The day before a big exam seems the perfect time to update.
Tomorrow is the Microbiology exam. I had no idea, but it turns out "Microbiology" is synonymous with "Everything That We Come Across in Medicine and How We Treat It". It has been incredibly interesting; we have covered a wide range, from the pathogenesis of bubonic plague to the appearance of elephantiasis; why you never give tetracycline to a pregnant lady and why scotch tape is the best diagnostic tool for finding pin worms around somebody's anus.
This class also tested my ability to shove new words in my brain; Now that all is said and done, I have *learned* over 500 new terms, 114 new diseases, and dozens and dozens of drugs. It feels a little bit like academic bullemia though - after tomorrow, will I remember that it is E.Coli 0157-H7 that doesn't ferment Sorbitol on MacConkey Agar?
Less boringly, school is almost over! This summer I will be working for the VA in west roxbury. I am excited for the chance to get back into actually providing care, and am interested to see the way a government health system operates. My only exposure thus far has been the woman from human resources who told me "you der done good" after I had gotten my work physical done on time. More updates to come, I am sure...
Hard to believe first year of medical school will be over in less than a month. It is exhilarating to take a look back and see all that has happened, and yet still I am constantly reminded that there are mountains beyond mountains to climb.
ok, enough paul farmer puns, back to studying.
Thursday, May 21, 2009
Saturday, April 4, 2009
So you want to be a doctor?
These past two days (4/3-4/4) I was invited to speak at an over-night conference for BC undergrads. The title of the conference was "So, you want to be a doctor?". It was run through the intersections office (the same lovely people who brought you halftime) with the goal of helping students on the pre-med track have time away from campus to do some good old Ignatian reflection on the sacrifices and joys of pursuing the physician track.
All the students were engaged and genuinely interested in the mysterious combination of diligence, sacrifice, passion, and luck it takes to get into medical school and follow such a path. It was great to share with them some of the wisdom I took away from the entire experience of applying and my first year, as well as to liberate them from the idea that there is one set path to getting into medical school. Rather the process of self-actualization does more for getting you into medical school (meaning, finding out 'do I actually WANT to be a doctor?!') than any MCAT strategy or personal statement secret incantation could ever do.
Two topics of particular interest we covered were sacrifices and limitations.
Limitations.
I cannot do everything. I cannot even do most things. In fact, I am finding, really, that I can do medical school well and than maybe one or two things for fun. Anymore than that I can do, but I get really tired, cranky, and burnt-out.
There are other people around me (classmates) who amaze me with their ability to take on more and push through the challenges that would keep them from taking on more. But maybe in my own process of self-realization, I am finding that I like doing a few things well. I get stressed even when I think about doing more things right now, fun or otherwise.
Sacrifices.
And so, I led this retreat, and then it was necessary to say no to other invitations for this weekend (dinners with friends, social time, a little bit of sleep... sleep is always inviting me). It's only one weekend, no big deal. But as we talked about at this conference, it is not just this weekend, it will continue to be an escalation of life choices, deciding what must get cut. There will come a time when I will miss out on the weddings of friends, school plays... the freedom that is afforded by a 9-5 job. But, I write that paragraph not as a remark of "my life is so hard", but rather that it is a serious decision to go into this profession, and one that really does require a feeling of being called. Every profession, every following-out of who you are requires sacrifices - the essential part is knowing which ones you are capable of making.
We all have gifts to share, possessions to steward. In many ways, as a physician the gift you continually give to your patients is time and presence. For now, my patients are only figments, but today, these Saturday hours, are a joy-filled gift to them, an investment in their well being. An affirmation that these are sacrifices I am called to make.
All the students were engaged and genuinely interested in the mysterious combination of diligence, sacrifice, passion, and luck it takes to get into medical school and follow such a path. It was great to share with them some of the wisdom I took away from the entire experience of applying and my first year, as well as to liberate them from the idea that there is one set path to getting into medical school. Rather the process of self-actualization does more for getting you into medical school (meaning, finding out 'do I actually WANT to be a doctor?!') than any MCAT strategy or personal statement secret incantation could ever do.
Two topics of particular interest we covered were sacrifices and limitations.
Limitations.
