The Adventures Continue

This time it has been 6 months.  The delays in my posts get longer, but life proceeds at its frenetic pace.  And there is much to update y'all on.

1.  Senior Resident

It's been interesting being a senior resident and overseeing the brand new baby interns.  There are 2 overwhelming thoughts: 1.) It's crazy how much I've grown as a resident and as a doctor, 2.) I have a new-found appreciate for my senior residents when I was an intern (and I found myself doing some of the things they did!).  I've also developed an unofficial "rule" for a well-functioning team: the team that laughs together, works well together.  :-)

2.  Fellowship Interviews

For most of September and October, I've been busy with fellowship interviews.  I decided to pursue a fellowship in pediatric rheumatology after all.  There are few fellowship programs in this field and oddly even fewer applicants!  It's not a well-exposed or popular fellowship.  But hey, I guess that works in my advantage.  Here are pics of some places I've interviewed:

 Cincinnati, OH

 Pittsburgh, PA

Ann Arbor,MI

Seattle, WA

3.  Another Away Rotation

Yay another away rotation!  This time in pediatric dermatology because, well, I suck at dermatology.  And knowing some dermatology will be useful for rheumatology in the future.  See if you can figure out where I did my rotation from the following pics:

4.  Match Day

And about 1 week ago, I found out that I matched fellowship in Pacific Northwest.  That's exciting.  I'm a tad annoyed that I didn't match in the Bay Area, as my odds were higher of matching there.  Oh well.  I can't ruminate on this for too long.  I must admit, it's probably the better program.  I was willing to "sacrifice" some career potential in order to be closer to family and focus a bit more on social life, which has been on hold for so long.  But it seems that the universe has other plans for me.

5.  (Lack of) Social Life

Yup.  Still single.  Not for some lack of trying, but maybe I'm just doing it wrong?  Maybe I'll find someone in the area where I do fellowship?  Should I remain always hopeful?  I don't know.

Found and Lost

.Lost and found. by Nonnetta on DeviantArt

I've become worse and worse about posting.  Sorry.  Residency has been busy and I've been too tired/lazy in what little free time I have to reflect.  But as I'm on vacation this week (and my original first and second plans fell through), here's Part 1 of several updates.  Without further ado, Part 1: Found and Lost.

So in my last post, I mentioned Pikachu.  We did end up going on a trip to the Big Sur area.  It was an amazing (albeit too short) trip.  I'm always stunned at how gorgeous the coastlines of this state are!  Here are some pics (from just the first day):

Big Sur coastline

Bixby Bridge

Valley View

Pfeiffer Beach (yes, parts of the sand are purple)

More stunning coastline!

And the iconic McWay Falls

We had a great time!  Yes, we did fool around a bit in bed at the hotel.  That was not planned but practically expected.  I won't elaborate much here, but suffice to say he's a passionate kisser and left me with a few hickies (which was a bit of a problem hiding behind my collar in clinic the following Monday, lol).  More than anything sexual though, it was just nice to lie next to someone and cuddle.  It's a wondrous thing, the sensation of touch.

Suffice to say, by the time we parted ways I had fallen for him.  But then an odd thing happened.  His work really picked up speed and he became very stressed out and distant (presumably from all the work he had to do).  We had gone from texting/Skyping almost every other day to just a couple times a week.  I continued to say "Hi" and "Good morning" almost every day for a while with a scarce reply.  I was beginning to wonder what was going on.

When we finally carved out some time to chat on Skype, I confessed that I really liked him in a way that I hadn't felt towards many other people before.  He took it as a compliment but didn't elaborate much more.  Later he would go on to say that long-distance never works out.  He was referencing a friend and her long-distance relationship, but I took it as a sign that we weren't meant to be (at least, not at this time).  The distance between us is about 2.5-3 hours' drive, and he categorically refuses to come to my part of the state.

And so perhaps that was it.  It almost felt like things evaporated away.  We still text and chat from time to time, but it's mostly me doing the initiating.  I feel the gulf of distance and at first it ate away at me.  Yeah, I still have feeling for him and I wonder if I were to match fellowship near him, would we have a chance?  Or would he find someone else in the intervening time?

I let my guard down.  I let a mask fall.  I let myself feel vulnerable.  And things didn't go as I had hoped.  I hate this feeling.  And what's worse is the feeling that I may very well end up alone anyway.  My 20s are quickly fading with each advancing day - is there any hope for this remaining time?  Or will I find what I seek in my early 30s?

Mask of Loneliness

Loneliness by *MikaTrta on deviantART

Of all the ways to express loneliness, why have I chosen a picture of the empty park bench above? The world around it is bright and sunny, the trees and grass a luscious green, people and life moving about in the background. Precisely because it's the kind of loneliness I'm experiencing . . . and have been all along.

That bench is like my Mask of Loneliness. It sits there, alone, in a vibrant world waiting for someone to occupy it and linger for a while. To a passerby it doesn't appear "sad" or "happy," it simply is. Only when one takes pause to notice and contemplate the situation can one appreciate the loneliness. And so too it is with me. My Mask of Loneliness often appears invisible, even when worn directly in front of you. I'm surrounded by friends and peers. I have few enemies and I get along with most anyone. I wear my Mask of Smiles even when I don't feel like it. I can now interact and blend in so flawlessly that you'll probably never notice that I'm alone.

