Where in the World is Aek?

Gosh it's been a long time!  About 3 months since I last blogged!  I would say it's because I've been super busy with residency and all that, but that'd be partly a lie.  Truthfully, I've just been lazy.  Heck, I sat on this post for the better part of a month!  So where in the world have I been?

Well, I've run the gamut from the pediatric intensive care unit (PICU) to outpatient urgent care clinic.  Such a dichotomy in medicine and such different arenas, haha. 

From there I did another rheumatology rotation, but at another institution.  That was an amazing experience!  It was great just being away in a different area, working in a different system, and exploring.  It was also awkward because I felt like I couldn't perform to my full potential because I was learning the system and the hospitals.  It was almost like being a medical student again, almost.

Then I returned and did neonatal intensive care unit (NICU), which sucks as a second year resident, I must say.  You have double the patients to yourself, your patients are way sicker, and you're expected to just know how to manage things.  And on the weekend it can be just you taking care of the entire unit with the attending, which really sucks.

Currently on pediatric emergency department (ED).  It's alright.  I can see why people would want to do it - shift-based hours, sign in/out, lots of potential procedures, patients are in and out rather quick (MUCH quicker compared to adult ED), and you don't have to worry about continuity of care and the frustrations that can sometimes present.  But this is all not quite my cup of tea.  Parents sometimes bring their kids to the ED for really silly reasons.  I mean, if it's not an "emergency" you should really bring your child to his/her primary care pediatrician first . . .  I won't give examples as that may be a HIPAA violation, but if you see and hear the things I have . . .

There's a certain degree of "brain rot" that I feel as a result.  I live for the interesting cases.  The ones that make me think, that make my mind tingle.  On the flip side, as a patient you NEVER want to be "interesting" to a doctor, lol.  And when something could be rheumatic in nature, my mind definitely tingles - like it hungers and salivates for that diagnostic puzzle.

Anyway, to be totally fair, I can honestly understand why some parents bring their kids to the ED even though it's not medically justified.  There are so many factors and when it is YOUR kid, you freak out.  I get that.  I just wished that people utilized primary care as it was intended instead of the ED as their first stop.

Anywho, next post I'll post pics of my adventures.  :-P

The Fastest Longest Year

hospital floors by JESSERZZZ on deviantART

Farewell to intern year, the fastest longest year ever!  It's certainly been a crazy ride full of up and down roller coaster emotions.  And boy did the year finish with a bang!  Time to muse on a few thoughts:

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1.  Doctors incognito

I've noticed an interesting trend among us "newer" physicians: we never let anyone in public know that we're doctors.  At least not initially.  We never introduce ourselves as doctors, we never use our hard-earned titles in public, and when asked what we do for a living, we'll say something along the lines of "I work in the medical field" or "I work in the hospitals," but almost never will we say outright "I'm a resident/doctor."  Why is that?

In a twisted way, it's almost like a sense of shame or being marked.  Open your mouth and say that you're a doctor and people instantly treat you differently.  Either they ask you about your opinions on this or that (I get the "Should I get a flu shot?" question A LOT), or they ask you about homeopathic remedies, or their negative experiences with doctors comes out.  I mean, I don't go to someone who says he/she is a lawyer and say, "Man, I really hate all lawyers.  They're all scum."  Or "Are you the kind of lawyer who stands in a courtroom and all that?"

As such, I'm never offended if someone calls me "Mr." instead of "Dr."  Although, an interesting thing to note that in Britain, "Mr." is a title ascribed to surgeons whereas "Dr." is a title ascribed to physicians.

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2.  The misunderstood adolescent

I may have said this before - I'm one of the few pediatricians who actually enjoys interacting with teens.  Not all teens, mind you, but in general yes.  Anyway, this bodes well especially if I'm really intent on pursuing peds rheumatology (which skews heavily toddlers and teens).

This may be coincidence or it may be intentional, but most of the teens in my continuity clinic are males.  They're such amusing creatures.  I can get most of them to open up at least somewhat (and a handful almost way too much, lol).  I think it helps to understand where many of them are coming from.  And I may be a bit too . . . liberal in my advice to them.

Anyway, there are 3 things I always iterate to every teen guy: 1.) wash under your foreskin (most of them where I am are uncut - good for them, lol), 2.) monthly testicular self-exams, and 3.) ALWAYS USE CONDOMS.

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3.  Rising seniors

As interns we are the lowest person on the totem pole that matters (sorry med students, the hospital functions very well with or without you).  We're often abused - intentionally and unintentionally - by senior residents, attending physicians, nursing staff, etc.  It's a frustrating place to be.  But at the end of every intern year is the promise of becoming senior residents and FINALLY stepping out of the intern role.

