Gender-free?

A person's sex is biological, primarily determined by XX or XY. A person's gender is largely a social construct, or what being of one sex or the other "means."

This may be old news, but it's interesting nonetheless. A couple in Canada decided to withhold their newborn's gender from the world and him/herself. The idea is to let the child discover his/her own gender and decide for him/herself. It's an interesting "experiment," to say the least, and one that has drawn a lot of controversy.

Personally, I think the child will be all right. S/he will figure out gender, as it's been shown that a child's concept of gender is innate and becomes cemented by the time they're 4 or so. A child "knows" if they're a girl or boy. But what does it "mean?" That can be challenged.

I'm not sure I agree with the way the parents are withholding the child's gender from the child and the world. I think they'd be better off treating the child in such away to avoid gendered stereotypes. Because, honestly, gender stereotypes (to me) seem to be getting less distinct and less important. But maybe that's just me. There's a related article on masculinity that's an interesting read.

---TANGENT---
On a completely different note, I came across this recently:


Oh to have a body half as good as that, lol. Yeah, it's totally unrealistic for the vast majority of us to ever have a body remotely like that. And I can accept that. Doesn't mean I/we can't try to get halfway there (which, honestly, is more than good enough). :-P

Btw, Chris Fawcett is HOT. It's mostly his eyes to me, and less his body.
---END TANGENT---

Now You Feel It!

This semester really hit us fast and hard. I was (and still am) unprepared. And before you proceed with reading the rest of this post, steel yourself; because you see, we just learned how to do a female pelvic exam. Proceed with caution.

It's definitely something that I'm sure many of you reading now will never have the "pleasure" of experiencing (because you're guys and likely gay/bi). I can't say that I blame you. The female pelvic exam is one that every med student is uncomfortable and nervous about the first time. But, after actually doing it (and seeing it done 5 times before I did it), I can confidently say that it's not that bad - as long as you're aware of a few things.

One, know the planes of the female anatomy. See, here's a cross-section picture from Netter's Atlas of Human Anatomy:

And here's the same picture turned 90 degrees:

A few things to notice: 1.) the uterus points "up" towards the belly/ceiling, 2.) the vagina tilts "down" towards the floor, and 3.) the bladder is in front of the vagina and uterus. All of this is critically important.

Two, be ever conscious of everything you say. Never say "oops" or "I think." Those are key words to get you kicked in the face while you're down there.

Three, go slow and be careful! This is one exam where you can actually hurt a patient. And you see, because the vagina is tilted down, you don't insert the speculum straight in but angle it down as you go.

Four, the cervix, uterus, and ovaries aren't "fixed" in place and can move about a little inside the body. That can make finding things a tad tricky . . .

Okay, with those 4 points in mind, the pelvic exam! Our volunteer patient wasn't the "ideal" patient as she was heavier, older (post-menopausal), and had something called a "retroflexed" uterus where instead of pointing "up" it curled over and pointed down. BUT she was an amazing patient otherwise. I also got stuck holding the speculum for everyone. -_-

The exam is pretty straightforward. First examine the external genitalia. I don't know what the big deal is, but the clitoris actually isn't hard to find. Then do the speculum exam, keep in mind the points above. All that was the easy part.

Now, the harder part (IMO) is the bimanual exam, where you stick 2 fingers into the vagina, have your fingertips behind the cervix, and push "up" so that the uterus bumps up against the abdominal wall. I was skeptical about being able to feel the uterus (and especially the ovaries). Because I was the last of 5 students to go, our patient's bladder filled up and pushed her cervix and uterus to the right - which made it difficult for me to examine, grrr. At least our patient told us every time we felt her uterus/ovaries (she was very in tune with her body). She'd say with an odd smile, "Now you felt it!" And we'd all be like, "What? Let me try that again. I feel something, I just don't know what it is."

Anyway, that's that. TMI perhaps, but I just had to share. It's not every day that you can say that you've had your fingers down a woman's vagina and felt her uterus and ovaries (which I still can't distinguish from other things in that region internally). And truly, it was a good learning experience because the patient and physician were both awesome.

Questions? Yes, it smelled a bit but not too bad, hard to describe though. Also, different sex positions suddenly make a lot of sense, lol (light bulb moment for sure).

Lost in Conversations

Well, no comments on my last post. Whatever, no answers for you. :-P
-----
Anyway, a couple days ago I called my best friend from undergrad to wish him a belated birthday and to just catch up. We've both been quite busy, what with me in med school and him in grad school halfway across the country. Now I'm not normally the kind of person who likes chatting on the phone for hours, but we chatted for almost 2 hours!

I could chat with him for hours. I always appreciate his perspective on things and he's probably one of the like five people who I can let my guard down and be completely open with. And that's saying something. After being surrounded by med students day and night, constantly discussing and whining about classes, it's refreshing to talk to someone whose background is just so radically different (he's doing his PhD in political science). We talked about anything from arsenic-eating bacteria to parasite-carrying flies in Africa (to which he suggests a genocide of all the flies) to Liu Xiaobo to the idiocy of certain Midwest governors for refusing federal dollars for constructing an interstate high-speed rail system.

I also found out that his fiance doesn't have texting. People without texting unite! Lol.
-----
On another note, remember Online Guy 2 (Drew)? Well, we've been chatting here and there online for almost a year now. And I still haven't met him in person. :-/ He doesn't have a car and doesn't particularly care to travel halfway anywhere to meet up. Or should I say, didn't?

I had previously discounted a possible relationship with Drew for a variety of barriers. The least of which is the 30 minutes or so that separate us (rough estimate). But he had been having some very rocky months with his ex-boyfriend and almost every time I chatted with him he wasn't in a good place. Recently things have been looking up though since they broke up for good.

Last night we chatted online for a few hours. We first talked about our desire to travel and such. And then he wrote, "Maybe we should finally meet in person, get to know each other, and do something like that [camping]." Apparently he likes camping and I've never really gone. That sounds fun (though certainly not in these winter months here), and thankfully the only real thing I have to worry about is Lyme disease, lol.

So progress? Hmm, we'll see where this goes (if anywhere). It'd be nice if he'd want to meet up somewhere for a coffee date or something (except I can't remember if he said he liked coffee or not). Our conversation then became quite sexual, which it never had in the past. I guess we were both kinda horny. It was kind of fun making him even hornier online, hehe.

---TANGENT---
So I recently came across this:

It Gets Better by Chris Salvatore

He's really attractive and has a great voice. Though, he makes some rather over-exaggerated facial expressions when he sings, haha. He's also not afraid to bare it all either!

There are some parts of this song that's quite cheesy. However, I like the following refrain:

We will make it, we're stronger,
for all the pain they put us through.
Words won't hurt us, no longer,
our dreams will be what get us through.
And when it feels like your whole world is ending,
remember me and all the other ones saying,
"It gets better, believe me."

---END TANGENT---

The Shadow in White

These past few days I've been doing some doctor shadowing - an infectious disease (ID) specialist on Wednesday and Thursday, and my mentor (a pediatrician) on Friday. It might not have been the wisest timing to do my shadowing, what with my first block of exams this coming week (then again, I shouldn't be blogging right now for that same reason . . . oh well).

Anyway, I was a bit hesitant to blog about this in some detail, as I had to look up the HIPAA (Health Insurance Portability and Accountability Act) that would put me in deep trouble if I disclosed certain info. So I looked up the 18 personal identifiers that I'm supposed to avoid. Ironically, we as M1's haven't had HIPAA training yet. Fortuitously, I don't know any of the 18 personal identifiers for any of the patients that I saw, so there's nothing I could really disclose anyway. So without further ado . . . (this post is long).
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Wednesday - ID Inpatient

I spent almost 4 hours of my afternoon shadowing an ID attending, I'll call him Dr. P. I met Dr. P at the LGBT meetings, as he's the faculty adviser for the group. I'm pretty sure he's gay and super nice and kind of funny (I guess I may have a tiny crush on him) . . . beside the point! Once I discovered he was ID, I kind of stalked him at these meetings so I could get his contact info to shadow him. Don't look at me weird, a lot of med students do this.

After wandering around the hospital for a while looking for his office/clinic area, I finally found it and waited several minutes for him to arrive from . . . probably seeing a patient. He came in with another doctor, a nephrologist (who I guess was doing a rotation through the department or something, idk). Anyway, the nephrologist has pretty long hair and amusingly, some of the patients we saw that day referred to him as "Dr. Long-haired." I sat and listened to the nephrologist present a case to Dr. P.

After the nephrologist finished presenting the case, Dr. P turns to me and asks, "So, did that all make sense? Do you have any questions?" After saying no, he quickly responded with "Psh, come on, of course you do. Don't be shy." At this point, my mind was racing to come up with some question to ask. So I asked, "Well, this patient is anemic. Is there a family history of anemia?" Apparently, that wasn't something either of them had thought to ask the patient. WIN. (Ron, if you read this, for the love of God come up with questions to ask - they're hard to think up on the fly.)

