A Difference in Philosphy

A few days ago, several of us got together for wine and cheese tasting and we decided to hang out afterwards.  There was a teacher, a surgeon, a pediatrician, and an MD/PhD in training.  Much of the evening was wrapped in very heated debate, from gun control, to "Obamacare," and to education.

At the heart of the debate is a difference in philosophy, not dissimilar to democrats vs republicans.  It is no secret that education in the US is in need of an update.  The question is, how to best remake the education system in the US?

On one side is the surgeon, utilizing a surgeon's thinking.  The argument: We should focus our resources on those who can best utilize them and elevate those students to their maximum potential, and not "waste" resources on the students at the bottom who cannot demonstrate improvement.  Society should strive to equip the best and brightest with the means to achieve what they're meant to.  This makes sense in a surgeon's mind, as a surgeon must be able to triage which patients are suitable for surgery and which aren't.

On the other side is the teacher and (peripherally) the pediatrician.  The argument: We provide all students the necessary resources to succeed - for the bottom of the class to reach the middle, and for the best and brightest to soar.  Every child in society deserves a fair shot at an education, with resources devoted to the struggling as well as to the gifted.

The problem with the first argument is that it is in danger of creating a tiered caste society, only widening the achievement gap into a chasm.  The problem with the second argument is that there simply aren't enough resources or political will to make it a reality everywhere.

My personal issue with the first argument is that I believe that all children deserve a fair shot, not just some.  And yes, some children need more help and resources to achieve, but it is possible.  I have seen it.  I have worked with a charter school that - rather takes the best of the best students - takes the worst students in public schools and demonstrates that they can at least achieve to the middle.  These are students who dropped out of school due to LGBTQ bullying, teen pregnancy, domestic violence, mild mental health issues, etc.  Given the right learning environment, they are not hopeless.

On a more personal note, I have a good friend growing up who went to the same schools as me for most of our K-12 lives.  I was almost always in the honors/AP courses.  He was barely scraping by in the regular courses.  His educational experience was vastly different than mine.  My teachers expected us to push hard and succeed.  His teachers treated him as though he could not achieve and would never amount to anything much more, that learning wasn't as important for him.  This negatively impacted him until he had a moment where he was determined to change his fate.  He transitioned from a 2-year college to a 4-year state university, and from there got a good stable job helping others in bad social situations.  He was able to succeed.  Is he the next Steve Jobs or Bill Gates?  No.  But neither am I.

The reality of the current status in education is neither - currently the system is more and more being set up to "teach to the test," thereby aiming to bring the bottom up but also inadvertently bringing the top down, both meeting in the middle.  Critical courses such as creative expression (art, music, theater, etc) and physical activity (gym, recess) are being cut out in order to cram more math and science to satisfy the tests (and I'd argue that science isn't even being taught properly on the whole).  Current education is trending towards mediocrity as more tests are implemented to demonstrate achievement and teachers are being paid for performance (an oversimplification and generalization, but I'm not in education so this is just what I hear).

I don't know the answer to "fixing" the system, just as I don't know the answer to fixing healthcare.  Obamacare is one answer, but I'm not convinced it's the best or final answer.  The alternatives aren't much better though.  What I do know is that the answer depends on the philosophy we choose to take, both on a personal level and as a society.  Are only some worthy of the resources?  Do everyone get the exact same resources?  Or is the answer more nuanced?  I don't know but I do know that the answer is a difference in philosophy.

To Be Wanted . . .

It's such a weird feeling (for me) to be wanted.

What I'm most caught off-guard by during these residency interviews is just how much the program wants me (I suppose that makes sense, otherwise they wouldn't invite me for an interview).  Still, I'm left awkwardly speechless when an interviewer enumerates the various things I've done in med school and react amazed when I describe them.  It's almost embarrassing.

Up until now I've received little recognition outside my circle of friends and faculty advisors for the things I've done.  Everything I've done felt like it was being quietly conducted in the shadows outside the glowing praise of my institution at large.  I never received an award or anything of that sort, and I doubt I ever will - I simply don't have the overwhelming popularity to bring visibility to the things I champion.

But at almost every interview I've been asked to describe (in some detail) the community advocacy work I've done for the Asian and LGBT communities.  Some interviewers are more keen on hearing about the health literacy project I did in the Asian-American community, others are eager to hear about the cultural competency training I forwarded in LGBT health education, and still some want to hear about my involvement on a state policy level.

At one of my recent interviews, my interviewer asked me, "How are you able to do all this?"  And I began to reply that I was lucky and these opportunities fell into my lap in such a way that I couldn't turn them down.  He cut me off and corrected me that I instead "seized the opportunities."  I never thought of it that way, but I suppose he's right.

As these interviews wind to a close, I'm more and more certain of what I bring to a residency program.  This wasn't crystal clear at the beginning, but now I know.  Programs didn't choose me because of my grades or Step 1 score (verily, I'm positive that many programs rejected me based on those criteria), but rather the extensive community outreach and advocacy work I've done.  I'm glad that the 11 places that chose to interview me saw beyond the numbers to something more important that I can bring.

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P.S. For anyone applying to residency programs, everything you write in your ERAS application is fair game for interviewers to ask you about - and they will ask you about them, so know your application stone cold.

Check & Check

Step 2 CK: check. (Did 20 points better than on Step 1, woot!)

Step 2 CS: check.

Letters of recommendation: check.

ERAS application: check.

Schedule my first few residency interviews: check.

Haven't actually gotten a residency interview invitation in a while now, and it's making me nervous.  I applied to 29 programs, which most people have told me is overkill for pediatrics (on average, people applying to pediatrics apply to about 15-20 programs).  I really need to hear from more programs NOW.

I'm on pediatric anesthesia right now.  For the past month I've been on my vacation month (for another post), so coming back to starting at 6:30am is a bit of a shift.  It's been a good experience so far.  I like getting the opportunity and practice of putting IV's in babies and kids, as well as manage the airway.  I like being able to see a diversity of pediatric surgeries because I can migrate from OR to OR each day and see something totally different than if I were just on one surgical service.  Everyone I've interacted with has been very nice and (usually) patient with me.