And at the end of each intern year, it's an opportunity to reflect on the kind of senior we aspire to become.  I've had the good luck to work with one of the best and by far the most hilarious senior residents I've ever known.  Although the last month was rough, he made every day go by quickly and with enough laughter to sustain us.  I can't say I want to exactly be him, I will aspire to carry on aspects of him.

In less than a week, I'll be considered a "senior resident" and I'll have no idea if I'll be a good one or a bad one.  The best advice I've heard was, "Remember what you liked in your senior residents and do that.  And especially remember what you hated done to you as an intern and don't do that."

Please Don't Misunderstand Me

Please don't misunderstand me, I do love seeing my patients even though for every minute I see them I have 5 minutes of paperwork and other "work" to get things done for them.

Please don't misunderstand me, if I can't make it to your bedside immediately it's not that I dislike you or am lazy, I truly am quite busy doing things behind the scenes for you or another patient.

Please don't misunderstand me, as much as I love thinking and taking care of patients, I lie here right now musing over whether I've made the right choices that can sometimes be literally life or death.

Please don't misunderstand me, if I seem beaten down it's because I've worked a 13+ hour shift for the n'th day in a row often without a single heartfelt thank you. And perhaps I was yelled at for something I did or didn't do for you.

Please don't misunderstand me, as much as I could go back in time and undo med school and residency, it is truly a profession of great privilege and honor.

Please don't misunderstand me, when I say I would not redo all this again it's not out of regret, but rather sadness of all the sacrifices I've made - the art I missed drawing, the music I missed playing, the sleep I missed getting, the opportunities for love and travel.

Please don't misunderstand me, when I discourage others from pursuing medicine it's not because I hate my job, but rather I don't want others to make the same sacrifices without truly appreciating what they'll be giving up.

Right Place and Time

right place right time by Hitomii on deviantART

There is something to be said for being in the right place and time.

There's a phrase my mom says: 这个是天规定的.  The translation is basically, "This is mandated by heaven."  The concept of a "heavenly mandate" is an ancient one.  Heaven decrees that certain things are meant to be, and certain events happen at certain times for a reason.  How we interpret that and what we do with it is up to us.  It's not exactly fate or destiny, but is along a similar line of thought.

I did my pediatric rheumatology rotation last month and pretty much loved it.  Towards the end of the month, one of the rheumatologists told me that he received an email with an application for a resident to apply for an award to attend this year's peds rheum conferences essentially for free!  How could I pass this opportunity up?  Imagine my joy at receiving the award, and I'm off to Orlando for the conferences next week!

If I didn't do that rotation that month, and if I hadn't heard about the application, I wouldn't have the opportunity to attend these conferences.  Right place and right time.  On a larger scale, matching in California for residency is probably meant to be (though it doesn't always feel like it).  And perhaps dating and finding "the one" (out of many possible "ones") is a matter of time and place as well.

That's not to say that this concept means I should be passive about things, like destiny or fate.  But rather, when the right time and place produce an opportunity, I must not let it slip.  For who knows where it could lead?

In Other News . . .

So what's up with me otherwise?  A quick summary:

I passed USMLE Step 3!  Woohoo!!  Really, the odds of me passing were vanishingly slim but you always worry on test day.  I was amused that I did worse as the patients in the questions got older.  Definitely affirms my training in pediatrics, lol.  Also my highest sections were Behavioral/Emotional, Musculoskeletal, and Immune/Infectious Diseases.  Fascinating, because it leads me to . . .

I'm like 95% sure I'm going to pursue fellowship in pediatric rheumatology.  It's definitely one of the least "sexy" subspecialties because: 1.) there aren't many procedures, 2.) it pays less, and 3.) it's not well understood.  But I find it fascinating.  It commonly affects joints (as you'd expect), but it can really affect almost any organ in the body.  And I seem to be one of the few peds residents who kinda likes (or at least doesn't mind) teen patients.  It's also a rather "rare" subspecialty, there only being 26 fellowship programs in the country (for about 60ish spots).  There's an estimate of about 1/2 the number of peds rheumatologists in the country as there needs to be.  As one senior resident described to me, doing this fellowship is basically a golden ticket to practice anywhere in the country that I so desire.  Yeah, I'll make less money.  But to echo one of the peds rheumatologists that I worked with, "I didn't come from money.  So this pay is pretty good to me."

It's astounding how stress and sub-optimal nutrition leads to weight gain!  I seriously gained like 15 lbs in residency so far.  No bueno!  I just started working out and slowly ramping things up.  I'm woefully out of shape, but that's what I get for being on inpatient rotations for 5-6 months in a row, working on average 6 days/week, and up to 80 hrs/week.  Where in there is there time for working out, much less healthy eating?!  For the first time in many months, I have the time and there wherewithal to realign my health to where it should be.  I've been a poor example for my patients.

