Firechick Goes to Med School

Walking Pool of Incontinence

2009-11-01T20:40:00.000-08:00

Darron is having his annual fundraising basketball tournament on 12/19 for the Sarcoma Foundation for his late friend. You can find out more about it by visiting his blog, I'm sure.

Ever heard of a fistula? Probably not, because it's a gross topic. This article gives you an idea about the problem. Essentially, when tissue heals, sometimes it heals all wrong. A fistula happens when tissues heals incorrectly between two pipes - like the trachea and the esophagus (the windpipe and foodpipe), or the vagina and the anus - and leaves a permanent hole connecting them. In babies with tracheoesophageal fistula from an error in development, they gag and turn blue when they try to eat, because food enters their lungs through that hole that isn't supposed to be there. In vaginovesicular (vagina/urethra) or vaginoanal fistula after a difficult childbirth, a permanent hole allows urine or feces to dribble continuously into the vaginal canal. If any of you has ever dreaded the thought of getting old and incontinent, this is your nightmare: being a young adolescent or teenage mother - likely by crime or at least social/cultural choice, not your own - having a difficult labor, then shunned from society for being disgusting.

When my life seems so hard, sometimes my breath is taken away by how awful my patients' and other unfortunate people's lives are. There are so many worthy causes out there, but with the holidays approaching, please consider adding this one to your list.

I better be careful with this blog, lest it become too much of a party pooper (haha, no pun intended) and my vast readership takes a dive.

My Heart Bleeds

2009-09-25T19:13:00.001-07:00

The article.

International Medicine

2009-08-28T21:50:00.000-07:00

Not that it was drastically different from the norm, but it was a little more concentrated than usual: the international flavor of my daily routine, beyond the normal Spanish and Vietnamese.

I finished my emergency medicine rotation and am now readjusting to being back in the inpatient medicine setting. Of our patients, we currently have a Korean man and his wife who speak very limited English, a Spanish-only spouse of a man rendered stuporous, a Romanian-only, and an Arabic-only speaking patient.

I am constantly surprised by otherwise very intelligent and caring medical professionals, who don't seem to be able to relate to English learners. Even if they are nice people who aren't purposely being mean toward a patient for not speaking English well, they don't seem to be able to modify their rate of speech or vocabulary. The same happens even with native English speakers that just have less education. The doctors continue to use idioms or phrases and words that are more advanced, like saying, "we anticipate he will leave soon" instead of just saying, "we think he will leave soon." Sometimes the low-level English speaker glazes over when they are faced with a few difficult words like this in a row, and I can tell they have lost the thread of the conversation. But the doctor will continue on, oblivious that the person isn't making obvious his or her confusion, perhaps due to embarrassment over suboptimal English skills.

This happens to me all the time in Spanish. I appreciate Spanish speakers who have lived in the U.S. for a while compared to Mexicans at the clinic I used to go to in Mexico through the Flying Samaritans. Even though both groups spoke only Spanish, the ones who had come to the U.S. generally knew to use simpler Spanish words and slow down so I could follow along. The ones without experience with non-native Spanish speakers would just chatter along at the speed of light, or use colloquialisms I had never heard.

I think I'm a pretty good contextual comprehender; it's how I blended into American life as a teenager without knowing teenage lingo or many swear words when I came here. It helped when I was in the fire department, whether it was banter in the firehouse or with the public out in the non-standard English-speaking neighborhoods. It's proven helpful when I traveled in Europe and South America where I often understood the gist of what was being said even if I didn't catch all the words perfectly. But tourist conversations hardly compare to the gravity of medical explanations and decision-making. It's hard enough for the lay person to understand medicine as it is, without a language barrier to compound problems.

In any case, all my non-English speaking patients and their families seemed happy at the end of the day. In particular, the Spanish-speaking spouse was adamant yesterday that we call an interpreter when they transferred him to our service. My Spanish isn't great, but the translator was going to take a while to arrive, so we tried her out anyway in the interim. At first she was dubious, but by today, she was appreciative, smiling and waving at me as I walked by the room. Her otherwise healthy husband has been gorked out for a month, the doctors at the prior hospital hadn't been able to fix him or even tell her what the problem was, and she was freaked out. The Koreans too, they were sad that they were stuck out here in California when all they wanted was to get back home to the Midwest, but they were a little happier when they had a better grasp of their care.

In a place like California, no one is going to learn every language spoken and there just aren't enough translators. But I think simply slowing down and using simpler words so people can understand really helps them cope with their medical issues.

Veggies

2009-07-06T19:48:00.001-07:00

About a month ago a classmate on his family medicine rotation told us about the hypertension (high blood pressure) clinic he was at that week. He remarked that he was going to try the DASH diet that we tell patients to follow, which stands for Dietary Approaches to Stop Hypertension. Essentially, it is all about eating 10 servings of fruits and vegetables per day, especially at the beginning of a meal before getting to the other stuff like meat, bread, potatoes, etc. So I decided to give it a try too, not even paying attention to reducing salt, but just concentrating on the 10 servings.

It's hard! I'm so full after eating fruit and vegetables that I don't have room for much else. Of course, I also try to keep it reasonably low-fat, without actually going on an "official" diet. I don't pile on the butter, although I do use some to keep it interesting. And since I started this because I wanted to see if I could do what we tell patients to do, I also began to ponder how I could convince someone used to eating pretty unhealthily to start eating well. And I think the answer is in 1) changing expectations and 2) educating taste buds.

I was raised on plenty of veggies daily, and our minimum level was salad with dinner every single night. It was a very simple salad, but its mere existence got us accustomed to eating fresh vegetables, I think. Even for "movie night" where we had popcorn and chicken nuggets and potato chips, we also had carrot and cucumber sticks without fail. So even now I have a fundamental expectation that there will be some sort of vegetable to eat every day. In fact, if I don't have fresh veggies for a while, say I'm on a trip, I start really noticing their absence and missing them, just as I would unhappily notice if I hadn't eaten any meat or starch in several days.

A while back, my uncle Tom gave me bunch of veggies from his garden. They were delicious! And that is my second point. The typical Western diet is really just a super-saturated behemoth of taste. Like McMansions and SUVs, Americans tend to want bigger and more, like taking something sweet and adding something else sweet to it to make it even sweeter, instead of just enjoying the one sweet thing on its own. Like cake and ice cream with chocolate sauce. Deep-fried Twinkies, anyone? You get my point. It's just more! more! more!

In grade school I remember we did an experiment in science class when we were learning about the digestive tract and the enzyme amylase. The teacher told us that amylase starts breaking down starches into glucose in the mouth, even before the food gets to the stomach. And to illustrate this, we all took a bite of plain white rice. After several chews, the rice indeed started to taste sweet, and we were amazed! So really, veggies and grains have their own sweetness that we have trained ourselves out of being able to appreciate with our 30-teaspoons-of-sugar-per-can sodas. Of course steamed broccoli will taste bad when your taste buds are hungering for tons of cheese, salt, or ranch dressing; they're underwhelmed because they've been oversaturated for so long. But if you slow down a minute (take time to chew a little more and let that amylase start to do its thing) and actually learn to appreciate the subtlety of a vegetable, I think it starts to become a more enjoyable, and thus, sustainable operation. Growing your own is a great start, because you're already primed to have pride in and appreciate your creation.

This all is exactly the same as music or art or finances or NASCAR. To those unversed in it, classical music sounds all the same; so does rap or country music. Art can be pretty boring, especially modern art, which just looks like paint splotches to me, as can finance for those of us who just want to stick money somewhere and have it grow a bit. To the casual observer, NASCAR is just driving in circles. So appreciating fresh veggies is really the same as with anything; the more you take interest, the more you know, then the more enjoyment you get out of it, and eventually you will be able to discriminate higher quality from the crap.

I wonder if any of my patients will be convinced... what do you think? All right, back to the grind. I can't believe I wasted my study break thinking and writing about patients!!!

Attention Span

2009-06-16T18:33:00.000-07:00

I find myself comforted by the fact that I get bored during long surgeries. When they're interesting, surgeries definitely are fun to watch or to help with. I like sewing people back up and feeling the immediate gratification, so I can only imagine the satisfaction that must come with opening up someone's heart and making it better. But it's not worth spending a lifetime of not being able to take a break! A few years back, one of our UCI surgeons had a heart attack during a super long surgery. There was no one else who could take over, so he just had himself hooked up to a nitro IV and finished the surgery because he couldn't walk away and leave the patient flayed open on the table. Now that's just craziness. Admirable, certainly, but crazy nonetheless.

I find my boredom comforting because for a little while I thought surgery might sway me away from emergency medicine. Switching to surgery as my specialty choice, however, would throw my life into a vortex, because every extracurricular activity I've done so far, my whole medical career foundation, revolves around emergency medicine. Many ER doctors I know confessed to their utter boredom during their med school surgery rotations. One, very near and dear to me and who shall remain unnamed - a certain Dr. P - fell asleep while he was holding a patient's chest open with the retractor! So by being bored in surgeries sometimes, I know I'm on the right track.

Moments of Clarity

2009-06-15T23:47:00.000-07:00

As I was getting bored during a surgery the other day, I realized that no matter how long the surgery drags on, surgeons can't just wander off to grab a bite to eat or get on the internet like I do to recharge before going back to studying. And THAT, my friends, seems like a drag.

Another thing I realized today: regret is a terrible thing to have. They say, you usually regret the things you don't do more than the things that you do. I think that's quite true.

First (Academic) Publication

2009-06-01T22:13:00.000-07:00

Yay!!!!!!!!!!!

Sent:	Monday, June 01, 2009 6:04 PM
To:	Swan, Pamela
Cc:	The Authors [authors-uciem.westjem-1584@cdlibrepositories.bepress.com]; The Editors [editors-uciem.westjem-1584@cdlibrepositories.bepress.com]

Dear Pamela Yamamoto Swan; Beverly Nighswonger RN; Gregory L. Boswell RN; and Samuel J. Stratton MD, MPH,

After careful review, your article "Factors Associated With False-Positive Emergency Medical Services Triage for Percutaneous Coronary Intervention" has been accepted by the editors of the Western Journal of Emergency Medicine. You will receive a page proof prior to publication.

Thank you for your submission and we look forward to receiving your future scholarly work.

Sincerely,

Mark Langdorf MD, MHPE
Editor
Western Journal of Emergency Medicine

Conquering the World

2009-05-28T17:21:00.000-07:00

Hooray for mutts!

The editors thank Darron Evans of Huntington Beach, CA for contributing this article.

CABG

2009-05-15T22:45:00.000-07:00

CABG stands for "coronary artery bypass graft." I watched a patient's heart beating during a bypass surgery today. It was pretty cool, but not as awe-inspiring as I thought it might be. Am I too jaded, or too educated now to be stricken with awe? The weird thing was that the most memorable part of that surgery was when I told the surgeon the three standard expressions of Japanese surprise were: "Eeeeh?" "Waaaa!" and "Oooooh!" The whole room burst into laughter while the dude's heart was hanging out in the open. And THAT, to me, was the most remarkable part - that they were all so at ease even while elbow-deep in some guy's chest cavity that they could have a belly laugh during bypass surgery.

Ah, I so miss being at ease and good at what I do. People used to think this about ME as I stabilized and packaged multiple gunshot wounds, did CPR on heart attacks, and dragged myself half-asleep to put out car fires. Now I get excited about drawing blood. "Someday" can't come soon enough.

Unplanned

2009-05-12T18:33:00.001-07:00

Just as we were sitting down to morning rounds to discuss our patients' treatment plans for the day, the traumas started rolling in. With five back to back, it was crazy - kind of like you see on TV, in fact. The most critical of the five was a girl in her early twenties, hit on the freeway during the morning commute. She had been extricated from her car by the FD and was unresponsive but with a pulse and breathing. All sorts of stuff was done to stabilize her cardiovascular system. Once it was stable she was taken for scans and tests, but she deteriorated again into unstable condition, so they finally decided to do an exploratory laparotomy. Basically, they sliced her open virtually from neck to pubis, a good 2-foot incision, and just started looking around for the source of bleeding. They found it - it was her spleen - and at the end of the day, she had: half her hair shaved off presumably to put a tube in her head to relieve the swelling or bleeding of her brain, a collapsed lung, a shredded spleen, 12 units of blood, a shattered pelvis, and major abdominal surgery. And no one knew who she was, so no one could contact her family.

The humane thought: I'm sure she didn't mean for this to happen when she woke up today. I hope they figure out who she is soon and call her family.

The med student insight: this must be the satisfaction of surgery, to see a patient from crash to fix, the beginning to end. But I still like being in the ER more than the OR.

The cynical side note: do not worry whether you wore clean underwear or not when you crash your car. We really don't care or look when we cut them off, and you probably will have peed or pooped in them by the time you get to us anyway.

Sad and Happy

2009-05-10T19:16:00.000-07:00

We had a sad case today and a happy one.

A 17 year old kid was brought in after hanging himself because he wasn't getting along with his girlfriend and his mom. His mom found him on the floor of his closet, unconscious, because the belt broke. She of course followed the ambulance to the hospital, but he had regained consciousness by that time and was insisting he didn't want to see her. Some mother's day.

In another case, we had a post-operative guy (I'm on the surgery rotation now, on the trauma surgery team) whose pneumonia I found. So now we can treat it early before it turns into something really bad. The team gave me kudos, which was unexpected, as they usually just ignore the med students. I also get to do some things now that is not in the paramedic scope of practice. I got an arterial blood gas out of someone's groin and took out a chest tube, and helped staple a stabbing victim back up.

Paradoxically, I'm feeling better so far on surgery than I was on pediatrics. I say paradoxically, because peds is supposed to be all nice and fluffy and warm, and surgery is supposed to be harsh and unpleasant. The only hard part for me is waking up at the crack of dawn... I will never get used to that!

Well, Happy Mother's Day to my mommy and all the other mommies out there! May your children never bring you pain like the sad case today.

Phoenix

2009-04-26T12:38:00.000-07:00

What does it mean to have self-esteem? Parents think their children having enough of it will prevent them from doing stupid things to mess up their lives. Books are written on how to acquire or nuture it. But what is it, really? Who has it? What happens when you wake up and realize you don't have much of it?

Medical school is designed, much like fire academy, to show you your lowly place. That you know nothing, or that the work you do is so worthless it is always repeated by someone else. There is a never-ending parade of exams, all orchestrated to assess how much you don't know. Rounds are structured so that people ask you questions you can't answer, or they ask you harder or more questions until you can't answer, then they provide the answer to show you that you don't know enough. Occasionally you get lucky and get it right, but usually the question is set up so the asker can deliver the answer, like a joke. And virtually without exception, your intellectual emasculation is in the presence of witnesses. There's a name for this: pimping. Rotations are scheduled so that every month or two weeks you are sent to a different hospital or neighborhood clinic - sometimes every day for two weeks - with different people, hospital hallways, security codes, computer systems, equipment, storage, forms, at times you even have to switch your brain over to the predominant language of the new locale. Even the antibiotics used for an infection with the same bacteria might have different resistances depending on the institution or geographical area you are in, so you could find that what you knew last Friday at Hospital A is the wrong answer on Monday at Hospital B. Or that what works for adults, due to whatever random biochemical reason, doesn't work for kids. I want to shout, same species! same species! all the time.

