Saturday, June 26, 2010

YouTube Time-Sink

Every now and then I tend to browse YouTube. It's a surprisingly effective time-sink. Here are some YouTube vids that I particularly like.

Pink Glove Dance

I think this vid is really cute. I wish my med school did something like this. I especially love the part at about 0:54 minutes - the lone black male researcher in what appears to be a lab of otherwise only women. That's just priceless to me.

JK Divorce Entrance Dance

This is a spoof of sorts in response to this vid. I thought it was pretty hilarious, especially towards the end. :-P

Muse - Time is Running Out

This song has been stuck in my head for . . . weeks. Particularly various string versions of it. Notably, I like the arrangement by The Section Quartet, but the version by Vitamin String Quartet is also pretty good.

Lady Gaga - Greatest

I'm not generally the biggest fan of Lady Gaga, but I do like this song. I think, moreover, I like the lyrics. So if you don't to listen to the song, fine. Just go to the YouTube page for it and read the lyrics under the vid.

Wednesday, June 23, 2010

Not Medicine, But Life

Well, it seems no one read (or cared) about my inner issues from my last post. That's fine, not like I expected anyone to care about my ranting and whining. Kind of like I wasn't invited to a friend's wedding, even though I've known him for 4 years in undergrad. Granted we weren't really close friends, but we hung out and chatted and all that. My best friend from undergrad (his best friend) was really mad that I wasn't invited - but such is the story of my life.
Anyway the purpose of this post is to update you all on my last week and a half of my externship. What I saw was surprisingly little medicine, and a lot of life's psychosocial issues. What I saw were mostly "special populations."

Pediatric HIV patient
Last Monday I observed a patient in Dr. H's pediatric HIV clinic. The patient had contracted HIV via mother-to-child and was slowly being transitioned to adult HIV care (being 24-years-old already). I was in there with Dr. H and 2 of his HIV nurses. It was clear that Dr. H had known the patient for many years - 10 years at least I think.

Of the 1-hour or so visit, surprisingly little time was devoted to HIV care. Most of the time went towards helping the patient resolve personal issues - with her relatives, with getting a job, with her boyfriend, etc. She broke down more than once and cried on Dr. H's shoulder. All this was necessary such that she'll be able to get herself out of a rut and take her meds regularly again.

The following morning, Dr. H left me with some words of wisdom:
When a doctor or a student says, "The patient won't take his/her meds," change "won't" to "can't" in your mind. Think, "The patient can't take his/her meds."
Powerful words indeed. I could go into a whole post on those words and what he asked me to look up after the clinic visit, but I may save that for some other time.

Children's Court
Last Wednesday I went to Children's Court with several other externs. A retired judge met us there and gave us an introduction to Children's Court and what they did. They handle cases such as: juvenile delinquency, child physical abuse, child sexual abuse, negligence, etc. Their "goal" is to eventually reunite parent and child, even if the parent is . . . less than perfect. Usually - and curiously - the alternative (foster care) tends to be much worse for the kids.

I'm glad I was able to get an opportunity to sit in on a few hearings, though the presiding judge seemed rather annoyed at our mere presence in the courtroom. It's an opportunity not many get (at least, not in such a manner). It really is kind of like how it is on TV, lol. As such, I'm really glad I didn't go into law - the procedural stuff isn't for me.

International Adoption Children
Last Friday I accompanied the head of the pediatric infectious disease department (Dr. C) to an international adoption clinic. He had me read 6 chapters of a book the night before (which took me forever to get through - all but one of the assigned chapters was about infectious diseases). The 2 clinic visits were . . . interesting.

The first clinic visit went pretty smoothly. The adopted baby was quite cute and playful, and seemed to be adjusting alright. Dr. C did seem a bit concerned by the kid's "hyper-geniality," that is, he's too friendly with strangers. In the reading he assigned me, this could indicate lack of attachment to caregivers, which is a problem as kids can wander off with strangers too easily. The child psychologist agreed that it was something worth watching.

The second visit was kind of bizarre. The 5-year-old kid was adopted from Hong Kong and knew very little English. An interpreter was called in (alas, I can only understand but not speak Cantonese). The kid had so many issues, mostly behavioral. The parents seemed at wit's end at times during the 1-hour visit. On the way back to the hospital, Dr. C told me that, while most parents probably mean well, they don't fully think things through when they adopt international kids. Often times these kids are "damaged" in some way - either inherently or as a result of institutionalization (orphanage, foster care, etc). Dr. C only saw disaster for this family in the future.

Inner City Kids
This week I began working on my primary care pediatric mini-rotation . . . in the inner city. I get this feeling that all of us externs are to do our primary care bit in the inner city. While the last primary care pediatrician I shadowed was in the suburbs (where almost all his patients were white), this time I'm in the inner city where almost all the patients are black. And also, a lot of the patients are younger in age - so I saw a lot of babies.