But I have to say, some people have got to stop trying to make me question why I want to do pediatrics.  Yes, I will be making about 1/4 to 1/3 of your salary.  No, it's definitely not for the money, that's abundantly clear.  I'm well aware that I'll be making among the bottom salaries as far as physicians go.  That said, I will make more money than both my parents' salaries combined.  And I see absolutely no need to "upgrade" my lifestyle.  Yes, I will come out with far more debt than both my parents, but I don't doubt that I'll have the ability to pay it off (annoying rough as that may potentially be).

Anyway, there were some cases I've seen that have definitely reaffirmed some of the reasons why I choose to pursue pediatrics (for another post).  And who knows, if I get bored or burnt out, pediatric anesthesiology might be an option, as it seems almost 1/3 to 1/2 of the staff peds anesthesiologists here apparently started off as pediatricians.  Hmm . . . I must pick their brains on this.

Re-examine

Re-examine by ~Meow2puchiko on deviantART

On Saturday I went to a friend's wedding.  It's the 6th wedding I've been to in the last 5 years.  It was a small, intimate, outdoor wedding of family and close friends.  Though the forecast threatened scattered thunderstorms, the weather couldn't have been more perfect.

I sat (as I usually do) next to friends I knew in undergrad - some of them married, many of us single.  My friend sitting next to me remarked, "Every time I come to a wedding, I feel like I have to re-examine the course of my life."  And I sympathize with him 100%.  It seems like friend after friend has been getting married, and where am I?  Where are the rest of us?  Even if it's not entirely true, it feels as though we're lagging behind in "life progress."  It's rather unsettling at times.  I'm so far from marriage that I can't even see it in the distant horizon.

At least my other friends (married couple) spoke the truth that as we get older, our dating pool only increases (formula: minimum age of dating partner = 1/2 your age + 7).
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The following day I met up with another friend (also married) on my way back from the wedding.  We chatted for a while on politics and catching up and all that.  He always relished my medical stories, especially the gory ones, haha.  His wife was a trooper too with my descriptions.

After a while when it was time for me to go, he gave me the location of his brother's grave, the same brother I had considered one of my closest (and longest) friends.  It felt strange driving to his grave.  I found it rather easily.

There I stood on the road, looking between two small stone walls along rows of graves.  The sun was bright, the sky blue, and the trees and grass green.  At the far end stood a statue of Martin Luther.  And there I saw his sign, a temporary placement for his headstone not yet finished.  Standing at the foot of his grave, I could see it was a recent-ish burial as the grass had not fully grown in the spot.  I had brought no gifts, no tokens.  I saw a single black feather and placed that under the sign.

And I began to say my last words.  It was weird, talking to no one but the breeze.  I wasn't even sure of what to say, my ramblings barely coherent even to myself.  And then I teared up as I admitted that I was bi, something I never got around to telling him while he was still alive.  The words choked, stuck in my throat as I said, "I know I never told you, but I thought you should know . . . I'm bi, probably more gay than straight but I'm working on figuring it out.  I know you would've been okay with it, you would've helped me figure it out in your own way, but there's no way to know now, eh?"

It was awkward, but what does that say?  What does that mean?  That even now, even talking to no one but the air, those words would be so damn hard to say?  I suppose I really haven't changed too much since the beginning of this blog.  I don't see an endpoint.

Having too much time makes idle thoughts wander, too much time to re-examine and yet still do nothing.

The Truth of the Matter

About a week ago, I was having lunch with some friends (most of them in med school with me). I can't recall how, but we arrived on the topic of "conventional" vs "alternative" medicine.

We had all read at least some excerpt of Anne Fadiman's book, The Spirit Catches You And You Fall Down. It's a biography of a Hmong girl who develops seizures and about the divide between Hmong culture and and Western medicine culture. Interestingly, my friend and I took away very different messages from the book.

He cited a quote from a surgeon towards the end of the book saying to the effect, "Western medicine works" and claims Fadiman ignores that fact and moves on. He believed that all of the alternative medicine and cultural beliefs of the Hmong in the book were essentially crap and that Western medicine was the one true solution to the girl's seizures, and that everything else got in the way. Western medicine is the only thing that works. I disagreed on two points: 1.) it doesn't really matter if Western medicine is superior or not if the patient doesn't want to take it, 2.) not all alternative medicine is necessarily crap - a lot is just unproven medicine.
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1. The truth of the matter is, patients don't always think highly of doctors. It's our fault, really. Doctors can be so dismissive and so readily "reduce" patients to numbers, diseases, and organs. We can appear cold and disengaged. It doesn't matter if Western medicine is the only thing that works - if patients don't take the medicine we give them, the effect of our medicine is zero. We must negotiate without patients, we must compromise with our patients, we must work with our patients to get them the best medical care possible.

There's a great article written on KevinMD.com (a great medicine/health blog) titled, Stop the Us versus Them mentality in medicine, that speaks very well to this point.

2. The truth of the matter is, not all alternative medicine is crap. A little over decade ago, acupuncture was scoffed at as a sham and now it's routinely used as an adjunct to treat pain and some other conditions. Though the research on acupuncture can be argued as not being the most rigorous and powerful out there, it did demonstrate real potential. Garlic has some medicinal properties and so does St. John's wort.

Herbal medicines and teas can augment or interfere with the effects of our conventional drugs. It behooves us to know what these herbals may do, so we may advise patients accordingly. More research needs to be done. There a lot more alternative medicine out there than research is able to elucidate its true effects. There's a lot of untapped potential that needs to be refined into a product that can reliably and safely work - to disregard it all as "for hippies" or "essentially placebo" is a disservice to patients and the spirit of science and medicine.
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Another friend at lunch remarked, "Do you know what alternative medicine that's proven to work is called? Medicine." I disagree somewhat. There's a difference between the word "alternative" and "integrative and complementary." Not too long ago research showed that a tablespoon of honey in a cup of hot water helped temporarily relieve symptoms of sore throat and cough. But these things alone usually can't suffice, and hence are integrative and complementary. Alternative implies a divergence from conventional medicine.

