We Are the Champions

Guess which white belt novice beat out two yellow belts and three blue belts at UCSD's karate tournament today to win 1st place in the women's collegiate beginner division? Oh yeahhhhhhh. UCI also beat UCSD in overall team points, and UC Riverside heard we were coming so they didn't even bother to show up to battle the inaugural UCI Karate Team (apparently we've never had a team before). Now I attempt to parlay my athletic success into academics... success begets success!

I hope.

Decapitation

We decapitated our cadaver today. I'm not sure which I dislike getting in my hair more, dead guy parts or live guy vomit/blood/feces/urine. Well, considering most of my future patients are going to be living (or at least on the verge of living), I guess I should like the latter more. I'm so sick of anatomy. It is so foul. Not only did we have to take the guy's head off, we had to saw down through the middle of his face. I elected to saw through the top of his head from the back so I wouldn't have to watch the blade going through his face, but it was still nasty enough.

We learned something interesting in lecture today about "brain death." Did you know, if you are in a persistent vegetative state and your family elects to keep you hooked up to the ventilator, when you finallly do die they will get a bill from the hospital? Medicare/Medi-Cal doesn't cover very much, and most insurance companies have a limit. The lecturing doctor said people can go bankrupt, lose their retirements, their childrens' college funding, etc. over the bill incurred by keeping your body running. Also, regardless of what your driver's license says, your next of kin still has to legally approve of organ harvesting if you should end up in the position of being an organ donor. So, to make this quite clear, I don't want to be kept on machines after my brain is dead or if I have no chance of being myself after a so-called recovery. Just pull the plug! They can have my organs, I won't need them anymore. Did you know that an otherwise healthy donor can change 8 people's lives for the better by giving good organs?

Quickest Blog in the History of Blogs

Week 5

Plants Week 4

Gettin shaggy! I can't wait for the little blooms to come up. By the way, I have an odd feeling that these plants I first called pansies then changed to violets are actually marigolds. I guess I'll know for sure when they show off their flowers, but I have a feeling I've seen these leaf patterns before, when we grew marigolds in 3rd grade.

I spent part of my evening in the anatomy lab tonight. My partner and I have a presentation to make to the rest of the class, so we were doing extra dissection. Usually when I go into lab, no matter what day of week or time of day, there are at least a few other people there. But this time, at 10pm on a Sunday, there was no one there. It was just me and Janet and 20 dead people sleeping in the dim, singly-lit laboratory (Janet and I were not sleeping, the dead people were). It was creepy so I switched the lights on really fast. We were both a little skittish until we started dissecting, but as we picked away at the intermuscular fat and strings of facia among the cervical plexus, it seemed perfectly normal to be sitting there, talking about random things, and wiping away strands of hair that were falling into another person's body cavity. We were proud to have found our parathyroid glands, as they are often inadvertently removed during thyroidectomies due to their inconvenient location and size.

Next week we I hear we have to decapitate our body. Now that will be interesting and not a little bit gross.

Plants Week 3

I should be studying. But I am a proud mama.

Daisies: Actually, I just learned a few days ago that they are violets, not daisies. Notice the first two leaves of any type of plant are rounded on the edges, then the subsequent leaves to sprout have their distinctive shapes.

Hapas Rule

Today's karate teacher was a Japanese/white guy. How cool is that? Maybe I should have taken up martial arts a long time ago.

Pam's Amazing Patio Garden - Week 2

I suspect the cute little bunnies around here munched on my daisies one night. It could have been the rain that broke off some of the leaves, but I had to elevate the plant pot a bit to keep it out of their reach, just in case. Here they are:

Daisies

Karate Kid

I took my first karate class today! It was the result of my friends pressuring me, but it turned out to be really cool. I'd wanted to take kendo (swordfighting) and had recently been browsing taiko (drumming) groups and classes, but karate is cheap for UCI students, and not as much of a time committment as kendo or taiko. Another reason I went was because I need to exercise on a regular basis. Running on my own was great but inconsistent. Reflecting upon my history, I realized that I was an athlete in high school, and I did pretty well academically. In college I didn't play sports, and I didn't do so well. In paramedic school I went running every night at 11pm to work off my stress, and I did really well. When I went back to school for my post-bacc stuff, I went running a lot then too, and... I did really well. The last two quarters of med school I've been just trying to not fail. More study doesn't equal better grades for me, it just equals more boredom and frustration. And yet I still purposely don't take up any activities so that I can keep my schedule clear in case I DO get magically motivated to study all day. I do this all the time, but it ain't working. So maybe getting beaten up a couple times a week will make me pay attention to my bodily parts and that will translate into correct anatomy answers. It's promising, so far. My friends and I all spontaneously and simultaneously thought about the safety of our ACLs and tibial collateral ligaments as we were kicking each other in the legs today, because we just learned about them and how they can get blown out, often in football, by a swift medial kick to the knee.

So, we learned some basic moves (but we did not learn how to put wax on, wax off). We kicked and punched each other in the torso and back a little bit, but since we don't have any fine control over our lower extremities yet, my friend and I nearly got each other in the face and genitals several times by accident. Yikes! I think I should partner with a more experienced partner next time. They shout out the commands in Japanese, but what's ironic is that the instructors aren't Japanese and I can't always understand what they're saying! It could be that I'm not understanding because they are unfamiliar words, but the off pronunciation really doesn't help at all. I'll have to look online to find the proper words so I can see what they are really trying to say. Otherwise I keep wanting to laugh while we are supposed to be solemnly learning how to kill people with our bare hands, because I keep thinking, "Don't touch my moustache" (say that really fast and slur a little, and it sounds just like "you're welcome" in Japanese).

Other than that, karate is kind of what I expected, but not entirely. It's fierce and all that, but it's also kind of like learning the choreography to a dance. We have to do all these movements together in a sychronized fashion - we move about the room and have to turn in certain ways and all that - and it really reminded me of why I didn't last long in ballet as a kid. I got smacked with the ruler a lot for not being able to do the splits, but the kicker was that I could not for the life of me figure out where the heck in the room I was supposed to be flitting off to next. Karate was the last thing I imagined I'd ever compare to ballet, but there you go. We don't flit (we stomp, very undelicately) but I still ended up getting beaten up and confused at the end of the class.

Well, here's to the hopeful return of the successful Student Athlete. We'll see if I keep going all quarter. HAI!!

Marigolds and Herbs

I was starting to worry about my other seeds, but I came home today to discover dozens of tiny little green things push-push-pushing against very heavy (to them) clumps of dirt so they could reach the sun. They haven't quite poked their little heads out completely yet; I can see them still buckled under the weight. They're quite inspiring - being weighed down by all that dirt won't keep them down. It makes me want to sit there and watch them grow; once they sprout, they grow so fast! They might be up by this evening, for sure by tomorrow morning. Hooray! I think I'm going to go find more stuff to plant. I want tomatoes and morning glories, any other suggestions?

Sprouting!

My daisies seem to be the first to want to jump out and see what's going on. They're called "Johnny Jump-Ups" and now I see why. It's amazing how you can have these little things that are for all intents and purposes just bits of pebbles or sand, but when you put them in dirt and add a little sun and water, they get "activated" and become a living thing. Welcome to the world, little guys!

Green Thumb

In my adventures with dead people and coming home smelling like them, I think I must have started to want something different, because I developed an intense desire to grow something. Darron helped me start a little garden on my patio - we planted pansies, marigolds, and in typical "hanayori dango" fashion I also planted basil and cilantro. I want tomatoes and morning glories too, but I'm going to try these out first and see how I do. I used to have a green thumb, but do I still?? We'll see.

Madam President

I applied to become the Vice President of Education for the UCI School of Medicine's Emergency Medicine Interest Group. Then yesterday, I got a call and was asked to actually be the Co-President. I had considered applying for it, but I'm just a 1st year and don't know a lot about the Emergency Department yet. Plus UCI's EMIG is one of the most active EMIGs at any medical school in the US - we are the only school to host an Emergency Medicine Student Symposium, a symposium put on by UCI students specifically for students and NOT for doctors, unlike any other medical symposium - so I was going to hold off until next year to run for president. But, they think I can handle it (hehehe) so it would be silly for me not to do it. I have the advantage of knowing that I want to go into emergency medicine already, so I might as well start networking and taking on responsibility and all that now. Plus I already have lots of ideas on improvements I want to make, and this would be the better position to accomplish them: BBQ on the helipad, gurney races down the ER hallways, weird-object extraction practices... I'm taking suggestions!