Today I was eating lunch outside with one of my co-interns.  And she remarked how nice it felt to have the wind blow on her face, how normal it felt, and how sad that she was thinking that in the moment.  But it IS sad.  This residency thing is not something I'd wish on someone else.  Fuck that, if I could re-do things, I wouldn't re-do this.  But I've already come this far and I'm going to see it to the end.  Because at the end of it all, I have a chance to regain normalcy.

Recently got into a new show, Looking.  It centers around 3 gay friends in SF.  It's entertaining.  About halfway through like the third episode, I realize that one of the main characters, Patrick Murray (played by Jonathan Groff), is basically me in a lot of ways.  He wants to have a good sustainable relationship, but sucks at it.  He's conservative in his actions and tends to thinks before he acts (sometimes too much).  Anyway, a good show to check out.  :-)

I Survived . . .?

I survived by ~CasheeFoo on deviantART

Somehow I survived my first block of wards (and my second inpatient block, the first being NICU).  Wards is basically what you would imagine hospital medicine to be like, the kind of thing you see on "House" or whatnot.

The first day I was handed 6 patients I knew nothing about, one of whom was a cluster-fuck of complicated medical problems.  The rarity and severity of her illnesses terrified me.  Within a day or two I was expected to know her inside and out.  I was literally running around the hospital trying to figure my way around and see all my patients before meeting with the rest of the team for rounds.  This was far worse than any experience I had as a med student, because as a med student you're still under the aegis of your resident who protects you - more than I had previously appreciated.  And oh yeah, I had to basically learn an EMR (electronic medical record) and use it by the end of the first day.  Not cool.

I felt so overwhelmed that by the end of the second day I was ready to throw the laptop I was working on out the window and run out of the hospital screaming at the top of my lungs and quit on the spot.  I somehow, not sure how, held it together.  The med students arrived the third day.  I held it together.  For them.  I could not show my weaknesses in front of them - I had to give them the impression that peds was a great field (it still is).  Luckily I had inexplicably hit my stride as well and starting doing alright after that.

Having a med student by my side did wonders for my morale.  I'm not entirely sure why.  I guess I just wanted someone to talk to and bounce diagnostic ideas off of who won't judge me or think I'm an idiot.  Also once I discovered the most efficient path forward for me, nothing stops me.  As a med student I really struggled with finding that path, as it's not a med student's job to be efficient.  On the contrary, med students are supposed to be exceedingly thorough.  My sub-I as a M4 student kicked my ass, but in hindsight I was only able to survive wards now because of that experience.  I dare say I became the most efficient of the 4 interns on during this block.

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In other news, guys here kind of suck.

I've been stood up on a couple dates or otherwise had plans change/get delayed.  It's okay if you're going to be 10-15 min late, but 2-3 hours?!  Come on, that's just rude.  Makes me want to give up looking (as if I had the time anyway, ha!).

Been chatting with a few people, hopefully something goes somewhere.

All the Babies!

Sorry for the lack of posting, it's been quite hectic (but manageable, sorta).

I just finished a block of genetics subspecialty outpatient clinic.  Genetics is a fascinating subject as always, and I must say, this block reignited some of my former interest in the field.  I'm not sure if it's enough to make me want to pursue it as a fellowship and career, but it's back on the radar, lol.

In the middle there I did a week of nights.  I got pretty good at assessing normal healthy newborns, haha.  But man there's such a learning curve when you haven't done it in like 2 years!!  I was lucky enough to get some sleep most nights, but the schedule of nights (6:30pm to 7am) is still rough.  Takes a while to adjust and adjust back.

Now I'm in the NICU (neonatal intensive care unit).  I was terrified of it at the start, but it actually turned out to be a really nice rotation.  I'm definitely learning a lot about taking care of premature babies, often with other health problems too.  After a while they mostly become "feeders and growers," that is they're just eating to gain enough weight to go home.

Anyway, up until now, the majority of my experience has been with babies.  All the babies!  Haha.  They're pretty cute, I must say.  One just has to get on the good side of their territorial and protective nurses, lol.

I've had the privilege to see some weird and rare things, which is really cool.  I mean things that we should not be seeing because current routine medical care should have picked up these things earlier, but there are always babies that slip through the cracks.  It's quite unfortunate when a baby could be otherwise perfectly normal and healthy sees us and by then it's too late to stop the worst of it.

Anywho, enough rambling.  Must sleep.  6:30am to 7pm schedule is pretty rough too.  Unfortunately that's my schedule for the next several months . . .  As one of my senior residents said to me, "Oh wow, I'm sorry.  But the Lord doesn't give us more than what we can take."  I hope she's right.  Still, I'm soooo glad I'm not a surgical resident.

Hardest Month . . .