I cannot do everything. I cannot even do most things. In fact, I am finding, really, that I can do medical school well and than maybe one or two things for fun. Anymore than that I can do, but I get really tired, cranky, and burnt-out.
There are other people around me (classmates) who amaze me with their ability to take on more and push through the challenges that would keep them from taking on more. But maybe in my own process of self-realization, I am finding that I like doing a few things well. I get stressed even when I think about doing more things right now, fun or otherwise.
Sacrifices.
And so, I led this retreat, and then it was necessary to say no to other invitations for this weekend (dinners with friends, social time, a little bit of sleep... sleep is always inviting me). It's only one weekend, no big deal. But as we talked about at this conference, it is not just this weekend, it will continue to be an escalation of life choices, deciding what must get cut. There will come a time when I will miss out on the weddings of friends, school plays... the freedom that is afforded by a 9-5 job. But, I write that paragraph not as a remark of "my life is so hard", but rather that it is a serious decision to go into this profession, and one that really does require a feeling of being called. Every profession, every following-out of who you are requires sacrifices - the essential part is knowing which ones you are capable of making.
We all have gifts to share, possessions to steward. In many ways, as a physician the gift you continually give to your patients is time and presence. For now, my patients are only figments, but today, these Saturday hours, are a joy-filled gift to them, an investment in their well being. An affirmation that these are sacrifices I am called to make.
Wednesday, January 7, 2009
Atrocities and Activism
The twinkling light of the holiday season has been ebbed away by the swirling dark of the January sea
:: end melodrama::
A warm San Diego break and I find myself back in Boston, ice skating to school (well, not literally, but I did get passed by a man on cross country skis a few days ago) and trying to ward off the cold in my below freezing house (this, unfortunately, is not melodrama, as i returned from California to a house below 30 degrees F, frozen pipes, and an icicle dripping off of the faucet of our kitchen sink!) Thankfully, an electric blanket was among the gifts I received this Christmas, so I am managing to survive our house's version of winter camping.
Classes have started again, and the winter-term finds us (among other things) planning out the research/studies we will complete. Before the break, I had solidified plans to take an intensive Spanish course in Boston and then travel to El Salvador where I would continue Spanish training, and onto Guatemala, where I would work in a rural clinic sponsored by the Harvard community. Dastardly, sometime in December the HMS administration decided to cut funding for the Boston based medical Spanish classes.
More-so than the anxiety created by needing to come up with a new fundable project fast, I am distressed by the priorities of our administration. Harvard is an institution with many personalities: there are (for sure) voices among the faculty who advocate the importance of services and skill sets to benefit the under served, yet there are (seemingly) a multitude more who believe that the above is the first cargo to be thrown overboard during a storm. And tragically, they control the purse strings.
In response, I took on my first ever "stick it to the man" project. I spent yesterday crafting a petition about the issue of funding cuts, and the absolute necessity for funding re-distribution. I had a few of my liberal arts friends check it for spelling, grammar, and cuss words, before sending it out to my class list serve. About 1/3 of the class has signed it only 5 hours after my having sent it to them.
Now the question is, what do I do with it?
(You'd think I would have had a plan, but I'm new at this). I think I will go to the Dean of Student Affairs, first. I am sure it will be plainly evident that I have no experience in this and no idea what I am doing, but somehow I am certain that I should be doing this. If we don't emphasize the importance of Clinicians learning the language of their patients now, then when? I have browsed through our curriculum and (shockingly) it does not slow down.
Maybe I have too high of standards set for Harvard, but I don't think so. Even with the financial crisis this institution has a crap-top of money (scientifically speaking) and I will give Spanish it's due defense.
:: end melodrama::
A warm San Diego break and I find myself back in Boston, ice skating to school (well, not literally, but I did get passed by a man on cross country skis a few days ago) and trying to ward off the cold in my below freezing house (this, unfortunately, is not melodrama, as i returned from California to a house below 30 degrees F, frozen pipes, and an icicle dripping off of the faucet of our kitchen sink!) Thankfully, an electric blanket was among the gifts I received this Christmas, so I am managing to survive our house's version of winter camping.