This article, The Believers, that my friend sent me yesterday unsettles me a little. It may seem hypocritical of me to say that, given what I've argued above. But I am by training a scientist. I acknowledge that there is a world outside what research has touched (because if research has touched it all, there would be no further research). I believe that many alternative therapies warrant further scientific research to see if it truly works or not.

Anyway, the truth of the matter is, we shouldn't dismiss alternative medicine so readily because we don't always have proof it doesn't work. Also, if we dismiss it so readily, patients may take offense and refuse to take the medicines we prescribe. And if they don't take our medicines, that have research backing that they work, then what's the end effect? Oh yeah, nothing.

Chosen Path

This post is actually 2 weeks later than when I made my decision, but it has to be written nonetheless.

I've decided that I will not return and finish my MPH.

It's not like I'm necessarily giving up on getting an MPH (eventually), it's just not what I'm looking for in my career at this time. I may end up getting an MPH as a part of a preventive medicine or ID fellowship, if/when that time comes. I may end up coming full circle and return to some lab work, but not now and not in the near future.

And I've decided this for the reasons I wrote in my previous post. The words that clarified my decision came from my M4 advisor, who told me:

"I'm going to tell you what I tell residents who're deciding whether to do a fellowship or not. A fellowship, like your MPH, requires you to give it your all and your total dedication. If you're going back and forth now, ask yourself: is this really what you want? Or is your doubt telling you something?"

Those words shone in my mind like a sun burning up morning fog. I've made my decision. And I'm at peace with it.

Uncertain Crossroads

Crossroads by ~Nadja18 on deviantART

Last week my application for re-admission to complete my MPH (Master's in Public Health) was approved. Initially I was ecstatic because I had been talking about this moment for over a year, about how I loved/valued the program, etc. Now for the past week or so, I'm not so sure - I've been getting some cold feet and doubting whether I will actually go back and finish what I started. The conviction which I had held for the past 1-2 years is gone. And it all hinges on "uncertainty."

I am uncertain that:
1. I will get funding to finish my MPH (I do NOT want to tack on any more to my growing student loan debt).
2. I really need to finish my MPH to do what I want to do.
3. I still want to do what I had originally set out to do when I began med school.

Here's how those primary uncertainties are being addressed at the moment. 1.) I stand a fairly decent chance of getting funding via teaching undergrad courses as a grad student. It was reassuring that the professor I taught for was very willing to write me a letter of recommendation and remembers me so well. 2.) I do not need to finish my MPH to do what I want to do. Would it be useful? Perhaps, but it depends on what I end up doing. Which brings me to, 3.) Without even realizing, I've changed. I had set out to be the so-called "triple threat," that is the doctor who sees patients, does research, and teaches students. Now I'm not so keen on the research bit, haha. Also I had set out to do ID (infectious diseases), and while that's still on my career list, I've begun to shift away towards primary care or another specialty like rheumatology.

My MPH degree is very specific towards a particularly ID-oriented skill set. With my degree I would be better equipped to understand infectious diseases, conduct laboratory "bench" research, and create surveillance programs relating to infectious diseases and the agents to treat them. And prior to med school, that was one aspect I had wanted out of my career. Now I don't know.

Now a few things are certain and have remained certain (if not strengthened) over the past several years: 1.) I want my career to be clinically focused on treating patients. 2.) I want my career to have a public health/community engagement component. 3.) I want to teach students (doesn't have to be med students). 4.) I want a good work-life balance. None of those require an MPH - or more specifically, my focused MPH program.

So I'm in a bind. Will I regret later down the road for not having finished my MPH? If I get my MPH and never end up going into an ID field, will I feel like I "wasted" a year? I can see myself going either way, and neither road is superior to the other (not really, anyway). I can convince myself to go either way and I've been changing my mind on almost a daily basis for the past week. Ugh.

Talking to one attending physician who basically does what my MPH would prep me to do, he asked me, "What do you want to do?" And I said either peds or something within peds, like peds ID. And he emphatically said that I did not need an MPH to do peds or peds ID, and it wouldn't necessarily help me that much. What matters most is not how many letters I had after my name (so long as I had letters at all); what matters most is talent, hard work, and good networking. That said, if there's something I wanted to do within medicine that requires an MPH (or practically requires it), then I should definitely get it.

Anyway, what do you all think? I've talked to so many friends and several faculty, and I keep ping-ponging between the two options. I can't delay my commitment too much longer, have to make a final decision soon!

The Importance of Caring

Several days ago I came across this article, The foundation of medicine is care. Like many words in healthcare, "care" has become overused (right up there with "professionalism"). What does it even mean anymore?

We adhere to standards of care - the set of questions, actions, labs, imaging, etc that we do to diagnose a patient's problems and provide adequate treatment. We provide care to patients, to help them when they request it of us. None of this necessitates that we care about our patients. As the article argues (and I agree), this last kind of care is the most important.

Today, a distraught parent explained her daughter's "history of present illness" to the physician I am working with this week. In trying to get an accurate picture of her daughter's current illness, he asked the mom question after question to make sure he had the story right. The mom got frustrated because she's had to explain the whole thing for who knows how many times and she felt like he wasn't listening - such is the perils of an academic teaching hospital, you must tell the same story at least 3 times (and often more). The mom became so frustrated that she broke down. She was the first person I met who said how horrible this hospital was, how no one seemed to care enough to get the story right or talk to each other so that everyone's on the same page. She's not entirely wrong. Our hospital system is set up in a rather fragmented way. We provide the same standard of care (if not better) than most other hospitals, we provide good care for our patients. But we, as a system, didn't care about the patient.

Inpatient medicine is very different from outpatient medicine. In the outpatient setting, I felt that every physician actually cared for his/her patients on a personal level. I had a . . . heated discussion with my roommate about a month back. He asked me why I cared so much, why I get so worked up over a patient encounter. Really, I couldn't help it. By actually caring about my patients, not just for them, I feel like I am able to do more and am willing to try harder for them.