Precocious Patient by ~ThirstyEye on deviantART

M3 year has flown by.  Sometimes I still can't believe I an M4 now and on my pediatrics sub-internship.  This is by far my most difficult month of med school yet, more so than even surgery.  I literally act as a functional intern on one of the pediatrics ward teams, except all my orders have to be verified by my senior resident.

There are rewarding moments.  There are moments and areas that I feel I shine at.  But all that is overshadowed by this constant anxious feeling that I'm not doing enough, or not doing things the right way, or not thinking fast enough.  It's terrifying.  Being the one responsible for a child's care in the hospital is daunting.  It's not that I don't basically know what to do, it's that I'm unable to instantly anticipate all possible (worst) outcomes and prepare for it.

I'm able to prioritize tasks fairly easily, to do what needs to be done, but I can't prioritize my thoughts as quickly when someone asks me a question or I'm asked to present a patient.  The information is there, but it's not organized the way I (later) type it up and it's unfiltered because I just ramble all the information - pertinent and non-pertinent.  I don't know why I'm getting flustered and blanking.

I'm now 2 weeks in to the rotation, about half-way done.  And I feel like I haven't significantly improved despite working my ass off.  Today was the worst day.  I showed up and was instantly handed 5 patients I didn't know, didn't have sufficient time to read through their chart, and on top of that I was the one admitting a new patient and had to do her whole work-up.  I was a mess and constantly second-guessing everything I said the whole day after that.  It took me way longer to catch up than it should.

Words can't express how defeated I feel right now.  How stupid I feel.  How slow I feel.  How not cut out for this I feel.  Maybe I should consider switching fields.  This was not how I expected to start M4 year, and definitely not how I expected this month to go.

The Past Few Months

It's been a while since I last blogged.  I could easily claim that I've been busy (which I have), but it's just as much my fault for being lazy.  Blogger has changed in this interval time (I kinda like the old version better, lol).  I've seen and learned a lot these past few months in the various rotations I've circulated through.  Each month presented a different slice of medicine.

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Family Medicine

Truthfully, this was easily one of my favorite rotations.  I worked in a clinic with a preceptor, no residents on site, and I got to do a lot.  It was almost like a continuation from outpatient pediatrics the month prior and I loved it.

Family medicine is the "jack of all trades, master of none" field insofar as it sees the full spectrum of ages and patients, and can do a little bit of everything but is unable to narrow down into most sub-specialties (e.g. cardiology, pulmonology, etc).  But you see the bread-and-butter of everyday illnesses and do things like lance boils, freeze warts, do a little physical therapy, and things like that.

But the one thing I most took away from family medicine was my preceptor's outlook on life.  He spent his career nurturing his perfect work-life balance, and it was something he reiterated to me over and over again.  He didn't mind earning a little less money than the other physicians in the practice because the flip side was that he got to spend more time with his family and kids.  It all comes down to priorities.

One life philosophy that was parroted by his son one day is, "Have a good day, or not.  The choice is yours."  And he told that to more patients than I could count that month.
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Pediatric Infectious Diseases

Peds ID was something I was almost certain I would do coming into med school.  My background almost perfectly set me up for it - a year of public health, focus in genetics and molecular biology, interest in HIV/AIDS, etc.

But then something curious happened.  I loved outpatient pediatrics.  I loved family medicine.  I loved pediatric rheumatology.  I could no longer choose or peg myself down for something so narrow as pediatric infectious diseases with a focus in HIV/AIDS.  I found myself wanted to become more general.

That said, I still enjoyed the month.  I got to know my patients in the hospital (they didn't always know me, several of them being babies or else mentally handicapped).  I got to understand the work-up for an infectious etiology.  And every Wednesday at the weekly conference where all the staff physicians in peds ID got together to discuss the treatment plans for all the patients on service, they would all go at each other.  It was one of the most entertaining, and intellectually stimulating, things to sit through.  I was entertained, anyway.

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Perioperative Medicine

Aka, anesthesiology (with bits of trauma and emergency medicine tossed in).  I knew I'd like this rotation.  I liked doing things with my hands and doing small procedures (not surgeries though).  I didn't expect to love it but I did.

In anesthesiology, you put patients to sleep in the OR (operating room), keep them alive throughout the surgery, monitor pain, and wake them up.  Your job is one of the most important jobs because you are directly responsible for someone's life.  You control every aspect of their physiology - their breathing, their heart rate, their muscles (via paralysis), and their consciousness.  My resident asked me, "Who is in the best position to kill the patient?  The surgeon?  No, it's us, the anesthesiologist.  Without us the patient can't breathe.  And if we make a mistake with a medication, the patient may never wake up."