The nephrologist leaves and Dr. P and I go to see a patient. I had never been in the areas of the hospital where patients were, so I was instantly lost. The first patient we saw was a middle-aged guy who got an infection in his leg, and they had no idea where it came from or how it got under his skin. So they wanted to take some of his white blood cells, tag them with some kind of radioactive tag, inject his white blood cells back into his body, and see where they go (and hopefully they'll go to where the entry of the infection is).

After that we went to one of the doctor's stations where he typed up a note on the EMR (electronic medical record). He kept all these sheets of papers on his patients folded lengthwise in one of his pockets, which I found amusing. He showed me this one patient of his, who they called "The Train Wreck" because he had been in the hospital for months and kept getting different infections (somehow). They don't know what to do with him. He showed me this guy's labs and he had 3-4 simultaneous bacterial infections. I didn't know a person could be infected with so many bacteria at once, and all resistant to most of the meds they had!

He finished the note and declared that he was hungry, so we were off to have lunch. I just got a sandwich, which he paid for, and we sat and ate together. Being this close, I saw that his left ear was pierced (no idea why I noticed that). We chatted for a bit before heading up to meet with his fellow and M4 for afternoon rounds. On the way he asked me why I joined the LGBT group. I was caught off-guard and gave some lame (but true) answer about how I was interested in LGBT health issues and thought the group would be helpful. Alas, the group isn't (helpful, that is). Dr. P was really concerned about the future of the group because so few students in my class show up to the meetings.

We went up and met with the rest of his team. The fellow presented a case of this elderly woman with an echinococcus infection that they don't know what to do with (echinococcus, a kind of tapeworm parasite, is rarely seen in the US and is considered a "3rd world disease"). The case was frustratingly complicated though I'm not sure I can say more on it. We finally went down to see her in the SICU (surgical ICU). It was so sad looking at this patient and being unable to really do much for her, due to the complicated nature of her illness. You could see the doctors' frustration.

Then we went to the MICU (medicine ICU) to check in on another patient, who was comatose and undergoing a lumbar puncture when we arrived. We didn't even enter the room and I forgot what kind of complicated infection she had; all I remember was that she has liver cirrhosis. After a few minutes of just standing in the hallway, with the fellow explaining her case to me (which, again, I sadly forgot), we went to see the woman whom the nephrologist had presented on earlier.

She was in her 20s, was admitted with pretty serious anemia, and had an ELISA test indicating she was HIV+. When the 4 of us entered her room and closed the door, the tension became palpable - you could almost cut it with a knife (I was never really in a situation where that applied, until now). Dr. P asked about family history of anemia and then began the quiet conversation with her that she might be HIV+. The ELISA test is great for telling someone they're HIV-, but if a person tests HIV+ it may be a false positive. So a Western blot is done to confirm the diagnosis. Dr. P ordered a viral load instead as the Western blot is done elsewhere outside the hospital and takes 3 days to get the results, whereas the viral load test is done in-house and takes a day (but is more expensive).

When we were done talking with her, we stood in the hallway for a few minutes. Dr. P was complaining about how one of the other departments (I think it was pathology) blamed her anemia on the HIV even though it hadn't been confirmed yet. We all agreed it was lame, as HIV can't cause anemia. Dr. P kind of mocked pathology sarcastically, like "Oh look at that anemia, it's HIV's fault. No it's not, that's just lame."

With that, it pretty much concluded my time on rounds with them. They were surprised to get done at around 4pm, as it usually goes for much longer. On the other hand, I couldn't believe how long rounding took on so few patients! Dr. P apologized that I happened to shadow on a day with very complex cases, and kept reassuring me that there are days where the cases are straightforward and you can go home knowing you've solved a case and have definitively helped someone. Not so today, and it was rather House-like.
-----
Thursday - ID Outpatient

The following morning, I returned to the Dr.P's office/clinic area. On Thursday mornings he does outpatient HIV clinic in the hospital. So we saw several HIV patients. It was much more chill than ID inpatient.

For some of them, he was basically managing their care and serving as their primary care doctor. The patients I saw were really nice and overall pretty upbeat. Several of them were teasing and harassing Dr. P playfully, probably because I happened to be there. More than one was like, "I take my meds because if I don't, this guy here [points to Dr. P] gives me a look that slits my throat with his eyes." At which point, he does. It's pretty funny actually.

One patient was like, "I was in the hospital a few weeks ago and you didn't come to see me! I kept looking and looking for you." Dr. P was like, "Well I didn't know! Do you know how many doctors there are in this hospital? Over 800, and I don't know them all. You should've called me." Dr. P then asked if he had made an appointment with his nephrologist. The patient says, "No, because he's not you." At this, Dr. P wonders if there's something about the nephrologist he doesn't like so he could refer him to another one. The patient reassures him that the nephrologist was a fine doctor, he just wasn't Dr. P. I thought that was rather touching. :-)

According to Dr. P, these patients were the super compliant ones. They keep their appointments, the maintain their drug regimen more or less on schedule, they have a social support to help them, and they're not confrontational. All of them were on a cocktail of antiretroviral drugs. But man, are those drugs expensive! A supply of 3 pills costs about $2000 (I don't know if that's per month or per year) and this one patient was waiting for his tax return or something until he was able to pay for the next prescription refill.

It just makes me wonder how horrible it would be if these patients didn't have at least one other person - like a family member - to help take care of them, or if they weren't able to pay for their meds, or if they're unable to take their meds regularly at the specific times. That must be a nightmare. These are life-sustaining pills and if you forget to take them precisely, it could make things messy as HIV quickly develops resistance - leading to more complicated drug regimens.

Also surprising was what Dr. P told me the ages with the fastest growing incidence of HIV cases were: between 15 and 25, and older than 50. Dr. P had one 19-year-old patient who missed his appointment. That's some scary stuff, so people remember to use condoms every time!!

Oh, and the woman's test came back confirming HIV+ status. Dr. P paged every person on his team, as well as the nephrologist and a social worker. I didn't stick around to see what was going to happen, but as it is, there would be 5 people entering her room at the same time to talk with her. I hope everything went okay.
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Friday - Peds Outpatient

Okay, by now this post is long enough. This visit wasn't dramatically different than the last 2 times I shadowed my mentor so I'll keep this short.

Notably, I heard rales (crackling sound in the lungs) in one kid, and my mentor ordered a chest x-ray on her to rule out pneumonia. I was so proud of myself for actually hearing it. And I saw scarlet fever on another girl. It was pretty classic textbook scarlet fever.

There were many kids with strep infections, and I kept hoping that I don't catch it as it'd be really bad for me to get sick during exam week. Though . . . if I end up getting strep, everyone in the room with me would get infected by the end of the first exam . . . Anyway, thank God for hand sanitizers in every room.
-----
So that's it. I had to read through this a couple times and edit out details (so just know that it was longer still, lol). I actually really enjoyed ID, I thought it was fascinating. I still like peds though, so we'll see what happens from here.

Now to study more for my neuroscience exam on Monday . . . *Sighs*

It's a Long Day When

. . . you start daydreaming about sushi halfway into the first lecture of the day (out of five 1-hour lectures). And it just went downhill from there, lol.

In one of the breaks between lecture, I was talking to some fellow students and we unanimously agree: recess and nap time for med students. Seriously! Med school is rather like high school again, but please let us regress just a bit more so we can have recess and nap time, please? We'd be so much more effective and happy. :-)

I did learn something in neurobio today: effect of cannaboids (marijuana and such) = fat, dumb, and happy; calm, cool, and collected. I just found that really amusing. Actually, it's the receptors of the neuro-lipid 2-arachidonoglycerol (2-AG) that cannaboids act on. And I'm sure that last sentence meant nothing to most readers right now, so . . .

I skipped the cell & tissue bio (CTB) lab today, hoping to do it on my own time in my apartment since all the histology slides are online. But no, technology has to hate me. I'm unable to log in to my med school email as well as school-related site that requires my email name and password. The funny thing is, I save my passwords on my Firefox browser. So I went in there to make sure the password I was entering was correct. It was. AND IT STILL WOULD NOT LET ME SIGN ON.

I succumbed and just sent an email to the IT people to have my password reset so I could (hopefully) log on later tomorrow or the next day. Fortunately, I have all my med school emails forwarded to my gmail account.

In other news, "Online Guy" and I chatted a bit last night and now we're Facebook buddies, lol. He asked if I'm free this weekend to meet up for a drink. Details pending, hopes tentative.

---TANGENT---
Two things:

1. Thanks to everyone who read my last two posts and commented. Things got a bit heated I think, so I'd like to just leave those two posts alone for now and move on. I mean, my last post became so epically long! But it's not like it's going to substantially change the minds of people who're dead-set in their views.