He didn't share my same views. For him, once he met the standard of care, he need not go further. If he couldn't get a patient to comply, then he is perfectly satisfied to give up and walk away from the situation. While in some scenarios this is indeed the correct course of action, I felt that it would be a disservice to our patients if we gave up every time they gave us even the slightest hint of grief.

Anyway, just some thoughts.

Privilege & Entitlement

"The moral test of government is how it treats those who are in the dawn of life, the children; those who are at the twilight of life, the aged; and those in the shadow of life, the sick, the needy, and the handicapped."

I came across that quote in this article, Addressing the needs of the disadvantaged in our health system. The words themselves struck me and the article is well worth a read (it's by a med student).

I linked that article to a friend and she shot it down as overly idealistic because people will find a way to take advantage of and manipulate the system. Then people will begin to feel entitled to the help from the government and stop trying as hard to pull themselves out of whatever situation they find themselves in. The public health aspect of me balked. She turned it back on me and remarked that I probably felt more entitled than her, and that her boyfriend almost certainly feels more entitled than either of us. I was confused. She stated that I must feel entitled to be paired with good physicians as my clinical teachers and that I expect certain things to happen or else. I was taken aback. This then became a philosophical discourse of sorts.

I have never really felt entitled to much past high school. I learned very quickly that things in life must, more often than not, be earned. I have never felt a sense of entitlement in med school. Whether or not I am paired with a good physician or not is purely luck (that said, I've been pretty lucky lately).

Every moment I have time to give pause I am filled by a sense of privilege. Truly, being a doctor is a privilege and one of the highest out there. In how many other professions can you ask someone to take off their clothes and allow you to touch them in ways that would otherwise get you arrested? In how many other professions will someone come to you and ask you to cut them open and do what you will inside them without getting sent to jail? In how many other professions can you ask someone about the whole "sex, drugs, and rock-and-roll" without getting them arrested?

I am aware that every time I walk into a patient room, I have mere seconds to earn their trust. It's an interaction that takes place within a few seconds' time, but it is so critical. With adults, this is an introduction and a shaking of hands. With kids, this is more subtle but can be sensed by the look in their eyes (and whether they give you a high-five or fist-pound). With newborns, it's a settling back into a calm. I am motivated by a sense of awe for the practice of medicine. For patients to allow me to listen to their stories, to examine them physically, to place trust in my words (as a M3 med student), to consent to have me assist in their surgeries and be elbow deep into their abdomens - I'm not sure words can express the sense of gratitude and privilege one can feel.

Unfortunately for many of my peers, the rigors of the training and the complexities of the patients out of our control have jaded them. To quote Dr. Walcott in the movie, Patch Adams:

"Our job is to rigorously and ruthlessly train the humanity out of you and make you into something better. We're gonna make doctors out of you."

In a profession that deals with humanity, how have we allowed it to smother out our own humanity? It's a curious thing. I would be lying if I said I haven't had my moments when I wondered why I even bother to help some patients, knowing that they will not or cannot help themselves. I would be lying if I said I haven't ever been pissed at a patient when things took a turn for the worst.

But thinking back to WHY I'm here in the first place brings me around full circle and sustains me. Everyone has a reason for going to med school, some of them better and nobler than others. I believe those who hold onto their reasons and do not lose sight of it are best able to make it through without become (as) jaded.

Well, this post has been rather long and I'm not sure it makes a whole lot of sense. I'll have more to say after my exam on Monday. Eep!

Introspection & Privilege

This weekend is a "golden weekend," so called because we have both Saturday and Sunday off. This is a golden weekend because we're now halfway between our surgery rotation here, and we're all switching hospital sites. Starting tomorrow I'll be at a different hospital for surgery. So this weekend is a temporary respite.

I'm glad that the first month is over. There are days that I was seriously doubting if I could make it to the end. On average in September, I was in the hospital about 60 hours/week. It could've been much worse . . . though I'd rather not think about it. However, a moment of retrospection brings me to my final patient on surgery at the first site.

(Paraphrased)
Patient: "I admire you all and what you do. I really do. You do so much to take care of us."
Me: "Thanks. That's our job. We wouldn't be here if we didn't want to help take care of people like you. We chose this."
Patient: "Yeah, but thanks anyway. I wish you the best."

I'm not sure if I can adequately describe in words the profoundness of that brief moment. No matter how I or others may whine, bitch, and complain, it remains truly a privilege to take care of patients and do what (little) you can for them. It is a privilege to have others trust you with their health. As one of my friends said (in a jokingly serious manner): "What other profession do you get to cut people open and touch them in such ways without getting jailed? In fact, they're paying you to do just what you're doing."

Anyway, I think it's worth a moment of introspection for us to appreciate that which society allows us to do, and understand the responsibilities that society expects us to bear (justified or not).

A Helping Hand

a helping hand by *poivre on deviantART

A couple days ago in the resident's lounge, one of the physicians came in to round with his team (of residents and med students). Because the lounge is rather small, I overheard most of what they said.

They discussed this one patient in his 30s who didn't finish high school, has uncontrolled diabetes, has peripheral neuropathy (numbness & tingling in fingers and toes) as a result, has chronic pain, and is taking narcotic pain meds in order to bear it all. According to the med student and intern taking care of him while in the hospital, they report that he is unpleasant/uncooperative to work with, appears to be "throwing away his life," and just want his pain meds. The physician took this as a moment to ask, "Why?"

This segued into a discussion from the physician about here is a guy who's slipped through the cracks of health care. He takes narcotics for the pain, but narcotics likely make him sleepy and also feel not great, throwing him into an endless loop. His PCP (primary care physician) likely tried to truly help him once, but since he's uneducated and doesn't know how to manage his diabetes, thus his health deteriorated. In his frustration, his PCP likely labeled the patient as "non-compliant," which is technically true - but again, why? It became easier for the PCP to just refill his narcotics and send him on his way. His PCP is also an older physician who's likely jaded from seeing so many of his own patients fall despite his care.