But I notice. I feel the Mask of Loneliness on my face. I'm painfully aware that several of my friends are now married, at least one of whom now have kids. Though I don't show it, I'm actually rather awkward when I'm one of maybe 3 people in a group who're single. And though you don't notice it, I don't really care to hear about your relationship problems with your girl/boyfriend/spouse.

And no matter how much I tell myself that we all go at our own pace, how I still have time, how my busy-ness is only "for now," I can feel this Mask begin to harden on my face. It is, after all, partly my fault. I don't make a particularly concerted effort to "get out there." And the longer I wait, the more excuses I make and the easier it becomes to make them.

Lately I've begun to feel that I'm "undatable." I hung out with Drew on Sunday (he's seeing someone else now, figures) and it was . . . rather awkward. Neither of us had any particularly good conversation topics. We were just on two completely different pages the whole time. I felt like I had become so one-dimensional as the conversation topics I brought back either drew from a subset of things I knew well or otherwise drifted towards the medical. Even I wouldn't date me.

Lol, I suppose I've become more like that park bench than I thought. At first glance, I'm just made of wood - one-dimensional. But if you happen to come closer, you'll see the words etched into that wood and read the stories of my past, present, and future. And it's not like I'm intentionally hiding, I'm right here in front of you! I hope you linger a bit and keep me company, and take from me my Mask of Loneliness.

Until then, may this quote ring true:

"Pray that your loneliness may spur you into finding something to live for, great enough to die for." ~ Dag Hammarskjold

Yes, I've used that quote before in this post (if you recall).

Mediocrity

mediocrity by ~seven20 on deviantART

In grade school (K-12), I was always at the top of my class. I was pretty good at everything (except gym) and the world was full of endless possibilities. In undergrad, I understood that few people are truly Renaissance men. I learned where my strengths were and I knew where my limits were, in some cases hitting that unmovable wall. In grad school, the world - while more limited - was still full of potential. I learned what I loved and I learned what I could excel at.

In med school, I am mediocre. During M1 and M2 years I did pretty average on exams. Actually, no, I often did below the class average (though, my end grade was "average"). Even the classes that I had a solid background in and did above average I usually was still not among the top. But this didn't deter me as I had come to learn that grades don't necessarily equate with how well you know, understand, and appreciate the material. Then on the USMLE Step 1 exam I did below national average. While this was a hit, I eventually shrugged it off because I still passed, which was what truly mattered. Plus, since I would likely be going into pediatrics (or possibly internal medicine or both), it didn't matter SO much as long as I passed.

Surely come M3 year, with largely subjective evaluations, I should do better! Alas, it appears that I'm still relegated to being mediocre. It seems no matter how hard I try, how hard I study, how excited and motivated I appear, how much I care for my patients, I am only "mediocre." I am only "average." And this befuddles me. Here I am compared against my peers, many of whom I KNOW do not care for their patients in the same way that I care for mine, and yet we end up with the same grade (and sometimes they do better than me). What gives?!

I'm kind of afraid. I really really wanted to excel on my pediatrics rotation. I've mustered every ounce of excitement, enthusiasm, motivation, genuine care for my patients, willingness to do scut work (aka, the residents' bitch work), willingness to receive feedback to improve . . . and yet I'm not sure I can make it out with more than "average." I'm afraid that no matter how hard I try I will remain in the same place.

I am tired from my months on medicine and surgery. I've worked my ass off in hopes that I'm able to mask my exhaustion and put on a face of enthusiasm. And I honestly did care for my patients. I don't know what else I could do, I don't know what other well of strength I can draw from.

As I talked to my friend, he said the following to me:

"Don't feel defeated, you passed and you are a bad ass med school person. You're like, proving yourself beyond 99.9999% of all people in the world. Can't get too upset about that last 0.00001%."

I always loved him for his perspective on things.

Welcome To Life

Newborn Egg by !Kikariz on deviantART

Welcome to this thing called life. Open your eyes and see the love that brought you into this world. Sleep in the arms that embrace you, linger in childhood while you can, but grow up strong and healthy. You are full of the world's hopes and potential - you can become anything! What will you choose to be? You won't remember me, what with me prodding and poking you. But I hope my thoughts are etched into your heart: I wish you the best on this journey called life and I hope you are equipped with the love and the help to get through anything.
-----
I just spent the last 2 days in the newborn nursery. I had the opportunity to examine a baby less than 48 hours old. The mom handed him over to me, trusting me unequivocally that I wouldn't hurt him. He peeked at me through suspicious eyelids and went back to his tenuous sleep. Of all the people to have examined him in his brief existence, he tolerated me the best. I believe there aren't many people who have "the touch," or the ability to connect with babies in a way that they tolerate you poking and prodding them (they're still not happy, but they'll tolerate you); I'm hoping that I've got it. Really, there was only one baby who didn't tolerate me, but that was because he was fairly sick.