Stress and Immune System

It's been a while since I wrote. I don't have a lot of wisdom that I've accumulated to share with you, just a lot of snot in my head. I've done this empirical study so much - actually it's only an observational study - that I know for a fact now that final exams area damaging to one's health. Every break I get, I spend the first bit of it very sick. This time, it seems to be worse than usual. At least we just studied the endocrine system and now I know why one's immune system takes a dive under stress (the hormone that mediates long-term stress, cortisol, inactivates your immune system in order to do other things like keep your heart rate up or build up your liver stores of energy for when you really need it). So anyway, I just took my morning shower, and now I am going back to bed!

Beer Before Noon

I just finished a hellish exam this morning and made a beeline, with two other classmates, for the brewery across the street from school. Such joy! I've never had such an urge to drink beer before. Except after manual labor. This means that nothing much has changed, really, from my life as a firefighter to my life as a med student.

Fan Mail

I received some fan mail today. I was floored. It was very nice.

You might be thinking, "Yeah, right... fan mail? Where would you have fans from?" This just strengthens the assertion I make in my blog subtitle, that I used to be the object of public adoration. It also strengthens my intermittent confusion at why, exactly, I gave up a great job with great pay and great time off, just to be poor, disrespected, underestimated, haggard, frustrated and stressed. If I remember correctly, the original idea was to become of a more scientific mind. So I decided to analyze what exactly qualifies a piece of mail as fan mail. After some thought, it seems the criteria that a piece of mail must meet in order to be differentially diagnosed as "fan," rather than "normal" or "junk" are:

1. The recipient is a publically known figure.
2. The writer is a person, not a marketing computer program.
3. The writer does not personally know the recipient.
4. The writer has a positive impression of the recipient, based on outside information.
5. The writer makes a one-sided effort to contact the recipient.
6. The writer shares his/her stories and feelings.
7. The writer may hope for, but does not necessarily expect, a response.

The letter I received was from a new office employee at the fire department. He is from Irvine, so when he happened to see my name attached to an Irvine address, nostaliga and curiosity combined to culminate in him sending me fan mail. He says he has never met me, but has my new Firefighter I training completion plaque (it takes years to complete the on-the-job training) sitting in limbo in his office, since he cannot deliver it to me at a firehouse anymore. He says he hears firefighters mention my name from time to time, and it apparently adds to the intrigue about this mysterious figure with the interesting last name who went off to med school in his hometown.

It is a nice, handwritten letter. It is quaint that someone out there would hear good things about me and feel compelled to write a letter by hand. I actually sent some fan mail of my own a little while ago, even though it was by email (which is much easier to do, so unfortunately not as meaningful). I spotted my old shoulder surgeon's name in a magazine around Christmastime, honoring him as one of the top doctors in the Bay Area. I felt nostalgic and somehow inspired to congratulate him, so I looked him up online to send him a quick email. I told him how well my shoulder held up in the drill tower and since, and that I was now a medical student to become a doctor just like him. It was a very one-sided letter, but I thought it was nice. And now I have my very own fan mail, similar to my message to my surgeon. It certainly made me feel fuzzy and warm inside that my old co-workers say good things about me, and that I am gone but not forgotten. Maybe what we all need is to send fan mail to people from time to time, and hopefully get fan mail of our own every so often.

Football

I was a wide receiver for Powder Puff Football yesterday. Granted, I haven't been working out in months and months, but muscles I didn't know existed (because we haven't studied them yet in anatomy) hurt. I've never played football before, and I can't throw the ball to save my life. But I can run, and I can catch, and I sure am big compared to the other med school girls.

Powder Puff football is when the girls play football and the boys are the cheerleaders. My class had a great turnout. A couple of my classmates came dressed as white trash, complete with "Mom" heart tattoos, cheap beer, John Deere caps and cutoff t-shirts. Some of the boys came out and coached us for an hour before the game. Now I know what a "buttonhook" is, as well as a "flag," "post," "five and out/in," and "the option." At one point, I was going deep to catch a long pass, and ended up getting turned around because I wasn't positioned on the field to watch the ball as I ran. I fell very ungracefully on my rear, and I was running so fast, I kept going and did a reverse somersault, like a tuck-and-roll, then my shoe fell off to boot! It was lotsa fun. I have an increased appreciation of football, now that I've played a little bit of it. I also finally figured out why football games take so freakin long! It's because men cannot contain themselves from arguing over every little sorry detail and just play the darn game.

