture, the food. Experiencing the city is so wonderful and refreshing.

I am thankful for my SLR Digital Cannon Rebel camera (it allows me to see the beauty in world through a lens and produce timeless images). I am thankful for my running shoes, my bike, the gym, Golden Gate Park.

I am thankful for you (reader)- for entering my inner world. It makes writing worth every word, when I know there is someone out there, who reads and is interested in learning about my life. Having an audience brings meaning to my writing. And for that I am grateful.

There is so much more to be thankful for; I could go on and on. But I'll stop here.

Happy Thanksgiving!

***Image: Dad's B-day Fruit-Tart (our pumpkin pie equivalent)

Break!

It's break time! From noon yesterday until Monday morning at 8 AM, we have our first official break. Thanksgiving!

Before making the journey back home, I spent my afternoon at Jane's prenatal appointment. The waiting room was filled with expecting moms and the temperature was as cold as ever. It's the 25th week. Jane is doing well; her mother and father will be visiting soon. She is anxious to see her family.

The babies are moving a lot and being monitored very closely on ultrasound. On the black screen, we could make out the little hands of Baby A (the boy), who was either punching or attempting to wave. We could see Baby B's (the girl) heart pounding. On average, the babies should be kicking at least 5 times an hour.

Jane will also have her blood checked for gestational diabetes, a condition that some pregnant woman develop during pregnancy. According to the American Diabetes Association, approximately 4% of pregnant woman will develop this condition, which can result in hyperglycemia (high blood sugar).

Normally, sugar is broken down by a insulin, a hormone secreted by the pancreas. But in pregnancy, the growing placenta secretes hormones that prevent insulin from working. As a result, higher blood sugar pools in the blood, which move into the placenta and can cause birth defects and complications in pregnancy.

***

I will see Jane next week at her next ultrasound appointment. We will continue to watch the babies as they grow and exchange family stories.

For more information on Gestational Diabetes: http://www.diabetes.org/gestational-diabetes.jsp

Image: "Gestational Diabetes." http://www.pennhealth.com/health_info/diabetes2/images/19724.jpg

The Power of Touch

Come on. Admit it. You are afraid of something. Even Superman was not invincible--there was krypnonite.

We all have our fears--everything from darkness, snakes, rejection, falling, etc. Being afraid is being human.

I would say I am afraid of being alone and exams, but that is only half-true. I think it's more the anticipation that gets me. Tests are just a necessary evil. Speaking of which, our first cardiovascular midterm ended and we move right along...

After the exam, I decided to spend time in the Women's Health World alongside Dr. S, my mentor. I spent my summer conducting research on HPV and cervical cancer in her lab. She is renowned for her work on HPV, including her research into the effectiveness of newly developed HPV Vaccine.

Being reunited took me back to the summer days of experiments--PCR, running gels, Immunohistochemisty, and staining slides. It's hard to believe how much time has passed and how different my life has become (so far from land of test tubes and pipettes).

I was with Dr. S during two straightforward gynecological procedures in the OR.

What I remember most (aside from using a laser to remove warts) is the power of touch, when a patient must face her fear.

Before surgery, a peripheral intravenous access must be obtained so that anesthesia and fluids can be administered during the surgery directly into the circulation. But to establish this access, a needle must be injected into a peripheral vein, such as the vein on your hand or arm.

For most patients, this is an uncomfortable procedure. But for some, needles can be so scary that they physiologically induce something called the vasovagal response that can lead to hypotension (lower blood pressure) and syncope (fainting epidose).

The second patient has struggled with facing needles. And today was no exception. To help her, I offered the only thing I could- my hand. As the needle was inserted, I held her hand and maintained direct eye contact with her, while initiating a conversation to keep her mind preoccupied. There was discomfort, but she stayed with us. After the needle was in, we covered the needle with a nice blue sleeve and she was ready.

As Dr. S said, "Sometimes mind overcomes matter."

After surgery, we visited her in recovery. I will never forget her words.