If you can imagine changing jobs every month or two weeks and having to learn a whole new set of skills under pimping supervisors who you can't tell where to go, you are on your way to imagining a med student's life. To add insult to injury, you are paying for the uplifting experience of being everyone's bitch. Or maybe someone else is paying for it, be it your spouse or your family or the bank, then you are not only everyone's bitch who pays to be mistreated, you are also everyone's bitch who goes into debt to be mistreated. That certainly doesn't bolster confidence in your own intelligence. Even the fire academy was only for three months, and I was paid $10/hr for my daily beatings. It is a wonder to me that medical students ever smile.

Some of us have incredibly supportive, nurturing, caring significant others who don't take advantage of our state of constant humiliation to make us feel worse. Others maybe have friends or family outside of medicine who can provide perspective that outside life isn't quite as punishing - it may be to some degree, but not at the steady pace of Chinese water torture as in medicine. And then there are those whose inner Phoenix gives them strength from within, that reminds them that they are intelligent, accomplished, rational, sensitive, caring, and good. That the mental torture may be pretty bad at times, but can be survived as long as one doesn't lose the broader sense of one's self.

Maybe self-esteem is really a little firey bird in your soul that rises out of the ashes of your emotional beatings to remind you who you really are, when you are led to doubt your own perceptions of yourself.

Teenage Lessons

2009-04-13T20:38:00.000-07:00

What can you teach a teenager in five minutes?

I've been doing pretty well with my three year-olds, six year-olds, and I've been all right with the 17-18 year-olds, too. I've made a pleasant discovery that doctors totally take off diapers to check whatever, but then they get to say, "Okay, I'm gonna let you put him back together now," and go on their merry way. I can even calmly complete an ear exam with a screaming one year-old now, which I consider the crowning glory of my first pediatric outpatient week.

But those adolescents and early teens, they're awkward and weird and not at all like the other age groups. To be sure, I am the consummate professional, and always do my best to speak factually, without showing signs of discomfort. Sometimes I just make a quick little speech about teenagers being at higher risk of STDs, drugs, etc. because 1) we don't have the time in one office visit to explore the depths of their bourgeoning sexuality and angst, 2) the pediatrician himself doesn't go near the topic but I feel like they should - even if briefly - hear the message we are taught to deliver, and 3) I've been told teenagers just want the spotlight to be off them and not have to talk much about themselves. I do all the things they tell us in class, to make sure the parent is out of the room when asking about sex and drugs, always reiterate safety, and let them know they can talk to their doctor if they want information. I do the speech in front of the parents, skipping the personal questions part, when I don't actually think the kid is into anything yet. But it bothers me when the parents look uncomfortable. I think, this is their kid and they're the ones uncomfortable here? Then I second guess myself: am I overstepping boundaries? I sure would want an authority figure drilling into my kid that they should avoid sex and drugs but be careful if they do decide to do them. But of course I realize I'm not everybody, in fact, I'm not even a parent. So what do I know.

So what can I do... I guess just stick to the biological and statistical facts and be nice and polite and personable. And bide my time until pediatrics is over in three weeks and I can go back to talking to adults about their sex and drug habits... you know, back to the easy stuff!

I Don't Remember Saying This

2009-04-06T19:39:00.000-07:00

To whom might I have said this? Back in December 2004? I've never even seen this article before. Another good reason to avoid the media, perhaps.

Highlights for Children - ER Editon

2009-04-05T19:41:00.000-07:00

No one wears button-down shirts and ties in the ER, and the monitor behind us is blank. What other wrong things can you find in this picture?

And to be clear, I didn't exactly say all those things that were in quotation marks. This is why everyone knows - avoid the media at all costs!

Coupon Fairy

2009-04-01T09:15:00.000-07:00

Here's something Darron and I like to do:

Next time you go to a restaurant with coupons, take along the inevitable second coupon that you won't use in the next three days before its expiration date. Scan the room, and find a nice couple, the lone diner, a cute family. Then give them the coupon. It's always smiles all around.

The other night we picked a little family of a dad and his three kids. As they left, the teenage boy jubilantly said, "thank you for the dessert!" while the little kindergartener just smirked sheepishly and looked around nervously as his dad told him to "say thank you!" It was cute.

OPD Memorial

2009-03-30T15:20:00.000-07:00

March 27th was the memorial, which I was able to attend. My OFD buddy Linda said, "What? You're driving up here after work?" and promptly bought me plane tickets instead. She's an amazing person.

I arrived inside the Oakland Arena for the memorial early, but it sounded like the morning was an amazing thing to see, with the motorcades escorting the caskets to Oakland. Freeways were jammed as miles and miles of patrol units, motorcycles, and fire engines made their way to Oakland. I read that as they crossed into the city limits, each freeway overpass was lined with firefighters from Alameda County and elsewhere, saluting the motorcades below.

There were cops from everywhere. In all the talk with OFD folks, as well as newspaper articles and online reports I read since then, I heard about so many departments that made the trek. There were cops from all over California, to say the least. An Emeryville firefighter told me there was a group of motorcycle cops from Orange County Sheriff's Dept. that left their motorcycles at her firehouse the night before, after the 8-hour ride up. I heard Chicago PD made the 2100 mile drive out here, some PD from Minnesota also driving out. There were 50 cops from Boston - I saw many of them myself - and I heard JetBlue donated a plane for 250 NYPD members to attend. We saw Canadian Mounties, and I read somewhere that there was even a cop from Tokyo. One department had their SWAT unit there. I was asked why cops would drive out from so far away in their patrol units or motorcycles instead of flying in, and the reason is so all those cop cars could be present, to show solidarity and support. I saw many AMR employees too, and I heard Highland Hospital staff were there as well. Of course, several fire departments had members in attendance, and the majority of OFD was there, too. I got to say hello to lots of old co-workers, even though it was for the worst reason. Geoff, my old captain, as well as Heather, his friend from Emeryville FD, passed up sitting in the fire dept section so they could sit with me in the general section. It's good to have good friends.

I've never seen a memorial like this before, and I doubt I'll ever see anything like it again. The entire Oakland Police Dept. was in attendance, the motor units with their domed helmets and K9 units with their German Shepherds, non-sworn employees, and Animal Control too, as Alameda County Sheriff's, the CHP, and I even heard LAPD were on the streets to handle Oakland during the memorial. There were so many people in attendance, a few thousand spilled over to the Coliseum to watch on the big screens. When the honor guard took the flags off the coffins and folded them for the police chief to present to the surviving families, there was not a sound. There was an occasional throat cleared, the sound of men trying to control their tears, but nothing else. No babies crying, no cell phones, no K9s whining, no sirens outside, nothing. To say "you could hear a pin drop" would be too cliche, so I will say instead that in the whole arena where they play NBA basketball games and were maxed out to their 20,000 seat capacity, you would have been able to clearly hear someone dropping a water bottle or a plastic cup. That's how quiet it was. And it lasted for about 10 minutes.

There were many people who spoke in the ceremony, but the most memorable was the SWAT captain. He was just impressive, with the perfect amounts of sensitivity, toughness, grief, inspiration, and praise for the four officers, as well as the rest of OPD. He singled out and gave a heartfelt thank you to the citizen who rushed over to perform CPR on one of the first downed officers. He too sighed a lot, but delivered the eulogy bravely and toughly. He projected the air of one of those natural leaders, the type of man you flock to in fearful or uncertain moments. After the general remarks and eulogies, each officer had their own. I had long lost it at the beginning, the moment the bagpipes started playing, but Dan's part was the hardest. The K9 units were impressively silent throughout the service, but when someone walked out Dan's K9, "Doc," to the coffin, he gave four or five barks. It was the saddest sound all day, even more than the bagpipes or the bugle playing taps.

At the end of the service, we saw four groups of five police, Coast Guard, and rescue helicopters, one group for each officer, fly above the Arena in Missing Man formation. There was a 21-gun salute by the National Guard as well, which I later learned is the highest symbol of honor the United States can give.

The memorial was a good tribute. I'm so glad I went. At the end of freshman year at Cal, I was stranded in Berkeley without a car. I was going to live with Grandma in Lompoc and borrow Tommy's car that summer, but I needed a way to get down there. So Dan gave me a ride. He drove five hours down, politely said hello to Grandma and Grandaddy Lee, maybe had a cup of coffee, then turned around and drove the five hours back up! He said he could go visit his own grandparents in Nipomo, but I don't think I ever really believed him - I'm still not sure he wasn't just being a really great person. Grandma liked him, which of course says volumes about his character. So I'm glad I was able to finally make the trip for Dan, just as he did for me, many years ago. I just wish it had been for a different reason.

Still There

2009-03-24T19:20:00.000-07:00

I was looking around for more information on the OPD officers, when I found this on the OFD homepage. I was touched that they hadn't taken me down. Probably because no one can recognize it, but it's still nice at a time like this to feel like I belong to something.

Rest in Peace, Dan

2009-03-23T13:03:00.000-07:00

It's hard to lose a family member. It's sad to lose a friend. It's sobering to lose an acquaintance. What do you call it when you lose a fellow sworn public servant? What if the fellow public servant used to also be a friend? What if he was a friend and former co-worker and was murdered in the line of duty?

I knew Dan Sakai when we went to college together. We worked at the UCPD where he taught me the ropes. We were pretty good friends for a time, then he moved to Japan to teach English while I moved to LA to become a paramedic. We were both the EMTs of our group at work, but he eventually continued the law enforcement path and I took the fire route. In reading the recent news about him, I realized we were both hired by the City of Oakland in December 2000, he at OPD and I at OFD. We popped up in each others' lives every so often, sometimes on scene at an incident in Oakland, sometimes outside of work. I last ran into him a few days before I left the OFD. Our engine and a few patrol units happened to converge on a Starbucks for some emergency caffeine. We caught up a bit, his wished me luck in med school, and I wished him luck at OPD. A couple months ago, I texted him out of the blue when I was in Big Bear, because I remembered he was from there. Of course he asked me how med school was going and such, I told him to stay safe, and that text exchange was the last.

What is it about emergency services? Is it having served in a dangerous place like Oakland together? Is this what military people feel when they hear about a downed soldier? What was it that I felt after 9/11 when 343 firefighters I'd never met died 3000 miles away? It must be a bond of some sort, although I have a hard time describing it. It must last even after one leaves their agency, because I still feel sad even though I'm not at OFD anymore. When they swear you in, you take an oath to serve and protect. But of course that means you swear to your crew and co-workers, too. And when you leave, they don't swear you out.

Still, I am mostly sad because although we grew apart in recent years, he used to be a good friend and mentor. It must be a combination of sadness for a friend and regret for someone who worked the same streets I did, because I wonder if I would feel this way about a similar friend in college but with whom I didn't serve the public. I've had a flurry of calls with former UCPD and OFD co-workers over this. I really want to go to the funeral. I miss being around them. I have not regretted changing career paths, but right now all I want is to be in Oakland and sit around a firehouse table or run into AMR or OPD on a call and sit around and BS or just look at each other, and know. I feel stranded out here. I requested the use of one of my two days off for the year so I can attend the funeral. I hope they don't reject my request just because it's not for a family member. There is a very strong tie among those who wear navy blue, and even though I gave up the blue on the outside, I think I will always be a lot of blue on the inside.

My thoughts to the families and the kids who will grow up not knowing their dads, particularly Dan's, who I think must be about three years old by now. I hope their sorrow soon abates to pride.

Where I Stand

2009-03-03T23:57:00.001-08:00

Today, math nerds everywhere celebrated square root day.

You know how violas are the butt of the orchestra and tubas get laid? And truckees are not too bright, engineers are lazy and medics are wusses? Or PE teachers are gay and chemistry teachers are dorks? Subgroup analysis abounds everywhere, even in this nice little tool to help me find my life's calling:

Blissful Ignorance

2009-02-12T21:27:00.001-08:00

I like knowing things, as any person might, but there are some things I just would have been okay not knowing. I'm having many such experiences on OBGYN. I have had enough vagina to last me a long, long time. And I have really seen enough infected ones to last me forever. I also get to be at the hospital by 5:30am to go look at them. The good news? I have narrowed my prospective career choice by yet another specialty.

25 Random Things About Me

2009-02-05T17:54:00.000-08:00

There has been one of those silly chain things going around online lately. I usually don't fall for or participate in them, but since I have not had a post recently and I actually succumbed and wrote something back, here it is for your passing interest:

Though I worry about certain things, I usually delete chain letters without a single thought to the karmic implications.
I love when it rains and I am in bed with nowhere to go.
There was a period when I dreamed about being murdered or committing murder every night or every other night. Now I have nightmares about dirty houses.
I am not always grumpy in the morning.
I am currently a Disneyland annual pass holder. I never thought I would be one of "those people."
I know a Robin, a Hawk, a Jay, and a Bird.
I have always wanted a pet, but the one time I actually got one, I couldn't handle it.
I found a job four days after moving away to college. I worked at a bookstore. It lasted a few months until the creepy old stock guy with cigarette breath started standing too close to me on his breaks.
I eat sausage and hot dogs, but I don't eat pepperoni.
Of the things I used to do for work, I miss driving with lights and sirens the most.
When I was born, my dad was surprised to find I was the ugliest thing he'd ever seen.
I am addicted to Dear Abby.
I never ditched or got detention in high school.
The longest I've stayed awake at once was 46 hours. At the 43rd hour, I played pickup basketball with the guys after work.
I like frozen yogurt better than ice cream.
My first career aspiration was a novelist. I started writing a novel when I was twelve. I quit because I hated my childish writing but didn't know how to fix it.
I am neither a leader nor a follower. I often wander off on my own.
I have only broken up then subsequently gotten back together with one man.
Once when I was a new driver, I was so angry at something I actually called someone to pick me up because I didn't think I could drive.
Excessively bubbly people seem either insincere or a little slow.
When I was a kid I got really good at sneaking peanut butter, which we weren't allowed to eat because it would stick to our teeth too much and give us cavities.
My mother used to let me run around in the snow in only diapers.
I buried a dead mouse on the way home from school once because I felt so sorry for it lying in the sidewalk. When I got home later than expected, my uncle said he was going to write a book called, "101 Excuses by Teenagers."
On the other hand, I used to chop off the heads of ants as a child and watch the headless body run around.
I have occasionally stood in front of the mirror making funny faces at myself and cracking up when home alone.

Anyone else care to share random facts about themselves?

Big Bear

2009-01-08T19:28:00.001-08:00

Our Big Bear stay at the Honeymoon Hideaway did not last long. There were several little things that were suboptimal yet tolerable, until we spent nearly three hours trying to get out of the driveway the next day! We imagined it would be icy in the morning, so fighting all natural instincts to wake up early, we waited for it to warm up before we set off around noon. Darron had tire chains, but the incline of the driveway coupled with the ice proved to be insurmountable and we learned the feeling behind the phrase, "snowed in." Our entire day was shot just trying to leave the cabin.

So we very nicely brought this to the management's attention and requested another option. For our trouble, we were upgraded - for no extra charge - to a grand, new cabin that slept six, had marble countertops and stainless steel appliances, a jet jacuzzi, pool table and darts board, two decks, a fireplace, a heating system and effective insulation, and best of all, a driveway we could drive in and out of!