Classes have started again, and the winter-term finds us (among other things) planning out the research/studies we will complete. Before the break, I had solidified plans to take an intensive Spanish course in Boston and then travel to El Salvador where I would continue Spanish training, and onto Guatemala, where I would work in a rural clinic sponsored by the Harvard community. Dastardly, sometime in December the HMS administration decided to cut funding for the Boston based medical Spanish classes.
More-so than the anxiety created by needing to come up with a new fundable project fast, I am distressed by the priorities of our administration. Harvard is an institution with many personalities: there are (for sure) voices among the faculty who advocate the importance of services and skill sets to benefit the under served, yet there are (seemingly) a multitude more who believe that the above is the first cargo to be thrown overboard during a storm. And tragically, they control the purse strings.
In response, I took on my first ever "stick it to the man" project. I spent yesterday crafting a petition about the issue of funding cuts, and the absolute necessity for funding re-distribution. I had a few of my liberal arts friends check it for spelling, grammar, and cuss words, before sending it out to my class list serve. About 1/3 of the class has signed it only 5 hours after my having sent it to them.
Now the question is, what do I do with it?
(You'd think I would have had a plan, but I'm new at this). I think I will go to the Dean of Student Affairs, first. I am sure it will be plainly evident that I have no experience in this and no idea what I am doing, but somehow I am certain that I should be doing this. If we don't emphasize the importance of Clinicians learning the language of their patients now, then when? I have browsed through our curriculum and (shockingly) it does not slow down.
Maybe I have too high of standards set for Harvard, but I don't think so. Even with the financial crisis this institution has a crap-top of money (scientifically speaking) and I will give Spanish it's due defense.
Tuesday, November 11, 2008
Transformation
In re-reading over some previous entries, I notice that my ponderous-thoughts tend to use sexy words like "enshroud" and "mystery" to describe the new classes and adventures I am introduced to in this process of becoming...
Let me take a moment to underscore that gross anatomy is gross.
Last Friday, we dissected the "perineum". What's that, you say? Perineum is akin to "private parts", "unmentionables", or my personal favorite "baby makers"; all euphamisms for the penis, the scorutum, the clitoris, the vagina, and the anus.
This lab was doomed both to fail and to leave permanent scars on the psyches of all my first year classmates. First, the lab didn't get posted until the last minute, meaning that no one was able to prepare by reading grey's anatomy and at least being empowered with facts. Second, our time was cut in half, meaning that we had to rush through a three hour lab in 90 minutes.
Next, these "private areas" are very difficult to gain access to; to even "open" up the area requires raising the cadaver onto plastic blocks, and putting the legs into the "spread eagle" position. But wait, there's more. Because of the overall stiffness of each cadaveor from the embalming process, the legs have to be tied down with rope and secured to the ends of table in order to keep the cadaveor in a somewhat function-fitting position.
Got that image in your mind? Then, we were ready to begin...
Up until this lab, gross anatomy had been somewhat of a detached experience. Work in any given area allowed you to drape the rest of the body with cloth, much like surgeons do, in order to disconnect yourself from the whole person. We instead focus on the smaller structual anatomy, and feel incresingly confident in our chosen career path as we master nerve plexi and muscle function.
But Friday, much like our special lady, our emotions and insecurities lay exposed for everyone to see. No longer capable or in control, visceral emotions took over. Julia found herself struggling to contain her laugher while Sam struggled to contain his breakfast. We muddled through the lab, and mutually decided to skip over instructions such as "palpate the clitoris" or "insert two fingers into the vagina to simulate a bimanual exam". As Spencer remarked, "Thanks, but no thanks... I don't want to add 'fingering a dead lady' to my list of medical school firsts."
Later, out of the anatomy lab, I felt sick to my stomach. Long after the smell of formaldehyde had left my skin, the feeling remained that I had done something brutish, invasive, and disrespectful. I went back over each moment of the lab in detail; what I had said, what I had felt - what in the world had gone on in there? It was perhaps the first time since getting going that I paused to reflect on what a crazy thing it was that I was doing in this class - I had chosen to become a doctor to heal, hand't I? What was happening to me instead?