Here, said the physician, was an opportunity for us - med student or intern - to turn the guy's life around. Here, in the hospital, where we have "control" we can say to him, "You need to get your act together and turn your life around." Here we can extend a helping hand and spend the time to give him the education necessary to manage his diabetes. He's a young guy and has a shot of doing well years down the line, why should we also abandon him just because he has a label of "non-compliance?"

I have friends who call their patients "idiots" for smoking and having a BMI of well over 40, and then gets admitted for pneumonia. Or for being alcoholics and developing acute pancreatitis as a result. Sometimes I look at one of my friends, who's overweight and gets winded after going up 2 flights of stairs (how sad . . .), and say "Dude, you get winded after 2 flights of stairs. When was the last time you exercised?" To which his response is, "I've been busy and I just don't feel like it." How dare he call his patients idiots for ballooning up to a BMI of 40+ (FYI, that's more than morbidly obese), for telling them to exercise and eat healthy, when he doesn't do the same and could be in their shoes 10-20 years down the line.

Anyway, righteous indignant rant over. We all, medical and non-medical alike, have an opportunity to turn someone's life around. We all fail from time to time, but that doesn't mean we no longer deserve help. Even so, I'm beginning to feel myself become jaded with adult medicine after just 2 months . . .

A Good Day

It's been a good day.

1. I finally had an adult patient with a "fix-able" disease. He had pseudogout, which is readily cured with medication. I called the rheum consult and happened to be there when they came by to examine the patient. So I went in with them to see what I could learn. I had forgotten how much I liked rheumatology, haha.

2. I was able to answer most of my attending's questions without sounding/feeling stupid. This feels like an achievement for me because sometimes I feel like no matter how much I read, I fail to recall what the attending determines to be the most salient points. But today I was prepared (or at least phrased my answer in an acceptable way if I didn't exactly know the answer).

3. My attending gave me feedback on my performance. She told me how proud she was of my progress from day 1 to today. I went from an unsure and kind of shell-shocked student to someone who's confident and proactive in taking responsibility in my patient care. And I do feel like a different person since day 1 last week (I almost can't believe I've been doing this for 2 weeks already!). I chose the hospitalist service precisely because I knew my attending would throw me into the fray and force me to be an independent learner without training wheels, and I got what I wanted.

4. As such, my attending offered to write me a letter of recommendation for residency later! She told me how she's written LORs and how she's called residency programs to give her former students an extra edge. Now, when an attending offers to write a LOR, that means that the attending truly regarded you highly. I hope I can continue this momentum with future attendings on rotations down the road.

5. I met the city's oldest woman cop/detective! She quickly became my favorite patient (though she wasn't technically my patient). She was great to talk to. :-)
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Yesterday I hung out with Drew a bit. I picked him up from his house and we went to a coffee shop. We sat down and chatted and people-watched. He kept pointing out all the cute guys and guessing which were likely gay. Btw, I still don't get what people see in asses/what they notice about it; it's simply a body part that I rarely pay attention to. Someone enlighten me?

Anyway we had some good convo. He told me about this guy he likes and likes him back, but they both agreed that neither were in any position to date the other. I suppose that keeps the window open for me a bit, but Drew alluded to the fact that he just got comfortable being single again and would like to stay that way for a bit longer. I'll respect that . . . and also I couldn't get the right words I had wanted to say out of my mouth, lol. And I still couldn't get a feel if I even have a shot. Fail.

I did, however, manage to get him to take his shirt off in front of me. But I assure you it's for a legit reason. He had this rather nasty cough on and off as well as some sinus issues. I just so happened (unplanned, I assure you) to have my white coat and stethoscope in the back seat of my car. So he humored me in allowing me to listen to his lungs and heart. His heart sounded good but his upper lungs did sound a bit congested to me.

All in all, it's always great to hang out with him when we manage to align our schedules.

You're Better Than Me

About a week ago, I had the following conversation with Michelle on gchat (slightly edited):

Michelle: Hey, I try to be open. But when I'm not good enough to talk to someone . . . I get really irritated.
Me: Awww. I never got that sense from her. Maybe I'm just oblivious, idk.
Michelle: No, you fit into a different class of people than me. This is most certainly not the first person I've experienced this response from in our class.
Me: Lol, what do you mean by that?
Michelle: You're better than me. I'm overweight, and I don't look like I have money . . . so I get relegated to a lower class. Plus a myriad of other factors. But I'm judged on the first two sooooo quickly.
Me: How am I better than you? And how do I not meet those criteria too?
Michelle: You're more peppy than me. More positive. People like you. I don't know anyone who doesn't like you.

I was rather taken aback by her statement. While it's true that I don't know of anyone who overtly dislikes me, I'm not exactly best buds and close friends with most people in our class either. I tend to hover outside near the fringes of most social circles. It's a rather weird place to be, tbh.

Maybe I am peppy, though I don't really feel it. I try to be positive, but sometimes that's difficult. In any case, I certainly feel no better than anyone else (and very much the opposite compared to some people I know). If only personality is everything, hehe.

---TANGENT---
1. I got an iPod Touch a few days ago. We need one for use in the hospitals and clinics (apparently). I had the option of getting an iPad but I turned it down. Before you shriek, here's why: it's bigger and less practical to carry around in the hospitals. True, it fits in my white coat, but it's just this big bulky thing that I don't want to have on me at all times (and we'd be required to use it and have it with us at more or less all times). So yeah, I've been fiddling around with this iPod for the past few days. I resisted for a while before getting the Grindr app. I still don't see what the big deal is about it . . . Anyway, any "must get" apps?

2. Landyn's back (sorta)! Go read his update on his blog, Stuck In The Middle.
---END TANGENT---

Finally!!

Finally . . .

1. Shadowed Dr. P. Well, I guess I didn't actually shadow him as I shadowed his ID (infectious disease) fellow, Dr. S. She was really laid-back and really cool. Dr. P was supposed to mentor another ID fellow, but he never showed up. I was shadowing at a STI (sexually transmitted infection) clinic downtown. It's this small clinic that you'd easily drive by and never notice what goes on in there, lol.