From then, we could not be stopped except by our own vacationy laziness! As it was midweek and the crowds were gone, we went on a peacefully (mostly) solitary walk around the frozen Big Bear Lake, built a snowman, made yummy dinners (one night Darron made the most perfect s'more ever), went skiing where Darron avoided smashing his head for once and I avoided having shoulder surgery again, read books, watched cable TV (remember, I gave away my TV and Darron only has snowy analog network channels!), explored the neighboring town, and also visited the little local Moonridge Zoo, which takes in injured or orphaned local animals, or sometimes even abandoned exotic pet animals.

We saw retired San Diego Zoo arctic foxes, owls of many sorts, a black bear who was found as a baby abandoned and starving in a watermelon patch, some bison, bald and golden eagles and hawks who got cataracts and went blind from pesticides or were shot by ranchers, a mountain lion, a squirrel with vertigo that was found injured after he fell out of his tree, a tortise named Speedy, a very nervous African hunting cat called a serval, and these young timber wolves. So mournful and eerie. If you've never heard a wolf howl, hit the "play" button below.

And we adopted a snow leopard named Milo for a year. Snow leopards are an endangered species, very rarely seen in Central Asia, and never below 5000 feet elevation, which is probably why he's in Big Bear. Our little adoption fee goes toward feeding and caring for him, though watching him eat, it probably only buys him two days' worth of food! You can read about all the animals' stories here.

Tom's Niece

2009-01-03T14:54:00.000-08:00

Turns out Tom is not the only one in this family with perfect pitch (aside from our more actively musical family members, undoubtedly). Darron came up with an electronic tuner, and I hit A right on the money! followed by E, D, and G. Now I just need to dust off that ol' violin and record a few albums to pay for all those lessons that apparently taught me this vastly useful skill...

Cultured

2009-01-02T23:29:00.001-08:00

Our LA field trip:

I'm not a huge museum person, as anyone who has been to one with me can attest, but I wanted to see the Getty for its architecture and the views were supposed to be fantabulous! Turned out to be foggy with visibility of like o.1 mile, but it was kind of cool to be high up on the mountain in a neat place in the wispy, drippy fog. Made me feel like I was in Star Wars, in a place like Naboo. Darron wasn't keen on going, but he ended up enjoying the art quite a bit (and I finally learned what Rococo style is), so that made the acculturation all worth the $10 parking fee.

A couple of hours later we headed a few miles away to Beverly Hills. On our way we found some irony. For lunch, I am so sick of Mexican food that I never eat it if I can help it, but we went to a place that made oh-the-best Mexican food I've had in a long time, if ever! Today it finally occurred to me why I'm sick of it: it's because it's ALL the same. Everywhere you go, it's all the same. Burritos, enchiladas, fajitas, tamales, flautas - with 50 bajillion Mexican joints to choose from around here, it's all the same! But this place, they had the most interesting Mexican food ever, and it wasn't some sort of fusion food - their recipes came from their ancestors (or so they say). Darron ordered horchata too, and although I usually don't like it, this stuff tasted just like liquid rice pudding! And the corn tortillas, which I also don't generally like, were so soft and fluffy.... mmmm, sooooo good. It was all good. My Mexican taste buds were revived in this oasis of yum. The price was not bad either, compared to the cost of an ordinary lunch elsewhere, for the resurrection of a cultural cuisine.

After our wonderful gastronomical experience, we wandered over to Rodeo Drive for a little window shopping. I have to say, the famous Rodeo Drive didn't impress me much. For one of the priciest shopping destinations that the stars all go to, it was only two blocks long, with the same stores you see in major cities everywhere. There were even a few storefronts with "For Lease" signs and carelessly hung butcher paper in the windows. It was a very uninspired place, save for the Mikimoto store. We dropped in and found one of the employees to be nice and chatty, considering we must have looked like hobos compared to their normal clientele. We learned a few tidbits about pearls, the economy, and "luxury-class" shoppers. These shoppers have not been immune from the economic downturn because, as the employee put it, "they have money, but they're scared money." And about pearls: the golden pearl is the most rare and from the Tahitian seas, while the smaller white ones are cultured in Japan. Earlier at the Getty we learned that when Mark Antony first met Cleopatra at a feast she threw for him and was surprised at its opulence, it's said that she threw a pearl into her wine and drank it to show him that luxurious excess didn't concern her. Now that's brave money!

The Griffith Observatory was our final stop. Since its 4-year renovation, it looks great! If you haven't been there since 2002, it's worth another visit. The new reclining seats in the planetarium and the show itself are nicely redone. Did you know that the earth "wobbles" on its axis one full turn every 26,000 years? For this reason, astrology, which is based on readings from 2000 years ago, is off by about a month! Does this mean I'm actually a Sagittarius? I should go read my astrology book again and see if that explains the complexities of my character!

Altogether, an acculturating day.

(Disclaimer: future blogs are likely to be much shorter.)

New Year's

2009-01-01T20:34:00.000-08:00

I don't do New Year's Resolutions because they rarely last past the 2nd or 3rd, then I feel like a loser, so why inflict pain on myself needlessly?

Darron and I did a bunch of nothing today. It entailed:

Sleeping in until 11am (early morning today!).
Eating cereal.
Taking a shower.
Checking the news and email.
Studying the Industral Revolution by way of teaching Darron to use a sewing machine to mend a rip (he said he felt "so domestic" - and he's a fast learner).
Watching Darron take a nap.
Eating a sandwich and some soup.
Checking the movie listings to see if there are any movies out that we haven't seen (there aren't, except some really bad ones).
Putzing around while Darron went home to clean dishes before I drove over to meet him for dinner.
Writing this blog.
Helping Darron brainstorm the notable things that happened to him last year and coming up short.

It's a good thing we have stuff planned for the rest of winter break! We're going to Big Bear next week to ski and play in the snow for a few days, since it's only three or so hours away. Tomorrow we're going to the Getty Museum, then grab lunch in Beverly Hills on the way to the Griffith Observatory for a little science and sunset action, then maybe some stars (you know, Venus is really bright and close to the moon right now, and Jupiter was visible very close to the moon a couple weeks ago). The best part? The museum and observatory are free, as is celebrity hunting! Aside from the once-again-cheap cost of gas, the only cost will be for lunch... one place I found has lunch entrees for $9-12, so considering we are going to spend the whole day in LA, we're going to make out like bandits! Sure beats going to The Happiest Place on Earth for a whopping $69 apiece (food not included).

So... hurray for cheap entertainment! Hopefully a trend-setting day for the rest of the year.

Swan'ola

2008-12-31T00:18:00.000-08:00

My parents have made their own granola since I was a kid. I don't know what it is about this family and granola, but a few years ago, Grandma gave me her recipe. I've since made and given her granola to several people. I've made my own little changes to it, but it still gets rave reviews. This year I branded it Swan'ola and Darron and I made some to give for Christmas. Darron thinks it should be Swa'nola instead, to make the post-apostrophe portion as long and as close to the word 'granola' as possible, but the jury is still out on that (why don't we call it Sw'anola then, hmm?). Anyhow, I suppose I could have called it Boydola or Yamamotola, but Boydola sounds like an Italian dish, and Yamamotola reminds me of a cell phone. Beside its rhyming with 'granola,' Grandma used to be a Swan anyway, so I took Head Chef's liberty and went with Swan'ola. In any case, I think somewhere she must be pleased that her granola has made many people smile. So here's to Grandma, always making people happy - even when she's not around!

Happy New Year, everybody.

Omen?

2008-12-02T22:02:00.000-08:00

So, as a sort-of response to my dad's question: over the Thanksgiving long weekend three things happened in four days.

On Wednesday, my classmate had a first-time grand mal seizure during our final exam (see previous blog). Definitely out of the ordinary.

On Friday, I was on the freeway when a car ahead of me caught on fire. It's common enough to see a car with smoke coming out, but this one was actually on fire, and it was under the engine so the driver didn't even know he was flaming. Very rare. I don't think I've ever seen a moving vehicle with flames that wasn't part of a prop. I pulled over, though there was little I could actually do for him without a fire engine or even a fire extinguisher.

On Saturday, just after dark, I was on my way to Darron's and I happened upon an accident and a near-hysterical 18-year old in an intersection. I lit my trusty flares behind each car and quickly checked the girl out, although she was just "shook up" and not hurt. I waited with her and a couple other Good Samaritans until PD and fire came, then took off. Not so rare, but taken together with #1 and #2 in the previous days, highly unusual.

I've had enough off-duty incidents during my active firefighting days to know these things happen from time to time. But that's just it, they happen from time to time. Three in four days is a bit freakish. I felt like Nancy Drew, whose life is conveniently one event after another. I tend to think it was happenstance: if I had made life-saving split-moment actions or decisions in each of these cases, I would probably be really freaked out. But things would have turned out all right whether I'd been there or not. Still, things sure happened close together all in a flurry, and I just happened to be there.

What do you think? Something subtly reinforcing my career choice, or mere coincidence? Perhaps it was a reminder that I need to do some ride-alongs with the FD because I clearly noticed that my thought process has slowed down quite a bit. After two and a half years of not doing emergency response, I'm definitely out of practice. But I still love it! And perhaps that's the most telling omen of all.

Something To Be Thankful For

2008-11-26T15:10:00.000-08:00

Thank God It's Over.

The worst rotation yet. I may have to retake the final exam again, because I just wasn't into it and didn't study that much. But on the bright side, I won't have to do another psych rotation again for the rest of my life. Thank god! That's what *I'm* thankful for this Thanksgiving.

The exam itself wasn't much fun, but we had an "unusual testing condition": one of my classmates started screaming a few minutes into the test. At first I thought it was in frustration at a particularly hard question, and I inwardly concurred, glad I wasn't the only one feeling that way. Then I realized he was having a seizure. I guess my autopilot came in handy, because I found myself directing the students next to him to lower him to the floor and the proctor to call help. I don't even remember seeing him seize before I got there, it's just kind of an unmistakable series of sounds. Responding to an emergency as it's happening is quite different from what happens to medics on duty: you get the dispatch, you get on the rig, you pull on your gloves, get your equipment out of the engine, walk up to the scene, and then you're finally there. That's plenty of mental prep time. But it's quite another matter when you're concentrating on taking an exam and someone seizing is the farthest thing from your mind! It's a little rattling.

Eventually the FD came, and we turfed it to them. Ironically, the neurology department was having their grand rounds meeting in the conference hall right next door, so one of the fellows wandered over. He didn't do anything, which further confirmed to me that emergency physicians are the experts at the first two hours of anything - then they lose interest and hand it off to specialists who pontificate endlessly the etiology of the illness at hand, but don't like to get their hands dirty. To add further irony, while my classmate discovered during this rotation that psychiatry was his calling, he inadvertently helped confirm emergency medicine to be my thing. Anyway, it made for an interesting, albeit a little bit sad, conclusion to psychiatry.

Can't Make This Stuff Up

2008-11-23T22:46:00.000-08:00

Excerpts from the psych unit.

36 year old female:
Me: So how's your mood today? (we have to ask this every morning, you'll see why)
Patient: My mood has been following me around.

26 year old male Ivy League grad:
"I started thinking, well, I call my family overseas and so maybe they're wiretapping my phone calls to intercept me. I think people are out to get me, to turn me into a terrorist. Sometimes I can tell myself, 'It's not real,' because I've never participated in any sort of terrorist activities, so why would they want me? But other times it seems they plant magazines and newspapers at newsstands to try to influence me, and the thoughts become so overwhelming that I can't convince myself that it's not real. So at one point I was in [foreign country] and walked into the embassy, because I was sure that they were trying to get me to recruit me into being a terrorist. And that's when this last string of hospitalizations began.

45 year old female who just tried to escape:
Me: So are you able to sleep well at night?
Pt: God comes to visit me every morning around 4am. I just push him away. But he changes his mind a lot. I'm not pregnant anymore.
Me: You're not? You were pregnant with twins three days ago.
Pt: See? He changed his mind. You know the "virgin baby?"
Me: Yes.
Pt: You're God's type, I can tell.

26 year old bipolar male:
"I just recently went through puberty. I found a way to arrange my sleeping bags into a cocoon, and in there, I learned freestyle masturbation, and that allowed me to transition into adulthood."

Asian male in his 40's, psychotic and barely speaks English:
Marching around the unit: White power! White power!

Nuts

2008-11-18T23:03:00.000-08:00

I think I've effectively ruled out psychiatry. Even though it was nice to see a former patient today who had found a job since he left, patched up things with his dad, and whittled all his girlfriends down to just one that he actually liked. Even though he asked me when I was going to be a doctor so I could be his doctor. How could I resist, I don't know. I'm an impatient person to begin with, then you give me all these nutty people who are all over the place and can't communicate, and I just don't deal well. Perhaps emergency medicine really is the place for me so I can bring 'em in, patch 'em up, and ship 'em out. What good is an impatient shrink anyway?

Secessionist

2008-11-13T23:38:00.000-08:00

I've long thought California should secede, along with a handful of coastal states and other blue states. Some news articles make me not want to share a citizenship with a lot of people "over yonder," east of CA. A lot of them are scary. So Darron and I have thought about taking a trip to better understand these strange gun-slinging, religion-clinging, abortion-denying, so-called fellow Americans, with whom I don't think I have an iota in common.

I came across this piece, which I have abbreviated slightly at the end. It sums up my feelings pretty well.
____________________________________

Dear Red States Cousins:

We've decided we're leaving. We intend to form our own country, Nuevo
California, and we're taking the other Blue States with us. Bye.

To sum up briefly: You get Texas, Oklahoma and all the slave
states. We get stem cell research and the best beaches. We get the
Statue of Liberty and Hollywood. You get Dollywood and Branson.
We get Intel and Microsoft. You get WorldCom. We get Harvard.
You get Ole' Miss. We get 85 percent of America's venture capital and
entrepreneurs. You get Alabama . We get two-thirds of the tax revenue,
you get to make the red states pay their fair share.

Since our aggregate divorce rate is 22 percent lower than the
Christian Coalition's, we get a bunch of happy families. Please be
aware that Nuevo California will be pro-choice and anti-war, and we're
going to want all our citizens back from Iraq at once. If you need
people to fight, ask your KKK members, your evangelicals and
your hockey moms.

With the Blue States in hand, we will have firm control of 80 percent
of the country's fresh water, more than 90 percent of the pineapple
and lettuce, 92 percent of the nation's fresh fruit, 95 percent of
America's quality wines (you can serve French wines at state dinners)
90 percent of all cheese, 90 percent of the high tech industry, most
of the U.S. low-sulfur coal, all living redwoods, sequoias and
condors, all the Ivy and Seven Sister schools plus Stanford , Cal
Tech and MIT. With the Red States, on the other hand, you will have to
cope with 88 percent of all obese Americans (and their projected
health care costs), 92 percent of all U.S. mosquitoes, nearly 100
percent of the tornadoes, 90 percent of the hurricanes, 99 percent
of all Southern Baptists, virtually 100 percent of all
televangelists, Rush Limbaugh, Bob Jones University , Clemson and the
University of Georgia. We get Hollywood and Yosemite, thank you.

Additionally, 38 percent of those in the Red states believe Jonah was
actually swallowed by a whale, 62 percent believe life is sacred
unless we're discussing the death penalty or gun laws, 44 percent
say that evolution is only a theory, 53 percent say that Saddam was
involved in 9/11 and 61 percent of you crazy bastards believe you
are people with higher morals then we lefties.