"Thanks for holding my hand and talking to me, it really helped."

Sometimes, the smallest things can have the most powerful effects.

***

Image: "Hands." http://artfiles.art.com/images/-/Christine-Ellis/Loving-Hands-Photographic-Print-C12153830.jpeg

I can't get the Heart off my Mind

Just thought I'd share what's going through my mind...it's more of an obsession with knowing the heart with an exam in less than 24 hrs...

Image: http://library.med.utah.edu/kw/pharm/hyper_heart1.html

Lub Dub S3

If only the heart was this simple. In fact, the heart looks like nothing this. I have no idea why the heart is always represented as such. Any anatomist (or first year medical student) could identify all the innacuracies. Let's not go there...

The real heart looks something like this. But the veins are not color coded (there is no blue; just shades of red).

I can not get the heart out of my mind. I know the heart is the universal sign of love, but it has occupied my brain for other reasons. Our cardiovascular midterm is on Monday.

So, we're all getting to know the heart very well, no love here- just endless amounts of facts and understanding this incredibly complex organ.

Images:

"Heart."http://www.annerpino.com/2003/heart.jpg

"The real heart." http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/1097.jpg

When the War Comes Home

Consider this ethical question: would you be willing to kill one violent/evil individual at the expense of 3 innocent individuals? If no, do you think it's justifiable to send someone in your stead to take care of this business?

Aidan Delgado, a Conscientious Objector of the War in Iraq, posed this ethical question to an audience of medical students, residents, physicians, staff, and community members when he opened his discussion "When the War Comes Home," hosted by the UCSF Iraq Action Group. In particular, he highlighted the concept of "collateral damage" and moral casualities of war.

According to Delgado, "Collateral damage has no meaning to us. It is faceless." He believes that the public will attribute collateral damage to the numbers on the CNN ticker without thinking of individuals, such "Ahmed or Mohammed."

Having been stationed at Abu Ghraib prison, what he calls the "Baghdad Correctional facility," Delgado reflected on his experiences, providing graphic images of the causalities of war--mutilated children, injuries of war, defaced bodies, prisoner brutality--images that captured the dehumanizing effect of war.

Delgado, who is profient in Arabic and grew up in Egypt, enlisted in the army on September 11th. He joined before the attack, feeling vindication, which later transformed into moral opposition.

"My small part was like a tiny cog in a machine that allowed the war to take place," he said. As he became exposed to the reality of war--the cruelty and horrific human cost and the dehumanization of fellow comrades, he was determined to make a decision, drawing from his Buddhist religion. He could either be a Sunday Morning Buddhist (practice Buddhism once a week) or Live Buddhism in his daily life.

He decided to turn in his rifle and become a Conscientious Objector of the War. Despite the initial ostracizing and hostility, he has remained opposed to the war and shares his experiences with groups all over the nation.

"War has such a profound, corrupting effect. There is no family that has been untouched in Iraq." He compares the ongoing war to the the mythical hydra: cutting one snake causes two more to sprout. Like the hydra, the insurgency continues to grow in opposition to the US attack.

According to Delgado, we can not kill our way to peace. And an American presence will not promote stability, due to a prevalent Anti-American rhetoric in a country where families have lost loved ones to the war.

Delgado admits that there are 2 sides to the coin: Americans are helping civilians with building schools and hospitals. But the violence and cruelty of war dominates, negatively impacting and blackening the American image.

Delgado compares the war to a barbed arrow. We can either pull the arrow out, or let the wound bleed until there is no more blood left. There is no way to undo the damages of war and bring back all the lives that have been lost, or reverse the prisoner brutality at Abu Ghraib. He believes it is time to pull the arrow out--withdraw and bring our troops home. And despite the challenges, he believes that there still is hope.

In opposing the war, he does not oppose the troops. Instead, he questions our rationale for entering a war that is morally wrong. He believes that the image of a soldier should be changed into that of a peacekeeper.