2. Biki over at her advice blog, You Could Have It So Much Better, invited me to write a guest post. So read it here! :-P
---END TANGENT---

Geeked Out

use the force by *Blepharopsis on deviantART

Not much has transpired since I finished up with exams (and I rather like it this way, for now).

After I went to Michelle's birthday celebration, we went to her house for cake and wine. There I met Alice, a fellow M1. Somehow it came to the topic of how horrible our genetics course was way back in August, and how frustrated we all were with it. I find out her undergrad major was basically in genetics, so we commiserated and felt an instant bond. We probably spent a good hour or two talking about genetics, how it was taught, how it should've been taught, its ethical ramifications, its growing utilization in health care, etc. At one point she was on the edge of her seat as we both bemoaned our dislike for the lab technique called "maxi-prep" (where you take a ton of cells, break them up, and extract the DNA).

Totally geeked out.

Around 7:30pm or so, we decided to hit up the bar crawl that Leslie was organizing. We went to the first place to find that no one in our class was there. o_O We saw 2 guys, so all of decided to go to the second bar early. The second bar was rather . . . avant-garde. Again, no one from our class was there. What gives?! We hang around there for a bit . . . there weren't many people at the bar except for some people in their 30s to 50s that looked like they had went there right after work. At one point several of them started to line dance to something . . . wtf. Well, at least their mango mojito was really really good. :-P

At around 9pm or so, after we had been there for well over an hour, people from our class finally started to show up. Leslie showed up a bit later, all dressed up and rather tipsy already. She bought me a shot of tequila, lol. Then several of us spotted this really really tall guy at the bar. He must've been at least 6'6" if not more. Several times people would whisper (insofar as much as one could whisper in a bar) how they wanted to go up to him and ask him if he had Marfan's syndrome . . .

Totally geeked out.

Lastly, I was chatting online with my friend JW-M (I'll call him . . . Jake) from undergrad. For about 3 years now, Jake has been trying to get me to sign up for Steam, an online gaming vendor of sorts. He bought me 2 games on Steam, Torchlight and Jade Empire. He knew I'd never play these games or get Steam unless he did something like getting it for me, lol. Truthfully, I haven't really played any PC games since starting med school - maybe a little bit here or there right after an exam. :-/

Anyway, now I'm pretty much addicted to Torchlight. It's a "dungeon crawler" very similar to Diablo II except that it's easier to play and level. My brother is also kind of hooked on it too, as I let him play a character on my account. I haven't tried out Jade Empire yet! Alas all good things will come to an end once med school starts up again.

And yes, we've totally geeked out (much to our parents' dismay).

Mask of Genetics

Genetics is a mysterious and complex realm, a field that frustrates and scares many. I've never explicitly explained why genetics is a field that fascinates me and motivates me. If you told me 4-5 years ago that I'd be so interested in genetics now I might've laughed at you. If you told me that I'd be wearing my Mask of Genetics now I might scoff at the thought. Why then is it such a focus of mine? Truth be told, I kind of "fell" into this field of interest and here's how it began.

I did a lot of research in undergrad. I first worked in a pharmacology lab that focused on the Ras oncogene (genes that are over-expressed in cancer) pathway - in particular its role in neurofibromatosis and breast cancer. Then I worked in a human genetics lab on genetic deafness. With some genetics research under my belt, I had a decent grounding before I even took the intro to genetics course. I continued in my one-year foray into grad school by working in a colorectal genetic epidemiology lab.

Also in undergrad, genetics was emphasized in many of my biology courses. It was taught as being the "thread" that united and wove through all of biology, and all of life. Through genetics we can better understand evolution, development, and disease. It helps to connect things such that things that wouldn't otherwise make sense starts to make sense. It's not perfect (is anything?) but it gets the point across pretty well.

Research!
Evolution Class
Mask of Biology I
Mask of Biology II

I then began to pursue my interest in genetics further, in grad school. I took several courses with genetics as the focus - how genetics was utilized in public health, how the public views genetics, how physicians view genetics, how med school education shies away from genetics and how this can be improved, etc. My friend, AG-F, is a genetic counseling student. So having her perspective had a huge impact on me.

At this time, with the more I learned about genetic diseases and cancer genetics, it began to become a bit more "real." I had a friend whose cousin had/has colorectal cancer in his early 20s. And towards the end of the semester my friend, RZ-F, calls me to tell me someone who used to live in her hall sophomore year died of colorectal cancer. At age 22. I had vaguely known him. Something like this was obviously genetic in nature. In fact, with my (public heath) knowledge I could diagnose that without even having to think. How could it have been missed? How could his doctor(s) not notice? Did they not take an accurate and detail family history? Was he adopted? So many questions, so many frustrations that I could know "so much" and be able to do absolutely nothing.

Apparently genetics is something most physicians avoid or forget easily (or never learned it well in the first place). As such, genetic conditions are often missed or misdiagnosed. I had endeavored then, as I had all semester long, to continue to teach my undergrad students about genetics with a health "twist" so that even if they never take a genetics course again, it lingers in the back of their mind. The least I could do (at that point) was educate the generation or two of potential physicians and researchers after me about the emerging importance of genetics in health and medicine.

Just Gotta Press On
Too Epic
Mask of Teaching

Perhaps above all, genetics holds this kind of awe and mysticism for me. It's difficult to explain, but there's something to be said for genetics to be a literal and metaphorical link between all people and all organisms. That we share over 99% of our DNA with the person next to us, that we share the same building blocks as the food we eat, as the diseases that make us sick, as the grass and the trees and the animals. And DNA operates without consciousness, it just continues to work almost flawlessly every second of every minute of every hour of every day.

0.01%
Life is for the Living
Masks of Sexuality I
The "Gay Gene" Part I
The "Gay Gene" Part II
The "Gay Gene" Part III

Hopefully after this one would have a clearer view of my Mask of Genetics. If not, read the links in this post to all my past posts with a heavy genetics emphasis to them (and likely there are a couple I missed). It's clear that genetics permeates many posts in my blog and blends into several of my other Masks. I suppose in a sense it's also the "thread" that binds parts of my blog and some of my Masks together with me.

Life's Hand and Death's Mask

I know it's 9-11, but many others are covering the significance of this day so I won't belabor it here . . .

So yesterday was a LONG day. I saw my apartment for a total of about 45 minutes between 8am and 9:30pm.

For lunch I went out with some other M1s to this Mexican restaurant/bar. It was in a pretty shady part of town (thank God we went in the middle of the bright day). It was my first time having mole and it was delicious! Though I think I may have burnt my lips and tongue a little, grrr.

After classes were done, I had a meeting because I was a member of the M1 genetics liaison committee, a group of students who met with the genetics course director and gave our feedback to them. I won't discuss this here as that can be a post in it of itself.

After that I went to the Saturday free clinic mandatory meeting. I had signed up to be a volunteer but I was accidentally left out of the schedule. After a few pokes via email I was assigned to volunteer two Saturdays this semester. I'm sure practically every med school has a free clinic run by med students for the uninsured and under-served population. Here, each M1 is paired with an M2 and we take the patient history together. Then an M3 or M4 conducts the physical and, with the M1 and M2, makes a preliminary suggestion as to treatment. The volunteering doctor then either approves or modifies our decision. Interestingly, we have pseudo-prescribing powers as med students at this free clinic (though we use a very limited formulary for dispensing drugs, as we're not allowed to prescribe brand-name drugs because the patients would never be able to afford them, even if they worked better than a generic). I say "pseudo-" because we can write the prescriptions, but the volunteering doctor(s) there must sign off and okay it. Same thing goes with referring powers.

Practically every med student volunteering for this free clinic is super-excited because this is the first instance where we'll have real clinical experience and have real patients. This is what we went to med school for (well, hopefully most of us).
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Life's Hand

After the Saturday free clinic mandatory meeting, I met up with an M2 and went to the APAMSA (Asian Pacific American Medical Student Association) dinner at a faculty's apartment. He lives in a very nice apartment right on the riverfront and he's incidentally the founder of APAMSA, so it was quite an honor. He's a pediatric gastroenterologist (they call him the baby vomit doctor) and it seems like an interesting field . . . I may ask to shadow him in the clinic and during procedures.

It was a lot of fun and great getting to know other M1s, M2s, and even some M3s and M4s. I met the M4 who's "assigned" to my anatomy table to help us out. She's a really pretty half-Asian who's going into neurology. Gah, why're all the M4s so hot!!

