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.

Finally!!

Finally . . .

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

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

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

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

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

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

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

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

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

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

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.

Defeated & Scattered

I had a pharmacology exam last week. It was brutal. Memorizing 200+ drugs - how they work, what they work on, what they're for, when not to take them - is brutal. There was one question where I literally wrote: "I forget and I give up. I'd rather admit this than make up a drug like loperamine." And then I drew a sad face. With a single tear.

Yes, I felt defeated. I still kinda do. I'm tired and I'm scattered. My desk is a mess (it's an accurate reflection of my current state) and I haven't felt motivated to clean it up. And for the first time all semester, I didn't work out 6x/week (P90X) consistently. :-/

There are many things I should do. There are many things I have to do. But I can't seem to remember what most of them are right now. ::Thinks::

Haven't met Drew yet. I'm not sure when/if that'll happen. He's busy, I was busy. He's apparently been dating a couple of guys (sigh), but it seems none have what he's looking for in a relationship. Perhaps I'll have better luck? (At least I got his address . . . he had wanted an impromptu back-rub and to give a bj that I refused - why? I'm not sure.) I've told him either Monday or Wednesday this week would work for me, or else I'm calling him out on a Saturday after Spring Break (next week for me - excited to go home!). Let's see how he responds.
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Anyway, in other news . . .

Zheng Lab - Bad Project (Lady Gaga parody)

I found this hilarious. I could sympathize with the person in there (having worked in similar labs before). And I love how her dresses were made of lab materials, lol.

Tonight I'm Frakking You

This is hilarious as well. I think the person in the Princess Leia cos-play is pretty attractive, haha.

Life in Adagio

Adagio: a slow musical tempo.

These last few days my life felt as if it's moving to an adagio tempo. Valentine's Day came and went. I spent most of the day studying for an exam the following day, ironically an exam on human sexuality.

My best friend from undergrad is getting married. I just got his save the date. He and his fiance look so happy together. I've known the both of them for the last 6 years or so. I was looking at their engagement pics earlier tonight, and I really like the theme they chose. And as I clicked to RSVP, there was a slot for how many guests and I would be at one. I hesitated and didn't complete it. I'll do it later I guess. Weddings have been really weird for me for the last 3-4 years.

I came across the following a month or two ago (on this site):
I couldn't have put it any better. I've been chatting with Drew off and on, as usual. Earlier tonight he said something like: "We still haven't met yet, this must be corrected soon." It seems like we're tentatively planning to meet up on a Friday in the near-ish future. Trying to catch him online is kind of like throwing a dart at a board with one eye covered, haha. Here's hoping for good things, but I'm not sure we'll progress much farther than "just friends." Hopefully I'm wrong, but I'm not sure how one could maintain a decent relationship during rotations.
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Adagio: a slow musical tempo.

Adagio for Strings by the YST Cello Choir

This is one of my favorite arrangements of this piece. It's such an expressive piece and it perfectly describes my mood these days. While Barber's Adagio for Strings has been described as one of the saddest pieces ever, I don't necessarily hear "sadness." It is, for sure, one of the most beautiful and emotive pieces I've heard with the notes painstakingly drawn out without so much as an accelerando. I hear a resignation that describes the world as it is, a kind of eternal reflection. Not necessarily sad, but it can be perceived as such.

Here's a recording of the original piece (not an original, the original as conducted by Toscanini who Barber himself requested to conduct it).

Finally, to end with a quote I found on my brother's Facebook page:

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

You've Gotta Go Deeper

A few weeks ago I posted my recount of the female pelvic exam. So last Thursday I walked over to the urology clinic with other med students to do the male genitourinary exam. This is what you've all been waiting for, lol. But . . . it was rather anticlimactic.

So we walk over to the urology clinic, which is (curiously) in the lower level of the hospital. We were to examine a male standardized patient in groups of 4-5 with a resident or an attending physician. My group got this really nice and laid back resident. I especially love his preface with something like, "You know, urology is great. I never thought that I'd be doing what I'm doing, but I love it. As long as you can explain to your kids why you're not a pervert, and explain to their parents why you're not a pervert, then you're good to go. And within medicine, it's a highly highly respected field."

Some more chatter to relieve the inevitable tension of the situation (though less tension than for the pelvic!), and then we enter the tiny exam room. Sitting in our room was a guy in one of those hospital gowns. As soon as he lifted his gown, we noticed all his tattoos and he looked like your stereotypical biker guy (beard and all!). He later told us that he uses the money from doing these things to get more tattoos, lol.
So as with all exams, it begins with inspection. Some things to note: circumcised or uncircumcised, symmetry, and anything "weird" (lumps, bumps, sores, etc). This part is so important that the resident told us that if we were to ever consult urology after doing a male exam and didn't note whether the guy is circumcised/uncircumcised, then they think we didn't really do a male exam. Our guy was circumcised (unlike the prototypical picture above, and unlike 70-80% of guys on the planet - but still pretty common in the US).

Next was palpation. So basically, just feel along the penile shaft for any lumps/bumps that can't be seen, and gently open the meatus of the urethra (pee hole) to make sure nothing's wrong there. Note that it's "patent."

Then examine the testicles. There's a particular technique to "trap" the testicles between the fingers so it's easier to feel without causing (much) discomfort. Feel for lumps/bumps, find the epididymis, the spermatic cord, etc. Ask them to cough and then feel for any varicoceles.

And finally, do a hernia exam. This was actually a tad tricky, because you have to follow the spermatic cord back into where it goes into the body (and it's not as easy as it'd necessarily seem) and then ask them to cough. Our guy had to constantly tell us whether or not we were in the right area. Often he'd say something like, "You've gotta go up and you've gotta go deeper." Yeah, that was a bit odd, lol.

We didn't do a prostate exam on him. Instead, everyone did a prostate exam on a plastic model. Eh, chances are I'll never really need to do one anyway (in peds), so whatever.

And that's that. Clinical, short, easy. Like I said, rather anticlimactic and not very exciting. Our guy could've used some lotion on his penis, it looked rather dry to me (especially the glans). ::Shrugs::