There is something about holding a newborn. It's the feeling of holding unadulterated potential in your arms - something so fragile and yet resilient. I mean, come on, the childbirth process is rather traumatic (for both mother and child).

And so it is that I thought the above in my head as I laid him in his bassinet next to his mom and left the room. The odds of me seeing him are next to nil, but all the same - welcome to life.

Respect for Death

death is.. by ~er0k on deviantART

In a way, it's apt that I'm writing this post on Halloween, even though this event transpired about 4 days ago.

I had been following this one patient ever since we admitted him to the hospital from the clinic towards the beginning of October. He came to us after seeing many other doctors, all of whom had failed to solve his problem and relieve his pain. We promised him that we'd try, that perhaps we could finally release him from his suffering.

I had checked in on him every morning before the team, at the crack of . . . well, evening (since it was well before dawn). I saw the misery he was in every day. After the first week, we had identified the problem - an infected bypass graft in his leg. We operated and removed the graft. As a complication, a clot was "thrown" down to his foot causing his foot to become ischemic (lack blood flow) and die. We operated and amputated his toes. Every morning I changed his dressings when I rounded with the team.

We assured him that we had fixed his problem, but he was still miserable. Every day we prayed that he would get better. He wasn't getting worse, but he wasn't progressing either - just stayed in that limbo where he wore a pained mask. Last Thursday, my resident remarked, "He isn't getting worse but he's also not progressing. If he doesn't get out of here, he will die here." I changed his dressings as he waited patiently to watch The Price Is Right on TV. To me he had looked better than he had that entire week.

That afternoon I got the call that he had coded. He had a seizure or a stroke or a heart attack, no one was really sure. The resident did CPR on him for 20 minutes before the surgeon found a pulse. He was wheeled off to the SICU (surgical intensive care unit). One thing was for sure, he was in bad shape. Later he was found to be in PEA (pulseless electrical activity). He quickly approached the threshold beyond which treatment would be futile. After discussion with the surgeon, his daughter made the decision to withdraw care and at around 8:30pm, he died.

The following morning, the other med student and I stalked his chart to figure out why he had died. When he had read that his daughter made the decision to withdraw care, he said out loud, "What?! She withdrew care? His family killed him!" That infuriated me. He was in that zone where we could keep him technically alive but without any quality of life. To me, his daughter had saved her father from a week of agony in a state of painful limbo - neither truly alive nor dead. That afternoon as we briefly discussed about him, the surgeon agreed that the daughter had done the right thing. She had saved him from a miserable pseudo-existence, a kind of hell on earth.

One of the most important things to learn is when not treating is the correct treatment, and when we should respect death rather than fight it. This goes against almost everything we've been taught and trained to do. We must always keep in the back of our minds whether or not aggressive treatment is worth it, especially in absence of a cure. The figures don't lie: we spend most of our health care spending in the last 6 months of life. Why? Because for one reason or another, we just can't let go when we really should.

More Weddings!

Wow. I've been so consumed by rotations that I had completely forgotten to post about 2 very important events that happened over these last 3 months! As much as I want to bitch, whine, and moan about surgery, this post is dedicated strictly to non-medical things. So here we go!

-----
July - Best Friend's Wedding

In early July, I drove 4 hours to my best friend's wedding. He's a recurrent character on this blog, though I forgot what name I gave him. His original "code name" was JW-M, so I'll stick to that, lol. This wedding was actually referenced months ago in this post. Over the years I had come to admire his intellect, his wit, his calm mind, and above all his inner child. He's one of perhaps five people who knows exactly what to say to put me in a great mood. Only a handful of things (death being one of them) could have prevented me from attending his wedding.

The lovely chapel.

Their wedding was short and sweet, perfectly suited to the newlyweds. Several of our mutual friends were invited to the wedding (or were part of it), and it had been so long since I'd seen all of them in one spot. The reception was quite nice as well and their cake was delicious (I expected nothing less from the dessert palate of my friend, lol). At the end of the evening they had a cookie bar. :-)

This cake is no lie! So yummy!!

The married couple cutting the cake. Showing the back to protect their anonymity.

The following day, several of us drove to the lake to hang out. Since I had gone separately from most people, I headed over to the lake about 3 hours ahead of everyone else. Though it was in the 90s, it still felt nice oddly enough.

Lovely beach area. :-)

Lighthouse!

Pirate ship on the lake!

Back wandering in town.

I was glad that I went. JW-M told me that I was one of the few close friends he had made in undergrad.
-----
September - Old Friend's Wedding

About 3 weeks ago I flew home for my old friend's wedding (I'll call him TR-M here as I think I had before). We had known each other since kindergarten and we were next-door neighbors for almost a decade. We stayed friends even after I moved to the other side of town. Like my best friend's wedding, this was one I couldn't miss.

I love stained glass windows.

The ring-bearers. They were SO ADORABLE!! Especially the younger patting the older one on the back in reassurance.