It was really interesting, actually. Yeah, the diseases were all the same, but every guy had a different story to tell (the clinic wasn't set up to do pelvic exams, and hence few women go there). I also got to review some of my microbio with Dr. S, and now I know the treatments for chlamydia and gonorrhea pretty well (1g of azithromycin for the former, 250mg IM shot of ceftriaxone for the latter).

Afterwards Dr. P kept asking me if I was "alright" and if I was bored or not. And I was just like, "Hey, I'd much rather be here doing this than studying pathology right now." I like ID (not 100% sure that's what I'm going to do with my life, but), and I needed something to remind why I'm doing all this (the med school thing, that is). I can say though that I left that clinic with a smile. Go ahead, I know you probably think that's a bit weird, lol.

2. Met Drew. Finally!! We met yesterday at a coffee shop about 10 minutes from where he lives (and about 20 minutes away from me). I arrived earlier than him, because he doesn't drive and takes the bus, so I order a chai. Man, they took their sweet time with making that chai!

I see Drew walk in and he walks right by me. He turns around, I wave, and we say hi. The place was pretty packed, but a table had just opened up as he walked in. We sat down and just chatted. He has one of the prettiest eyes - it's a greenish hazel or something, and it's really nice if the light hits it just so. He also had an adorable smile (and his body appeared a lot fitter than I expected). He plays with his scruffy hair saying how he needs a haircut.

We start kinda joking wittily back and forth about random things, with him referencing a lot of TV shows and such. The witty banter was almost like a light-hearted game of chess - it was fun and kinda silly, hehe. Then he described his geology research (it was actually pretty interesting, however dissimilar from the research I've ever done).

It was good. Before either of us knew, more than 2 hours had flew by and he hadn't ordered a thing. He had wanted to but didn't want to spend the money on it. My friend called me wondering if I would make it to a film screening for Restrepo followed by a discussion with a Vietnam veteran. I told Drew that time was short and had to run soon. We chatted a bit more, and then I gave him a ride home since it was kinda on my way to the highway anyhow.

I never did give him that back rub. And I never collected my rein-check on that bj. But I prefer it this way - coffee date (of sorts?) with just some good talk, and the promise of more later. Later online he said, "It was nice meeting you btw, makes it easier to talk on here."

I like him. He makes me smile. I don't know if this will ever go anywhere or if it can. It almost feels like we're living worlds apart and, just for a moment late one afternoon, met at the boundaries separating us. I kept thinking halfway through, "Man, if only we had met sooner. If only we had a better/more efficient way of meeting. If only we weren't both super-busy. If only you still weren't in love with your ex, even though you know he's a worthless breath of air." C'est la vie.

3. Handing over the reigns. The new leaders for the student groups I've been heading for the last year have been chosen. All of them are competent and I'm confident that they'll do a good job. My obligations are winding down (as boards studying ever ramps up). Just a couple more events and a few "transition meetings" and I'm done!

Lost in Conversations

Well, no comments on my last post. Whatever, no answers for you. :-P
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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---

By Starlight

Orion Constellation by ~Eric-P on deviantART

A few days ago, I managed to catch up with an old friend who I had known since kindergarten. We were next door neighbors for years until my family moved to a different part of town just before 8th grade. We had drifted apart - it being in the years before cellphones and high-speed internet (I almost can't believe that!).

I had told him how, upon returning to town, I looked up at the clear night sky and for the first time in perhaps years, I saw the stars. I saw the constellation Orion, clearer than I had ever seen it before from home. In response, he told me how a while ago, while backpacking with friends up north, he looked up to the clear moonless night and saw only the stars. There was so much starlight that everything around had a soft glow. And not just your typical stars, but stars of different colors - reds, oranges, yellows, blues - that you'd normally never see. It was later under this same starlight that he proposed to his fiance. Words could not describe how beautiful the world looks under nothing but starlight.

And I thought to myself, when was the last time I had that sense of amazement? Or any sense of amazement, really. I remember looking up at the stars as a kid and reading about every constellation, every star, every nebula, that I could look up. I wondered, when was this sense of awe and amazement quenched? When does growing up suffocate the curiosity and wonder of childhood? Becoming an adult is a perilous thing to the capacity of kids to dream.

Recently, I had a brief moment of amazement (granted, a somewhat twisted version). You see, viruses amount to nothing more than RNA or DNA, some proteins, and perhaps less than a dozen genes. And yet, without consciousness, without cognitive intent, viruses naturally just infiltrate our bodies and subvert our own cells to serve their own ends. How curious that we all share the same building blocks of life, the same atoms, and yet we must be so antagonistic. And on a loosely related note, how all thought and sensations are but the products atoms interacting. There's nothing of substance to our thinking, and yet like magic we make real what's only illusion - we materialize it in words, sounds, writing, actions, etc. To think that an orgasm or love are just chemicals interacting with each other at the right time and place, now there's some awe in that.

You may not think so, you may not agree, you may not even care or are thinking "wtf." But when was the last time you took a moment to take in something and think deeply about it - to reduce it to it's simplest elements and marvel how something so complex and, indeed, miraculous came about?

Anyway, enough of my rambling.

Catharsis

Now that this round of exams is done, the "what I learned at the GLMA Conference" post, as promised.

I just talked to Dr. P about it earlier today and how to move forward with the info we (I) learned. I've basically grouped it into 3 categories: immediately useful/actionable info, good to know info, and personal.

1. Immediately useful/actionable info
Students. 29% of LGB students aren't out, mainly because it's: nobody's business (fair enough), fear of discrimination, and fears of not getting into a residency of choice. About 60% of transgender med students aren't out. Few med students feel that med school curriculum has adequately prepared them to serve LGBT patients. Students want more clinical exposure, more cases, lectures, and supportive faculty that they can turn to. On average, med schools in the US and Canada spend about 5 hours over 4 years on LGBT health issues (not including HIV).

Med schools. Deans of med schools have a different view on things. Most (68%) have LGBT content interspersed throughout the 4 years. It should be noted that 79% of med schools have no LGBT clerkship rotation sites. Transgender health issues are rarely taught. The good news is that 52% of deans are willing to improve curriculum; but, they aren't too keen on developing new stuff (because it's time-consuming and hard).