This one M2 guy brought his wife and 14-month-old son to the APAMSA dinner. He's the first Asian Mormon I've ever met! And his son was soooo cute, and shy; he wouldn't let anyone but his mom and dad touch him. The mom sat near me with her son for a good portion of the dinner. After a few minutes the son got comfortable enough with me to cautiously lay his little hand on my leg a few times (he was still avoiding everyone else but his mom and dad). A few minutes later he was pointing at something and looking at me to follow his gaze (he avoided eye contact with all the other strangers). And then he put his little hand in mine and just rested it there for a minute or two. It was definitely an "awww" moment. If we had a bit more time to interact I think we would've become friends. ^_^

This impressed the people around. I can generally establish rapport with (most) babies and kids within half an hour, somehow. I'm not sure how. But it's really cool that they just feel comfortable around me. I really like kids of almost all ages and I have my ways of connecting with them (usually). As a fellow M1 said, it's almost as if I was "destined" to be a pediatrician, lol. Babies!!
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Death's Mask

Today we started the 2nd block of anatomy - the head and neck. Omg, there are sooo many bones, muscles, nerves, arteries, and veins in the head. I think I saw more names flash on the screen today in just 2 hours than in all of the last block combined. Not cool. -_-

Then in lab we had to finally uncover the face of our cadaver. Now, cutting into our cadaver's arms was disturbing, especially since we had to sometimes tie them up so there was a rather grosteque Christ-like appearance with arm parts splayed out. But we got used to this easily enough, and certainly during the lab practical exam there were arms sticking up at random angles, almost as if to wave or grasp at the air. And now we do the face, one of the most personal and "human" parts of the body next to the hands.

His eyelids were slightly open, his glazed eyes staring blankly and deathly at us. We cut into his face and began to peel back the skin. We initially cut too deep and stripped the muscles and everything from the top of the skull. A professor took such pity on our mutilation that he spent more than half an hour dissecting the skin off half the face for us to show us just how superficial we had to cut, as well as pointing out structures we surely would've destroyed without knowing.

Staring at our cadaver's face as it was being stripped of flesh was an . . . interesting experience. He died with this expression that I couldn't quite place - a rather quizzical death mask. From one angle he looked sad, almost with regret. From another angle he looked quite peaceful. And from yet another angle he appeared almost arrogant and proud (even as flesh was slowly being sliced away from his right cheek). The professor remarked that our cadaver had nice facial muscles and that perhaps he was a particularly expressive person in life.

The other cadavers around us each had their own unique death masks etched upon their faces. The old lady beside us had this creepy almost-grin, and as the group stripped her skin off it reminded me of a horror movie. Another group further down had progressed even further and the skin hung by the sides near the ears - it wasn't really recognizable as human anymore.

To be honest, I'm very surprised that no one fainted or vomited. It seemed like the normal thing to do in this situation. Perhaps we've become comfortable with death . . . As my friend said, "You can't pay me enough to do what you do." And my response, "Ironically, we're paying a lot to be able to do what we do."

The First Cut

I've only had two classes thus far: genetics and clinical human anatomy.

Genetics
Ugh, this class is taught sooo poorly! We haven't really learned anything about genetics, just the biochemical mechanisms of genetic processes (like replication, transcription, translation, etc). This class is really biochem pretending to be genetics. This material isn't the important part about genetics!! It's not necessary that we know all the details of processes because 99% of us will NEVER use that info!

We should be learning about inheritance patterns (more than the grossly simplified Mendelian dominant/recessive inheritance), how to recognize genetic abnormalities, how to prevent them, etc. We do not cover things like: co-dominance, incomplete dominance, penetrance, expressivity, multigene traits and diseases, etc. One of our lecturers even oversimplified the definition of "allele" to the point that it was just wrong info. Honestly! Nothing in this class thus far is of clinical importance, unless you're a pharmacist and want to know how every drug mentioned in our notes thus far kills cancer. Always cancer. -_-

There are CLASSIC examples of genetic diseases that aren't even going to be mentioned (I know, I've flipped through all the notes already). Diseases like Huntington's corea, sickle-cell anemia, fragile-X, HNPCC, FAP, as well as multigenic ones like Alzheimer's and diabetes. We don't go over newborn blood screening and the metabolic and genetic diseases detected therein. In my opinion, we've learned very little useful info thus far. It gets marginally better, but not by too muich.

Ugh. No wonder why so few med students go into medical genetics. If I hadn't had such a strong genetics background, if I didn't already learn the clinical relevance and application of genetics, and if this was my first and only "real" exposure to genetics, I would NEVER go into medical genetics. This is just awful, truly. Again, this class is NOT genetics, it's biochem dressed up as genetics. I know there's a point where the two fields intersect, but what I think is more important simply isn't emphasized. It doesn't help that our professors are from the biochem department.

/end rant

Clinical Human Anatomy
This class is . . . I'm not sure what to think about this class. All of our professors are ancient. Omg, there's this one professor who's been teaching the course for 50+ years. He's been teaching this class at this institution way back when it was under a different name! He taught one of the other professor's dad as well as the other professor himself (and that guy isn't young either). He had to be at least 30 or so before he got his teaching position, so that makes this guy at least 80+ years old. And you know what's creepy? I think he's older than some (many?) of our cadavers. >.>

Now as for cadavers, we began dissection on Wednesday, the 3rd day of classes. It's truly a strange experience. To see all the humidors (yes, like the thing you keep cigars in, that's what the bodies are kept in to keep them moist) lined up in rows in a really large room. Then to see med students open the lids and slowly raise the cloth-covered bodies up, it's like watching the ressurection of mummies.

And then you're hit by the smell - the smell of formaldehyde (I had SO wished they used an alternative preservative). It's a strong odor that makes the saliva well up in the back of your throat, a similar feeling you might get right before you're about to vomit. And it burns the eyes if you lean too close, and gives you a headache that lasts hours if you inhale too much (which I think I did).

Then you pull back the cloth, uncovering the part of the body you're working on. In our case it was the chest. You see this leathery thing that somehow doesn't look quite human. You make the first cut, squirming at the easy with which your scalpel pierces and slices through skin and fat. Two of you grab the flap of skin you've just created and pull back, as someone on the other side lances away the connective tissues with scalpel and blunt probe. With each cut, with each peeling back, the body becomes somehow less human and you distance yourself - somehow it becomes easier to cut the deeper you go.

You encounter the muscle, the pectoralis major that you need to peel back (reflect) from the pectoralis minor. It has a curious red-brown color, with the muscle fibers looking even more curiously like the dark meat chicken. Someone remarks how they will become vegetarian for the duration of the semester as a result. You continue, removing the fascia from the muscles, going slowly and hoping you haven't severed important nerves, arteries, and veins. After all, for the 5 of you there is only one body, and you only have two chances to get it correct - once on the left side and once on the right.

You find the structures you're interested in and are ecstatic that you didn't eviscerate the body for nothing. Someone at a table further away yells out they encountered breast implants in their female cadaver (awkward . . .). You are thankful that your body is skinny with very little fat, as you look at the table across from you with the yellow fat dripping off the inner flesh. You wonder at the identity of this body but you dare not pull back the cloth that covers the face, for fear that the experience becomes "too human."

---Edit---
Today we proceeded further with the dissection of the chest and upper arm area. We had to tie up the arms of our cadaver to the sides of the humidor with rope. With the armpit area splayed open, the brachial plexus (nerves) and the assorted arteries and veins stretched out like cords, there was a disturbing Christ-like appearance to our cadaver. I refrained from much cutting because I discovered (not surprisingly) that I do not have "surgeon hands."

We sawed through the clavicle (collar bone) in order to expose the nerves, veins, and arteries hidden behind it. With an electric saw and much snapping and twisting, the sound of breaking bone is oddly familiar. The chicken analogy again works well. Another night of vegetarian for me.

We discovered a gash or some kind of laceration/puncture wound to our cadaver's skull. We wonder if that was how he died or if it was perhaps a part of the embalming. We have no idea who our person was, what his life was like, how his family was like, how he lived, and how he died. I suppose this was designed to distance us so that we may literally dig into his innards without much hesitation. When this is all over, when this is all said and done, then his identity will be revealed to us.
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Anyway, to end on a completely different note to distract from the gruesomeness above, Courage from the (now finished) blog, A Beautiful Addiction... linked me to the following YouTube vid:

(D) Rep. Barney Frank SLAMS woman comparing Obama to Hitler at town hall

Rep. Frank's response is pretty epic, I must say. :P Ugh, people are being rude and really stupid at these town hall meetings. It's difficult to take away what's true and what's false about health care reform. Damn Palin for her "death panels" statement that ignited the flames. Someone should bitch-slap her for her idiocy.

Lastly, a song that rather warmed my heart, "Funny Little World" by Alexander Rybak.

It's such a cute song. I wish something like that would happen to me in real life. Ah well, I suppose such things might only happen in fairy tails. :-/ You can see a YouTube vid with lyrics here and a YouTube vid of him performing it live here.

Under the Shadow of Leaves

It is a good day.