It's About Time

2008-11-08T01:32:00.000-08:00

I wish people would quit saying Obama will be the first black president of the U.S. In fact, he will be the first biracial president of the U.S. And did you know, mutts are hardier, genetically? They can't have recessive diseases that are found in the purebred population, at least in the first generation offspring. Someday asking someone's heritage will be the same as asking what his favorite ice cream flavor is, just an interesting conversation piece, and not a loaded question.

Crazier Than the CPS

2008-10-29T00:21:00.000-07:00

Excerpts from the psych ward:

36 year old female:
Me: So how's your mood today? (we have to ask each patient this every morning, you'll see why)
Patient: My mood has been following me around.

26 year old male Ivy League grad:
"I started thinking, well, I call my family overseas and so maybe they're wiretapping my phone calls to intercept me. I think people are out to get me, to turn me into a terrorist. Sometimes I can tell myself, 'It's not real,' because I've never participated in any sort of terrorist activities, so why would they want me? But other times it seems they plant magazines and newspapers at newsstands to try to influence me, and the thoughts become so overwhelming that I can't convince myself that it's not real. So at one point I was in [foreign country] and walked into the embassy, because I was sure that they were trying to get me to recruit me into being a terrorist. And that's when this last string of hospitalizations began.:

45 year old female who just tried to escape:
Me: So are you able to sleep well at night?
Pt: God comes to visit me every morning around 4am. I just push him away. But he changes his mind a lot. I'm not pregnant anymore.
Me: You're not? You were pregnant with twins three days ago.
Pt: See? He changed his mind. You know the "virgin baby?"
Me: Yes.
Pt: You're God's type, I can tell.

26 year old male:
"I just recently went through puberty. I found a way to arrange my sleeping bags into a cocoon, and in there, I learned freestyle masturbation, and that allowed me to transition into adulthood."

Gas Prices

2008-09-26T18:02:00.000-07:00

This morning as I was walking into the hospital bright and early, I passed by an old man veeerrrry slowwwly inching himself down the hallway in his wheelchair. As I passed by him, he looked at me and said, "These gas prices are killing me!"

Salutations

2008-09-23T21:07:00.000-07:00

I'm at the Veterans' Affairs hospital in Long Beach now. Things have a different feel than at the UCI Med Center. The elevators fly up and down compared to the UCI ones, and the big tower building housing the main hospital wards is nice and pretty and new. The rest of the buildings are a bit run down, as I thought the whole place would be. The people work slower, but they seem happier. Everyone seems to smile and wish each other good morning. Today, a nice old man saluted me. "Good morning, ma'am!" he said. I wasn't quite sure what to do, so I smiled and nodded and wished him a good morning back. It kind of felt like being offered crackers and grape juice in church, where I would sort of go along with some of it to be polite but not all of it because I didn't really belong to the group.

The banter in the multi-patient rooms is different, too. Actually, the fact that there is banter is different to begin with. More than the UCI patients, these patients seem at ease with sharing their room with three others and it doesn't faze them at all. So far I have yet to see a single female patient, and the banter reflects this pretty well. As we were finishing up rounding on one patient this morning, he said, "Thank you, guys." The patient in the next bed corrected him, "...and girls." The first one mumbled, "Yes, and girls," and the neighbor grinned, "See, I notice girls!" To which the first one grumbled, "I get in trouble if I notice girls."

Overall, it's not a bad place to be. It doesn't hurt that the seven-mile commute is on PCH right along the ocean and it's really pretty both going and coming from the hospital!

Gross

2008-09-22T22:34:00.000-07:00

We have a patient who is so constipated that it's backed up all the way through his intestines into his stomach, which means he's vomiting poo. Gross!!! Now that's a bona fide potty mouth.

Gravity II

2008-09-20T15:14:00.000-07:00

My bed must have extreme amounts of density, because I could not escape its gravity this morning. The sun was shining onto the bed, there was a pleasant little breeze ruffling my curtains, and I didn't have to go to work. I felt like a happy little kitten napping in the sun. My bathroom light died but it was light so I was able to see in the shower, did laundry for a change, and got some errands done. Now I get to study before I make my first home-cooked meal (vs. cafeteria slop) in a long time! Hurray for days off!

Gravity

2008-09-19T13:14:00.000-07:00

Yesterday was my last day at UCI for the next month. Starting next week I'll be at the Long Beach VA, with a very different patient population.

This past week has been a week of serious patients who aren't going to make it. My team's workload of patients all of a sudden were rather young patients who were terminally ill. Other young patients we've had were chronically ill, but not on their deathbed. It's one thing to treat patients, make them better, then send them home. It's entirely another to know you can't help, no matter what you do.

One was a 36 year old woman with breast cancer that had metastasized everywhere despite a double mastectomy - her lungs, liver, spine, pelvis, and brain. There was so much cancer in her brain that she was throwing up constantly but still coherent and talking when we admitted her. By the next morning though, her brain had swollen so much that all she could do was groan and reflexively contract her arms inward, a very ominous sign called decorticate posturing. They call it "decorticate" because you can tell that the site of the brain injury was such that it essentially shut off her brain cortex functions. The neurologist happened to stop by while I was at the patient's side and he remarked that it was a sign she was about to stop breathing, and we'd better intubate her before she did. So much mayhem and excitement later, she was sent to the ICU, from which she will probably leave only in a casket. I met her children the first day; the boy looked around fifteen and the girl looked about eight. The girl didn't seem to understand that she was about to not have a mom.

Another was a 37 year old man who'd essentially drank himself to death's door. He was in the hospital with our team for over a week, a belly swollen with fluid backed up because it couldn't get through his too-damaged liver, looking like he was pregnant. He was so jaundiced that it looked like someone had taken a black-and-white photo of him and colored in his eyes and skin with a yellow crayon. Literally. I'm not even exaggerating. I was part of the team taking care of him, but he wasn't primarily my patient so I didn't talk to him much when we visited his bedside during rounds every morning. Still, we had a little ritual that kind of came about after seeing each other every day. He always had downcast eyes while we were there, but as the team left his room, I would wave and he would look up and smile. Yesterday he looked so sad, sadder than usual, but he did give me a smile at the end. It was dimmer than usual, but it was still our little ritual.

Another was a 41 year old man who found himself diagnosed with HIV a week ago. He had been mysteriously losing weight for a couple months, but had suddenly started going blind and had spots growing all over him, so he went to the doctor and that's how he found out. The tell-tale spots were surprising because those aren't seen anymore with HIV therapy that's available nowadays. He thought he got it from a tattoo he got in Viet Nam several years ago, because he said there they use the same needles for everyone. It was a very cool dragon, but to think it could have been the cause of his death diminished its luster. He started to cry as I was talking to him. Apparently he had been married a few years ago and he had always used condoms because the wife didn't want children, then she left him after a year. He was so sad and didn't want the burden of sadness in life anymore, so he started studying to become a monk. He completed his three years of studies and was set to go to Tibet to finish up, but ended up in the hospital. Can you imagine, studying to find eternal peace as a monk, and one day you find out you've got AIDS. He squeezed my hand when I asked him if he'd like me to try to find a Buddhist monk that he could talk to. I hope he gets reincarnated into something nice.

Even though these people are a few days away from death and no amount of medicine will cure them, I guess the one medicine they can benefit from is kindness.

Irony

2008-09-14T22:15:00.000-07:00

One of the great ironies of medicine, from paramedicine on up, is this: even if you're a great doctor, if you're an asshole you'll get sued, but you can be a crappy doctor as long as you're nice to patients, and they won't sue you.

Following that irony, I received my first patient letter yesterday from a very nice young lady in her mid-twenties who's been chronically ill since she was a toddler. She's one of the calcifying patients I mentioned in an earlier post. In her letter, she said she's had lots of experience with doctors, but I stood out as someone who was so kind to her and her family. She's had all sorts of expert care and I know the least amount of medicine on my team of course, but it was simply that I sat down at her bedside and talked with her and her mother for about 20 minutes that must have made all the difference. Maybe it was also because I said, "Hi XXX" and addressed her by name whenever my team visited her, who knows? I certainly didn't do anything superhuman.

I was actually very inclined to be nice to her because I had met her before my internal medicine rotation began. She didn't remember me, but as part of a different rotation two months ago, my group was assigned to fan out around the hospital to look for patients with interesting physical findings. One of them was her, on her prior admission. About eight of us crammed into her small room, checking out her body parts, himming and hawing, staring, talking about her, but she was very gracious and talked about her disease course with us, let us poke and prod, and answered our questions thoroughly. At the time I kind of thought it a little distasteful that we were marching in huge groups into patients' rooms to stare at them, even if UCI is a teaching hospital. So when I discovered that she had come back and was assigned to my team, I guess I wanted to make amends, or at least show appreciation. I never told her directly why I was being so nice, so I feel a little bad, like I tricked her. In any case, one day she asked the attending if she would be able to have a baby some day. He gave her a general positive answer, but somehow I got motivated later that night and found an article. It said that women with her condition should be monitored prenatally as high-risk, but that there was a good chance she would have a healthy pregnancy. When the attending gave her the article the next morning, she said that it was the best news ever. It took me only about an hour to research the article, and about 20 minutes of extra conversation to apparently make a big difference in her life.

As we discharged her, I wished her a happy fourth anniversary with her boyfriend. She had told me she wanted to be home by Monday so she could celebrate it with him. I hope she has a long and happy life with as many healthy children as she wants.

Long Call (again)

2008-09-13T00:25:00.001-07:00

I hate long call. It's very long.

Days Four and Five

2008-09-11T20:59:00.001-07:00

So Day Four is called a "regular work day" where you just monitor the patient, try new things to make them better, or send them home. No new patients. Day Five is "pre-call" and is much of the same. The best case scenario is that you've discharged all the patients you got on long and short call, and are ready to start long call the next morning with no patients left over! Yeah, right.

Changing gears:
Today marks an interesting day. 9/11 has for several years now been the epicenter of intense politics, but to me it carries a different meaning. Every year as 9/11 approaches, I groan inwardly, knowing that people will get all worked up about this day, but then completely forget about it the rest of the year save for the politicians who continue to evoke it to their benefit. If this day just passed every year without anyone noticing, I'd be okay with that. It's like Valentine's Day - you're not supposed to love your significant other only on Valentine's Day, you're supposed to every day. Yet the commercialization and superficiality that is synonymous with V-day is pretty nauseating. Inasmuch, those who sacrificed their lives to save others should be remembered privately all the time, not staged once a year into a political tool.

I woke up today like any other day. Of course, I was aware that it was 9/11, but it didn't compel me to do anything differently than I would any other day. However, I was driving along PCH to go study at my favorite Starbucks this afternoon, when all of a sudden, there were hundreds of firefighters on motorcycles driving north. As I continued south, there were local fire engines parked along PCH, waving at the motorcycles. It was a huge, noisy spectacle, as cars and motorcycles honked and firefighters stood atop their rigs with their emergency lights flashing, waving at the motorcyclists as they thudded by.

I suddenly became really "homesick" for my fire family back home up north. How many other professions do this? Can you imagine hundreds of CPAs rallying together on a giant motorcycle ride to remember their own who were killed in New York seven years ago? Firefighters are pretty unique, along with the few other professions where you must live together despite your differences and sometimes rely on each other with your lives. I never had any Backdraft moments of falling through the roof into a fire, but there are countless less sexy or dramatic times when my ass was saved by someone I worked with. I haven't forgotten what it is to be a firefighter. The job and the landscape where my firefighter self was born, trained, lived and worked, has changed me for good.

I wish everyone could experience such a tie to their brethren - known and unknown - sometime in their lives. The world would be a better place for it. And that would be the best way to pay respects on such a day like this for those who gave their lives, unarmed but for rescue tools, surely terrified, but still answering the call for help.

Short Call

2008-09-09T22:08:00.000-07:00

This is Day Three. Short call means we take new patients from 7am-4pm, with a cap of four new patients. Sometimes you get all four first thing in the morning from the "night float" resident, who is there to admit any new patients who come after 7pm when the long call team stops taking admisssions, and to make sure the rest of the patients don't die in the middle of the night. Other days you get the four dribbling in throughout the day.

I was assigned one of the new patients today, a young lady whose skin is calcifying. It's a very sad disease. She can't open her mouth completely because the skin at the corners of her mouth are calcified, and she walks with a limp because she can't bend her leg due to the calcification. Patients with her variation of this disease supposedly have no reduction in life expectancy, although it's a restricted and not-so-fun life. However, patients with the diffuse form of this disease have a very poor prognosis owing to organ involvement in addition to the skin problems, and most often die because their lungs lose capacity to expand and contract. There's no cure for this disease, so we do all we can to give supportive care. I hope my patient doesn't go from her limited end of the disease spectrum to the diffuse end. She seems really nice and I hope she can leave soon. There was another patient we had recently who had the diffuse form. It came on suddenly a few months ago when she had her baby. She was otherwise healthy, but has since developed calcified skin and organs everywhere, and her skin turned nearly black everywhere too. Her baby isn't going to have a mommy soon.

Anyhow, after we finish rounds in the morning, we work up our new patients and treat and monitor our old patients. It's not as long a day as long call, because we only accept new patients until 4pm, then we are generally able to interview the new patients, admit them, order some labs and studies, and finish their paperwork by 8-9pm. We even got done early enough today for me to hang out with Darron and try out his neighborhood Japanese restaurant. He liked everything we ordered! I'm so proud of my newly Japanophilic baby!

Okay... off to study up on skin-calcifying disease.