Delgado compared the war to a game of chess and we can not blame the pawns or the rook, when the chess player controls the moves. But he believes we must keep the war on our moral radar and remember about our mounting karmic debt.

****

Image: Event Flyer in Med-Sci Lobby

Aidan's Biography (provided by Iraq Action Group Flyer): "Aidan Delgado will speak about his experiences in applying for Conscientious Objector status while serving as a soldier in Iraq and at Abu Ghraib prison. He will show slides depicting some of the violence and brutality that pervaded the Army and discuss the morality of war from a Buddhist perspective. His intends to bring home the reality of war to citizens here in the U.S., so that they can make an informed moral decision about whether to consent to this war. Aidan Delgado is a peace activist, member of Iraq Veterans Against the War, and the author of "The Sutras of Abu Ghraib: Notes from a Conscientious Objector."

Dinner with Dean

Last night was a Thanksgiving preview. Our college dinner featured the Dean of UCSF and a harvest theme, complete with decorative squash, pumpkins, turkey, asparagus, potatoes, and white table clothes.

In bringing the medical students together with the dean around four tables arranged in a square, we were able to to interact with the dean and learn a bit from his wisdom in an informal setting complete with food.

I had known a great deal about his legacy, spanning decades of health policy work in the anti-tobacco campaign, development of nutritional labels and anti-retrovirals drugs. Also, he has served a number of US presidents and as dean at Yale School of Medicine before coming to the West Coast to become our Dean (among other accomplishments). I did not know that he is an avid spinner and that he is a Springstein fan.

What I got from our interaction was that he really cares for medical students. Although we lack the extensive knowledge and years of experience, he believes we have something unique to offer to our patients, which is "time."

When asked how we were adjusting to entering medicine and if it had hit us that we are going to be doctors, there was a mixed response. Excitement, uncertainty, happiness, intensity- just a few of the feelings mentioned.

We were also asked if any of us felt like "frauds?"

And for some of my classmates, the term strikes a cord--some of us continue to have our doubts about why/how we ended up here and feel like we have yet to earn our short white coats. We worry about not knowing the answers, or not being able to retain information for more than 1 week after an exam.

But that is too be expected. The dean looks forward to witnessing our transformation from year 1 onward (me too!). And he reassured us that learning is just beginning and that we will soon feel less like frauds and more like doctors. Let's hope...

Image: "Thanksgiving."
http://www.lakejunaluska.com/uploadedImages/Lake_Junaluska/Packages/thanksgiving.jpg

Christmas, Cider, and Clinic Visit

It is already Christmas. Well, that is, if you happen to be at Starbucks. While I was standing in line beside some of my dearest undergraduate friends, debating whether to order the usual overpriced venti chai tea latte or the seasonal peppermint mocha or the caramel spiced apple cider, Dr. Y asked me if I was interested in getting any dessert.

The clear glass box housed big chocolate chunk cookies, thick slices of pound cake, cheesy bagels, nutty brownies, and rice-krispy treats. All so tantalizing and seductive.

And yet, I responded by saying: "No, thanks. I just feel so guilty eating anything unhealthy after spending a day counseling patients about not eating sweet, fatty, delicious desserts."

*

Earlier that day, I was seeing patients at the Shifa Community Clinic, a student-run clinic in Sacramento that offers free services to underserved patients populations. Shifa has a special place in my heart; I spent four years as an undergraduate serving patients, learning, and exploring and crystallizing my interest in medicine.

*

Today, my role was different from my usual role as a clinic volunteer or monitor, where I would perform vitals, coordinate patient flow, room patients, and oversee clinical activity.

The role was completely reversed; I was seeing patients, and flying solo, interviewing each patient, performing the physical exam (good thing for passing my recent observed Physical Exam), and presenting to the preceptor and developing an action plan to help each patient.

I saw two patients and in the course of the day, I learned about everything from hypertension risk factors to ace inhibitors to syphilis to diabetes management to composing a SOAP note to viral rash presentation. I also injected my first flu shot and counseled my first patient about the numbers written on his lab tests.