Allies. The barriers to being an effective ally must be addressed. This might be: a desire to avoid controversy, afraid to be called gay/associated, and not asked to speak up. Some strategies to help remedy this include: getting educated about the issues, talking about it, have some symbol of support (like, a small rainbow pin or something), learn the "language," ask the right questions, assume nothing, and discuss confidentiality upfront.

Some of things that can be done here right now include: working with the Office of Student Diversity, working with the Admissions Office, working with the new curriculum committee, safe spaces/ally training, and just continue general awareness. Incidentally, I somehow ended up on the student diversity committee. I just happened to attend the one meeting - a case of being at the right place at the right time I guess.

2. Good to know info
I didn't learn much about LGBT issues and health care reform, though I went to a couple sessions. I did attend a few transgender health sessions though, and they were actually really interesting.

Transgender kids. Toddlers start developing gender identity around age 3-4. This process evolves until the kid's about 7. This process appears intrinsic. That said, some kids are "just in a phase" or gender-fluid. Thus follow-up and just observation over the years are important. These kids tend to get distressed between age 2-5 and again at puberty. To treat these kids, one gives them hormone blockers to delay puberty until they're old enough to make a decision about transitioning or not. Apparently only about 10% of "gender variant" kids do end up transitioning. The point is, that up to 33% of transgender youths attempt suicide. But by showing acceptance, support, and delaying puberty until age 15 or so, it greatly reduces the rates of suicide and depression. Furthermore, the medical home concept is quite apropos for these kids.

Transgender care. Holy crap it's complicated! Someone's got to do it but I do NOT want to be among them. When to give hormones, how much to give, how to pay for them - it's all so overwhelming. Don't get me wrong, I like endocrinology and all that, but this is like endocrinology on steroids (lol, pardon that pun).

Also, HPV can apparently survive under the fingernails for a while (apparently that's how straight guys can get anal cancer, who knew?). I need to remember to buy Purell . . . Don't know if on that random off chance I'll get HPV from shaking someone's hand.

3. Personal
So Dr. P asked me if the Conference did anything for me personally. I suppose it did. It was nice to just be away from the Midwest and meet new people and not talk about classes and such. Yeah, still surrounded by medicine and such, but at least it's not worrying for this exam or complaining about that lecturer or something comparatively petty like that. He did concede that in hindsight it was perhaps a bit too overwhelming for me to experience that all at once, lol.

But then it was also incredibly cathartic. I disclosed more about my personal life/struggle to him than I had anticipated or expected. I suppose I wanted some kind of answer from him, but I didn't get what I was looking for (whatever that was). There were moments of long silences - of him staring at me and me staring back, of him staring at me and me staring off in the distance to avoid his gaze. Words just abandoned me and the silence doesn't force him to say anything to break it.

It felt like the more he subtly pressed against my walls, the more I wanted to crumble. He didn't tell me anything new or anything I didn't already know about myself. Other than perhaps suggesting that going to a therapist might be good (though how I'd pay is questionable). In a way I guess he forced me to realize just how uncomfortable I still am with all of this and how lost I still feel.

This catharsis was paralyzing and deafening. I've clearly still got some work to do. It never ends. :-/

I Blame the Wine

So, 2 days ago, we hosted an opening social for the LGBT group at a physician's house. Dr. P was there helping the physician set up and all. Kat and I arrived early to help out, though we didn't end up doing much. (Kat has been surprisingly upbeat these last couple weeks, I hope it stays that way.)

The turnout was actually really good, considering that pathology tutoring for M2s was the same night and the anatomy tutors moved the mock anatomy practical for M1s from Thursday to Tuesday this year (which sucked, since this meant that no M1s would be attending). Surprisingly, one M1 did make it! Our other faculty advisor came with her partner. I must say, they make a really attractive lesbian couple. o_O For a while, there were almost the same number of physicians as med students . . . awkward. But then more med students started filing in, which was good.

Halfway through the social, Kat wanted me to make an announcement to thank Dr. P and the physician whose house we were at. I drank some more wine. I'm no orator. I can be terribly awkward in such situations. I can be quite awkward in social situations, but I somehow managed to talk to almost everyone in attendance, which was no simple feat for me! Thankfully the wine helped. All 6-8 glasses of it (granted, the glasses were small-ish).

Also, I don't know if it's the wine or not (but I blame it anyway), but I had a mini-crush on Dr. P that night. o_O I mean, him + polo shirt + shorts = swoon (also, he's only in his mid- to late-30s). He has really nice arms and legs; well, he's just really nice overall. But, he has a partner, and it'd be a very bad idea to let this get any further considering our respective positions. Partway through the social, he leaned in close and whispered in my ear, "I know this isn't politically correct, but are there any gay M1s or M2s?" I answered, "I honestly don't know because I didn't make it a policy to ask."

I must admit, it made me a tad uneasy. Every time he asks me a similar question, I feel like he's looking into me for answers or a confession or something. I've wanted to come out to him so badly, but I just can't seem to. How odd. I just want to chat with him about life and let myself vent and ask him for guidance, or something. But I don't think that's going to happen in the near future. What's holding me back?

When Kat and I left (we carpooled), we talked about Dr. P's whispered comment to me. There's a reason why there are so few openly LGBT students. If you come out, you are the gay student. You are the gay person that everyone looks to and you have to be the "model" gay med student. You become the reference. It's not a burden most would want to carry.
-----
Anyway, my thoughts feel very disjointed. I'm beyond overwhelmed with things right now. Something just doesn't seem quite right inside at the moment. :-/

Rant: Frustrations

Blargh. Day 2 of classes and already I'm stressing out hardcore, but not over classes. Oh no, classes wouldn't stress me out quite as much as some of the people and drama around me.
-----
1. I don't know why, but I've been really snappy and short at my roommate. Little things he does seem to set me off in a corner of my mind. He doesn't understand that my family is quite strapped financially this year, and he even suggested that my brother or I get a part-time job. But we're med students . . . there's precious little time for adequate decompressing, much less a job.