I sit on a stone bench under the shadow of leaves, the sun poking through as if light were leaking through the green canopy. Looking out, the sky is clear blue except for the presence of a few wispy clouds. The day is bright and full of colors forgotten in the seasons prior.

I close my eyes and hear the sounds of toddlers and children laughing, of students talking, of many feet walking by. I wonder, how many hundreds of thousands of people have passed this point? What were they thinking as they passed by? The birds above sing their chorus in a language I cannot decipher. Far off a group of people are playing some instruments - a guitar and some drums. Though unrefined and unpolished, the sounds mix organically into carefree music.

A breeze blows by, carrying with it the scent of approaching summer. It is the smell of leaves, of living wood, of flowers, of the stone buildings - sentinels that resist the wear of time. It is the smell of life itself, and nourishes my lungs in a way I had taken for granted. I hold out my hands and arms into the breeze, as if to slow it down or capture it. Instead, the invisible force flows up over and down under my arms. It flows between my fingers, eddying slightly and briefly into an almost tangible ball in the palm of my hands. It feels as though I was almost able to grasp the breath of the world.

Something speaks to me, faint just beyond the detection of my senses. I see nothing, hear no words, smell no source, touch no object - but it is there. It surrounds me like an emotion but is not an emotion. Suddenly it feels as if things will be okay. And all those times I have tried to believe, to rationally seek answers to the mysteries, to understand that which cannot be tested, all this does not matter. It is there, it is here, and somehow I know things will be okay.

I open my eyes and walk away from my stone bench, away out from under the shadow of leaves. I am cloaked in the day and the moment and the world and this mystery. I will be okay.

It is a good day.
-----
A small prose passage. A memory - a snapshot capturing what I feel on the best of days. It is curious how I never expect it but always welcomed, replenishing my inner strength.

You may have noticed my new blog title banner thing. I'd like to give a HUGE shout out to J of Southern Inebriation for designing it for me at my request (he's an art major, can you tell?). I will explain the 5 panels of this banner from the left to the right:

The first panel is of Chinese opera masks and the Great Wall. It represents my background: being Chinese, culture and language has been a huge influence in my life (sometimes good, sometimes bad). The second panel is of a stethoscope on a book. It represents my future, my goals and aspirations: for a long time I have worked my ass off towards getting into medical school and (hopefully) I will come out poised to be an excellent doctor. The third panel you should all recognize as the smiley face banner I had previously. It represents outlet and others: it is this blog and all of you who read, and all of you I talk to. The fourth panel is of a flower I took while visiting a clinic in China. It represents life: I was a biology major in undergrad not primarily because it's the "easiest" path to medical school, but because it can give one an appreciation for life - for all its complexities, and mysteries, and frailty, and endurance. The last panel is of a ghostly mask of sorts. It represents conflict and struggle: all the uncertainty and frustration that being bi/gay brings and a kind of loneliness that comes with an inability to find "the one."

Finally, to conclude this post, I would like to give a shout out to the following 3 blogs that I've had the pleasure to read fully on. They may need no introduction as many of you already read them, but if not, do go over and say hi! And they are:

Enjoying the Journey
Hellogenation
Overrated Integrity

The "Gay Gene" Part III

In Part I, I presented a "single gene, single trait" model of sexuality. Simple, straightforward, black and white. In Part II, I presented a sample of the current literature on the biology of human sexuality. Not surprisingly, the current literature doesn't even come close to developing a complete biological model of how human sexuality works. The only conclusion science has reached at this point is that human sexuality is "governed" by several genes as well as environmental factors. Why is it so hard to pinpoint these factors?

In this post I will attempt to elucidate why it will be very difficult to develop anything nearing a complete biological model of human sexuality, at least in my lifetime. There will be terms and concepts that I'll try to explain in such a way that can be understood by non-scientists, but I apologize in advance if things start flying over your head. This is also a long post. You have been warned.
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Additive Alleles
The first concept is "additive alleles." Recall in Part I, I mentioned how alleles are different "versions" of a gene. When a trait is controlled by several or many genes, the alleles could have an additive effect on the trait.

Example: let's say there are 5 genes (genes A, B, C, D, E) that affect height. For each gene there are 2 alleles, an "upper-case" allele and a "lower-case" allele (i.e. A/a, B/b, C/c, D/d, E/e). Assume that each gene contributes equally to height, and that each upper-case allele contributes 3 inches to height and each lower-case allele contributes 1 inch to height. Thus, if an individual has alleles ABCDE, that individual will "gain" 15 inches total, whereas an individual with alleles abcde will "gain" only 5 inches.

In the example just given, each gene contributes in a completely additive fashion. However, each of the genes may very well have a different inheritance pattern and may contribute or otherwise affect the observed trait differently, such as one of the following.

Co-dominance
In co-dominance, different alleles of a gene are equally dominant and expressed at the same time.

Example: a plant has a gene that determines red/white flower color. The "red" allele and the "white" allele are co-dominant. Thus, a flower with both alleles will have red and white striped petals.

Incomplete Dominance
In incomplete dominance, the dominant allele does not completely "mask" the recessive allele. That is, some of the recessive allele "bleeds" through.

Example: a plant has a gene that determines red/white flower color. The "red" allele is dominant to the "white" allele. But because the "red" allele is incomplete dominant, a flower with both alleles will be pink.

Penetrance
Penetrance refers to the degree, or "likelihood," that an allele is expressed.

Example: a woman has the BRCA1 gene mutation that causes breast cancer. The BRCA1 mutation is 50-80% penetrant. Thus, that woman has a 50-80% increased chance of developing breast cancer.

Epistasis
In epistasis, one gene masks the effect(s) of another gene(s). That first gene is said to be "epistatic" to the other gene(s).

Example: 2 genes partly determine fur coat color in cats. Gene A is epistatic to Gene B. If a dominant allele of Gene A is present, then the fur coat color is black and Gene B is never observed regardless of what Gene B is. If only the recessive allele of Gene A is present, then the fur coat color depends on Gene B. Gene B produces either a white fur coat, an orange fur coat, or a white/orange striped fur coat depending on the alleles; again, Gene B can only be observed if only recessive alleles of Gene A is present.

Other
Topics I chose not to discuss include: variable expressivity, linkage, developmental pathways, biochemical pathways, cis-acting and trans-acting gene regulation, repressors, activators, maternal effect, and X-linked traits. To discuss all this would probably bore you all into oblivion.
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Now, to tie this all together. How might all the above apply to the biology of human sexuality? Well, to begin with, we know that the genes affecting sexuality must be additive in some fashion. Several genes "stack" their effects to influence a person's sexuality.

Let's say a gene is co-dominant for sexual orientation. Thus, for some guy, 2 copies of Allele 1 = straight, 2 copies of Allele 2 = gay, and 1 copy of each = bi. But bisexuality here might be a little strange, as that guy might find himself more attracted to females at one point in his life, and more attracted to males at another point in his life. The attraction might "alternate" between males and females, or depend on the situation.

Let's say a gene is incomplete dominant for sexual orientation. Thus, for some guy, 2 copies of Allele 1 = straight, 2 copies of Allele 2 = gay, and 1 copy of each = bi. Assuming both alleles give equal weight, a bisexual would find himself equally attracted to males and females.

Let's say having the dominant allele of a gene is 70% penetrant. Assume that the dominant allele represents heterosexuality. Thus, possessing 2 copies of the dominant allele = 100% straight, 2 copies of the recessive allele = 100% gay, and 1 copy of each = 70% chance of being straight and 30% chance of being gay.

Let's say there is a gene that is epistatic to the gene with incomplete dominance just mentioned. As long as there is a dominant allele of the gene the guy will be straight; it doesn't matter if the "incomplete dominance" gene would "make" a person straight/bi/gay. But if only the recessive allele of the epistatic gene is present, then sexual orientation would depend on the "incomplete dominance" gene mentioned above.

If there were multiple genes (well, there are), and all the inheritance patterns above are expressed at least once within this "set" of multiple genes, then this could easily account for the spectrum of human sexuality from straight to bi to gay. It could explain why some people who're bisexual associate more with being straight or gay, or how some people are attracted to women at one point in their lives and men later. The complexity stacks upon itself to yield a spectrum of results.

So far, this is a completely biological model that ignores environment, and yet it "can" explain everything. But how might environment play a role? How does the environment affect genetics? Through something called epigenetics.

In the end, just having the gene "for" something isn't enough. It must be expressed, or in other words, the gene must be turned on. Our genes turn on/off in response to environmental cues. The "environment" is a very broad term and can refer to: the air, the water, the food we eat, the uterine environment of the fetus, social and cultural factors, the people we meet, etc.