Managing chronic conditions, such as diabetes and hyptertension, can be challenging. To help patients, who are at a higher risk of developing these metabolic syndromes, we encourage a healthy diet and excercise.

When I recommended regular excercise to a patient, he asked me if "sex was a type of excercise." I guess it is. I recommened a more traditional source of cardiovascular activity, like biking or walking. We'll see how that goes...

Discussing diet and excercise with patients, always make me more conscious of my diet and fitness level, a constant reinforcement of eating 5-vegetables a day, excercising and giving up the goodness that is cookies and sweets.

***

There are lots of firsts. And my first return to Shifa as medical student is truly memorable. I still remember the good old clinic days, when I would see the first and second year medical students in their short white coats and stethoscopes taking care of a patient, with so much knowledge and skill, while talking to the physician in a completely different language that was filled with big medical words. Now I am one of those medical students in a short white coat with my red stethoscope.

It is hard to believe that I am now in the position. I feel so lucky to be able to return and provide my services to the patients, who contributed to my passion for medicine. And being reunited with the undergraduate volunteers I worked directly with during my time at Shifa is like the cream on top of the spiced apple cider I ordered at Starbucks.

The undergraduates are the nuts and bolts of the clinic; without them- there would be no clinic. When I was a volunteer and Dr. Y, the director and my mentor, would say this to me, I did not fully understand this meaning until I returned on the other side. I will remain a Shifa volunteer, and I hope I can return to serve future patients in clinic and work alongside such dedicated volunteers.

Happy early Christmas to anyone visiting Starbucks. And I hope you will think twice about grabbing something sweet (such as the big choclate chunk cookie, my personal favorite) from behind the glass window. Well if you do go for it, just excercise the calories off (in any activity you please :)

***
For more information about Shifa Clinic (Mission, Volunteering, Donating, etc): http://shifaclinic.org/

Images: "Caramel Apple Cider." (it's too sweet for my preference). http://www.kvue.com/sharedcontent/dws/img/11-05/1122brllstarbucks.jpg

Decisions

Can you imagine having to decide whether or not you want to terminate your unborn child?
And to further complicate this, how about being given only a week to make this decision?

No parent should have to make this decision. But this is a reality when dealing with possible complications of a pregnancy.

The developing baby relies on the amniotic fluid for protection and proper development of muscles and organs. When we think of a baby swimming in the womb, the amniotic fluid serves as the medium of movement.

By the second trimester, the baby will begin to swallow the amniotic fluid and breathe. The mother provides the fluid up to 20 weeks of development and later the baby's urine will add to the fluid. For proper development, there must enough amniotic fluid.

In a condition know as Oligohydramnios, the placenta has low amniotic fluid, which is problematic for the developing fetus. Because of the low amniotic fluid a number of outcomes are possible: the developing fetus may not make it to term (and die in utero), experience delayed development in the organs, or may be born normally.

When the ultrasound reveals findings indicative of Oligohydramnios, the Obstetrician and Neonatal Specialist must inform the parents about their options. And one option is to terminate the baby in utero with an injection of potassium chloride into the heart to stop future contractions.

This option is complicated in the case of a twin pregnancy, when there is another developing fetus. Injecting into the womb poses the risk of infection to both fetuses, as well as premature delivery. Also, the terminated fetus would not be delivered; it would remain in the womb. So, the mother will be continue to carry both fetuses: one that is viable and one that has died.

It is hard enough to make such a decision. But how about carrying a dead fetus for a few months?

There is no way to know what is the right option or decision. The mother and her family will need to carefully consider each option and the impact it will have on their lives. It's difficult to even fathom being placed in such a situation.

And yet, this is what Jane and I were discussing at her last prenatal appointment.

A Day in the Life of a Medical Student- Uncovered

The title says it all- the Class of 2010's class play basically uncovered everything. Cole Hall, our normal lecture hall, was transformed into a stage and was packed to the brim. The annual play was organized by second year medical students and featured faculty members and students in a series of skits, movies, dances, songs, off-color jokes, and innuendo.