There was a sense of immediate gratification and power in anesthesiology.  I got to put in several peripheral IVs (didn't miss a single one I'm proud to say).  I really liked putting in IVs . . . I got to monitor and chart the patient's course in the OR.  I got to breathe for patients.  I attempted to intubate a few (intubation is quite difficult for me, grrr).  I got to help prep and push drugs that slowed a person's heart rate down when it got too high, or boost a person's blood pressure when it dipped too low, or reinforce paralysis when a person began to twitch in the middle of surgery (always under the direct watchful eye of a physician, of course).

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Obstetrics/Gynecology

I . . . didn't really like ob/gyn. I mean, it was okay.  Not as brutal as surgery.  I just don't think I could stand women and pregnant women all day.  The vast majority of the residents are women as well!  That said, I did like participating in vaginal deliveries.  Got to catch a couple babies too!  They're just as slippery as you'd imagine.

The one thing I REALLY disliked about ob/gyn is that you spend almost zero time with the baby once it's out of the womb.  You hand the baby off to the nurse or the neonatologist and don't bat an eye at it again.  I found myself lingering more at the baby's side than the mom's.  Yeah . . . it's a sign.  Babies are so cute (even right after they're born and are all slimy and malformed-looking)!!

One other thing - you don't truly appreciate blood loss until this rotation.  In surgery you think you've seen someone bleed during surgery.  Just wait until a birth or better yet, a C-section.  A woman is expected to lose one liter of blood during that procedure - one liter!  The vast majority of women do just fine afterwards though, because their bodies have spent the better part of up to 9 months prepping for that loss.  Still though . . .

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Neurology/Psychiatry

Well I just finished neurology and will be starting psychiatry tomorrow.  Neurology was okay.  I was on an awesome team with great residents and good attendings who taught quite a bit.  But I saw a very small slice of neurology as I was on the neurovascular (aka, stroke) team.

We saw many patients with strokes or suspected strokes.  The neurological deficits are interesting to see when they're there.  What's nice to know is that most people recover and do just fine after a relatively small stroke.  It's the large ones that really take out half your body that're devastating.  There were a few devastating strokes on our service in our short time there.

So public service announcement: exercise some, eat healthy, take your blood pressure/high cholesterol medication if you need them, do not smoke.  A stroke is a scary thing to have happen to you, especially when you're young (less than 65 years old).  There are a lot of things we can do to reduce that risk.

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.

The Rheumatological Posse

So, I meant to write this a while ago. Alas, that didn't happen since I've been unusually busy and things have been rather hectic. My peds externship is already more than half over! Wow how time has flown.

I'm on my pediatric rheumatology (peds rheum) placement for the remainder of this month. And while I don't think I'll go into peds rheum, it's pretty interesting. All the people I've been working with the last week and a half have been great as well.

Last Tuesday I met with Dr. N, the attending who's responsible for me, and two of the fellows, Dr. K (1st-year fellow) and Dr. C (2nd-year fellow). Peds rheum is a 3-year fellowship that one does after a 3-year pediatrics residency. I must say, Dr. C was adorable! He's this cute little Asian dude who has an adorable smile and voice. Yes, I may have a tiny crush on him. Alas, he kept pimping me last week.

What is pimping you might ask? Well, pimping is where a senior medical person asks a series of questions on medical facts to a younger medical person to test the limits of their knowledge. Often it's done in a way to embarrass the younger person and "put them in their place." Earlier, Dr. N and Dr. C had discussed an article that came out called The Art of Pimping. In there is a section on how to defend oneself from being pimped; I particularly like The Muffin, lol. Anyway, Dr. C pimped me on shingles, which I hadn't formally learned about but because I know a little bit about it in the past, I got all but one of his questions correct. Later in the week he pimped me on how aspirin works in the body. I blanked and couldn't remember, but I finally gave the correct biochemical pathway (whew!) after he kept pressing me for an answer. If only he weren't so nice otherwise and adorable . . .

Anyway, my peds rheum placement is quite amusing. There are so many of us on this month! There's me (representing M1 and M2), a M3 who's in clinic once a week, a M4, 2 interns (1st-year residents or PGY1s), 1 second-year resident (PGY2), 1 first-year fellow (Dr. K), 1 second-year fellow (Dr. C), and 1 third-year fellow (Dr. S) in addition to the 5 attendings. I spent a lot of time with the M4 and she's been great in explaining things to me and how rotations work during M3 and M4 years. The residents and fellows were all great to get along with as well.

So my time in peds rheum is devoted between 2 primary things: clinic, and inpatient wards. Of those 2, the majority of my time is spent in clinic. On the first day I had no idea what peds rheum was all about, except childhood arthritis. By the end of the week, through clinic, I learned that peds rheum covers a lot of diseases, such as: juvenile idiopathic arthritic (JIA), psoriatic arthritis, spondyloarthropathies, Raynaud's phenomenon, and lupus amongst many others. By the end of the week, I had seen at least one kid with each of those. Since there are lot of us, often 2-3 of us would go in with a fellow or attending to see the patient. I'm sure many (if not most) of those kids felt overwhelmed when 3-4 people walk into a room together.