But man, do I hurt. Showing the youngsters that the old lady's still got it has its repercussions.

Creepy Thoughts Caused by Anatomy

I'm feeling prolific today. It's because it's 4:38pm and I'm trying to study. I know I get antsy in the afternoon, and that makes it hard to study, but I try to anyway. And then I end up cranky because I stayed in all day, didn't do anything fun, and yet didn't get anything learned. I do best at night and in the late morning. Too bad class is at 8am, always at 8am. The American Disabilities Act people should look into Circadian Rhythm Discrimination for those of us who perform best at night, but are rather dull at other times of the day. So that is why I'm writing a lot today, instead of studying like I should be.

Anyway.

I creeped myself out the other day. I will tell you how, but first, let me give you a little background on my latest cadaver. After the Juicy Lady fiasco (see "Anatomy," 11/28/06) ended, our dissection groups were split up and we got different cadavers. My group got a big guy with a huge neck, the "linebacker" among the cadavers. After two hours of unsuccessful dissection, we were instructed to abort our body and join other groups. He just had too much subcutaneous fat and we couldn't find anything in there, barely one nerve, one vessel, even the muscles were hard to pick out. The other cadavers seemed like they just fell apart in nice, perfect layers for the other groups, and we were feeling pretty bad about our dissection techniques. The instructor told us not to get down on ourselves, and told me that even surgeons can get lost in a body if there is too much subcutaneous fat.

Now, back to creeping myself out. Once a week, we interview fake patients in small groups. The actors come to school, are told what ailments they are supposed to be portraying, and we interview them. Sometimes we do practice physical exams on them. Last week, we had a "patient" who actually had a heart murmur for us to listen to. He was a retired guy, in very good shape. He played sports for a few hours every day, and he was very fit. He was so fit, and lacking any fat, that I could just imagine how nicely his skin would peel off, how easily his vessels and nerves would emerge from the connective tissue, how cleanly his muscles would separate from their anchors. As he lay down on the exam table to let us listen to his heart, I nearly told him that he would make a great cadaver. I'm glad my social filter was on, because THAT would have come out all wrong. A few days later, I was looking at someone else's neck, and in my mind's eye I could see what was under the skin. I've never been a man before, but I understand men undress women in their minds all the time. It was kind of like that; I was "unskinning" a person while we were chatting! Now that's just weird. I'd heard of medical students suddenly realizing that when they looked around, they saw diseases and injuries, not people. I thought that was kind of hokey until I found myself mentally reflecting my conversation partner's skin to find facia, subcutaneous fat, the sternocleidomastoid muscle and the vessels of the vicinity.

I wonder if I will always see people that way, now that I know what things looks like under the skin? It's like the inside of a See's candy box: can you picture that box of chocolates ONLY in its closed state, or does the image of the little chocolates pop into your mind, because you know what it looks like inside that box? Once you know, you can't ignore what you know. The image pops up whether you try to conjure it or not. The only difference is that for some people, it's milk chocolate with a butterscotch filling, but now for me, it's muscles and fat and tissue. And that's just creepy.

Lines

I had a busy weekend last weekend. On Saturday, I went to Mexico with a group called the Flying Samaritans. It began back in the day with a few doctors flying down to Mexico to provide medical care for free. Now it has grown to several chapters of the group at different schools, and UC Irvine School of Medicine now has its own chapter. We should be called the Driving Samaritans, because we get up early in the morning and drive down to a place south of Tijuana. Last weekend it was so cold it was snowing both in San Diego and Mexico, so we didn't have that many patients. Probably the really sick ones stayed home in bed. Nonetheless, we were there for several hours, without time for lunch. I was so underdressed that I shook and chattered all day and nearly caught a cold myself.