Unable to concentrate, I went back up to the lab. Alone in the morgue-like room I stood with our lady and tried to remember what she had looked like when I first saw her. Most of her skin is now detached, and her muscles, stolen of their protective covering, have begun to dessicate. In the quiet, I let my thoughts wander to people that she had loved, places she had lived. What had she seen in her life? What had she enjoyed? Her fingernails are covered with delicate pink nail polish - I hoped that it was a signal of the love which had been given to her by a caretaker.
What promted me to do what I did next, I am not sure. Maybe it is that deeper inner feeling - that still small voice - the one that has pushed me to stay on this life path. Maybe it was to attempt a reconcilliation from the "invasion" that was Friday. Or maybe it was only a moment in which I realized that this woman is not so different from the other grandmother like women I have loved.
Over the next hour, I wrapped each section of her muscles in damp cloth and then sutured her skin where it had been cut open. At the end, aside from the occasional patches of clumsily woven stiches, I could recognize her as I did that first day.
I turned out the lights to leave, and felt releaved. Despite this transformative indroduction to the profession, I can still recognize myself.
Let me take a moment to underscore that gross anatomy is gross.
Last Friday, we dissected the "perineum". What's that, you say? Perineum is akin to "private parts", "unmentionables", or my personal favorite "baby makers"; all euphamisms for the penis, the scorutum, the clitoris, the vagina, and the anus.
This lab was doomed both to fail and to leave permanent scars on the psyches of all my first year classmates. First, the lab didn't get posted until the last minute, meaning that no one was able to prepare by reading grey's anatomy and at least being empowered with facts. Second, our time was cut in half, meaning that we had to rush through a three hour lab in 90 minutes.
Next, these "private areas" are very difficult to gain access to; to even "open" up the area requires raising the cadaver onto plastic blocks, and putting the legs into the "spread eagle" position. But wait, there's more. Because of the overall stiffness of each cadaveor from the embalming process, the legs have to be tied down with rope and secured to the ends of table in order to keep the cadaveor in a somewhat function-fitting position.
Got that image in your mind? Then, we were ready to begin...
Up until this lab, gross anatomy had been somewhat of a detached experience. Work in any given area allowed you to drape the rest of the body with cloth, much like surgeons do, in order to disconnect yourself from the whole person. We instead focus on the smaller structual anatomy, and feel incresingly confident in our chosen career path as we master nerve plexi and muscle function.
But Friday, much like our special lady, our emotions and insecurities lay exposed for everyone to see. No longer capable or in control, visceral emotions took over. Julia found herself struggling to contain her laugher while Sam struggled to contain his breakfast. We muddled through the lab, and mutually decided to skip over instructions such as "palpate the clitoris" or "insert two fingers into the vagina to simulate a bimanual exam". As Spencer remarked, "Thanks, but no thanks... I don't want to add 'fingering a dead lady' to my list of medical school firsts."
Later, out of the anatomy lab, I felt sick to my stomach. Long after the smell of formaldehyde had left my skin, the feeling remained that I had done something brutish, invasive, and disrespectful. I went back over each moment of the lab in detail; what I had said, what I had felt - what in the world had gone on in there? It was perhaps the first time since getting going that I paused to reflect on what a crazy thing it was that I was doing in this class - I had chosen to become a doctor to heal, hand't I? What was happening to me instead?
Unable to concentrate, I went back up to the lab. Alone in the morgue-like room I stood with our lady and tried to remember what she had looked like when I first saw her. Most of her skin is now detached, and her muscles, stolen of their protective covering, have begun to dessicate. In the quiet, I let my thoughts wander to people that she had loved, places she had lived. What had she seen in her life? What had she enjoyed? Her fingernails are covered with delicate pink nail polish - I hoped that it was a signal of the love which had been given to her by a caretaker.
What promted me to do what I did next, I am not sure. Maybe it is that deeper inner feeling - that still small voice - the one that has pushed me to stay on this life path. Maybe it was to attempt a reconcilliation from the "invasion" that was Friday. Or maybe it was only a moment in which I realized that this woman is not so different from the other grandmother like women I have loved.
Over the next hour, I wrapped each section of her muscles in damp cloth and then sutured her skin where it had been cut open. At the end, aside from the occasional patches of clumsily woven stiches, I could recognize her as I did that first day.
I turned out the lights to leave, and felt releaved. Despite this transformative indroduction to the profession, I can still recognize myself.