There were many people at the wedding that I hadn't seen since high school! It was a very nostalgic feeling to see them and what's happened since we all graduated high school. Aside from the wedding train, we all sat at the same table . . . at the very back of the reception hall next to the bar. Though we were annoyed at being seated so far away from the head table, we had fun anyhow. The most interesting thing about the reception was the distinct lack of a wedding cake. Instead, the newlyweds had an assortment of desserts that came around quite frequently. It was differently delicious!!

Table 16/20 at the end.

This is what I had instead of cake: hazelnut creme brulee.

-----
All these pictures don't do justice to the events. But of course there are many more pics that I took that I will refrain from including. I'm glad that I was able to make it to both these weddings. This makes the 3rd wedding I've been to this year! Wow.

---TANGENT---
Remember the hot gay intern I met at the one meet and greet a few weeks back? Probably not, but that's okay. I randomly came across him on Grindr. Alas it says that he's partnered. :-( Sigh, such is my luck ALWAYS.
---END TANGENT---

Darkness Before Dawn

Scrubs by ~Tjelsi on deviantART

For the past week or so I have been getting up between 4:15am and 5:30am so I can be in the hospital and ready to go between 5:00am and 6:30am. More often than not it's dark when I wake up and it's still dark by the time I walk in the hospital. Surgery rotation has begun in full. And I hate it. I knew this coming in, but I truly do dislike surgery.

To be fair, surgery is actually rather cool and most of the people have been surprisingly nice: chief resident - amazing, intern - really nice, attending surgeons - amazing, nurses - really amazing. As a med student, I don't get to do a whole lot in one sense. I hold the retractors (aka, the "learning sticks") a lot to keep the surgical sites open, I got to stitch once, I get to cut sutures, and I help dress wounds. Nothing particularly exciting. Although I must say that operating the camera for laproscopic procedures is pretty darn cool. I've decided that laproscopic procedures are my favorite (and quicker recovery for the patients too!). Our other major responsibility is keeping "the List" updated. The List is a list of all our surgical patients in the hospital, and we have to update it every morning with the 3 sets of vitals over the last 24 hours.

That said, my experience has been sullied mostly because I have to wake up before dawn every day (NOT cool) and "work" 12 hours most days. This week alone I've been in the hospital in some fashion for over 60 hours (a "light" week, and only 20 hours shy of the residents' work hour restriction). Also, one of my residents is rather cold towards the med students and frankly, kind of a bitch. I don't use that term lightly.

Today she was:
1. Very dismissive of me. Nothing I reported (other than vitals) seemed to matter to her. After we finished rounding on our patients and she was covering for another team, I went to touch base with her and let her know that I was going to do some charting and such. Her response before I could get more than 3 words in were, "Is this urgent? I'm busy, I do NOT have time for this right now. I don't have time for you right now."
2. Very rude to me and the nurses. In the elevator she complained to one of the attending physicians how the nurses aren't properly caring for one of our patients. Now I can't say if that's true or not, but ya know, nurses have a tough job too! Stop being so stuck up.
3. Was unprofessional towards an emergency department physician. The ED doc called us for a consult on a guy with a hernia. She basically chewed him out for not knowing how to "reduce" a hernia and told him to read a textbook, as that's knowledge that he should've learned as a med student. Then she sent me down to see the patient. I was able to reduce the hernia (yay!).

It took a lot of self-control not to talk back to her and be like, "No, you do have 20-30 seconds for me because I'm your student. I'm trying to learn, I'm getting work done, and I just wanted to keep you updated on what I'm doing. I'm trying to get work done FOR YOU so we don't have to stay any longer than necessary." Argh. I really dislike working with her. At least in the OR (operating room) she's not in any position to chew me out.

I'm counting down the days to my next rotation. I'm so done with surgery and I'm only a little over a week into it! I HATE waking up to the darkness before dawn. I HATE standing for hours on end in the OR (my feet, back, and shoulders get sore). And I HATE having work with this resident who gives us such attitude, and I have to work with her for the entirety of this month! Ugh. I miss medicine. And I CANNOT WAIT until pediatrics come November. And I've come to realize that I enjoy talking to my patients more than operating on them. I'll linger a little longer than perhaps I should each time I talk to one of my patients.

At least this one patient I saw today was super nice towards me. As we were waiting for the attending surgeon to come fix his wounds, he told me that the surgeons are great and great teachers (all true). And then I must've had this look on my face, cuz then he told me how glad he was to see so many fresh young people going into medicine and that I'll be a good doctor one day.

The One to Make Me Dance?

The dance by *klairy on deviantART

Today I drove about 4 hours to make it to my friend's wedding. In fact, my best friend from undergrad and my roommate freshman year. But more about that later when I've returned home and had time to process the pics I took a bit more.

I can't remember if I've mentioned this, but I always have mixed feelings during every wedding I attend. On the one hand, I'm really happy for the new couple and the potential of their lives together. But on the other hand, I'm also rather sad for myself and still being so so single. This is only accented during the dancing portion of the reception, which I utterly dread.

First all, I feel rather awkward with/in my own body (hands aside - years of playing the piano and cello have mediated that, lol). And second, I usually don't have anyone to dance with because I attend most of the wedding solo too; and if I did have someone to dance with, I'm also not sure what to do. It's all just a really awkward moment for me unless I've had 4+ shots of alcohol within the last 30 minutes or so, haha.