Our first patient was a young guy who looked about college age. He'd been in a car accident a few years ago, busted a few ribs and got intubated while in the hospital. They left him intubated too long though, and it damaged his vocal cords, so now he can't talk. What's worse, they gave him a stoma, which is a hole in your throat that you breathe in and out of. It functionally replaces your mouth and nostrils, bypassing the blockage might be in your windpipe below your mouth/nose but above your throat. In his case, it was inflammation and scar tissue. He had nasty scar tissue all around his external neck too, from surgeries to repair the damage to his vocal cords. All this I found out from his mother, who accompanied him to the clinic and did the talking for him. So why did he come to see us last weekend? Apparently, he came for the first time to the clinic during the last trip down there, before I had joined the group. The tissue around his stoma had gotten so infected and was oozing so much pus that it was clogging his only breathing hole. If his stoma ever gets completely clogged, that is the end of the road for him. He doesn't have any other way to breathe except that little hole. So all he really needed was antibiotics to keep his stoma free of infections. But where he lives, he can't get antibiotics. He cleans his stoma with a cloth and water, and that's all he can do. My classmate Randy was down there last month, and he said that the patient had improved vastly with the antibiotics they gave him. Indeed, he looked well-built and healthy, not sickly. He even had a nicely shaven little stylish beard, like the ones I see on college-age guys here all the time. He just seemed like a normal guy. He didn't have fancy clothes, but they were clean and he wore them well. I know that sounds weird, but maybe it was the feeling I got that although he was seeking help, he didn't project helplessness. He had impeccable manners. When I brought a chair over to the exam room for his mother and him, he wouldn't allow me to stand. He silently insisted with his gestures that he would stand, so that his mother and I could sit, even though he was the patient. While the rest of us talked about his condition, he made appropriate gestures, participating even through his silence, and closed off his stoma with his hand at one point to ask me how many languages I spoke. He certainly did not play the pitiful part of a helpless patient.

We couldn't do anything for him. We had brought a family medicine doctor and a pediatrician, obviously neither of whom could perform correctional surgery on this guy, particularly not in a clinic without electricity or water, with just our cardboard box of ibuprofen, antibiotic ointments and blood pressure cuffs. But I could see that both the mother and the patient were here because we offered some kind of hope for him. We had brought doctors, after all, and doctors are supposed to be able to help. I felt impotent and frustrated. There are so many lines all around us: monetary ones, linguistic ones, and geographical ones. This dude lives just a few miles from the U.S.-Mexico border. If he was on this side of that line, his current state would probably be very much different. We talked about "papers," because it turned out he has "papers." That represented a surprising ray of hope, that he could legally come to the U.S. for treatment if he had to. But the line he cannot cross is not geographical, it's financial.

In the midst of all the anti-immigrant sentiment whose flames were fanned and made into a nice, roaring fire by Republicans for the November elections, I kept thinking about a student that Darron told me about. My trip to the clinic made me think of him again. Darron asked his class one day what they thought of people who didn't want them to come here from Mexico because it was illegal. This student, Darron told me, paused for a moment, then replied, "What would you do?" Seriously, what would any of us do if we were hungry just a few miles away from the Land Where People Die of Overnutrition? I don't think it should be a mystery to anyone. Particularly anyone who's been a parent should understand the motivation for anyone to give the very best opportunities to their children to be healthy, happy, and better off than themselves.

So that was just my first trip down there. It's depressing. Even when I've gone on vacation trips there before, I've never been able to completely enjoy myself in Mexico because of the povery. But I want to keep going. If bringing this dude antibiotic ointment will keep his stoma from getting infected, then we did something, however small. Many of the other folks, all they need for treatment are simple things. I heard there was a lecturer that went to Africa somewhere, and conditions are so bad there that all they need to make vast improvements to the health of the village as a whole is multivitamins. Multivitamins. Such simple cures for maladies that aren't medical mysteries, and yet people are still dying from them because we have lines. I'm not sure how I'll handle it if God forbid, I ever go back and hear that my patient died of suffocation, caused by a simple infection. I know that drawing lines is human nature, and this is the way things always have been. I'm not disillusioned into thinking that I can change human nature, but that doesn't mean I have to like it. For every person I see like the young guy with the stoma, I'm sure there are millions of other sad stories like it. Some days, being a doctor just doesn't seem like enough. What good does it do to know what someone is dying of if you don't have the means to treat it? Then all that medical knowledge is simply trivia to sit around and talk about while you watch people die.