To put a more accurate twist or spin on the strictly biological model above, each of the genes affect one's tendency to be straight/bi/gay. Whether or not people actually become straight/bi/gay might depend on various environmental factors. Here things get tricky. It can be assumed that for most people, the genes are aligned such that the tendency to be heterosexual is overwhelming and the tendency to be homosexual is minimal. That is to say, that the tendency to be heterosexual is so great that it's nearly impossible for the environment to turn that person gay. The opposite may very well be true - a person's genetic alignment (genotype) may be so skewd towards being gay that the tendency to be gay is overwhelming, thus any attempts to be straight will almost certainly fail. In this sense, these people are truly "born straight" or "born gay."

But there is a huge gray zone between the extremes of either end. What about people in the "middle?" Their sexuality might depend on the circumstances that "trigger" certain genes to go into high gear. For example (I admit, not the best of examples), a cute boy (or girl) passes along, "flips" on this gene or that, and gets the ball rolling towards one direction or the other (or it may just stay put).

The "epigenome" is thought of as a genetic landscape of hills, plains, and valleys. On either extreme end is a deep valley, and it'll take a lot of genetics and environment to move a person out of the extremes. But between the extremes are hills, plains, and smaller valleys. Where a person is along this genetic landscape determines his/her sexual orientation. The environment merely moves that person along until the he/she settles in a valley.

If you have reached this point then totally pat yourself on the back, you've reached the end. I hope you can see just how complex the genetics of human sexuality can get, as well as how both genetics and environment probably play a role. And again, despite all this, this post is BARELY scratching the surface of how complex it actually might be, as it's just a model to demonstrate that it's not easy.

Please comment, ask questions, etc. ^_^ I'm always happy to discuss biology and particularly genetics, which I've sort of "specialized" in towards the end of undergrad and in my one year of grad school.

The "Gay Gene" Part II

This is Part II on the discussion of the genetics of sexuality. Part I is here.

Medical and psychological research literature have underwent major shifts in regards to homosexuality (and bisexuality). Once it was deemed as a psychiatric illness to be "fixed," and gays "converted" into straights. This thought prevailed until somewhat recently (in the US).

A recent NY Times article questioned the classical Masters & Johnson "gay conversions." It questioned the science and reality behind the studies, suggesting that the conversions may have been faked. These conversions may have been "at best composite case studies made into a single ideal narrative, and at worst they were fabricated."

Yet despite this and a shift away from homosexuality being a psychological "problem," some psychological therapists still attempt to "help" homosexuals and bisexuals become heterosexual. In this article, Gay 'cure' still sought by some therapists, it was found that 1/6 of UK therapists have attempted to "help" gay people become straight. It certainly doesn't help that another recent article, Some Gays Can Go Straight, Study Says, only seems to reinforce the notion that, if a gay really wants to try to become straight, it may be possible. I have not read the primary literature of the study, I do not know the design or the biases, and I'm certainly not versed in psychological or psychiatric research, thus I cannot personally comment on how valid the study may be. However, this is not the focus of this post - it is not my purpose to prove or disprove a study. I shall merely mention them as food for thought.

Down to the biology of it all. What does the literature say? What has the body of scientific knowledge determined about the "biology" of homosexuality? One thing is for certain: there is no single "gay gene." In fact, there are almost certainly many genes that influence sexuality. Furthermore, are there environmental factors that influence sexuality? Research hints that there might be. First things first.

Genetics and Sexual Orientation
Article 1: Genetics has a role in determining sexual orientation in men, further evidence
In my last post, I posited the simplification that a single gene governs a single trait. Science now knows this to be false for most (if not almost all) genes. A single gene may affect several traits, and a single trait may be affected by several genes. Scientists have looked for correlations to see what physical traits appear to be more common in gay men compared to straight men. What have they found?

Left-handedness tended to be more common in gay men (39% higher, as quoted here, thus about 14% of gays are left-handed compared to 10-11% of the general population). Notably, left-handers and gay men tended to have a larger corpus callosum. The corpus callosum connects the two hemispheres of the brain, allowing greater communication between the two halves of the brain. Each half controls the opposite half of the body (e.g. left hemisphere of the brain controls the right side of the body) and "specializes" in different kinds of thinking (e.g. language is in the left, music is in the right).

What does this suggest? Possibly that whatever genes affect sexuality also affect the brain and handedness preferences. Of course, it makes sense that genes affecting sexuality primarily act on the brain. But this is hardly fool-proof, as not all homosexuals (most aren't, in fact) left-handed, nor do all homosexuals have a larger corpus callosum. The genetics is incomplete here.

Genetic Regions Identified
Article 2: Genetics regions influencing male sexual orientation identified
A study by Mustanski has identified stretches of DNA on 3 chromosomes - 7, 8, and 10 - that may play a role in affecting sexuality. Quick note: in every cell in our body (excluding the germ cells - aka sperm and egg) we have 23 pairs of chromosomes. 22 pairs of chromosomes are somatic (non-sex chromosomes) and the 23rd pair is the XX or XY chromosome pair. This study has found that these 3 stretches of DNA on chromosomes 7, 8, and 10 were shared in about 60% of gay brothers in the study, compared to the expected 50% by random chance (assuming no genetic linkage).

This suggests that there is indeed something genetic to sexuality. Specific genes have not yet been identified within these 3 regions, as that's actually pretty difficult to do still. However, some words of caution: 60% is not that much greater than 50%. Thus the genetic effect observed here is still somewhat weak and alone cannot explain the whole story. Additionally, it also means that these genetic regions are not shared among gay brothers 40% of the time. What's going on here?

Genetics and Environment
Article 3: Genetics, environment shapes sexual behavior
This article suggests that both genetics and environment play a role in determining sexual orientation. In the study mentioned, about 3800 same-gender twin pairs were studied in Sweden.

The study found that genetics accounted for 35% of male homosexuality while non-shared environment accounted for the remaining 64% (I don't know what happened to that last 1%). Interestingly, genetics only accounted for 18% of female homosexuality while non-shared environment accounted for 64% and shared family environment accounted for 16%.

The study is, like any study, not without flaws and limitations. But it's certainly worth noting how genetics could account for so little of sexuality (still a significant portion, but certainly not all). How does one proceed in formulating a model of genetics and sexuality from here? Furthermore, the study population was pretty narrow (genetically speaking - all from Sweden), could this study be replicated in several other populations?

Bisexuality?
Article 4: Researchers revisit male bisexuality
For the vast majority of the articles above, bisexuality had been completely ignored. Only the dichotomous heterosexuality/homosexuality were more or less assessed. Part of the problem is certainly finding and identifying bisexual individuals.

This article brings back into the foreground the 6-point Kinsey scale, allowing a spectrum from "completely straight" to "completely gay." But how would a spectrum of sexuality like this fit into the results from the articles above, much less a genetic model?

So many unanswered questions. Clearly sexuality is determined by multiple genes. But what is the effect of each individual gene? How strongly do they contribute? And if genetics seemingly contributes so little (at 35% for men), then are people really "born gay?" Is there a way to modify the environmental factors, either willingly or not? Does the greater impact of environment mean that one can, in a sense, "choose" to be gay? I'm still going to say "no" to that last question.

And then there's Part III, where I attempt to present a somewhat plausible genetic model that accounts for environment . . .

The "Gay Gene" Part I

I had an interesting conversation with Bob (and briefly with AJ) the other night. Currently biomedical science does not support the hypothesis of a single "gay gene." But suppose a single gene were discovered that overwhelmingly determines sexuality, what would the ramifications be? Would it be a boon or a blow to the LGBTQ community?

In this installment, I will make the argument that the discovery of a single gay gene would be one of the greatest blow to the LGBTQ community, judging by the direction medical genetics is headed. In Part II, I'll briefly summarize the current literature on the genetics of sexuality. And in Part III, I'll posit a possible genetic model of sexuality. Hang on and read slowly, otherwise things might just fly right past over your heads.

First, a review of Mendelian genetics. We have genes that control particular traits. Each person has 2 versions of any given gene (called alleles), one inherited from each parent. Alleles may be dominant or recessive, with the dominant allele of a gene "masking" the recessive allele. In regards to sexuality, let's say heterosexuality is "dominant" and homosexuality is "recessive." If a person has one "hetero" allele and one "homo" allele, that person will be heterosexual. The only way that person can be homosexual is if he/she inherits two "homo" alleles.

Now let's expand upon this model (and ignore bisexuals for the moment - there is a way to make bisexuality "fit" in this model, but the genetics of that is beyond the scope of this post). Let's say a single gene is discovered that overwhelmingly affects sexuality. With this discovery, sexuality is overwhelmingly determined to be "nature" and not "nurture" (a faulty dichotomy to begin with, but we'll ignore that). We can rejoice in knowing that individuals are born straight or gay and have little/no choice in the matter.