I mean, today most of the patients were 1-month-old babies. One of the dads yesterday looked at me and said, "You don't have a kid, do you? You have that look on your face." I asked a lot of dumb questions about babies because, again, I know nothing. It's nice to know that the medicine we're taught has such an emphasis on adult care that pediatrics often get shuffled to the side (or at least that's how it feels to me). ::Insert sarcasm::

At the end of the day yesterday (the pediatrician I'm working with now works 8am to 8pm on Mondays, Tuesdays, and Wednesdays), he held up 5 billing sheets and told me: "See these? These amount to about $600 because all these patients are Medicare. If they all had private insurance, it'd be closer to $2000." What's frustrating (to the pediatrician and me) is that in primary care, we have to treat the patient population as richer and poorer. And that dichotomy greatly affects care no matter how neutral doctors try to be.

He also told me that where he did his residency (in Illinois somewhere, I forget), the hospital system was in a bit of financial trouble and needed more revenue for whatever reason. So the hospital implemented a program to increase the number of circumcisions they did because each one brings in hundreds of dollars, it's relatively easy to do, and it's billed more because it's an elective procedure (that is, it's not necessary to one's well-being). And it's totally unethical - we were both in agreement on this point. It's almost like trying to promote appendectomies on healthy individuals. It infuriates me to think about it more. Note to self: avoid that residency program.

For health care consumers, I suppose you should be careful if a doctor or nurse pushes too strongly towards a surgical procedure when none is needed or when alternatives haven't been considered - there may be something more behind that than "good medicine."

Saturday, June 19, 2010

Behind the Masks

Sometimes I wonder . . .

Sometimes I wonder if there was ever really a face to the person behind the masks. Sometimes I wonder if the person forgets that he is wearing masks, like people wearing glasses sometimes forget. Sometimes I wonder if the person remembers that he is an independent entity apart from his masks. Sometimes I wonder if this person is able to separate himself from his masks . . .

I've blogged for so long now that it has itself become a mask - one through which I allow people who I've never met become my friends, one through which I let strangers glimpse some of my most personal thoughts and memories, and one through which I let the world read my secrets. Reflecting on this blog, it has seldom been me at my least restrained. More often than not, my posts are mere amplifications of my many masks.

Can I even dissociate myself from the masks I wear? Is there Aek without a love of biology, languages, and music; without medicine; without desire to help; without inner sexual conflicts; without confusion; without secrets embedded deep inside? Am I these things, or are they me, or is it both?

As children, the mind is amorphous and does many things - all things - simultaneously. As we age and become adults, the mind solidifies onto certain paths, narrowing options while enforcing those paths. And so I wonder, has parts of me been slowly chipped away by time and age, such that all that's left are the parts of me still attached to my masks? What is Aek when he's not a med student? What is Aek when he's still not sure if he's bi/gay/other? What is Aek behind the masks . . . behind that name?

Though it may not seem like it, though I may not always say it . . . there is still much vulnerability and insecurity to the face behind the masks. I'm still waiting for someone to take them off and look me in the face.

Sunday, June 13, 2010

Infections Everywhere, Oh My

On Monday I started my peds externship, starting with 2 weeks of peds infectious disease (PID). I think I'll talk about particular people/events rather than detail my day-to-day, as doing the latter would make this post too long.
First a cast of characters for this week:

Resident. Resident is a 2nd-year med/peds (internal medicine and pediatrics) resident currently rotating through PID. I spent most of my week with Resident. Resident is amazing - cute, adorable hazel eyes, a great smile, very intelligent and conscientious, very nice, and loves to teach. I learned and reviewed a lot with him this week - stuff that I learned (and too often forgot), some stuff I feel like I should've learned, and some stuff that I probably won't learn until M3 year. He gave me some tips for the USMLE Step 1 that I'll be taking this time next year. Also, he told some things I hadn't yet learned (like Cushing's triad) so I could "impressive" Dr. H and say I learned something from Resident. At least when Dr. H pimps us, he pimps nicely (sorta). I think I had a mini-crush on Resident, too bad he's on vacation next week. :-/

Dr. H. When I told Dr. P that I'd be working with Dr. H for 2 weeks, Dr. P was like, "Good. He's the guy to work with. I'll send him an email and let him know about you." So Dr. P hyped me up for Dr. H and that's kind of amusing. Dr. H is a quirky guy, and brilliant (maybe that's why he's quirky). He's been super-busy most of the week, hence why I've been rounding with Resident a lot (not that I'm complaining - Resident is awesome). One of the things I love about Dr. H is how he always makes a point to explain things to parents so they can understand the full situation. He'll sit down and explain any lab values and any radiology images (x-ray, CT, MRI, etc) until the parents understand. And the parents always appreciate it, because rarely do anyone else explain things in such detail.