Also, he keeps stating how talking about psychiatry and medical ethics are worthless unless we're immediately faced with those dilemmas. I vehemently disagree, as I believe that understanding how people think and how to reason through even hypothetical ethical conundrums are useful. He argues that because we're reasonable people with common sense, that those qualities alone are generally sufficient. Well, if they were truly sufficient we wouldn't have a need for ethics committees. I could go on and on, but I don't want to sound like I'm foaming at the mouth.

I've decided that I can't discuss such matters with him. He never accepts anything I say as valid and tries to "light-heartedly" discount my points, and I just get frustrated. I'm putting my foot down: I'm not discussing this with him from now on.
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2. There's tension between one of my friends, her roommate (my treasurer for one of the student groups I'm in), and me. Let's say my friend is M and her roommate is K.

So K sent both of us a rather bitchy email earlier telling us that she doesn't like how we've been talking about her to each other. M gets furious at this email. And I must admit, it did cast a dark cloud over my head for several hours.

I reply to K's email and tactfully apologize. She is pacified by this. Then M sends me a message on gchat asking me why I bothered apologizing. I replied that it was a tactical decision, not a personal one. I needed to be on good terms with K because we still need to work together, and if she's mad at me then things I've worked really hard on over the summer will fall apart. M isn't satisfied by this and is furious at K.

Then later I send an email to one of the deans, K, and M concerning a program that M told me about. Apparently, I had misinterpreted the reason that M brought the program to my attention in the first place, and she would've rathered that I hadn't sent the email before consulting her. Argh. Clearly, in my good intentions some grief has backlashed onto me.

Well, I had to apologize to M, of course, and explain that the intent wasn't to usurp her student group's program, but rather to bring it up as an example/model to develop an elective curriculum on. After my apologies and explanations, M seemed more or less pacified. She at least understands the good intent with which I sent that email.

Why are women so hard to deal with?!?! With guys, decisions tend to come quickly and easily with no feelings hurt (usually). With women, one must take into account their MOODS.
-----
At least with small-ish issues, I can resolve things pretty quickly and have people forgive me fairly easily. It's the larger issues that tend to linger and dwell on my mind for way too long.

It's only the 2nd day of classes, and already I'm at wit's end standing dangerously near the precipice of sanity looking over the chasm of insanity.

Frustration by ~stabTyler on deviantART

A Post of Quotes

"My personality description: I am an awesome person. Everyone likes me the moment they meet me. I am the life of the party and all of your lives will be improved once you have spent a day, nay, an hour with me."

I pilfered that from my friend's AIM blurb, which she took from her roommate (who had always wanted to say that in person to someone). I thought it was amusing and worthy of sharing. :-P
---

"In May, one or two huge decisions must be made and they affect many besides yourself . . . Gather your lieutenants. Sit down at a big table and sort out the details of these issues . . . You think big when you might better be thinking small . . . Drop the control freak behavior. You want to be everywhere at once, doing everything and doing it well. You must however make an attempt to concentrate on events at hand."

That's part of my horoscope for May from Facebook, lol. In many ways, it's eerily accurate. There are lots of decisions to be made this month, especially where student organizations and programs are concerned that I'm president/co-president/co-chair of. I may be overextending myself, and I may need to let go and trust my other board members to get things done (in a timely and organized manner). Fortunately, I make a big emphasis to make sure everyone's on board with something before I make a final decision - so I'd like to think that I'm a pretty good collaborator. So much work to be done over the summer, bleh.

"Love life? What's that? You will be far too occupied to play at hearts and flowers. There might be a tiny flirtation in the wings around the 21st of the month. But it won't lead anywhere because you will not let it . . . right?"

Well, that doesn't bode well, lol. So Drew broke up with his bf of 3-4 months. For good now (the reasons of which I shall not reveal here). He's still super-busy and it's still pretty difficult to get a hold of him on either AIM or Facebook just to chat. But that's fine, he has finals, I have finals, we all have finals. Studying should come first. I wonder where this might go, if anywhere at all. And given my like and the portends above, chances are it'll go nowhere. :-/
---

"He decided to open a sporting goods store instead because he wanted to get as much out of his life as he could before it was shortened by the disease."

That's a quote from this article. In short, a patient goes to see his doctor about whether or not he should go to med school. The patient asks that question because he has a family history of Huntington's disease, an autosomal dominant genetic disease. The patient finds out he does have the gene allele for Huntington's, which means he'd have symptoms starting in his mid-30s to early-40s, and he'd probably die by his 50s or 60s.

And so, instead he expresses what's quoted above. In a way, that's saying something. Particularly the part "because he wanted to get as much out of his life as he could." Those words are rather chilling (perhaps oddly so) for me to read.

Sometimes I do wonder. It's not like I'm going to drop out of med school (willingly), but I entertain the thought from time to time. I had a conversation with a friend earlier today about med school education. We're both soundly frustrated (as is pretty much everyone in our class) with the way med students are educated. The sheer volume we have to cram into our heads (and M1 year is like, nothing compared to M2 year) is just not productive. We can't retain it long-term. We have to re-learn everything, almost from scratch, every time.

Actually, let me rephrase myself. I've "learned" surprisingly little in med school. I've "studied" a lot though. Anything that I learn - like "really" learn - I retain long-term (at least for a few months to a few years). Studying means I just know it for a test and then move on. I learned a lot in undergrad and grad school, and I retain a lot of it. I retained more from my undergrad biochem class than my med school biochem class. There's something wrong with that. I hate studying things over and over again, because I didn't learn it well the first time (because it wasn't taught well). Some things don't really get that much easier the 2nd or even 3rd time around. ::cough:: cardiovascular physiology ::cough::

I remember the days when learning used to be fun, stimulating, engaging. I remember the days when I walked out of lecture able to recall exactly what I was expected to learn, rather than be utterly confused. I miss those days.
---
"I'm Yours" by The Script

The refrain:

I may not have the softest touch
I may not say the words as such
And though I may not look like much
I'm yours.

And though my edge is maybe rough
I never feel I'm quite enough
And it may not seem like very much
But I'm yours.