Inpatient wards generally aren't busy because peds rheum don't get many consults. Last week we only had one kid that we were consulted on. I'm going to call this kid "Kid of the Week" or KotW. So we, the 8-person rheum posse, see this kid on Tuesday. He presents with some minor neurological symptoms, and we don't really suspect anything rheumatological going on with him. So we leave a note suggesting it might be CNS vasculitis or something and leave it at that. The thing was that the areas of his brain that're affected made it practically impossible to confirm CNS vasculitis without destroying brain matter along the way to finding out.

By the following morning, the kid had several mini-strokes and his neurological symptoms had worsened, so they sent him down to the PICU (pedatric ICU). When we arrived we encountered a very irritated critical care attending. Shortly after we arrived, the neuro consult team arrived. The critical care and the neuro attendings started arguing in the hallway about how to care for this kid who's rapidly deteriorating in front of us. After the critical care guy calmed down a bit, we talked to the neuro team and see if they also agreed that it was CNS vasculitis. Neuro sent KotW down for an angiography of the brain while we started his treatment, even though we didn't have a definitive diagnosis (but to not treat him was less risky than the possibility of him worsening, so we decided to treat what was most likely the problem).

The following day, the results of the angiography seem to "confirm" our diagnosis. Of course, the fellows and the attending on service were skeptical because CNS vasculitis is very difficult to "prove," and it technically couldn't be proven in this case since it was so atypical (apparently). Also, none of us could interpret the films, so the rheum posse trekked down to radiology so we could find someone to interpret it for us. I do not want to be a radiologist. The room they were in looked and felt kind of like a bat cave. It was very dim so that the radiologists could see their computer screens more clearly. The only other source of light were desk lamps pointed away from the screens, which gave an odd ambient glow. Also, the radiologists were talking in low voices into their microphones to dictate their findings and notes; it kind of sounded like a low constant drone or perhaps chanting . . . as if they were all in a cult or something.

Well anyway, it seemed that the radiologists couldn't help us, so they directed us to interventional radiological neurology (I didn't even know one could specialize that much). So, someone there explained the films to us, and we mostly nodded in agreement because we had no clue what we were looking at (I'm sure even the attending with us had no clue - all those tiny tiny blood vessels just look like squiggly messes to me). So long story short, we think our diagnosis is correct and that KotW was getting better. They decided to keep him over the weekend to monitor him and see how he did.

5-Day Weekend

I'm now done with primary care pediatrics in the inner city, and I'll be starting pediatric rheumatology tomorrow. No idea what it's going to be like, so this'll be interesting to say the least.

Because the primary care pediatrician I've been with the last 2 weeks only works Mondays, Tuesdays, and Wednesdays (albeit, from 8am to 8pm), I got Thursday and Friday off. I also got today - Monday, July 5th - off as well. So all this translated to a 5-day weekend for the 4th of July. :-D

I've been taking it easy the last few days - hanging out, cleaning a little bit, and working out a little. I don't remember if I talked about this, but apparently I lost about 6lbs during my 2 weeks in pediatric infectious disease, and then gained 3lbs in primary care pediatrics, and now lost those 3lbs again (until I gorged myself during lunch today, alas). Curious. Since I'll be in the hospital for 4 weeks, I'll probably lose more weight (here's hoping?).

Anyway, on Saturday, I saw the new The Karate Kid movie with a friend. I actually thought it was a pretty good movie - I thought that the acting was great and the music was good; Jackie Chan did a really good job. It would've made more sense and been more aptly titled The Kung Fu Kid, but I read somewhere they changed it to The Karate Kid later on. According to my friend, they apparently call it The Kung Fu Kid in China, or something like that. And today, I watched the original The Karate Kid with some friends, just for comparison because it's been years since I last saw the original, and didn't remember it well. Honestly, I thought that the new remake wasn't bad and didn't do a disservice to the original - other than karate having absolutely no role in the remake. Ah well. It's still a movie I think that's worth watching.

Later on Saturday, I went to a outdoor live music festival by the lake with a friend to watch the city fire off fireworks. I've rarely been close to seeing fireworks, so it was really nice to see them go off by/on the lake. :-) The local fireworks were today, so a few of us got a good view of them. However, there were also LOTS of mosquitoes out, so we were all pretty much doing our mosquito-be-gone dance. I really like fireworks.