Initially this may be cause for celebration, but it won't be for long. If the gene has been discovered then it can be detected. If it's detectable, then it can be found and individuals screened for the "gay allele" of this gene. There is a technology available now, today, called PGD (pre-implantation genetic diagnosis) that allows scientists to screen embryos for particular alleles of certain genes. Through PGD, embryos can be screened so only the desirable embryos are implanted into the womb. If the "gay allele" is undesirable, embryos with that allele can be screened out so no homosexual individuals are born.

Alternatively, genetics is advancing at such a pace that gene therapy may become feasible in the near-ish future. If, through this discovery, homosexuality is viewed as a "diseases state," then research money will flow into the development of a "cure" to "fix" homosexuals and make them straight. Imagine taking a pill or getting a shot and changing your sexual orientation. If this outcome becomes a possibility, then the individual's consent might not even be necessary for these "cures" to be dispensed. If given to a minor before the age of medical consent, parents could force their "gay-to-be" children to take the pill or shot and "make" them straight.

Think for a moment: if you knew that your offspring could be gay, would you want him/her to go through the teasing, ridicule, and whatever emotional baggage comes with being gay because of societal and cultural norms? For most parents the answer is probably no - they would prevent such a future for their child if they could. And if a child is already born, well, a "cure" is on the way. Before you decry the above as science fiction, or say that even if it's a reality it will never happen, it's already too late. Similar cases have already begun. The prime example is deafness.

Deaf parents (the capital "D" is important) often wish to have deaf children so that their children may grow up as a part of the Deaf community. The Deaf community does not view deafness as a disability or a handicap; deafness is merely a normal variation within humans, and deaf individuals have their own culture. Deaf parents might utilize PGD to screen for embryos that may become deaf children, and thus screen out the "normal" children. In contrast, hearing parents view deafness as a disability/handicap. They will go to lengths to ensure their children are as "normal" as possible. This may include PGD, but more often than not they utilize cochlear implants to help their children hear. Deaf parents tend to find cochlear implants an abomination - a means to quash Deaf culture and suppress a minority.

How many parallels do you see between the LGBTQ community and the Deaf community in these regards? Because of this I find the prospect of discovering a single "gay gene" to be a very scary one. It only requires a tiny push from well-meaning genetics to tip into the dark history of eugenics. And I haven't even touched on the issue of health insurance and life insurance yet. Thank God that human behavior is too complex to be controlled by "merely" a single gene.

---TANGENT---
I've begun talking to a new blogger, AJ (yes, a "second" AJ), and have just caught up on his blog: coming out (on the net). Great kid, do go over to his blog, say hi, and make him feel welcomed.

Hey AJ, I apologize that I stuck this blurb at the end of a rather intense post. I just wanted to give you a shout out before I forget.
---END TANGENT---

Mask of Teaching

At 6pm on Wednesday, April 29th, I completed my last duty as a GSI (graduate student instructor, for those who don't remember what that stands for): proctoring the Intro Genetics final.

One of my students (upon turning in her final exam) said to me, "You're literally the BEST GSI I've ever had. I'm not even kidding, seriously."

Later another one of my students (upon turning her final exam) said to me, "I just wanted to let you know that you are probably THE best science GSI I've ever had. One of my friends actually transferred into your section because his GSI sucked and I told him that you were amazing."

At one point, the professor came into the lecture hall where we were proctoring and whispered to me, "Several students in my office hours tell me that you do a great job explaining things to them. Good job, I thought I should tell you."

Much later, a friend (whose friend is in one of my discussion sections) told me, "So my friend K says you're her favorite GSI."

Clearly I must be doing something right, right? I mean, I somehow achieved the highest section attendance (almost everyone came to my later sections) out of all the GSIs, and discussion sections were completely voluntary so no one had to come. Funny story about that actually: on the day of my last discussion, one of my students (a male nurse who's older than me) brought his two little kids - around age 3 to 5 - to my discussion section. Somehow he felt that my discussion sections were necessary enough to attend, even though he could've easily skipped to take care of his kids? (Btw, his kids were adorable, and I just so happened to bring cookies that day, and they loved them.)

The Mask of Teaching, I LOVE wearing it. It brightens my day (usually) when I have to go in to teach my discussion sections. And it feels pretty damn good to receive such high praise and comments about the way I teach. I don't know what it is I do exactly, I just sort of teach on-the-fly with a very bare-boned lesson plan in my head. I do what I feel like would most benefit them in the 1 hour (well, 50 minutes) we have together. I have, however, identified a few things I think have helped a lot:

1. Make it relevant.
Students tend to not like the theoretical stuff. They need a way to take the concepts learned and integrate them into something they can relate to on a personal level. I often used the example of cancer genetics, because it fits so well with many topics. I also tried to link up some concepts to things like cardiovascular disease, family history, etc.

2. Organization.
It definitely helps to know what you're doing, what order you're doing it in, and how long you expect it to take. Even better if you've internalized that organization so you don't have to always have it in front of you.

3. Reflecting questions.
As I work out a problem on the board or present a concept, I constantly ask my students about the next "step." What happens now? What do you think I should do? Why do you think this is? How do you think this works? Etcetra. They may not always answer (and in one of my classes, they rarely do), but they are thinking and considering. This is much more effective in office hours where they have "nowhere to run." I force the students to try to solve the problem on their own, with me basically giving them sign posts and clarifications - only give directions if they're lost.

4. Visual learners.
I always draw up a diagram on the board and describe what I draw as I draw. Genetics is not a very tangible subject, so you have to somehow make things visual so they can more easily and readily comprehend it. Also, you have to actually draw it out, it does no good to just flash a picture or a diagram up. You need to walk through how the diagram's constructed, what makes it tick, so to speak.

5. Understanding their needs.
I think one of my greatest assets is that I understand where many of them are coming from. It wasn't so long ago that I was "in their shoes." I understand what many want out of the class (that is, nothing to do with it) and I hoped to make them actually interested in genetics so that things stick in their heads. So I put myself in their shoes, "If I were taking this course again, what would I want to learn? What would make it interesting and relevant? What do I want to take out of it?" With that in mind, I try to meet them at that level. The professor actually remarked (with a hint of sarcasm), "No wonder why they liked you. You're a pre-med GSI for pre-meds."

Anyway, I seriously LOVE teaching. I'm a little sad that it's over now. :( I taught a mini-course with JW-M a year ago on HIV/AIDS to 10 or so freshman undergrads. We discussed the social, biological, cultural, and political aspects of this disease (well, I did biological and cultural; JW-M did social and political). And now Intro Genetics. It's rather fulfilling, I find. You see that glimmer in their eyes, and you know you've reached someone, you've piqued someone's interest. And perhaps that someone will take that interest and do something great with it.

Teaching >>> research, hands down. Seriously, it's kind of hard to describe how much I've enjoyed teaching. While it was my job, it certainly didn't feel like one.

And Now, Exhaustion Sets In

Today was my last final exam - cancer epidemiology. Last night, in the span of about 5 hours, I had to learn about 11 cancers: hematopoietic (leukemia, lymphoma), bladder, liver, breast, endometrial, testicular, prostate, lung, colorectal, esophageal, and pancreatic.

Some random factoids:

1. Pancreatic, lung, and liver are perhaps the worst to get (of the ones in the list above). Such low survival rates. :(

2. Being Asian is protective against like all cancer except esophageal (potentially genetic, related to the reason why many Asians turn red when they drink) and liver (and really, for liver that's only because Southeast Asia has a high prevalence of Hepatitis B and C - gotta get them vaccines!).

3. Testicular cancer is really really weird. o_O Seriously, freaky.

And now, exhaustion sets in. Also, I'm more or less done with grad school here. Off to med school in late July/early August!! Still not sure if I'm going to complete my MPH, eventually.

---TANGENT---
I'd like to welcome back Zee at Where I Stand.

At the same time, I'd like to say a fond farewell to Matt at Brass Matt. I, for one, will miss reading your blog. :(

Lastly, does anyone know what happened to Fiction Writer's blog at Writing Fiction? It's gone now . . . not even a goodbye. :(
---END TANGENT---

Too Epic

Yesterday was epic. Too epic. I'm actually still reeling from the epic-ness.

I was pretty tired from getting only 5 hours of sleep between Saturday and Monday, and 4 hours of sleep between Monday and Tuesday. So, because I didn't have class on Wednesday, I decided to catch up on some sleep. Then I headed down to campus. I met up with my friend, AG-F. After lunch, it began.

Starting at 1pm, we began to crank out the remainder of our final paper/project. It was due at midnight. So, from 1pm until then we worked almost non-stop. I had 1.5 hours of office hours, and we took a break to grab dinner and ate while we worked. I must've written over 25 pages (double-spaced) yesterday.

When we started yesterday, I had written my half of the paper (about 10-12 pages, double-spaced) and AG-F had only written about 2-3 pages. My half still needed serious editing, which I accomplished by about 6pm. I had drafted several of the figures we needed. We had our project planned out, we just need to consolidate all our loose sheets and mental notes into writing.