I'm still looking for that one person who can make me dance and not feel like an utter fool. Where is this person who can motivate me onto the dance floor and dance with them (or at all)? A part of me is sick of just sitting on the sidelines waiting. And a part of me is just too comfortable not exposing myself like that on the dance floor. I mean, I even feel embarrassed attempting to dance in the privacy of my own apartment!
-----
Anyway, on an unrelated note, Drew is now single. Again. Things didn't work out between him and his boyfriend and they broke up on friendly terms. It's been about 2 weeks since the break-up. In the intervening time, at least 3-4 guys have asked him out on dates, all of whom he had soundly rejected. For good reason! They should've given him at least 2 weeks to get over his last boyfriend - such quick rebound is good for no one.

But now 2 weeks are up. I don't know if I should make any kind of move while this window is still temporarily open. I don't want to be yet another guy asking him out on a date as I think that'd hurt our friendship (or at least make things a tad awkward in the future).

What I really want to do is just ask him if he'd ever consider dating me. And depending on his response I'd then ask him out (or not). But I also feel like it's cheesy to do that. Yet again, I don't want to be "yet another guy." Argh. What to do?!

I may ask him if he's free to hang out this coming Thursday afternoon/evening (because that's the earliest time during this week that I know I have some time off from rotations). I could ask him on the spot then. If he said yes things would actually work out nicely because I get my Step 1 board exam score this Wednesday, so he'd be either celebrating or commiserating with me depending on my score, lol.

He's one of the few people I've met who doesn't fail to make me smile and laugh when we hang out. I really enjoy spending time with him even as just friends. He may be one who can make me dance, lol. Argh, I don't want to mess this up. What should I do? Would things work out anyway since we're both so busy? :-/

Let . . .

Breathe by ~theflickerees on deviantART

Come here, lay with me,
Inhaling our breathes
together
On this lazy summer day.

Let the sun
caress us
in its warm embrace,
Let the breeze
fill us
with the breath of life.

And we may gaze
at the clouds
And imagine
sweet dreams of tomorrow.

Let us enjoy this day
together;
Nothing to do,
Nowhere to go,
Just lounging around
in each other's company.

Let us close our eyes
and pretend,
Just for a moment,
That the world
stopped turning
And that time
gave pause.

That it is just
you and me -
Whoever you are,
Wherever you are,
Exhaling with me
the breath of yesterday.

Epic Wedding

This post is long overdue. A couple weeks ago I drove down to St. Louis, MO with Michelle for a mutual friend's wedding. Michelle has a relative who lives near St. Louis, so we crashed at his place for the first night we were there.

That first night, we went to the Mehendi ceremony where the women got henna done. The bride's henna was really cool all over her hands.

The following morning was the Christian ceremony (groom's side) at Graham Chapel at Washington University. Though we left early so we could get there early, the universe didn't want that to happen. The highway I took narrowed down to one lane at one point and we were stuck in pretty much stand-still traffic for a good 15-20 minutes. I took the first exit I could find only to find the bridge I had to cross was demolished. I just went back on the highway and surprisingly it was fine after that blockade.

The Christian wedding was pretty sweet and short. After that wedding and taking a few pics, we went to the hotel where the rest of the events were held to attend the luncheon. By the way, almost every meal was provided buffet style with Americano and Indian options. Both were delicious and I was stuffed after every meal without fail. Probably gained like 10 lbs from all that food . . .

Anyway, after the luncheon there was a couple hours' lull as they set up for the Hindi ceremony later that afternoon. Unlike the Christian ceremony, which was about 40-45 minutes long, the Hindi ceremony was about 1.5 hours long. It was really cool though as I had never attended an Indian wedding before.

Finally, after the Hindi ceremony came the reception, which was really nice. Throughout the 2 days, the bride wore a total of 3 dresses, 2 of them being saris. She looked so good in all her dresses! I was so stuffed from the food that I couldn't finish a small slice of cake and attempting to dance was painful. Oh well.

The following morning, Michelle and I checked out of the hotel and decided to see some stuff around in St. Louis before heading back. We first went to the Shaw Botanical Garden where a really awesome tour guide gave us a most excellent tour of the gardens. It was such a beautiful place.

After that, we headed for The Hill area for lunch. But being Sunday and in a heavy Italian district, most places were closed. We did find a pizza place that was open (which was delicious) and then topped that off by going to a gelato place afterwards.

Finally before heading out, we had to see the Gateway Arch, probably the most iconic symbol of St. Louis. We didn't go up to the top but we took plenty of pics around it. All in all, it was a great trip with a couple of minor bumps along the way.

Homunculus of Touch

Argh. Been feeling kind of defeated lately with these frustrating qbank questions. Overall I'm improving somewhat, but my scores are erratic - they spike up and then plummet and then spike again. Anyway, after studying neurology for the better part of a day, I managed to pull off a 71% on a block of neuro questions! Not sure how that happened, as I generally consider neuro to be one of my weaker areas.