Yesterday, I watched Infernal Affairs and The Departed with a friend at his apartment. The Departed is an American remake of the Chinese Infernal Affairs. There were certain scenes, plot elements, and even lines that were almost verbatim translations. That was amusing. I personally liked Infernal Affairs better because the exposition at the beginning is shorter, the good guy/bad guy distinction is a bit more nebulous at first (adding to the mystery), and the two main characters were easier to sympathize with. Also, in seemingly classic Asian style, the movie was a bit more psychological and there was more display of high-tech/using wit scenes (if that makes sense at all). The movie had English subtitles, and it took me a little while to get used to them while hearing Chinese. I translate Chinese differently in my head, so the English subs messed with my head a little for a few minutes, haha.

Lastly, Jake (my best friend from undergrad), is now in Beijing. I meant to call him before he left, because I needed his counsel. Alas, I missed my window of opportunity. However, he told me that about a week ago he proposed to his girlfriend and now they're engaged!! Their wedding is about 1 year from this Saturday. I'm so happy for them!! And I'm soooo not missing their wedding, even if it means a lower grade on a rotation (though, I "shouldn't" be on service over a weekend . . . maybe on call? I really need to somehow figure all that out . . .).

Not Medicine, But Life

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

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

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

The following morning, Dr. H left me with some words of wisdom:

When a doctor or a student says, "The patient won't take his/her meds," change "won't" to "can't" in your mind. Think, "The patient can't take his/her meds."

Powerful words indeed. I could go into a whole post on those words and what he asked me to look up after the clinic visit, but I may save that for some other time.

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

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

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

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

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

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

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

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

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

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

Infections Everywhere, Oh My

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

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

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

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

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

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

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

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

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

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

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

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

Mask of Genetics

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

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

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

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

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

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

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

Just Gotta Press On
Too Epic
Mask of Teaching

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

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

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

Mask of Teaching

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pre-China Post

My sincerest apologies for not posting much this week and not having a the first China post up. But, tomorrow! I finally got all my pics uploaded onto Facebook. I'm going to call this my "Pre-China Post." In the meantime, I'd like to note two important things that happened to me this week.

1. I went into lab on Monday, and my researcher tells me, "So, our poster got accepted for the conference." I was like, "Cool . . . what poster?" Apparently, he submitted some poster way back in January to a super-important conference on cancer, and I'm second author! I was supposed to have been emailed and notified, but I figure I might've misread the email and accidentally deleted/archived it. So he printed me out an abstract. We're submitting the paper for publication in the summer, and if accepted, I'll have a citation! Seriously, this citation just fell into my lap. That never happens. Now I have to do the experiments to verify the data and prove myself worthy of my citation.

2. I had my 2 Friday discussion sections. It went well, as usual. I actually ran out of handouts for half of my students in my last section. The professor didn't give me enough, though she thought she gave me way more than I needed. Ha! I have like, 2-3 times more students show up to my sections than other GSIs. I was also amused that 3 students came to me this week in discussion or via email asking to be added to the course website I created for my discussion sections (they weren't originally enrolled in my sections). How cool is that?! My friend AG-F describes me teaching discussion sections as my "weekly pick-me-uppers." It so is, I love teaching!! It makes me happy that, on average, I seem to teach the material better than others and so am more "favored" by the students. At least, that's what the high attendance rate seems to translate for me. I could be completely wrong (but I really hope not).

Okay, now some teaser pics of China.

The Great Wall

The Forbidden City (The Imperial Palace)

To quote my friend: "This food is sooo good, it shouldn't be this good."

near Tiananmen Square

China posts forthcoming soon!!! In the meantime, let AJ's new pic blog, A Bi Boy's Pic Blog, entertain you. XD

Oh, and I changed the layout of my blog. Like it? :P

Resolution: the Intercession

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

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

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

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

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

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

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

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

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

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

Falling Glass

This is not a China post.

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

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

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

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

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

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

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

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

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

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

Jump Start

Wow it's been over a week since I last blogged. o.O I've been busy and tired like never before. A few highlights are warranted, I suppose. This is a surprisingly long post that I didn't intend on being so long. But there's your disclaimer.

Jump Start
So last Saturday my parents came by so I could take them to the airport and then I'd have the car with me for a week while they were in CA celebrating my grandpa's 80th birthday. Getting to the airport was fine, getting back was fine. It was very overcast, so my car lights were on. No big deal, they usually turn themselves off.

I went inside to just waste some time before I had to go down to central campus for GSI training. Well, an hour and half later I come out and see my lights still on! I thought, "Well, it's been less than 2 hours, how drained could the battery possibly be?" The engine wouldn't start. The breaks locked. Every warning light flashed on. :(

Yesterday morning a friend of mine, EA-F, helped me jump start my car. And it worked!! I gave her a ride to class on central campus, and drove around a bit to charge my car battery. Last time I checked (which was last night) the car still works. Hopefully it'll stay that way until I pick up my parents this Saturday afternoon.