Tuesday, October 14, 2008
post-life
Our fourth anatomy lab today. Anterior thigh and and crus. 90 minutes in and I was super woozy - I had to leave for a few minutes. Working at the upper thigh, streams of formalin and what is disgustingly named "body juice" poured out from my person. Layers of globulous adipose tissue clung to the fascia and muscles I clumsily and frustratedly tried to separate. Muscles zig-zagged over and under each other; arteries nerves and veins obstructed each place I attempted to make incisions - is it possible to be angry at a cadaver?
I am in a love-hate relationship with anatomy lab. In most aspects, it is such a holy place. We are allowed vision into a world most will never see (or want to see). I am transfixed by the interplay of form and function; the meticulous organization of each muscle, nerve, artery, vein in the human person. It is at once extremely detailed and complicated with the sheer amount of structures, while simultaneously elegant and simple as almost any function can be guessed by examining joints and attachments.
In the beginning of our course, we were given a letter in our course pack from the person who donated their body for our learning. In it, the woman described her full knowledge of the gift she was giving to us, and her great hope that her gift would benefit us, so that we could benefit others. At the close of her letter, she told us that each day since she made the decision to donate her body, she had prayed for us.
Reading that last line, I started to cry.
Much like I started to cry just several moments before. Tied into working with my very-committed and generous cadaver, I am reminded in a grossly-awesome way of the knowledge that all life is a gift; one that we are loaned temporarily. No function that we have is ours to keep; and for each person, a real and precise time will come when the loans must be returned. I am a doctor to heal people, but I am thinking more and more about how I will mostly be a doctor to accompany people as they face the loss of function, themselves, and their lives.
I do not want to make my career path out as being the grim reaper; in fact, I am certain that most of what I do in the day to day will be simple nuts-and bolts medicine and healing. But life, even a life well lived and long lived, is a painful thing to part with (at least, that is the only way I can view it now).
These entries are incomplete thoughts, but I have to return to my Netter's.
I am in a love-hate relationship with anatomy lab. In most aspects, it is such a holy place. We are allowed vision into a world most will never see (or want to see). I am transfixed by the interplay of form and function; the meticulous organization of each muscle, nerve, artery, vein in the human person. It is at once extremely detailed and complicated with the sheer amount of structures, while simultaneously elegant and simple as almost any function can be guessed by examining joints and attachments.
In the beginning of our course, we were given a letter in our course pack from the person who donated their body for our learning. In it, the woman described her full knowledge of the gift she was giving to us, and her great hope that her gift would benefit us, so that we could benefit others. At the close of her letter, she told us that each day since she made the decision to donate her body, she had prayed for us.
Reading that last line, I started to cry.
Much like I started to cry just several moments before. Tied into working with my very-committed and generous cadaver, I am reminded in a grossly-awesome way of the knowledge that all life is a gift; one that we are loaned temporarily. No function that we have is ours to keep; and for each person, a real and precise time will come when the loans must be returned. I am a doctor to heal people, but I am thinking more and more about how I will mostly be a doctor to accompany people as they face the loss of function, themselves, and their lives.
I do not want to make my career path out as being the grim reaper; in fact, I am certain that most of what I do in the day to day will be simple nuts-and bolts medicine and healing. But life, even a life well lived and long lived, is a painful thing to part with (at least, that is the only way I can view it now).
These entries are incomplete thoughts, but I have to return to my Netter's.
Sunday, October 5, 2008
Commitment
It is a brisk autumnal Sunday night. This past Friday was the final exam for my first medical school class - Biochemistry. It ended, and ushered in the first free weekend I have had since medical school began. I am recharged on time to sleep in, laughter with friends, freshly picked apples and sundappeled pumpkins...
Yet, palpably, there is a pit in my stomach. Tomorrow starts my first day of anatomy.
In part, my nervousness comes from the rumors enshrouding the gross anatomy course. legends run wild concerning the antics and outrageous events that happen in the class, and i find myself wondering what the practical reality will end up resembling...
But, much more so than the fantastic, I think that pit comes from knowing that I am entering into another seven-week period sans stopping. Do not get me wrong; I love medical school, I love what I am learning, I love the environment I am able to learn within. Yet, there is a strict regimen that must be kept to maintain adequate standing as a student, and huge parts of myself resist being tamed to one specific focus for such long periods of time.