HIV Nurse. On Thursday, I went with HIV Nurse to the local HIV/AIDS resource center for a management meeting with other nurses. So the management meeting is where nurses (and doctors) manage HIV cases - by adjusting meds, dealing with follow-up care, dealing with psycho-social issues, etc. I sat in on a peds HIV management meeting and this one for HIV+ women in the area. Then I went on a home visit with the HIV nurse. This poor woman takes more drugs than I think I've taken in my entire life combined. HIV meds, hypertension meds, insulin, and more. I'm really glad that HIV nurses exist to help patients manage their meds (and other life issues), but I certainly do not envy their job.

Doctors often prescribe a bunch of meds, but there's no real way to know if patients are actually doing them. So these HIV nurses are like the "executors" of the doctors' orders - making sure patients actually take their meds regularly and such. It's hard work, and I think it was a really good experience for me so I can appreciate the difficulties involved "downstream" after the doctor's visit. And from the HIV nurse I also learned that all the HIV management Dr. H does is for free, since that service can't be billed. So Dr. H spends a lot of his time doing stuff for patients that he isn't getting paid for; but, he must still somehow see enough patients to meet his salary. That's rough, but I only have admiration for what he does.
So, because I'm on PID, all I see are infections. Infections everywhere!! By the end of the first day I learned that there are different kinds of MRSA and that there are 4-5 main antibiotics commonly used in the hospital. Also, by the end of the first and second day, my feet wanted to assassinate me and walk away - it hurt so much to stand for so many hours. But I got used to it by the third day.

PID is basically endless rounds and consults. You don't really have any patients of your own; all your patients are referred to you from another physician/team as they ask you for a consult. The number of patients you'd see is actually rather small, but you do a lot for them and you spend a lot of time with each patient. A few patients we hovered around for a good hour or so, and also spent a lot of time talking to the (very worried) parents. So as a PID doc, you're basically a consultant (that does a lot of work).

I also saw several kids with pneumonia, and I got better at reading chest x-rays. I spent a little bit down in peds radiology to look at images with Resident and Dr. H, so that was cool. I must say, the radiology offices are dark - vampires could probably comfortably live there, lol. The radiologists also have interesting-looking (and possibly ergonomic) chairs that they sit in. o_O

Most of the kids I saw were quite sick, and several of them were in the PICU (pediatric intensive care unit). This one poor kid was sedated almost the whole time I was there and had like, 4-5 lines in him that were all infected. And he had this really uncomfortable-looking rash over his entire body except for a patch on his left arm.

Another kid was in the HOT (hematology/oncology/transplant) unit, and he was so adorable. It sucked that he had cancer and was scheduled to get chemo, but he seemed otherwise healthy and fine. We were looking into a mystery lung thing that produced no noticeable symptoms. That was truly curious. Just as curious as the teen who came in whose only complaint was a fever that persisted for 2 weeks and no other symptoms. :-/

The most interesting case I saw was a kid with tetralogy of Fallot. When I learned about it first semester, I never thought I'd see a case of it and here it was!! Alas, when Dr. H asked me what 4 features define it, I could only list 2 and he gave me a disapproving look. I also couldn't list the 5 cyanotic heart defects (though I'm pretty sure we only learned 4 of them anyhow). This kid came in with a brain abscess (likely of infectious origin), and so I found the neuro exam really interesting. Ipsilateral ptosis, downward gaze, and small pupil; contralateral muscle weakness. Very interesting. Bonus points if you can guess the location of the brain abscess on the CT. :-P

I also touched some babies' fontanelles! Babies are so cute. ^_^ The fontanelle feels different depending on how old the kid is, and also can bulge out if there's intracranial pressure (that's kinda freaky). Alas, at least one of them was in with bacterial meningitis, but I think he'll make it out okay. He was already on his way to recovery. That's something I do like about PID. At the beginning of the week all I saw were sick kids, but by the end of the week, 2 of them left our service because they got better and were discharged to go home.

Lastly, a funny note. Dr. H asked me how I knew Dr. P, and I said I met him at some event held at the med school and I shadowed him twice a few months ago. On the first day, we ran into a pediatric hospitalist I knew while she was on service. Dr. H was like, "Do you know everyone?" The following day, I ran into one of the faculty advisors for APAMSA while walking down the hall with Resident, and even Resident commented, "Wow, you do know everyone don't you?!" I was amused.
Okay, this post was longer than I thought. Ah well. So filled with medicine/health stuff, but that's the whole point. Remember folks, wash your hands. Germs lurk everywhere, and infections aren't fun.