Teaching
I've come to realize that I actually like teaching quite a bit. I like "imparting knowledge" on to others. I like seeing that lightbulb turn on in their eyes (doesn't always happen, but I've had a decent success rate). Being a GSI for the undergrad intro genetics course has been quite rewarding, if not exhausting at times. Each week, I actually look forward to teaching and it's just a high point in my day some days. We had extra office hours this week and end of last week because their first exam was last night. So many people came to office hours! Usually very few people (if anyone) shows up at all.

Proctoring the exam was alright. There were 2 GSIs to each of the two rooms where the exam was held (about 200 students per room). It went pretty smoothly overall, and no one seemed to cheat (as far as I could tell). Towards the end, with 30 minutes left, one girl started to have a massive nosebleed. There was blood all over her exam but, thankfully, not her scantron. I excused her to the bathroom. She came back and still turned in her exam early, so I think she was almost done when that happened. We probably would've given her a few extra minutes if she needed it.

And after the exam, no comes to office hours. XD So I'm here, in my office hours, typing this because no one has (nor will) show up today.

At This Rate . . .
Last Friday in lab, I (almost) royally fucked up my experiment. If I had actually messed up and my PI knew, he might've fired me. I would've fired me at any rate. But first let me back up.

That morning, at 8:30am, we had lab meeting as we always do on Fridays. I had to present my (lack of) data. The PI chewed my head off when I got the verification slide. Thankfully, the two researchers I work with and another grad student came to my rescue and defended me.

So I was doing my experiment, all fine and dandy. I went to teach my two discussion sections and then held office hours afterwards. And then, after all that, returned to the lab to finish my experiment. Half an hour before the end of the experiment, I added an enzyme that I shouldn't have. Basically, this enzyme degrades and destroys the sample I was trying to extract and purify. Luckily my researcher caught it before the enzyme had a chance to completely destroy my samples.

I can't believe this happened! In my defense, it was a long day (8:30am to 7pm straight) and I was following the protocol blindly. The protocol had this one small bolded section on the previous page that I didn't see that told me I wasn't supposed to add the enzyme . . . Sigh. I think when I'm that tired, if the protocol told me to sacrifice two mice to the lab gods I would've found a way.

And on Monday in my lab class, I added the wrong solution to the tubes. Luckily I caught it before I added my samples to those tubes. At this rate I won't be able to pipette by the end of the semester!

Rage with Righteous Fury
This will be brief, because I do not want to and cannot go into details without identifying the individual(s) involved because at least one of them reads this blog. When you read this, please forgive me for typing this out (and don't identify yourself unless you really want to :P). If you email me, I will happily delete this section.

I got an email from a friend the other day who I talk to frequently. He was ranting about something that went horribly wrong with someone he cared about when that person was just a young kid. It was a medical issue. Something got botched - maybe not visibly on the outside, but definitely underneathe the skin.

Being who I am, and caring too much about others as I do, I researched the possible ways it could've happened. I'm pretty confident in my diagnosis of the problem, but to the best of my (nascent) knowledge, there's no solution to the problem. The damage is done and is likely permanent, unless a graft or stem cell therapy is possible (neither is likely I think).

As my friend told me more, the situation got worse and worse. It went from what might've been a medical mishap/accident (things happen, isn't always the doctor's fault) to clear medical malpractice to nothing short of cruelty and torture. And I can't believe it happened in the US. I can't believe a doctor would act so unethically and that the family would be so uncaring and dismissive. It literally haunts me to think it happened the way it did. I think that "doctor" forgot the first tenet of medicine: Above all else, first do no harm.

Edit: My friend allowed me to disclose a few more details about what happened to the person he cared about. So what happened to this person is that he had a circumcision when he was 7-years-old or so. Something went wrong and the anesthesia didn't work right. They kept injecting anesthesia into his penis repeatedly as he screamed and cried. After the circumcision, he suddenly lost the vast majority of feeling in the head of his penis and now can barely feel a thing there. There are more details that would reveal the unethical and more cruel/torturous side of this, but I'll spare you all.

And so, as I write this, I'm burning at the thought and I want justice to be restored. Reparations, at least bodily reparation, is very unlikely. But again, I'm not a doctor (yet) and I'm certainly not a specialist in the fields required. And sometimes I ask myself, why do I care so much to let something that happened to someone I don't know and probably will never meet get to me?

Okay, I guess it wasn't that brief. Sue me (but really, please don't - save that for the "doctor" in question).

Other Highlights
On a completely different topic, I've been talking to more bloggers online! :D There are bloggers from everywhere (though a ton seem to be concentrated in CA). I love getting to know people from all over the place.

Hmm, I would say something more interesting here right now. But my office hours are about up and I'm going to head to the gym soon. I'll blog about something more . . . interesting later. ;-)