9pm came and went. We were almost done with the paper, in the final stages of editing.

10pm came and went, the paper was done except for the bibliography. AG-F goes to the computer and creates the bibliography while I type up the summary and concept documents of our project.

11pm comes and goes, we're still working on it, ever closer to finishing.

11:40pm-ish comes, and we still needed one figure. AG-F took my student ID card and dashed to the other side of the building to use the scanner and upload our last figure.

11:55pm comes, and I'm uploading our documents to an email to the professor. AG-F runs back, out of breath, and I tell her that she can relax now - it was all going to be okay.

11:58pm comes, AG-F stares at the time on her cell phone, and I hit "Send." It was (essentially) done.

By the time everything we completely said and done, it was about 1am. We had wanted to get a drink to celebrate this feat, but since the bars and clubs tend to close at 2am here (and we had work the next day), we decided that we'll postpone that until this weekend.
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What was this final paper and project? Well, that's also epic! Our paper was on the utilization of video games for genetics education. Games that currently feature genetics (e.g. SimLife, Spore, BioShock) are woefully inaccurate in their portrayal of genetics. Thus, we wanted to analyze the educational potential of video games, particular for science and specifically genetics.

Once we knew what our teaching goals and "game goals" were, we wanted to create the concept for a video game that centers on genetics as our project. We decided upon a MMORPG kind of game. You are a field agent of the government, and you work for the Federal Division of Genetics. Your mission is to investigate the suspicious activities of a massive biobanking and biotech company. This company is "morally gray" throughout the entire game.

The company is also the creator of the Platywi, an organism that's kind of like a cross between a platypus and a kiwi. Throughout the game, you determine the genetic inheritance patterns of various Platywi traits (e.g. Mendelian, codominance, incomplete dominance, continuous, X-linked, Y-linked, epistasis, etc) and map the traits to the Platywi chromosomes. You also discover a hidden message/password hidden in the Platywi genome.

Within this game we wanted to model various different kinds of inheritance patterns, some of which are directly modeled after human traits/genetic diseases. We wanted our game to be marketable to a diverse audience, rather than have it be a in-class video game. There are many references to biology and genetics, particularly in the way we named things. There are far more details that I'm not disclosing in this post, precisely because I don't want our idea to be ripped off by some random visitor to my blog. Of course, we were only able to come up with the rough and bare-boned concept for this game, but it was quite enjoyable nonetheless.

I'll leave you with a couple figures that I created for this final paper/project.

Platywi chromosome map

Platywi concept art

Resolution: the Intercession

As I mentioned in my last post, I was put back onto my two research projects. All thanks to the intercession by EV-M on my half. :D

EV-M has repeatedly expressed how it's impossible for him to work on the RNA extraction project all by himself, and I've essentially worked on the Western blot project so long that really, only I know what's going on. As such, EV-M has repeatedly appealed to SG-M, the PI (aka, head lab boss), to allow me back on the projects - particularly the RNA extraction one. Anyway, long story short, I'm back!

Now I get to spend 5-6 hours a week extracting RNA from 10-14 samples (3 slides/sample). Oh what fun - at least I have something to do so I'm not wasting my time and theirs. With respect to the Western blot project, the "wet" transfer box doesn't work. Our dry transfer box also doesn't seem to work. EV-M has examined both apparatuses with me and reached the same conclusions as I had. Not surprisingly. So we're going to borrow a transfer box from the lab next to us.

And I'm sure none of that means anything to 99% of you out there reading this. However, I think I know why EV-M has been pushing so hard to have me back on to the RNA extraction project. His wife is due to give birth to their first baby in 4 days (well, 2 now). So he'll be in and out of commission at the lab for the next 2 months. Now, it really IS impossible for him to work on those projects and I'm the only one who can do it (because everyone else is busy, and I'm the only one who knows how to do Western blots).
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On a completely different note, I got back my first exam for biostatistics (it sounds just as boring and hard as you think). Everyone had been stressing and fearing the worst. The exam is out of 60 points, the mean is 47, and the lowest score is like 33. There is apparently huge variation in the distribution of the overall exam scores as well as the scores within each question. To me, this screams a poorly written exam.

Anyway, I went into that exam praying (like you have no idea) that I'd just be able to finish and pass the exam. I did finish the exam, but I had NO IDEA if I was right on anything but the first problem - there were only 4 problems.

Well, I got back my exam. I was freaking out. Then I saw my score. 54/60. HOLY CRAP!! I actually kind of shouted exactly that out loud in the basement, I'm sure people could hear me halfway on the other side. Everyone I had talked to, people who actually KNEW the material, got near the mean score. But somehow I did better?! I hope I can only pull this off for the next 2 exams. The next one's in 2 weeks. T.T

Okay, next few posts about China (with pics), I swear!!!

P.S. I still love GSI-ing. Teaching is so satisfying, especially when more students come to your sections than to other GSIs, hahaha. I must be doing something right, right?

---TANGENT---
So, for those who follow Landyn's Stuck In The Middle blog, he's having a crazy time there. Go over and if you have any useful advice, freely give it because he needs some right about now.

Thanks a bunch.
---END TANGENT---

Falling Glass

This is not a China post.

First a bit of good news: my dad was able to recover 90-95% of my pictures off my SD card!! He downloaded some program that lets him rip data off SD cards or something. This was the second highlight of my day. ^_^
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Now, on to more serious matters. Ever knock over a glass at the edge of a table/counter, and you're just watching it fall to the ground in slow motion until it hits and shatters? That's how my research work is like right now. Let me elaborate. First, for this post, let my researcher = EV-M and my PI = SG-M.

At the end of last semester/beginning of this semester, my research was like a glass at the very edge of the table about to fall. My Western blot project had stopped working, and I was just beginning the RNA extraction project but I wasn't going fast enough for SG-M's satisfaction. In January I temporarily shelved my Western blot project to focus on the RNA extraction, which was the more important of the two. That is, until I royally fucked up (read here). That was the bit that knocked the glass off the table.

I haven't been doing much in the lab during February because the RNA extraction was shelved (from me) and my Western blots still weren't working (the transfer box refused to work). As a result, I've felt like my presence in the lab was just a waste of my time, EV-M's time, and SG-M's time. So I haven't been working much. I haven't be performing up to my standards, (or anyone's standards) it's been a long since I've produced results, and I talked to EV-M about all this today.

EV-M revealed to me that SG-M is not happy with my performance in the lab. Gee, me neither, no surprise there. But SG-M basically banned me from the RNA extraction project without directly telling me. EV-M told me that both he and SG-M felt I needed to take more initiative and get things done. That was seriously a slap in the face because I'm almost always the one to initiate things in any group project. I'm the one who tries to coordinate and make sure things get done. To say that I don't take the initiative in the lab was a blow to my ego.

But now I don't know what to do. Without the RNA extraction project, I don't have much to do in the lab. The Western blot is MY project, as in I designed almost every aspect of it from the moment I started. It's not my fault that the equipment failed. But now I'm supposed to somehow find a way around this?! Apparently people in the lab "notice" that I'm just not doing a good job. That almost makes me feel everyone's talking behind my back without letting me know what I'm doing wrong. The lab is "too polite" as EV-M puts it.

So I'm watching this glass fall towards the ground. As far as I know it hasn't hit the ground yet, so I may still be able to catch it and put it back on the table. But I don't know if I'll be able to make it in time and I'm not sure it's entirely worth it. According to EV-M, SG-M isn't someone I want to piss off. He's well known in both the medical and public health world, and so if he says anything bad about me, it'll doubly hurt my reputation. I had a pretty good reputation coming into this lab, and I'll be damned if I leave with a crappy reputation. He's already displeased with me, and I don't know how to properly fix this.

This and the jet-lag sucked away all the relaxation and happiness I rediscovered during Spring Break. I feel so beaten and broken this semester. I'm not the only one, my friend AG-F feels exactly the same (though for somewhat different reasons). Why does second semester suck so much?! T.T

What should I do?!?!?!
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I want to leave on a high note because I feel somewhat depressed by the possibility of (effectively) losing my research job and crawling away with a bruised ego and a severely damaged reputation.

So the first highlight of my day was in GSI prep session. I found out that most of the GSIs only have 5-7 students go to their sections, maybe 10-12 at most. In contrast, I generally have at least 10-12 come to my sections, and up to 20-25 students in my Friday sections. I must be doing/teaching something right if people keep coming! That makes me feel like I'm actually able to accomplish something.

Right now, GSI-ing is what keeps my head up. I love teaching and love leaving discussion sections feeling like I've helped someone understand the genetics material. Also, it doesn't hurt to know that I'm more favored by many students than the other GSIs, because I keep getting complimented on how I teach. ;-)