Somewhat related, one of the most interesting things I remembered learning while going through neuro was the somatosensory homunculus. You see, sensation is unevenly distributed throughout our bodies and our brains form a somatosensory homunculus of it on the pre-frontal cortex. It's rather interesting. So think, what are the most sensitive parts of your body? Now look at the distribution of the somatosensory cortex:

Does it match what you thought? You'll notice that the face and hands are far over-represented. The fingers, lips, and face are more sensitive than pretty much any other part of the body. Do you notice the genitals? Hint: it's by the feet. Interesting that it comprises such a small part of the homunculus. A drawing of the somatosensory homunculus would be like this:

So I find it kind of funny how we put so much focus and attention on the penis and genitals. Yeah, sure, it's pretty sensitive given its body surface area (more so than, say, the legs), but it pales in comparison to the hands, lips, and face. One would probably expected the homunculus to be more like this:

Lol, right? Well, apparently, some recent-ish studies kind of hint that the homunculus actually is a bit more like this last version (the things you find on Google, lol). In 2005, Kell et al. attempted to update the somatosensory homunculus for males - chiefly that genital sensation is not near the feet in the somatosensory cortex, but closer to where it'd be on the body. In 2007, Sorrells et al. reported that 5 of the most sensitive parts of the penis is removed during circumcision (so it's curious, and incorrect, that the homunculus above is circumcised).

Of course, one has to wonder, what about women? It's been presumed that the number of genital nerve endings in men and women are about equal; however, there just aren't that many such studies out there done on women. There are numbers floating around in the internet (with no source that I can pin down) stating that the glans clitoris (basically the entire clitoris) has about 8000 nerve endings, whereas the glans penis (head of the penis) has about 4000; presumably, the other 4000 nerve endings are distributed along the shaft. Furthermore, the foreskin has about 10,000 to 20,000 nerve endings (and the clitoral hood somewhere around there but perhaps a little less).

What does all this mean? Who knows. Everyone experiences sensation different anyhow. Sure, there are objective ways to test sensation: 2-point discrimination, temperature, fine touch, coarse touch, vibration, etc. And there are different nerves that sense different things (apparently the foreskin has a bunch of the kind that detect fine touch and vibration). But what it all "means" is another thing entirely. I mean, though the hands are sensitive, they're not particularly sensual, am I right?

Anywho, I'm rambling. I hope you were entertained and curiosity piqued. :-P

Leave Your Mark

Afterburn by `creativ82 on deviantART

It always amazes me how some people can have such an impact on others.

A couple weeks ago I attended a dinner event to which I invited Dr. H and his team to be some of the speakers. He's just as inspiring to me as always. I asked (innocently) the panel about how we as medical providers may help patients adhere to various treatment regimens. At that, the neurosurgeon present called me naive, how we can't change people's behaviors, and how we have to meet patients where they are. Instantly Dr. H took over and agreed that we needed to meet patients where they are. Some patients aren't ready to adhere to a treatment regimen, but what we must do is to help them prepare for the day that they are ready. It's more important that they see us and stay "plugged in" to the health system than to demand them to take their drugs.

I also attended a lunch talk by an MD/MBA about his journey in getting a dual-degree. I love hearing docs with dual-degrees speak because it usually tends to reinvigorate my desire to finish my MPH (which I still fully intend on doing).
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A few days ago I attended the state medical society's annual meeting in the state capital. At this meeting, resolutions are debated, recommendations are made, and then resolutions are voted on. We, the medical students, have made some great changes to the state medical society's policies on a variety of things.

One student put forth an anti-bullying policy that explicitly states the position to oppose bullying in all its forms (including against LGBTQ individuals), and to encourage and support school anti-bullying training programs for students, parents, teachers, counselors, coaches, etc. The specific inclusion of the LGBTQ wording caught some controversy from a few physicians, as they felt it detracted from the "oppose bullying in all its forms." On the floor of the House of Delegates, there were some amazing testimonies from students and physicians in support of keeping the language. One physician (a plastic surgeon) stated that LGBTQ must be included in the resolution as is because, unfortunately, many people still don't see bullying against that population as a legitimate issue. And a med student said that, while LGBTQ students are bullied about as much as any other student, the severity of the bullying may be worse. In the end, the resolution was adopted.

My resolution was adopted without opposition (which is rather rare). I "merely" reworded the hospital non-discrimination policy to include: sex, gender identity, sexual orientation, race, ethnicity, religious beliefs, and disability. The original wording only included class, means, age, and gender. While this resolution may seem like a minor thing, it's really quite significant. With this, it means that every hospital in the state must be that much more inclusive in their non-discrimination policy.

There were other resolutions that we fought for. In retrospect, words can't quite convey the importance of what we were able to accomplish. To be able to, as a med student, change the state medical society's policy and stance on things is pretty impressive.

Change is possible. We are leaving our mark.