Library Books Sarah Palin Supposedly Tried to Ban

2008-09-08T22:00:00.000-07:00

A Clockwork Orange by Anthony Burgess
A Wrinkle in Time by Madeleine L'Engle
Annie on My Mind by Nancy Garden
As I Lay Dying by William Faulkner
Blubber by Judy Blume
Brave New World by Aldous Huxley
Bridge to Terabithia by Katherine Paterson
Canterbury Tales by Geoffrey Chaucer
Carrie by Stephen King
Catch-22 by Joseph Heller
Christine by Stephen King
Confessions by Jean-Jacques Rousseau
Cujo by Stephen King
Curses, Hexes, and Spells by Daniel Cohen
Daddy's Roommate by Michael Willhoite
Day No Pigs Would Die by Robert Peck
Death of a Salesman by Arthur Miller
Decameron by Boccaccio
East of Eden by John Steinbeck
Fallen Angels by Walter Myers
Fanny Hill (Memoirs of a Woman of Pleasure) by John Cleland
Flowers For Algernon by Daniel Keyes
Forever by Judy Blume
Grendel by John Champlin Gardner
Halloween ABC by Eve Merriam
Harry Potter and the Sorcerer's Stone by J.K. Rowling
Harry Potter and the Chamber of Secrets by J.K. Rowling
Harry Potter and the Prizoner of Azkaban by J.K. Rowling
Harry Potter and the Goblet of Fire by J.K. Rowling
Have to Go by Robert Munsch
Heather Has Two Mommies by Leslea Newman
How to Eat Fried Worms by Thomas Rockwell
Huckleberry Finn by Mark Twain
I Know Why the Caged Bird Sings by Maya Angelou
Impressions edited by Jack Booth
In the Night Kitchen by Maurice Sendak
It's Okay if You Don't Love Me by Norma Klein
James and the Giant Peach by Roald Dahl
Lady Chatterley's Lover by D.H. Lawrence
Leaves of Grass by Walt Whitman
Little Red Riding Hood by Jacob and Wilhelm Grimm
Lord of the Flies by William Golding
Love is One of the Choices by Norma Klein
Lysistrata by Aristophanes
More Scary Stories in the Dark by Alvin Schwartz
My Brother Sam Is Dead by James Lincoln Collier and Christopher Collier
My House by Nikki Giovanni
My Friend Flicka by Mary O'Hara
Night Chills by Dean Koontz
Of Mice and Men by John Steinbeck
On My Honor by Marion Dane Bauer
One Day in The Life of Ivan Denisovich by Alexander Solzhenitsyn
One Flew Over The Cuckoo's Nest by Ken Kesey
One Hundred Years of Solitude by Gabriel Garcia Marquez
Ordinary People by Judith Guest
Our Bodies, Ourselves by Boston Women's Health Collective
Prince of Tides by Pat Conroy
Revolting Rhymes by Roald Dahl
Scary Stories 3: More Tales to Chill Your Bones by Alvin Schwartz
Scary Stories in the Dark by Alvin Schwartz
Separate Peace by John Knowles
Silas Marner by George Eliot
Slaughterhouse-Five by Kurt Vonnegut, Jr.
Tarzan of the Apes by Edgar Rice Burroughs
The Adventures of Huckleberry Finn by Mark Twain
The Adventures of Tom Sawyer by Mark Twain
The Bastard by John Jakes
The Catcher in the Rye by J.D. Salinger
The Chocolate War by Robert Cormier
The Color Purple by Alice Walker
The Devil's Alternative by Frederick Forsyth
The Figure in the Shadows by John Bellairs
The Grapes of Wrath by John Steinbeck
The Great Gilly Hopkins by Katherine Paterson
The Handmaid's Tale by Margaret Atwood
The Headless Cupid by Zilpha Snyder
The Learning Tree by Gordon Parks
The Living Bible by William C. Bower
The Merchant of Venice by William Shakespeare
The New Teenage Body Book by Kathy McCoy and Charles Wibbelsman
The Pigman by Paul Zindel
The Seduction of Peter S. by Lawrence Sanders
The Shining by Stephen King
The Witches by Roald Dahl
The Witches of Worm by Zilpha Snyder
Then Again, Maybe I Won't by Judy Blume
To Kill A Mockingbird by Harper Lee
Twelfth Night by William Shakespeare
Webster's Ninth New Collegiate Dictionary by the Merriam-Webster Editorial Staff
Witches, Pumpkins, and Grinning Ghosts: The Story of the Halloween
Symbols by Edna Barth

Who's scared? I am.
Please Snopes at your convenience to verify.

Post Call

2008-09-08T20:20:00.000-07:00

Day Two is the day after call, so it is appropriately named "post-call." So I got there at 7am and left by 5pm. Such a short day is hiiiiighly unusual! Last cycle we were there at 6:15am until 10:30pm or so. This is the day where you have done some initial workups of all your new patients the day before, so you finally get to present them to the attending (remember, he left at noon yesterday so he hasn't seen any of the patients who were admitted after he left). Since he is such a scarce character but does the most of your block evaluation, you want to shine when delivering your report to this guy. Additionally, the patient's been there overnight, so you get to see what effect your initial treatments had on your new patients... did they work? Are the lab test values any better? Any imaging studies that are done, with reports by radiology completed? The answers to these questions get incorporated during morning rounds (keep up with the terminology here!) and help form your all-important Assessment & Plan. Any Joe Schmoe can go find lab values and vital signs and report on them, but what they really want to see out of us is the ability to synthesize all this information and come up with a comprehensive "probable problem" vs. "possible other problems" list, explain how we can eliminate the possible problems, and how to effectively and safely treat the remaining most likely problem.

Usually this is a day of hard work but because we admitted so few patients yesterday, seeing that it was a Sunday, we had very little work to do. Plus we were lucky in that a lot of our patients weren't sick enough to hang around for days and days, we were able to send a lot home after just one night in the hospital.

So next time you are hospitalized and hate the food and being woken at all hours of the day and night to have your blood drawn and are bored in your little room, just know that the medical team wants you to go home just as much as you do! I, for one, came home, went for a short run and promptly fell asleep when I got back, since my body doesn't know what exercise or sleep is anymore.

Time to go scavenge for some food, then do some studying so I can be ready for Day Three!

A Typical Hospital Day

2008-09-07T20:23:00.001-07:00

I'm currently doing my internal medicine rotation. Internal medicine covers sick people who don't need surgery or aren't there on an emergency, and they can't ambulate in/out of their family doctor's office - they are the sickies. Think congestive heart failure, heart attack, leukemia, those weird rare diseases that kill you... etc.

Whereas my work cycle in the fire dept. was a 3-day cycle, here at UCI Med Center Internal Medicine it is a five-day cycle. The difference was, at OFD it was work-off-off. Now it is work-work-work-work-work with a random day off here and there. I used to have twenty days off per month. Now I have four. What the hell was I thinking?!?! Well, I guess I might have been thinking that it's priceless to hear someone blame away their syphilis on a wet gym towel and know they are lying sack 'o bleeps. Or that once someone develops a swollen belly from their boozing, you better say all your last thoughts because they aren't going to be around much longer. Or that I know definitively how to end a life. Although I won't use that knowledge, it's powerful stuff. Those sirens that were Odysseus' temptation? Sailors didn't throw themselves overboard to listen to them sing silly songs! The sirens' "song" was actually knowledge - of the past, present, and future. Knowledge is irresistable. Many a brave Greek sailor went to their watery deaths trying to attain it.

In any case, this is Day 1 of my 5-day cycle, with an intro to my team:

1. One attending.

He is the dude who makes the final call on treatments and plans for the patient. He comes at 9am and leaves at noon, and makes a lot of money. The 9-noon period is called "rounds" where first the whole team sits in a conference room and debriefs the attending on what new patients we have that day, or what the progress is on continuing patients since the day before. Then we run around the hospital together, the whole team, so he can examine each patient, one by one. On any given day in a teaching hospital, there are multiple teams flying in and out of all patient rooms. It's hilarity to watch.

2. One 2nd or 3rd year resident (aka "the senior").

She is the dutiful deputy. She runs things before 9am and after noon, and makes sure everyone's verbal reports to the attending during rounds are delivered smartly, adding clarification or background as needed. She is there at or before 6:30am and leaves after everyone else. She coaches the interns on their treatment decisions, orders to nurses, consults with specialists, and teaches medical students in between.

3. Two 1st year residents (aka "the interns").

They also get there around 6:30 or before and start examining patients, checking lab values, etc. They split the patient load in half and have the primary responsibility for the patients. They consult with the senior throughout the day to keep her informed and bounce ideas off her. They also babysit lost medical students who need help with menial things.

4. One 4th year medical student ("the sub-I").

She has already rotated through internal medicine before as a 3rd year, but 4th years have to do a dry-run internship for a month or so (the sub-internship) before they graduate and actually become interns. Optimally, she carries half the load of the interns, but is primarily responsible for patient treatment decisions just like the interns are. Of course she consults extensively with the senior, but it's obviously nerve-wracking and hectic for her. She's not responsible for anyone but herself, but she is the closest to us in experience, so she gives us good little tips and nuggets to help us navigate the behemoth medical system in the hospital.

5. Finally, the two 3rd year med students.

We just wander around with perplexed looks on our faces. We never know what we're doing, we just show up when told, and leave when told. The saddest members of the team. Don't know anything. Nurses fart in our general direction, but it's a happy time in the day when unsuspecting family members address us or benevolent attendings introduce us as 'doctor.' Of course the latter always clarifies that we are "student doctors," but it's still nice to hear! We come in at 6:30 just like everyone else and write up our paperwork like everyone else, albeit a reduced load, since we're learning and slow at it still, but none of our work counts for anything. The intern, senior, and attending will all repeat the work done, so we are actually useless on the team; rather we slow everyone else down. However, we are the only members on the team (and the 4th year too) who are actually paying money to be present, so they have to tolerate us and teach us a thing or two.

Day 1 (long call)

Being "on call" means you admit patients up from the ER, down from the ICU, or from doctors' offices. You can't just walk into internal medicine and say you want to stay in the hospital; someone has to determine you need to be admitted. Admitting a patient takes a long time. You have to go find the patient, spend roughly 30-60 minutes interviewing and examining and looking through the chart to see what's already been done to the patient. The interview is basically detective work so you can start thinking, "what's wrong with my patient and how can I fix it?" On long call days, we accept patients from 7am-7pm. Each team can carry a maximum of 20 patients - eight per intern and four for the sub-I. Med students generally get one to three patients, and our heads are spinning at that point. We round with the attending at 9am-noon as usual for our existing patients, but throughout the day, whenever there's another that needs to be admitted, the interns take turns getting assigned. At noon, there is "noon conference" which is just a fancy way to say "mandatory lecture on whatever and free food to guarantee your attendance." At 1pm, we go back to work, ordering labs, consulting with specialists, sending patients to get MRIs, talking with family, coordinating with the case worker, calling the family or the convalescent home nurse for background info, etc. It's an amazing amount of information synthesis that happens all day. The last long call day I had, by the time I drove home it was midnight, just in time to change, eat, shower, sleep for a few hours, and get up to be back again by 6:30am. Long call is aptly named!

Tomorrow... Day 2 (post-call)!

How much do you think the property tax is for one McCain property?

2008-08-25T19:32:00.000-07:00

I officially started my time in the hospital proper. Until now, I've been at the medical center, but technically I was assigned to the outpatient clinic of Internal Medicine. Now, I'm on inpatient medicine of Internal Medicine. These are the patients who are the sickest - CCU, MICU, ICU, etc., as well as the well-loved "wards" are all part of Internal Medicine. Outpatients aren't as sick, because they can walk in and walk out again. Inpatients are kept overnight, often for several nights.

I'm starting out responsible for one patient. He is a man who's fallen on tough times. He's a skilled worker in the civil engineering industry, but since land development has come to a screeching halt (though not evidenced by all the building going on across my street, darnit), he's been laid off. Money woes caused problems with his family, and that made him more stressed out. That led to an exacerbation of his illness, but he can't buy medicine because he doesn't have money anymore. So he doesn't get better, so he can't get a job, so the financial picture doesn't improve his family relations... and it goes on and on. In his hospital admissions interview, he cited finances were the thing that worried him most about being in the hospital. Why can't people's biggest worries be about their illness? And he has some serious stuff going on. Why is it that in the USA, in the 21st century, a skilled worker cannot pay for the medications he needs? Why is this so often the boring, dry topic of my blogs? I wish I had sunnier things to post! Or I could just content myself with telling funny stories. But when you see patient after patient, concerned with or worse, suffering as a result of, the inability to pay for their health care, what do you do? How can I meet patients like this day after day and not spout off every so often?

Seems like it used to be that doctors had to bear the looks in the eyes of their dying patients and live with the guilt of not being able to save them. Now, doctors scramble to do whatever they can to get patients medications and treatments so they will not have to look into their eyes, knowing they *are* able to save them, but having to weigh the cost. What is the value of a human life? According to one of my professors, the average cost the U.S. as a society has deemed acceptable to save a life is about $50,000.

I wonder if my patient is going to vote for John McCain.

The Lying Patient

2008-08-21T19:49:00.000-07:00

A sample bedside conversation alone with a patient:

Me: "Hi, how are you feeling today?"

Patient: "Oh, just great. Thanks for asking!"

Me: "So you don't have any pain today?"

Patient: "What pain?"

Me: "The pain that brought you to the hospital."

Patient: "Oh, that went away a long time ago, I took some medicine and it went right away."

Me: "So you're not having any pain? At all? Are you sure?"

Patient: "No, no. No pain."

Half an hour later with the attending and the whole team watching:

Attending: "So I hear your pain went away?"

Patient: "Went away?!?! My God, it's never been worse! In fact, I think I'm having a heart attack right now!"

Patients are *notorious* for changing their stories, invariably making you look stupid. As if 3rd years need help with that.

Hospice Reflection

2008-08-21T01:01:00.000-07:00

Part of being a med student is visiting hospice patients. The really odious part is having to write our thoughts on it. An excerpt of my "reflections" at 1am:

"The most important thing I can glean from my hospice experience, if I can remind myself to do it often, is to enjoy life and appreciate the minor things I take for granted. If I were told tomorrow I couldn’t drive anymore, I would probably actually relish my commute. If I were to learn that I was going to be in an accident and I couldn’t walk anymore, I’d probably go for a good, exhausting run. Stripped of a long life expectancy, a hospice patient may actually have an advantage most of us don't have – the hightened awareness to consciously appreciate and experience what is left of their lives."

Given that I whipped up over a page of these sorts of paragraphs in the last hour, as I sit blurry-eyed in front of my computer, I wonder, was my parents' hard-earned money for a liberal arts degree worth it? (Let us also recall that my essay-writing skills have already earned me $271 in exonerated fines for a carpool land violation, plus hundreds more in savings from my insurance rates NOT going up as a result of that ticket.)

Empathy

2008-08-18T18:53:00.000-07:00

First of all, I must say y'all are commenting like champs! I love watching That McNabster Guy vs. TGTAdventurenz - it's almost like watching the Olympic women's pole vaulting!

And on to today's depressing business. We were on task to find cool physical findings on patients today, so we were running around the hospital with our resident, dropping in on patients for a quick visit. Next up was a ptosis patient. (No, it's not an ailment unique to African click language speakers, it means "droopy eye" - why they can't just say "droopy eye" I don't know, but I think it has to do with keeping up with the lawyers and their secret language.) We'd already seen a girl with scleroderma, where the skin begins to tighten and calcify, and eventually you can't bend your fingers or open your mouth anymore - very sad; a patient who had an ablation to correct her irregular heart beat, but who ended up with a punctured lung- very unlucky; a patient with an old heart valve replacement that apparently clicks so loudly at night it keeps his wife awake - how exhausting; and other fun things. They were all supposed to be quick, in and out visits, but our ptosis patient trapped us!

He had just been diagnosed with leukemia and started on chemo. He was very angry. He let us know it. He was so angry at his primary care doctor for not catching it, he was gonna sue him as soon as he got out of the hospital. Can you say Stage One of the classical stages of loss? He went on and on and on, and in the end he was very appreciative of everyone at UCI because we had turned his life around (obviously it was our great work, since the four of us had never seen him before), but he sure let us have it. We were all very sympathetic and very professional and listened to him rant and rave for a half hour before we cut him off, but it just reminded me why I want to go into emergency medicine - so I don't have to deal with the same irate patients over and over.

The most depressing part was that I didn't really want to listen to him anymore, because I didn't care that much.

Times Are A Changin'

2008-08-15T12:10:00.001-07:00

I scrambled onto the employee shuttle bus, the last passenger before the door closed, and made my way to the one open seat. As I settled in for the ten minute ride from the parking lot to the hospital, I noticed: every single person on the bus was a woman. From the med students and lab techs with the white coats and the nurses with their conspicuously colorful scrubs to the more loosely business-attired clerks and the bus driver in her uniform, some were carrying lunch bags, some carrying Coach purses; stilettos, tennis shoes, clogs; long hair, grey hair, messy hair, perfectly coiffed hair; lots of mascara, lipstick and rouge, but also some without... it was a feminist's dream.