Palpable also is the temptation to go even further beyond these next 7 weeks, into the next 7-10 years, wherein (again) days of break from the schedule will be few in number and far between in spacing.
And here, I remember to stop pushing so far ahead, and to call myself back to this moment. Medicine cannot be learned in one night; but instead, little steps must be taken, spread over a lifetime of learning, observing, processing.
Maybe, for the first time, I am learning what the gritty parts of real commitment look like: moving forward, focusing, and doing what you promised you'd do, even when your physical body and mental concentration are no longer engaged.
I am not at such extremes yet, but in these early days I am trying to find resolution to build upon... more on all of this later
Yet, palpably, there is a pit in my stomach. Tomorrow starts my first day of anatomy.
In part, my nervousness comes from the rumors enshrouding the gross anatomy course. legends run wild concerning the antics and outrageous events that happen in the class, and i find myself wondering what the practical reality will end up resembling...
But, much more so than the fantastic, I think that pit comes from knowing that I am entering into another seven-week period sans stopping. Do not get me wrong; I love medical school, I love what I am learning, I love the environment I am able to learn within. Yet, there is a strict regimen that must be kept to maintain adequate standing as a student, and huge parts of myself resist being tamed to one specific focus for such long periods of time.
Palpable also is the temptation to go even further beyond these next 7 weeks, into the next 7-10 years, wherein (again) days of break from the schedule will be few in number and far between in spacing.
And here, I remember to stop pushing so far ahead, and to call myself back to this moment. Medicine cannot be learned in one night; but instead, little steps must be taken, spread over a lifetime of learning, observing, processing.
Maybe, for the first time, I am learning what the gritty parts of real commitment look like: moving forward, focusing, and doing what you promised you'd do, even when your physical body and mental concentration are no longer engaged.
I am not at such extremes yet, but in these early days I am trying to find resolution to build upon... more on all of this later
Tuesday, September 23, 2008
Steady Rhythm
An autumnal Tuesday afternoon. I see it only from a chair in one of the many HMS skill areas where I have taken residence. On one side of me sits a bag of granola that I occasionally munch on; the other side holds a tray of human brains extracted from cadavers, and in use by the second year neurology class.
The learning curve in these first few weeks has been tremendous. Daily I absorb more information than I previously absored in semester in college. While I am still so near to the beginning of my education, a part of me is concerned for my future patients: will I remember the biochemical causes of Type II diabetes years from now, when this day is just a distant memory? I make the conscious effort to will my mind to remember these details and nuances, knowing that someday it could make the difference, but I am doubtful that this has any affect on the actual knowledge I will take away.
This is not to say that I don't enjoy the pace and bustle of life here; quite the opposite. Everyday I am challenged to wrap my mind around biochemical mechanisms of disease - to grapple with complicated health policy and the social factors which exacerbate illness - to search for new and meaningful ways to lead and collaborate. While there is still the inborn insecurity that I could never stand amidst the giants (in mindpower, leadership, and clinical practice) who surround me, there is also my great hope in the process of education here: I am not sure it is possible to walk away from here in four years not charged to contribute in meaningful ways.
The learning curve in these first few weeks has been tremendous. Daily I absorb more information than I previously absored in semester in college. While I am still so near to the beginning of my education, a part of me is concerned for my future patients: will I remember the biochemical causes of Type II diabetes years from now, when this day is just a distant memory? I make the conscious effort to will my mind to remember these details and nuances, knowing that someday it could make the difference, but I am doubtful that this has any affect on the actual knowledge I will take away.
This is not to say that I don't enjoy the pace and bustle of life here; quite the opposite. Everyday I am challenged to wrap my mind around biochemical mechanisms of disease - to grapple with complicated health policy and the social factors which exacerbate illness - to search for new and meaningful ways to lead and collaborate. While there is still the inborn insecurity that I could never stand amidst the giants (in mindpower, leadership, and clinical practice) who surround me, there is also my great hope in the process of education here: I am not sure it is possible to walk away from here in four years not charged to contribute in meaningful ways.
Subscribe to:
Posts (Atom)