Operation: Dragon

Blue Dragon. by *Amisgaudi on deviantART

Spring Break never lasts long enough. I only achieved about 1/3 of what I set out to do. :-/

Anyway, "Phase 2" will soon commence. Operation: Phoenix was a partial success, but now to begin Operation: Dragon. In many ways, it'll be similar to Operation: Phoenix only more intense, lol. Goals:

1. Be in bed by 12:45am (12:30am apparently was not feasible)
2. Wake up by 8:30am (8:00am apparently was also not feasible)
3. Continue the P90X program
4. Actually be serious about my diet
5. Buy a Qbank for the USLME Step 1 board exam and begin hardcore studying
6. Other

So I took a few pictures on Day 1 of P90X and like, Day 42-ish. I didn't think I'd see a huge difference but I was surprised! Now, I'm nowhere close to the amazing bodies I've seen people accomplish on the program, but the progress for me was visible (if only a tad subtle). I also apparently lost about 6-8 lbs, which was kinda surprising too. Unfortunately, I've kind of taken the last 2.5 weeks off so I'm going to restart the program from the middle of Phase 2 (instead of going right ahead to Phase 3). I'm hoping for better results this time around! (Sorry, no before and during pics for you all, hehe - still pretty self-conscious about that.)

As for diet, sigh, my body's stupid. -_- I just had my physical check-up at the beginning of the week and apparently, my triglycerides are about 2x normal. Everything else is good though. How does that happen?! o_O Apparently, I should eat fewer sweets, fewer carbs, and drink fewer alcoholic beverages. But . . . I don't eat that many sweets (generally), I don't eat that many carbs (usually), and I seldom drink. Granted, I did eat a lot of gummy bears when I'm at my friend's place in the last 3-4 weeks and I did have a few beers to celebrate a friend's b-day right before break, maybe that's the cause? Hmmm. Weird.

I've really got to get on studying hardcore for the board exam. Got to buy a Qbank and do 10-20 questions a night until May, at which point I'll have to kick it up several notches. Also, I must review my books for that exam a bit more in-depth now.

Lastly, Drew is on Spring Break this coming week and my week is fairly lax. Meaning, we will (somehow) find a way to meet each other this coming week. I've promised him a back massage, lol. I did also take a rein-check on a blowjob he offered like 3 weeks ago, but I'm not holding him to that (not right now, anyway). :-P

What Brings You In Today?

So I didn't do as bad on my pharm exam as I had feared. Not as well as I'd like, but it's an acceptable score. Moving on . . .

Physician 5 by ~stitchxwitch on deviantART

One of our courses this year is on learning how to take a history and physical exam. It is almost entirely what you make of it. I have friends who simply go through the motions of doing a physical exam and are almost unable to distinguish a normal heart sound from bowel sounds (a slight exaggeration). It is insufficient to simply go through the motions when, come July, interns and residents will ask us to do a physical on a patient and expect to trust our findings.

Last week I had a 71-year-old patient. He had a rather extensive history and an "impressive" medication list. I recognized and knew the mechanisms of action for over half the drugs he was on (because we were just tested on those drugs the day before). His physical exam was a bit tough (as for some reason geriatric patients are always tough for me). Being overweight doesn't help either. :-/

This week I had a 13-year-old patient. Have I ever mentioned how I love pediatric patients (insofar as doing physical exams)? I could hear her heart and lung sounds so clearly. Her reflexes were easier to find. I felt her abdominal aorta. I've never felt anyone's abdominal aorta before (because one has to be rather lean in order to feel it, unless one has an abdominal aortic aneurysm - in which case it's a medical emergency!). I finally figured out the ophthalmoscope and saw the red reflex and the optic disk in the back of the eyes. Looking in ears have always been rather easy for me - I even once got a 2-year-old with an ear infection to cooperate with me!

It is truly a privilege to be able to ask someone, "What brings you in today?" and "How can I help you?", and have them tell you something so intimate and for you to (hopefully) be able to do something tangible about it. It is a privilege that people allow us to touch their bodies in sometimes weird and uncomfortable ways to figure out what's wrong.

Come July, I expect myself to be able to do a physical exam to the point where I can, at minimum, tell a resident what is "normal" and what is "abnormal." Unlike my friend, I will not mistake a bowel sound for an abnormal heart sound.

P.S. I've really got to get myself a clipboard.

Mask of Ideas

i used to have great ideas by *Formor on deviantART

"We are told to remember the idea, not the man, because a man can fail. He can be caught. He can be killed and forgotten. But four hundred years later an idea can still change the world. I've witnessed firsthand the power of ideas. I've seen people kill in the name of them; and die defending them."

I just watched V for Vendetta (finally) last night. It's definitely one of the best movies I've seen. I can't believe it's taken me this long to watch it! I love the premise of the movie. That an idea can be so powerful and consuming is certainly thought-provoking.

And so I ask: what was the last idea that you felt was worth fighting for? The last idea that was worth risking something for? Sacrificing something for?

While there are few ideas of mine that involve much risk, ideas have been consuming my time of late. Before this year, I never considered myself an advocate of much. There were few ideas that I felt passionate about to actively champion. But here I am, advocating for change and improvement. That ideas can be so enrapturing and form a mask is very real.