I wanted to snap a black-and-white with the morning sun streaming through the windshield and the faces at the rear of the bus in shadows, and title it something ordinary like "Off to Work," but display it alongside old 50's typical male work scene photos, you know, the kind where all the men have the thick-rimmed glasses and crew cuts and suits. The best part? An entire shuttle bus of workers on their way to run a major medical center in a densely populated metropolitan area happened to be female, and no one but me seemed to notice.

Medical Ethics

2008-08-12T23:30:00.000-07:00

If a patient came to you and told you his complaint, but then asked you not to document it because he was afraid of complications with his new life insurance policy, what would you do?

If a pharmaceutical company rep offered to bring you and your staff lunch so he or she could spend lunchtime telling you about a brand-new drug, would you accept? A free nice dinner with just you and the rep? Would you accept a trip for your family to go to Italy? How about a Starbucks latte? A pen with the name of the drug on it?

If a doctor yelled at the nurses and a med student for not completing the overnight lab work as ordered because he felt the delay would adversely impact his cancer patient's surgery scheduled for that day, should he be punished for unprofessional behavior and creating a hostile work environment? Or should he be lauded for advocating on behalf of the patient?

If you needed to learn how to perform a pelvic exam, and the young female patient was visibly uncomfortable but didn't specifically request that medical students not be present, would you stay or leave the room? What if you had to perform that exam that week and have it signed off in order to complete your required procedure practice and pass the rotation? What if you later found out she had been raped in the past? If the different scenarios changed your answers, how could you justify them?

If you were a nonreligious surgeon but a seriously ill patient wanted you to pray with herbefore the surgery, would you? What about if the patient asked you to carry a "lucky charm" in your pocket as you performed the surgery? What if you were atheist and actively did not believe in a god?

What would you do with a patient who is elderly, just feels "done" with life, and can't wait to die?

How would you react if you found out your patient was doing or has done illegal drugs?

Playing Doctor Can Lead to Uncomfortable Social Situations

2008-07-11T00:23:00.001-07:00

I was walking out of Starbucks today when I caught the eye of a guy studying at a table. I had a flash of recognition, he had a flash of recognition, I briefly hesitated in my step, and my hand was dangling in the air in the start of a wave, when it suddenly hit me why I recognized this man. I had just been party to examining his testicles last week! The wave already launched, the hesitant step already cut short, my body already half-turned toward his table, my brain screamed, "Abort!! Abort!!" but it was too late. Crap crap crap, I cursed myself and my recognition-betraying reflexes, but it was too late. I forged on. He had put down his pen and was standing up to greet me. In as quizzical a voice as I could muster, I furrowed my brows and said:

"Don't I know you from somewhere...?" He laughed and said, "You don't want to know... when I met you I was naked." The other patrons sitting at the nearby tables were getting quite an earful. He could have just said he met me at the clinic, or he was a patient, but nooo. At least he had a sense of humor. We were about the same age, so that made it all the more awkward. I felt a lot like those people in the Southwest Airlines commercials: "Wanna get away?" As I left, I remarked, "Well, it was nice to meet you fully clothed this time!"

Such is the peril of practicing medicine close to one's home, apparently. I wish they had put THAT into the "Clerkship Survival Guide" Chapter 13: How to Engage in Social Situations with People Whose Testicles You've Examined. I could have used a bit of guidance today.

You People

2008-07-10T00:40:00.000-07:00

I write passionately about health care coverage, and I get a trickle of comments if any. I write about assholes and all of a sudden I have six comments in two days. I see what sells to this audience!!! ;) And yes, fear not, I will have more and more stories as the year goes on. I'm not above pandering.

The Things People Tell Their Doctors

2008-07-07T01:42:00.000-07:00

I am now seeing patients. Patients trust their doctors, and seemingly, the med students that come tagging along. The trust patients have for their doctors is quite a powerful thing, and a serious responsibility. It also leads to surprising conversations.

One worried patient brought a litany of minor complaints. She went into detail about each one, even though she was an otherwise healthy young woman. She was a PhD candidate in humanities and didn't have medical lingo at her disposal, but nevertheless, went on with her descriptions with the vocabulary and manner of speech expected of an academician. When she was finished, I summarized everything, then conscientiously asked, "Is there anything else you'd like to discuss today?" She hesitated for a moment, then replied, "This is a little embarrassing, but..." and continued in the gravest of manners, looking straight into my eyes with no trace of humor, "can you take a look at my asshole?"

Are You Underinsured?

2008-06-16T16:16:00.000-07:00

There is much attention (well, of the attention paid to health care, anyway) on the uninsured in America. There are currently about 47 million uninsured Americans, and rising. But what about the underinsured? According to this article there are about 25 million underinsured Americans, adding up to a total of 72 million inadequately covered Americans. That's staggering! These are people who have insurance, but not enough. They pay for health insurance, but when it comes time for the insurance company to cover their expenses, they get shafted. I consider myself in this group. How do you measure up?

Learning

2008-06-14T19:44:00.000-07:00

I'm back to learning things, and not just stuff out of books. The month of June we have workshops and lectures to prepare us for being in the hospital starting July. Last week, we learned how to do pelvic, rectal, and testicular exams on real people. I always wonder about the people who voluntarily subject themselves to ubernovice examiners. I've heard they get paid $100/hr for an afternoon of pelvic exams, or $25 per poke for rectals. I have to say, I personally price my orifices much higher than that!

Thoughts on DC

2008-06-04T15:54:00.000-07:00

The White House was a lot less impressive than I thought it would be. Granted, I know there is a LOT more than meets the eye, but all I saw were two bored-looking cops keeping an eye on two bored-looking protester types with a few bored-looking tourists idly snapping pictures. I wouldn't have minded seeing a bunch of nattily dressed Marines doing tricks with their rifles. I mean, come on! I think I should get something for all those federal taxes I pay. Is a little entertainment when I visit the capitol too much to ask???
Allergens in NY/DC are pretty bad.
When the vice chair of the department you want to eventually succeed in tells you that partying with them is going to have a much bigger impact on your career than any presentation you could make the following day, you do as he says.
The best way to reduce performance anxiety when presenting research is to party way into the wee hours the night before so you are too exhausted to be nervous.
I got a lecture on Eritrea from a taxi driver at 3am, who declined payment because I seemed so interested in his country.
I really should travel to Africa someday.
The Metro in DC is pretty nice. Not as expansive as NY's Subway, but more similar to BART, except they have plastic seats. I like the design of the stations.
Sometimes you can get really good hotel deals by staying on top of "travel deal" e-newsletters. I got a fantastic hotel for a fantastic deal, which was my treat to myself for giving this presentation.
I felt a little ill on the day I was going to spend at the Smithsonian Museums, but after a couple of hours there I was so engrossed that I could have spent many more days there. And that was just one museum!

NYC

2008-05-29T07:33:00.000-07:00

I'm writing this post from somewhere in New Jersey I think, while riding on Bolt Bus, an awesome new service from NYC to DC. I didn't reserve my seat early enough for the $1 rate, but I did get a $10 ticket for a 4-hour ride. It's a very sleek, new, nice, nonstop bus, and it has a free internet connection! How cool is that?? I saw Juliann and Karen off to Boston at the Chinatown "Lucky Star" bus stop yesterday, and I have to say by far I think I got the better end of the deal! One might think a week in Manhattan/DC might be pretty expensive, but between being partially subsidized by the dean for it being a partial business trip, staying with friends, free conference-related dinners and lunch, and getting very savvy advice from an almost autistically intense travel expert former roommate, it's not turning out to be as bad as it could be. What a great way to re-enter the world of the living after my academic hiatus!

Manhattan is very cool. I've been to NYC a few times now, and I actually feel very comfortable in it. It's convenient, things work well, and I found lots of friendly people there. I'm sure DC will be just as cool. I'm reading about Scott McClellan's outrageous memoir "allegations" (which the rest of us know as "I knew it!"s) against George W. and the White House response just as we cross the border into DC. It'll be great! Okay, gotta turn off the 'puter and see the DC sights!

Fun? What's That?

2008-05-15T00:28:00.000-07:00

For better or worse, I am once again free - however momentarily - in just a few days. I plan to read a book or two while traveling to the East Coast. Any good suggestions? Nothing medical!!!!!!!!

I See Why

2008-05-08T17:57:00.001-07:00

doctors kill themselves cuz this lifestyle sure does suck.

Crunch Time

2008-04-18T16:26:00.000-07:00

I've entered what I've been told is the "suckiest time in med school." It is the few weeks preceding the Step 1 of the U.S. Medical Licensing Exam. Step 1 encompasses everything we've learned out of books in the first two years of med school. I'm currently taking an Intense Prep course for the exam, run by a private company, Kaplan, who does nothing but prepare students for professional exams. So far, we cover the material of a 4-6 month course in an average of 1-3 days. We are in class 6 days a week. Little did I know that when I "escaped" from the Japanese academic system, it was really jumping from the pot into the fire!

So why am I blogging, you ask? Because my brain is ready to explode. It was a medical emergency, for which the only treatment is mindless entertainment!

The Happiest Place on Earth

2008-04-08T14:45:00.000-07:00

I don't know when the last time was that I went to Disneyland. Over ten years ago, I think! It was cool to go back again. Darron had the Monday off for his last day of spring break, and I had another day to relax before real studying for the Boards begins. We got there pretty much at opening time and stayed until the end, like little kids. Space Mountain was my favorite! Since the upgrade, you can no longer see the track in the dark, so that made it especially great. We both felt they over-emphasized Johnny Depp in Pirates of the Caribbean, but it was still neat. I didn't like the Finding Nemo submarine ride at all, even though we waited the longest for it, because it was a total movie tie-in, too. There were quite a few people there, probably the last wave of spring break-ers. But we still got to do everything we wanted to, including eating at the Blue Bayou! Mmm, it was sooo good. We even got to return for a second time on some rides!

What a great finale to a fun spring break! Now it's back to work...

Some Facts on Health Care in the U.S.

2008-03-28T16:18:00.000-07:00

Uninsurance: Currently, about 47 million Americans are uninsured.

Underinsurance: Millions more are underinsured, meaning they are just a car accident, heart attack, diabetes diagnosis, or baseball-to-the-face away from a financial meltdown. As one reader recently commented, losing one's job also puts you just two steps away from that catastrophe.

Death by denial: Every year 10,000 Americans die preventable deaths because they were denied care by insurance companies. To clarify, these deaths are DIRECTLY caused by denial of claims, e.g. a patient needs cancer drugs and the insurance company says "no, your policy doesn't cover those drugs because they aren't approved by our administrative board" or "we've discovered you have a gene that predisposes you to this type of cancer, so we are canceling your policy for failure to disclose a pre-existing condition."

Insurance company practices: Currently, what insurance companies do is "cherry-pick," meaning they only insure the young and healthy who won't need much medical care, and deny insurance to older people and those with pre-existing conditions. This can include people who are otherwise quite healthy, but weigh too much, or have a gene that could cause disease in the future. The thing with genes is they don't always turn into disease. Genes are like words in a dictionary. They might be in the book, but that doesn't mean that every word gets looked up in the lifetime of that book. Similarly, not every gene is expressed in a person. In fact, many genes don't get expressed. So denying insurance to someone simply because they have a particular gene is very shady. But that's all par for the course because insurance companies make their profits by denying medical care, not by paying for it.

Insurance company costs: When the sick but uninsured finally get sick enough to need care, where do they go? The ER. Emergency care costs way more than preventative care. And guess who pays the ER doctors and hospitals to treat people who don't have insurance? You. It's called taxes. It's also called "out of the ER doctor's paycheck" because they never get paid for the services they render. And insurance companies get away with not covering those expensive individuals by pawning them off to the ERs-->ER doctors/taxpayers. Even the insurance that is supposedly paid for by employers, do you think they are really paying extra? No, they're taking it out of money that would otherwise be included in your paycheck. Let's not kid ourselves. Employers don't pay for our health insurance, they merely play middleman. Covering all Americans under a Universal Health Care plan would widen the pool and spread the risk/cost of insuring the very sick onto everyone, so each person's health spending burden is decreased. That's more money in your pocket from (the cost of insurance your company no longer has to pay for you) + (the money in taxes you no longer have to pay toward emergency care for other people). And let us note: insurance companies' administrative costs run 31 cents to every dollar you spend buying a policy from them. If a family is paying $1000 a month in premiums, that's $310 that goes toward hiring people to fill out a dizzying number of forms, put you on hold for half an hour before hanging up on you, or mailing you cryptic "coverage checks." Why not choose a system that puts that 31%, or at least a good portion of it, toward paying for your medical care?

World rankings: Even though the U.S. is ranked #1 in money spent on medical costs, we rank #37 in the world - between Ukraine and Costa Rica - in terms of overall health, measured by several standard variables. Our infant mortality rates are the highest, and our life expectancy is lowest of any developed country. We are the only developed country that doesn't have a universal health plan for all its citizens. To be sure, American medicine has amazing drugs, technology and procedures. But guess who gets that great care? It certainly is not the uninsured or even the underinsured.

Other systems: Some of the best systems in the world - Britain, Japan, France - perform much better on most, if not all, heath indicators for less expenditure per capita. They cover everyone. And last I checked, they were not scary communist or socialist countries like many are afraid we'll turn into if we insure everyone.

Match Day

2008-03-21T13:26:00.000-07:00

On one day every March, thousands of medical students across the country gather 'round for Match Day. Yesterday was that day.

Match Day is when 4th year med students find out what residency programs they matched to. This is important information, because even when you graduate from medical school and are technically an MD, your training is really only beginning. Without a completed residency, no one in their right mind would hire you as a doctor (you could work as a consultant for a biotech company, but most med students actually want to be doctors). Around January or February, you create your "match list" where you rank various residency programs you want to go to. Each residency program does the same for its medical student applicants. Everyone submits their list, and the day before Match Day, a central computer uses an algorithm to spit out nationwide match results that pair up students and residencies who have ranked each other high on their respective lists. It's a lot like pledging a fraternity or sorority, only obviously waaaaay more respectable.

At UCI, Match Day is such a big deal that everyone in the School of Medicine gets the day off, all the deans come out, they serve breakfast in the courtyard, set out chairs for the family and friends, have balloons everywhere, and put up a podium where the dean calls off a student's name from a randomly ordered list. When the student approaches, he or she hands the dean a dollar. The dollar goes into a pile for the person who gets their name called last, because it's such a stressful event that no one wants to be at the end! Then the student gets his or her envelope, takes the podium, opens the envelope and reads the result to the crowd. It's kind of like the Oscars. Watching the 4th years yesterday, there were a lot of smiles, shrieks, and joyful dances as most people matched to their #1 choices. But one girl opened her envelope, then silently left the stage in tears. Her husband caught her as she ran off, and led her away as she buried her face in her hands. It turned out that she had matched to the best orthopedic residency in the country, but it was not her #1 choice because her husband was already a maxillofacial surgery resident somewhere else.