I was there as an audience member and photographer for Synapse.

The play was absolutely hilarious. Probably because, it's nerdy humor that only we would find funny. I mean who would really think to redo Rihana's Umbrella song into a song/dance number about microorganisms called "Ellas." Or how about an anatomy number to Michael Jackson's "Thriller?" Or, a rendition of "Left my Heart in San Francisco?" about a heart surgery gone bad? Only we would do that and laugh at loud watching it.

And I can't forget the Med School Pickup Lines, which was all about using medical jargon as a way to flirt with random people at bars. "What's the point of going to medical school if it's not going to get you laid? We test out the aphrodisiac effects of our new knowledge on the San Francisco bar scene" (Class Play Program).

The Class of 2010 is very creative and has set the bar high for us first years. But I have no doubt that we will outdo the Class of 2010 with an amazing production next year.

Here is a complete list of the line-up from tonight's program (in case you are interested, which I highly doubt):

*UCSF 2010 Interview Day

*Welcome to Med School: The First Lecture

*Mission Baywatch (featuring our professors)

*The Ellas

*Left my Heart in San Francisco

*Pimp my Scope

*Top Ten List

*Jay Walking

*The Angina Monologues

*Jackasses

*The Small Group (my personal favorite)

*Med School Pickup Lines

*Robot Love

*Salsa de Microbios

*My Humps

*UCSF's Late Night Anatomy

Images: "Thriller," "Left my Heart in San Francisco," and Cole Hall Audience

All photographed tonight by yours truly

The Flash

You know it's a good sign, when you get a flash--the first sign of red blood that oozes out of the butterfly tube. And then with a push of a tube, you have it, a nice flow of red warm blood that quickly drips to fill the tube.

Phlebotomy is a fancy term used to describe drawing blood. Today, I drew my first blood. To be exact, I drew 2 tubes worth, one from my each of my classmate's arms. After a quick five minute demonstration, we gathered our equipment and materials: a lavendar-top tube, a container for the tube, a butterfly needle, a tourniquet, a cotton ball, and an alcohol pad.

In no time, we were applying tourniquets on the arm to enhance visualization and feel of the veins in the arm. And once identified, the vein was then pierced with a need until blood was withdrawn. It was as simple as that.

We are being trained, so that we can effectively draw blood from our patients at Clinica Martin Baro, a new student-run clinic and other future clinical sites. Now that I have drawn blood on a classmate, I am prepared to venture into the clinical world to draw my patients labs.

I left the training session with one band-aid on each arm. Oh, how I hate to peel the band-aid off my arm. But also having learned a new skill.

It is strange being pierced and poked and having a needle resting in your vein. Watching the dark red blood leave your arm is so bizarre, but interesting at the same time. Today was about learning--which also involves both performing the blood draw and experiencing the discomfort our patients will feel the next time we wait to see the flash.

***

Image: "Venipuncture." http://www.medicine.uiowa.edu/cme/clia/images/testID13/Image06A.jpg

Daydreaming of Saturdays at Ocean Beach

Everyday should be a day spent strolling the beach, camera in hand. My Saturday was unforgettable: me, my camera, and the great blue ocean.

It was actually warm enough to venture out to Ocean Beach, which is a short 20 minute Muni ride from my place. And for the first time since moving to SF, I finally spent some time in the Pacific Ocean. And the Ocean gave me a gift- sand in my sneakers that keeps resurfacing every time I go for a run or exercise.

What a marvelous day! And sharing Chicken Tikka Masala with friends (old and new) at dinner, really made the day so much better.

I believe that my new motto (well one of them is) that "I exercise to live and I live to eat."

Now it's time to prepare for another week of Cardio. Here's to a productive and relaxing week (with daydreaming about days spent on the beach).

Images: "Care-free" and "Easy-Going" (from my Collection taken at the Beach)