As I may have alluded to in the last few posts (or maybe not, I don't know), the idea of "diversity" has become my cause. Diversity competency has been slipping from the medical curriculum here, and that's not a good thing. It's such an easy thing to cut since with advances in medicine, there's more to learn and as they saying goes, "Something's gotta give." But as the patient population becomes more diverse, we must be keeping pace with being comfortable and competent to treat any patient that walks through our doors. As such, I've been working with the Office of Diversity, with the student Diversity Committee, with other students in the AMA (American Medical Association) to push for resolutions in the state medical society, and within my own student organizations.

And I never imagined I'd be doing what I am now, that this would be my idea and cause. I always thought that someone else with greater passion than I would take care of it. Clearly it hasn't been done, and so I step up.

But in that same quote above, follows the next line:

"But you cannot kiss an idea, cannot touch it or hold it. Ideas do not bleed, it cannot feel pain, and it does not love."

And this makes me wonder. What am I missing/sacrificing? That line rings true. I can't kiss, touch, or hold my ideas. They're intangible thoughts and only their actions can be become manifest, not them themselves. And sadly, I haven't experienced this thing known as "romantic love." I don't really know how to go about it. I run into walls and barriers every time I try. Have I, perhaps, diverted that energy towards an idea/cause bigger than myself instead? Who knows.

And coming back from school today, I thought to myself: what is the idea behind our white coats? What does it mean and symbolize? All I see is something that gets dirty incredibly easily but fortunately has a ton of utility (in its many pockets). The white coat doesn't make me better or smarter than anyone else, I am no different, it doesn't make me impervious to anything, so is there an idea behind there that I can rally behind?

Because you see, in pediatrics, few people (residents and beyond) wear their white coats and they often seem relieved to not have to . . .

Such existential questions behind this mask.

Happy Chinese New Year!

Zodiac The Rabbit by ~Dei--dara on deviantART
新年快乐！恭喜发财！身体健康！

So yeah, I hope everyone had a great day. More posts coming soon (I hope)!! :-P

Righteous Fury

Righteous Anger by *kysius on deviantART

This has been a post that I'd been sitting on (at least, in my head) for quite some time.

All throughout last semester and into this semester, I've put for so much effort into pretty much everything. I've been able to accomplish pretty much everything I set out to do. I kept my promises and made things happen. And so when someone tells me that they want to do something but wasn't able to, I feel a pang of something akin to righteous fury.

One med student announced that she had wanted to expand a program to other high schools, especially more inner city schools. Never mind that I gave her a couple contacts that I had made at such schools that were interested in her program. That, to me, demonstrates a lack of effort or follow through. Another med student told me that she no longer wants to organize an event that she had been in charge of since day one. All because she was unable to contact a particular person. There are so many other physicians out there who can speak on the topic!!

There have been days where, either sitting in meetings with med students or at events, that I wanted to almost scream out, "Step it up! Do what you said you'd do and follow through. Take responsibility. Use your best judgment. You're going to be a doctor one day and be responsible for patients' lives."

Anyway, enough ranting on that. I've an exam next Monday on hematology. Ugh, I hate hematology with the fury of a thousand suns. Anemias, leukemias, lymphomas - they all sound the same to me, and they all have similar presentations!! For the first time, I feel like I'm actually in danger of failing an exam in med school (or otherwise doing really poorly). T.T

At least I got my 2nd choice for my M3 rotation schedule. I actually like most of the people in my track. Incidentally, my crush is in my track! o_O He's like the only guy in my class that I have an attraction to. He's also one of the nicest guys I've ever met - he always has a smile and is just a happy-go-lucky guy. Too bad he's straight and is living with is his girlfriend. ::Sigh::

Operation: Phoenix

Phoenix by *Ahyicodae on deviantART

The phoenix is a mythical bird of fire that is said to consume itself in its own flames, turning back into an egg amongst the ashes and becoming reborn anew. As such, the phoenix is a symbol of rebirth.

One of my New Year's resolutions is to undergo a personal kind of "rebirth," as it were. My attempts in the past have often only meet with lukewarm successes, at best. This time, I shall stick to a more short-term but more intense schedule. Specific aspects of this include:

1. Sleep (aka, be in bed) by 12:30am every week night
2. Wake up by 8:00am every week day
3. Do the P90X (specifically the "P90X lean" program) every morning before breakfast
4. Be more cognizant of my diet

Operation: Phoenix clearly focuses on diet and exercise. With so much going on this semester, I need to focus on getting myself in order first. The theme of the semester is routine. And since I just schedule my USMLE Step 1 board exam (eep!), that's going to be the other monster I need to handle.

I've heard great things about P90X (as long as one sticks to it), so I hope it works for me as it has so many others who've stuck to the program! I'm aiming for a bare minimum of 60 of the 90 days of the program. That'll be right before Spring Break for me (not that I'm going anywhere where I can show off my hopefully "new" body anyhow, alas). Also, the link above for "before breakfast" is to an article on the benefits of exercising before breakfast. It's actually doubly nice since by working out first thing in the morning I: 1.) can't avoid it easily, and 2.) get it out of the way.

With some luck, I may get a body similar to the ones below (I don't remember where I found the following pics):

And so, let Operation: Phoenix begin!!