This sobering scene illuminated the sacrifice that med students make in order to become doctors. They give up their childhoods, their young adulthoods, their comfortable surroundings, networks, friends, all that potential free time, their childbearing years, and sometimes their families and significant others to pursue the doctor dream. Is it worth it? Many primary care physicians say no, they would not repeat their career if they could go back and do it over again. They get paid so little in relation to their sacrifices: the insurmountable educational debt, mounting costs to practice, dwindling Medicare reimbursement rates, minimal patient-care time, and unbelievable malpractice premiums. It's no wonder physicians in America are trending toward high-paid (read: costly) specialists just so they can recoup in their adulthood all the sacrifices they made earlier in their lives. However, that just leaves the rest of the populace with ever-decreasing access to primary care physicians and ever-increasing costs of health care.

Match Day. Luckily it's a joyful occasion for many. But it's also a time to reflect on the 4th years' achievements and sacrifices, wish them much luck in their residencies, and strengthen one's resolve to overhaul America's broken healthcare system.

Positively Black

2008-03-20T15:48:00.000-07:00

My friend Nancy sometimes gives me blogging inspiration, as you see in a recent post. Here's the latest, thanks to her blog. I actually wrote this over a week ago and saved it in my draft collection for release during my own inner Writer's Strikes. But now that Barack Obama has made his speech on race, it's serendipitously relevant to current politics!

Sometimes people say "dark" or "black" are associated with negative things. Here are some positives:

What is oil known as? Black gold.
The universal desirable male type? Tall, dark and handsome.
Quality chocolate? Dark.
Time when people spontaneously get lovey-dovey? Blackout.
Necessary item in every tasteful woman's wardrobe? Little black dress.
Most well-loved children's horse book? Black Beauty.
Attire associated with power or achievement? Dark suits, black gowns (graduation, judges).
Symbol of highest achievement in martial arts? Black belt.
Color you want your finances to be in? The black.

May the racial healing begin.

Health Care

2008-03-17T21:23:00.001-07:00

It's been over a month since Lobby Day. So, what was Lobby Day all about?

Lobby Day was held to support the health care bill (SB840) that Senator Sheila Kuehl (D-Santa Monica) hopes to pass. Not all of us present that day necessarily believe that a Single Payer Universal Health Care system is the way to go about achieving affordable health care in CA or the U.S. But all of us know that the current system has to change.

I could quote a bunch of facts about health care, but all the argument over facts won't change the opinions of someone whose basic values are different from mine. As a doctor-wannabe, I may be a sucker for suffering and death, but I think health care should be a right. If one is sick, one is not free to pursue liberty or happiness or much of anything else. But some people think health care isn't a right. They think it's just fine for us to attack the rest of the world, tooting our righteous horns about democracy and liberty, while we stand by and let our own people die of simple, treatable diseases in our own streets. People recoil in horror and stick their noses in the air when they see a photo of a dead Afghan/Kenyan/Brazilian kid on the side of the road, and think, "Oh my God, how barbaric! How indecent! I'm glad *I* live in a civilized country!" And the kid in their own town dying of athsma? Not a thought about that. It's not catchy news. The Republican Senator (or Assemblyman?) for North San Diego told our med students he flat-out thought health care isn't a right. If you are poor, stupid, lazy, unfortunate or old enough to get sick, then gosh darn it, you better pick yourself up by your bootstraps and get a job to pay for your medical bills. Otherwise you don't deserve health care, and can die in a gutter for all he cares. And guess who's paying HIS ample medical insurance bills? WE are! The taxpayers! Irony knows no bounds. I wonder what he would think if a person who was refused medical care, due to his politics, coughed on him at the neighborhood Starbucks and gave him drug-resistant, incurable tuberculosis. You think he might have wished he'd invested a little of his politics into helping others be healthy?

So even if you think people should earn things in life (which I generally agree with), it still makes sense to cover everyone so they don't spread disease around or drain the rest of our pockets by getting very high cost emergency care as their only form of health care. Prevention is so much more economical than reactionary interventions, but as a nation, we're not getting it. Cutting insurance companies out of the picture is the only solution. They are only in it to make a profit, and they make profits by denying care. Single Payer Universal Health Care makes the most sense because it does just the opposite - it replaces all insurance companies with a government agency that reimburses private doctors and private hospitals. This is not Socialized Medicine that everyone is so afraid of. Even if it were (and it's NOT), let's think about the effects of a socialized agency. We currently have socialized firefighters, police officers, highways, EPA, Medicare, schools, and libraries, to name a few "Scary Socialized Institutions." They aren't so scary. But I digress. Single Payer Health Care ISN'T socialized medicine; doctors and hospitals would still remain private. Single Payer health care would simply cut out insurance companies, because corporate greed just has to go.

Coming soon:
1) For you business types to mull over and comment on - why the "free market" won't improve the American health care system.
2) Some facts about the state of health care in the U.S.

Little Things

2008-03-04T11:03:00.001-08:00

I read an article about a person who impulsively bought a cute little purse that her oversized life had no use for, and suddenly she found herself unloading all the unnecessary stuff she'd been hauling around. It began with having to think about what she truly needed that day and what could fit into the tiny handbag. One day, she realized she had become more organized and productive - all stemming from that impulse purchase. She somehow had made a large positive change in her life without even knowing it. The point of the article was that it's the little shifts in our everyday habits that eventually beget large changes; changes that we ordinarily fail to achieve when we set out to achieve them in one fell swoop, like "losing weight" or "becoming happy." One little change causes another, then another, then another, until eventually something big and positive has happened and it was no effort at all!

Reflecting upon this, I discovered that I've done a couple of things like this. The first: I spent last summer keeping busy, and I didn't study at all. A week before school started again, I looked up something I couldn't remember. Once I'd brought out the ol' textbook, I read a little bit each day until classes began. I actually enjoyed looking at old material because it wasn't as confusing in posterity. And now that second year is coming to a close, I find that I've gamely, if not eagerly, studied nearly every day this year. Last year there were many times when I was unable to make myself sit down and study, but this year I haven't been fighting it. Even though there's more material and the testing schedule is harder, I strangely enjoy the process a little bit. My grades show it, too.

The second thing is my cloth bag. A couple months ago, I bought one to haul groceries in so I won't have to use those plastic bags. Unlike other similar efforts I've made before, I actually remember to bring it into the store with me now. This is probably because I'm pleased with my bag and I think it looks cute, regardless of any environmental good it does. It has an understated, tasteful logo (just the fruit/clock part, no words) from a new grocery chain called Fresh & Easy. The bag has since started conversations with checkers as they load my food into it, and I even had a woman stop me in the parking lot to ask where I got it! So I think my little change is already having a bigger impact than I set out to make. Actually, I must attribute the origins of my cloth bag change to Darron's dad. He gave me something a few months ago in a heavy-plastic Fresh 'n Easy bag, and commented that it was built to reuse. So when I saw an ad for "a new Fresh 'n Easy coming to your neighborhood," it caught my eye. I noticed the cloth bags they had for sale in the picture of the new store, and had been wanting one ever since. So this change is actually a little shift that Freeman started - see how nicely that works??

So (to take a page from Nancy's book - or blog, rather), let's hear it in the comments section: What little thing have you changed in your life recently that works for you?

Cardiac Petrification Disease

2008-03-03T14:47:00.000-08:00

There was recently a report that medical students have a hardening of the heart during medical school, particularly after the first/second years. It seems medical school sucks away their human spirit, rendering them less empathetic and more cynical. I just finished taking my umpteenth set of exams today, and I certainly feel like an empty shell of a person. Or maybe that's just because allergy season is now fully upon us, and I'm just feeling empty because I've blown all my contents into tissues. Still, I wonder what happens if one is already jaded before even hopping onto the bottom rung for the long climb up the prestigious medical ladder? Does it get worse?

Blue Cross Encourages Doctors to Snitch

2008-03-01T23:25:00.000-08:00

Blue Cross encourages physicians to snitch on patients about their pre-existing medical conditions so they can deny even more people insurance.

Aetna Wants Colonoscopies Without Anaesthesiologists

2008-02-27T10:55:00.000-08:00

Just another example how health insurance companies want to stick it up your bung-hole.

Good Karma Day

2008-02-26T17:17:00.000-08:00

I watched a sappy romance movie last night with my friends as a post-exam celebration, and got SO sappy that I paid Darron a surprise visit afterwards to give him lots of hugs and kisses! I think today I must've gotten good karma because of it.

I got to see the sunrise this morning because I got up really early. It was so pretty! Then I checked my email to find a message saying morning classes were cancelled because the professor retired. What luck! How often does that happen?! So I took advantage and went back to bed until really late. When I woke up again, I took a shower by daylight only, not using the fluorescent light (my bathroom doesn't have windows, so it has to be late enough in the day that the sun can shine through my bedroom and then into the shower). It's such a nice, pleasant, natural-woman thing to do! I had a nice leisurely breakfast/lunch, and it was a gorgeous day so I enjoyed my bike ride to class and back home in the sun - not too hot, not too cold, just right. It was so nice that I wore flip-flops and a tank-top with my New Zealand fishhook necklace, and got some nice compliments! And then I got a nice little present in the mail from my mommy and daddy on their trip to Hawaii last week! =)

THEN I came home to find an email saying my summer research had been accepted for presentation in May at the Society of Academic Emergency Medicine Annual Conference in Washington, DC. The funny thing was, I thought the doctor who I'd done the research for had submitted the abstract for the Regional Conference. UC Irvine is hosting that one in March, and it'll be a more local, laid-back atmosphere because it's run by my department. But the DC one is the biggie, and I didn't even know we were submitting for that! So imagine my surprise at the email... and a little excitement and a little nervousness.

Oh and another good thing: I got an exam score back today, and I did even better than I thought I did! THAT never happens.

What a nice day! At this rate, I should give Darron lots of hugs and kisses more often. =)

Drinking and Driving

2008-02-23T00:30:00.000-08:00

Our EMIG (Emergency Medicine Interest Group) pulled off a major DUI prevention event at a local high school yesterday, in an effort to keep little teenage drunkards from killing people. It started with a mock car crash, then an auditorium presentation by a doctor, then breaking the 400 students into small group discussions led by med students. Ironically, we were hoping to get good media coverage but they were all at Cal State Dominguez Hills for a report of a gunman on campus - big teenage sociopath trying to kill people. Maybe next year we should involve the Psychiatry Interest Group and have a mock shooting spree to talk about the dangers of being under the influence of psychosis. But, as it turned out, it was an ROTC student carrying his nonfunctional rifle out in the open to class. Daiiiii!! Even without the paparazzi though, everyone had a good time. You can imagine how much I missed my job that day!

Click here for pictures.

Lobby Day in Sacramento

2008-02-04T15:57:00.000-08:00

So you might be wondering what I do with all my free time.
See for yourself - I'm in the very back row.

Quantum Physics

2008-01-21T21:16:00.000-08:00

You won't believe it! Somehow, after my karate meet, I was accidentally transported to the delta quadrant via this time portal! Darron was there with me for some reason, and it turned out we landed on a hospitable planet, so we didn't burn up or die of oxygen deprivation. We found a wormhole to come back through within a few days, but when I got back, I discovered that the Darron I was with was an anti-Darron! He existed in the delta quadrant in what we understand as an "alternate universe." When I got back, poof! he disappeared, and suddenly I found myself in a Star Trek exhibition in Long Beach. It also turns out I've been gone for nine months and the real Darron has been here the whole time. I don't know how this happened, but I should have suspected something was up because the anti-Darron was always cleaning and wanting to go shopping.

So anyway, that's why I haven't blogged for so long... to you, although it was just a week ago for me when I last posted. I'm just glad I got beamed back in one piece! Literally. They had to try a couple of times because my signal strength was so weak during the Cardassian ambush, but you can see me arriving safely home here sans equipment - they stole it during the attack!

Click here to see it!

We Are the Champions

2007-05-26T22:28:00.000-07:00

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

2007-05-23T23:33:00.000-07:00

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

2007-05-17T01:17:00.000-07:00

Week 5

Plants Week 4

2007-05-07T02:02:00.000-07:00

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

2007-04-29T17:28:00.000-07:00

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

2007-04-25T00:16:00.000-07:00

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

2007-04-22T16:45:00.000-07:00

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

2007-04-19T23:06:00.000-07:00

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

2007-04-18T18:56:00.000-07:00

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!

2007-04-15T10:35:00.000-07:00

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

2007-04-13T00:33:00.000-07:00

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

2007-04-12T17:39:00.000-07:00

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

2007-03-31T10:49:00.000-07:00

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

2007-02-26T13:50:00.000-08:00

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

2007-02-14T16:23:00.000-08:00

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

2007-01-27T16:28:00.000-08:00

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

2007-01-21T16:38:00.000-08:00

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

2007-01-21T10:16:00.000-08:00

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.

Humility

2006-12-29T19:55:00.000-08:00

People often seek out stimuli for specific emotions. They watch horror movies to feel fear, volunteer at a soup kitchen to feel altruism, dress up to feel sexy, or attend church to feel pious. However, most don't go about looking to feel humility. It is a rarely sought experience. I, for one, did not go to the ER today to tag along with the doctors there, intending to be humbled.

I was hanging out in the doctors' room, listening to the banter and waiting for something interesting to happen. The kind of talk that ER doctors partake in is very similar to firehouse banter. It must be a function of being privvy to the nastiest, most private, raw aspects of a patient's life. I think the irreverence with which doctors and firefighters/medics alike talk about patients is refreshing. It is a welcome departure from political correctness. The particular story that one doctor was telling was about a fellow who came in after a car crash, fully strapped to a board with his neck in a collar and utterly unable to move. The doctor went into the room a while later to examine the patient, and found someone standing at the foot of the bed, but with her head bobbing up and down under the sheets. The patient, seeing the doctor in the doorway, cleared his throat, and the bobbing stopped. Everything was still for a moment, then as the doctor decided the patient could wait and turned to leave, the bobbing started again.