Saturday, June 12, 2010

Cool Breeze, Hot Air

I started my pediatric externship on Monday, but I'll get to that later in the next post. This post is devoted to 2 other (shorter) topics.
I haven't talked to Jay (Online Guy #1) in a long time. Well, we webcammed a couple weeks ago so I could tell him some answers to his homework. -_- Lame. I tried to not overtly give him the answers, as he has to learn to be a nurse somehow! Anyway, other than that, we've barely chatted. Eh.

In contrast, I've been chatting with Drew (Online Guy #2) fairly regularly the last month or so. Alas, all of our convos have been rather short, as I seem to catch him at bad times (this seems to be a recurrent issue). He's been having a rough time these last 2-3 months.

He broke up with his boyfriend (which I didn't know about when I first contacted him). They ended on really bad terms. And he's been dealing with that break-up, being depressed, overly busy, and all that. I haven't pressed anything and have just generally taken a step back and gave him some space. I don't think he's in a spot to think about a relationship at this point . . . maybe soon, who knows.

We have had some pretty good convos though, I think. Chatted about music and composing. Traded composition clips, lol. I think several of our interests/personality quirks overlap, which is good. But here I am, stuck (again). I don't know how to proceed. I don't know if I should. I don't know what to do . . .

Perhaps I should give up on the whole "relationship" thing again, as I obviously don't know what I'm doing or getting myself into. Perhaps I should just things cool and let the breeze take me where it wants. Perhaps I should give up on him - as it seems to be going nowhere. If it is nowhere (which is likely), then it's nowhere. It's a rather lonely summer. :-/
On a completely unrelated topic, my parents called a few days ago. So, my brother got into med school here (good for him). Since my mom's out of a job and my dad doesn't make that much, they want my brother to move in with me and my roommate.

Neither my brother nor I am thrilled at that prospect. We could easily get on each other's nerves pretty quickly. After some debating, I reluctantly relented (as did my brother), so we're compromising and just gritting our teeth and dealing with it. But I think my parents are pushing their luck too far. See, they also want my brother and me to share a bedroom - which we both adamantly refuse.

My roommate and I had agreed to convert a good chunk of the living/dining room into a psuedo-bedroom (since neither of us use that space much at all). My brother's fine with this arrangement (again, not thrilled, but better than sharing a bedroom together). Unfortunately, my parents refuse to this agreement. It's just ridiculous! Their reasoning is simply, "You're brothers - you have to share a room since it's so large." -_-

My ears are still blowing off hot air. My brother and I are really pissed at this. What'll probably end up happening is just us both banding together and putting our feet down. They can corner one of us, but not both of us at the same time.


Right now, both my brother and I (ideally) hope he miraculously gets off the wait-list at another med school in the next month or so.

Thursday, June 3, 2010

Summer Begins Now

Wow, it's been almost 2 weeks since I last posted. o_O Much has happened since, but I'll try to keep this short and sweet.
1. Final exams finished last Friday. They were all surprisingly brutal, but I kicked ass on neurosci (thanks to my PowerPoint). I can finally put the "M" of "M.D." behind my name now, lol.

2. I got my pediatric externship placements. I'm doing peds ID (infectious disease) for 2 weeks, primary care peds for 2 weeks, and then peds rheumatology for 4 weeks. I didn't even rank peds rheumatology, so I'm not sure why/how I got that. I'm not entirely sure what peds rheumatology is all about even - I'm guessing a lot of musculoskeletal issues like juvenile arthritis. I also hear that it's pretty genetics heavy, so this should be interesting. I start with peds ID next Monday.

3. Henry, my roommate, and I took a weekend trip to Chicago right after finals. We stayed with one of my roommate's friends, who has an amazing apartment in downtown Chicago. I'm pretty sure I spent more during this weekend trip to Chicago than my 4 days in Washington, DC. Some places we visited include:

Millennium Park (see the Bean!)

Grant Park

Downtown Chicago

Navy Pier


We watched The Prince of Persia which was a surprisingly good movie . . . after I got past the fact that Jake Gyllenhaal isn't even remotely Persian-looking (though, he was quite hot in the movie). While watching the movie, I couldn't help but notice the sheer amount of parkour in it. We also had Korean bbq, which was good. The Korean waitress attending us got quite annoyed at us (quite possibly because we weren't Korean, lol).

4. Spent 4 hours with my co-president planning out all the 2010-2011 APAMSA events. That was an epic 4 hours.

5. Had dinner with my lab group in downtown. Fun times. One of my labmates is getting married in July and I finally sent in my RSVP, lol.

6. Made steak last night for the first time ever. It actually turned out really well! Hurray for merlot. :-D Next, to learn how to cook fish. Also, the Chinese bbq duck (that I bought in Chinatown) paired oddly well with merlot.

7. Will be having a dinner meeting with the LGBTPM board and one of the 3 faculty advisors in about 45 minutes.
That's about all there is for now. Tune in next time for another post. :-P