As the laughter died down, one of the doctors asked if I wanted to see a "really nasty abcess." I perked up, "Sure!" and we headed off. A Latino woman was the lucky bearer of this malady. She could have been the sister of my aunt's housekeeper, who I used to help fold laundry because I was uncomfortable with the idea of someone cleaning my stuff in servitude. I nearly asked the patient if she was related to her, the resemblance was so similar. She was in the ER because she had an abcess under her armpit, on the side of her chest. The abcess was about the size of my fist in diameter, angry red, stretching the skin taut, and oozing pus. I had seen abcesses before, and they always looked like they were very painful. They are usually from shooting up dirty drugs under the skin instead of into a vein, where they are supposed to go, but the doctor said that women that speak only Spanish don't do drugs. The men, maybe, or maybe the second generation, but usually not the first generation women: a useful un-PC-ism, an anecdotal, practical truism, that I mentally filed away. He didn't know how she got hers. He then passed me off to the resident who was doing the actual procedure, and stepped out. The resident explained that he had numbed up the skin slightly beforehand, but he couldn't numb everything so it was going to hurt the patient considerably. Sure enough, as he made the two-inch incision, the woman started wriggling her legs around and making muffled pained noises. Pus flowed out of the incision, and I peered in and matter-of-factly muttered, yes, I see, you're right, it is a lot of pus. He asked me to hand him the suction, and sucked up the thick fluid that resembled melted vanilla-butterscotch ice cream with raspberry sauce, and the lady continued to kick her legs about. Then, the resident explained that with abcesses this big, there are pockets of pus branching out from the main pocket, so he would have to dig around for them in order to get it to all drain out. So he jammed in his scissors and poked into the gaping hole under the skin. The pus that I thought was all gone gushed out anew, and the woman screamed louder than I can remember anyone screaming in a long time. This was unexpected. I figured he would make a cut and squeeze the pus out, but the digging around seemed rather torturous. I felt a little bothered. I wondered if it was because causing more pain, aside from starting an IV with a needle to the arm or splinting a broken limb, is not really in my paramedic experience. I wondered if it was because he was poking around so much and that I didn't expect him to be so visceral about it. Maybe it was because I didn't feel that great when I woke up this morning. And this wasn't making me feel better. The gaping hole, the river of pus, the screams, the suction, my head felt a little funny, the resident asked for the suction again, the lady screamed more, the gaping hole, the stabbing scissors, I felt kind of stuffy, more suction, I swallowed, I was going to be fine, I took a breath, the scissors inside the open wound, she screamed louder, my vision got dark on the periphery, I couldn't make it stop, the scissors went deeper, more screaming, writhing legs, my vision finally tunnelled. I tried to put the suction down neatly as I told the resident that I was going to step out. "Sure, sure, no problem," he said, as I left the room and leaned on the handrail in the hallway. I found that standing upright wasn't so easy, so I sat down on the floor, taking deep breaths. I was sweating, parts of me cold, others hot. My vision wasn't so good. The attending came back around the corner and said something to me. I couldn't understand him. I peeled my head off the wall and a gravelly whisper came out, "I'm sorry?" He took one look at me, either said or waved "never mind," and left. A nurse came out of a room, and saw me there. "You okay?" she asked. "You want to come in here?" I didn't know where "here" was, so I laughed weakly and said I was okay. She held out her hand and I promptly changed my mind. She helped me onto my feet, and let me into the nurses' room. I found a chair, put my feet up in another, and she remarked that I looked awfully pale as she switched on the fan for me. I felt really silly but I was sweaty and cold all over, and the darn darkness of my visual field wasn't going away as quickly as I hoped. People moved in and out, variously comforting me and informing me that my face was shades of green or grey. Another nurse brought me apple juice and a packet of crackers. My vision was getting back to normal. I was very confused why my brain was doing this to me after ten years in EMS, the last six of which were as a medic in what most would call a hard-core environment. When I felt better, I went back into the room to watch the resident pack the wound with gauze. It went fine.

So now I sit here, pondering why I reacted that way. I slept in until almost noon today, and was parched when I woke up. I had two bowls of salty egg soup and a half a bagel for lunch, then a granola bar just before I went into the ER. Not the pinnacle of nutrition. I think it was also the causing pain part, and maybe the unexpected scissor-stabbing part of the procedure. Maybe I've seen so much so far that I was caught by surprise by something I didn't see coming. By comparison, cadavers are no sweat (although who knows how I’ll be when we start dissecting the face). At first, I wasn't that worried, but I did hope that I would make it through okay. Now that we have been in lab several times, I think they are distasteful, but they don't scream and cry and flail about. You can't hurt them. Living people are different though, and I think my tolerance of cadavers and prior patient experience has made me too comfortable. In any case, I certainly didn't see humble pie on the menu for the afternoon, but I got a slice of it. It doesn't taste all that great, but I suppose it's a necessary thing to have from time to time.

Discovery

2006-12-13T22:54:00.000-08:00

I discovered today that red wine in moderation is not only good for your heart, but also makes studying funner.

Random Thoughts Post-Exam

2006-12-04T17:58:00.000-08:00

I've discovered the key to excellent pesto sauce. I've made and eaten a lot of pesto in the firehouse. My favorite can be found at the Nob Hill Cafe in San Francisco, in -oddly enough- Nob Hill. Yesterday I experiemented. The secret ingredient is a little bit of cream. Yes, in addition to the olive oil and sausage. And Italians are slimmer than Americans? Hard to believe. It must be the wine. Also, the key to making good cranberry sauce from scratch is not necessarily adding more sugar, but a little orange juice. Of course, that has sugar in it too, but the OJ adds a little sumpm-sumpm.

My genetics professor really pissed me off. Today was the final exam. Her spelling and grammar were insultingly bad throughout the course - in the handouts and in the presentations. She didn't know how to punctuate either, and sometimes it would convolute the meaning of the sentence. If we are being held to such high academic standards, then the professors should be held to even higher standards. Medical school is supposed to be the pinnacle of higher education, so it's depressing that the faculty can't even spell. AND, she's from Britain! It's her first language! They're supposed to be the originators of the freakin' language! Rrrrgh. Poor spelling really makes a person look either stupid or lazy.

There are no good music stores in Orange County to go buy sheet music for my violin. The music library at UC Irvine is a joke - they have no music librarian, and all the music that they have is tucked away in some corner at the top of the library. Cal has a whole building dedicated to music, with its own librarians. I miss Cal. I didn't appreciate it as much as I could have when I was actually a student there.

I wanted to drive to Napa this afternoon, but it's too far. There's no place like that here that's within an hour's drive, like Napa is to Oakland. So I drove around the endless concrete jungle for a while instead, looking for a musical instrument store. It was rather unsatisfying. I miss Northern CA.

On a happy note... for our fake patient exams last week, we conducted a physical on a normal person who didn't have medical problems. I didn't do the reading beforehand, so I was winging it. The doctor who oversees me and my partner asked some questions to which I had no answer. I let my partner answer those questions and chimed in for the ones I did know from background knowledge. My partner had done the whole reading about how to do a physical exam. He is a very precise, intelligent guy with somewhat businesslike, but good bedside manners - he said "please" and "thank you" every time he asked the patient to do something. During the session, I could tell that the man was bored and not so impressed with what was going on. At one point as the doctor was rambling on about some technique, I quietly asked the man, "How are you doing?" with a slight smirk on my face, because I thought that the whole situation was rather silly, too. When we were finished, the doctor didn't single me out by name, but he mentioned, "...and you should always say please and thank you when you do something to the patient. They really like that." I didn't say please and thank you every time I had the "patient" do something; in fact, I didn't give him much direction because we were repeating what my partner had just done, and he seemed intelligent enough to get it. Plus we both thought the whole situation was rather silly. At the conclusion of the exam, as my partner and I were about the leave the room, the man asked, "What did you do before you came to school?" Taken aback, I told him I was a firefighter. "Paramedic?" he added. "Yes... You're good! How...?" He looked at me over his glasses and said, "It's the way you interact with people, the way you carry yourself. Keep up the good work." I know that there is more to being a good doctor than being a whiz in biochemistry, but sometimes you lose the forest for the trees. It was a nice reminder.

My Feelings Exactly

2006-12-01T22:28:00.001-08:00

At the UC Irvine School of Medicine, we often send each other study guides in the spirit of cooperation. I received one such study guide today, courtesy of one of my classmates, Shaun Chung. (Note: it's not plagiarism if it's cited.)

Hey Mitochondronauts!!!
I know there are a lot of people right now throwing there hands up in the air in frustration concerning Wallace's material. Seeing that there is just way too much convuluted mitochondrial minutiae, Greg and I sat down today and made a pretty comprehensive yet concise Wallace review sheet. Hope it helps. If there is any confusion or if you disagree on anything please let us know. Thanks.

Enjoy your weekend,
Shaun and Greg

Anatomy

2006-11-28T18:16:00.001-08:00

Today was the first day of anatomy. More specifically, today we started cutting up people. It’s supposed to be the course that makes you FEEL like a medical student, because it is the hallmark course of a medical education, a rite of passage, steeped in the tradition of grotesque assailings on the senses. I certainly haven’t felt like a medical student so far. It’s all just been more biochemistry, yucky chemistry, in the same lecture hall, day in and day out. Finally I feel like this is something more suited to me. I hope my combined paramedic knowledge and time in anatomy lab from last year gives me a small advantage over my classmates. They all seem to know everything about microbiology and biochemistry because that’s what most of them majored in, while I run around in circles trying just to keep up. I’m tired of feeling stupid. I want this to be MY time. They picked me to be in medical school because of my background; it’s about time it came in handy somehow. So far, it seems promising. My first trick was instinctive - breathing through my mouth so I won’t gag on the smell.

My person died just three weeks ago. They preserved her not with formaldehyde, but with some new chemical that they are trying out. One of my classmates is very pregnant and can’t participate in lab until she has her baby, because inhaling formaldehyde while being with child is not the best idea. The reason behind the new chemical is to get away from formaldehyde and to something safer. Great idea, but the stuff doesn’t dry out the cadaver like formaldehyde does. Consequently, our lady is very juicy.

We started with the thorax (the chest), and began by cutting the skin over the breastbone. But wait! The incision was made by scalpel. This is huge! The scalpel is a forbidden tool for paramedics. The general school of thought in EMS has been that scalpels are for doctors, and needles are for medics. Give 'em huge needles, but by God, don't give 'em scalpels. Knowing the lot that make it into the paramedic field, maybe that's not so unwise. So anyway, today’s exercise with the scalpel should have had much gravity. Actually, it was like using an Exacto knife to cut open cardboard boxes. I don’t see what the big deal is. So the incision went. Our lady had quite a bit of fat. It looks like yellow blobs under the skin. It took a long time to scrape the fat off the appropriate layer of membrane, peel it back, dissect the breast, which is just a big hunk of more fat with some stringy stuff in it, peel back the breast, peel back the muscle, first the pectoralis major then the minor, to reveal the ribs. The firefighter was nominated to saw through the sternum. Because, of course, firefighters saw through people’s chests with hack saws all the time. So I dove in. As I sawed, the juice started pouring out all over the place. There was slight pandemonium as my groupmates ran to get the turkey basters and plastic tubs to keep her from flowing all over the floor. Scheduling the first anatomy lab to be AFTER Thanksgiving was probably by design. The more I cut, the more she leaked. But we completed our task, which was to cut through the ribs and the sternum to remove the “lid” to the chest cavity. Just think of cutting the top off a pumpkin to expose the inside when you make a jack-o'-lantern, and that's kind of what the objective was. It's pretty neat in there.

When I took anatomy last year, I remember getting all spiritual about the whole thing. The dissections were all done for us ahead of time because we were just undergrads, so mostly we just moved things around and pointed and poked. But once all the organs are taken out of the body, you realize that the body is truly a shell. Where is the soul? Is there a soul? What is the person thinking as we cut her up? Is there such a thing as bodiless thought? Is it an "it" or is it still a "she"? Is she watching us? Where would she be watching from, still inside the body, or floating around above us? Or maybe from below. Or maybe through one of us. Before she died, did she imagine she was donating her body to more serious, appreciative, thoughtful, mature students than us? Did they assure her that her body would be treated with the utmost respect, when really we laughed about how we couldn’t tell she was a she until we checked between her legs because her breasts were so flat? Is tasteless humor as a coping mechanism disrespectful, or is it acceptable because most people understand that it’s a shield from the strong emotional response that dissection elicits?

So far, anatomy is creating more questions than answers. I haven't really answered those questions I had from lab last year. This time, it is more involved, because we are actually starting with whole bodies and doing the dissections ourselevs. Perhaps I will become more spiritual, perhaps not. All I know is that I was starving by the time I was done.

A Journey in Time

2006-11-19T21:26:00.000-08:00

When you take on a new interest, you generally learn things. Surprisingly, my new interest in pearls has led me to Japanese history.

I've been reading some Japanese web pages on pearls as well. I can't read like I did 15 years ago, but it always pleasantly surprises me that I can read at all after so long. Reading or speaking a rarely used native language is like an old song that you used to know by heart - you have a general sensation of the words that are about to come up, even if you can't formulate them, trapped and eager to pop out, but just stuck at the tip of your tongue. Immediately after you hear them, you think, "yeah, that's it!" and then they come back to you as if you had only forgotten them for a little while. You may have to relearn them to sing them by heart, but they are familiar and fit well, and you know that because you knew them before, they will come back again easily if you want them to.

The Power of a Compliment

2006-11-18T01:24:00.000-08:00

My parents bought me a pearl necklace and earrings for my birthday. Actually, they sent me a check and I got to go pick them out. It was the best experience I've had in a long time.

I didn't know where to go, thought that an independent jeweler would be out of my price range, so after doing my online research, I went to Macy's for some clinical education on pearls. I was helped by a woman who was very nice. She didn't seem to mind my obviously un-millionnaire outfit, and spent time showing me several necklaces. I was only there to learn about pearls that first day, so I thanked her and left. I went back another time, but she wasn't there, and no one helped me or asked if I needed any help. I left again, a little disappointed. Today, I had decided to not let indecision get the better of me, and to go ahead and buy one. I headed to the infamous South Coast Plaza, thinking that they might have a larger inventory to choose from. I had been out to dinner and was dressed up a little bit, so I thought I looked rather decent. They say when you are going to buy quality items, you want to look the part so that they treat you as if you are a real potential customer, not a window-shopper or a dreamer. Or a thief. My outfit did nothing for me though, as no one even cast a glance my way in the ten or so minutes that I eased around the cases of jewelry. I left, somewhat bitter at the pretentious Orange County merchants who wouldn't even say hello to someone who might want to spend money. In the Bay Area, thanks to the dot-com boom, many merchants learned that they could never know which sloppily dressed Joe Shmoe might be some wealthy programmer that was ready to buy out the store.

Despite the snub at South Coast Plaza, I did still want to get my birthday gift, so I headed to the original Macy's that I had been to before. I found the nice lady, Valerie, still working late on a Friday night. She was very sweet again, helping me and letting me try on whichever strand I wanted. She was an older aunt- or a young grandmother-type woman. We looked at different strands and mused over them together, she calculated with the sale discount what my final price would be, and gave me time to make my decision. When it came time to ring me up and open a new credit card to get me that extra discount, she wasn't so keen with the computer. Her co-worker, a very bejeweled, make-up-wearing, perfectly coiffed man with a bracelet that declared him to be "Blair," took over the computer and impatiently showed her how to do the transaction. He was slightly curt with me as well, but Valerie didn't seem to pay much mind that he was trying to hurry her up, and happily wrapped the necklace up for me. She made the whole experience rather sweet and sentimental, like a motherly figure, celebrating with me and lending a symbolic bent to my purchase. As I left, I beckoned her to lean over the counter and whispered, "I'm so glad it was you that helped me." She gave a little squeal and squeezed my hand tight, delighted and a little flustered, and said, "Oh, come back and see me, won't you?" It made me nearly tear up later when I thought about it, she was so happy. On my way out, I asked to speak to the managers. When I told them that Valerie had been so wonderful, they all lit up - with real, genuine smiles - as if I had personally praised them. As I walked away, I could hear them saying, "Oh, how sweet!" and "What a nice thing to say!" It might be a sad commentary on the ordinary clientele that they were so excited about a simple compliment.

I have my hunches that Valerie is working at a department store because she needs to augment whatever Social Security income or small bit of savings she might have. She didn't seem like she was trying to ascend the corporate ladder or get extra commission by rushing me through the transaction. She was simply very sweet, and treated me like my purchase was special to me. It didn't matter to her that it might take a few extra minutes to help me. Unlike buying a pair of socks, buying jewelry is a personal experience. Blair was technologically competent, but the interaction with Valerie is what I am going to remember. I felt powerful that I was able to make a perfect stranger feel so good with just a few words of thanks. I'll think of Valerie every time I wear those pearls, and it will make me smile every time.