Saturday, March 12, 2011

On the Radio

Another plug for the Sharewood Project...

http://www.blogtalkradio.com/abradio/2011/03/12/the-sharewood-project

I just wrapped up doing a radio interview on Asian Boston Radio about the Sharewood Project (the free health care organization outside of Boston, affiliated with Tufts, that I'm currently the Administrative Director of) and it is now on the "series of tubes" known as the internet. I was joined with the previous president of the undergraduate board as well as our current head of publicity. It was pretty fun. We didn't know what to expect when we walked into the room where we recorded the interview... At this point we discovered that it would be live, and last 30 minutes! omg! crazy... it went by really quickly, and for the most part I think it went really well.

This was my second time being on the "radio" - the last time was with the band I was in back in college, Get Dressed, when we played on the UW radio... pretty sweet gig.

Anyway, I'm about to go to an interview to get a grant from the Alumni board of Tufts Med to help fund the sharewood project... :)

Spring break... only one week away!!!!!

Monday, February 14, 2011

CC

The Chief Concern (many physicians still call it chief complaint) is the very short description, typically in the patients words, of why they are at the hospital. Examples include: "Swollen leg," "Chest pain," "SOB" (shortness of breath), "Diarrhea," "Stomach pain."

My favorite that I've heard thus far:

CC: Plan to kill self with a rocket launcher...

The patient was then searched by security and did not have any weapons on them.

Sunday, February 13, 2011

Sacrifice

Medical school makes you give up many of the things you love. I thought I'd find more of a balance... the unfortunate truth is that it's very difficult to do. I lost my soccer community - I went from playing 3 times a week, with a great group of friends, on three separate teams, to playing once every one or two weeks. I used to play guitar daily - I now sit down and play maybe once a week - sometimes I'm lucky and play twice a week for a total of 30 minutes!

After going to our medschool's multicultural performing arts show this past friday and watching dances, music, and other performances by students at our school (a talented bunch, which makes sense... med students are busy and involved with lots of stuff before getting to med school), I remembered how much I miss my passions that make me who I am (primarily soccer and music). I also remembered that many of the most talented individuals lack creative talent (many of the most skillful performers/singers/instrumentalists lack the ability to create interesting things). Both frustrated me.

I miss the band I used to play in, and I miss playing soccer. These aren't things that can be substituted. Soccer is a type of exercise that requires you constantly be assessing the game around you, the players, the ball, the flow, and at the same time communicating with players on the field, anticipating the play, all while running around, constantly. It's a great workout, mentally and physically. Med school gives you a good mental work out, and going to the gym gives you a good physical workout, but it's really not the same, and it's frustrating. Boston doesn't have much of a soccer culture either, making it that much more difficult to play.

I decided to start sitting down and playing more guitar. I started today. Instead of studying straight through the day, I took three hours to play and write some music. It felt good, and I think I'll continue doing it.

It's february 13th, so I hope tomorrow brings a great valentine's day for all five of you reading this :)

Seriously though, have a great day, a great week, and remember the many people who love you for who you are, they make life pretty awesome.

Sunday, January 30, 2011

First day flying solo

Last Tuesday was the first day of running the Sharewood Project (the free, Tufts, student-run, health care initiative outside of Boston) as the Administrative Director without the help of the previous board members. Within the first hour of the clinic opening I had already apologized to roughly 25 patients in the waiting area - Great start to my year? Yep.... awesome.
Because of a misinformed decision that I made, the patients weren't able to check in and be triaged until after the clinic had opened - this meant them waiting in a long line and setting the entire schedule of the clinic back over 30 minutes. When your peers are counting on you, it's one thing, and when attending physicians are expecting things to run smoothly, thats another, BUT when patients are counting on you, there is an entirely new element added to the equation. The patients are the element that trumps everything else. It felt terrible to have the first 30 minutes of the night gone to hell.

What I learned: Apologize, always. In health care I will be running late almost all the time and it doesn't matter why, it is always my fault. I will be taking blame for being late the rest of my life. Even if it is one minute and entirely not my fault, it is still my fault. This is part of building a patient report, and being a good healthcare provider.

After my first night, running around non-stop, feeling overwhelmed and constantly being asked questions, I realized a few things. I know that many students take part in the Sharewood Project to improve their history taking and diagnosis skills, to develop their leadership skills, or to just "do good" in the community around their medical school. I can appreciate this, but at the end of the day the real reason we are there is for the patients. Many of the patients that come in have no insurance, and if they do they probably can't afford the bills from a medical appointment, or blood work, or STI testing or a flu shot or other vaccines... That means that we are the only health care they may have. This is why I'm no where near satisfied with the state of clinic. I fear some of that patient-centered sentiment and attitude being lost when many of the board members don't show up to clinic because there is an exam that week.

It's amazing to me that some how what I did as an undergrad and after graduating (working with the UW Dream Project has been directly translated to experiences in medical school. Back then it was how is what you are doing going to help more high school students get into college? Now the mantra has changed... but not much. Instead of helping students, it is, "How is what I am doing going to best serve the patients and give them the best health care possible?"

This tuesday will be the second week of running Sharewood. Hopefully things run more smoothly and I get home before midnight this week...


LASTLY, IF YOU ARE GOING TO PURCHASE SOMETHING THROUGH AMAZON.COM, PLEASE GO TO THE SHAREWOOD WEBSITE AND CLICK ON THE AMAZON LINK, THEN BUY WHAT YOU PLAN ON BUYING ON AMAZON. USING THE LINK ON THE SW WEBSITE WILL GIVE US 6% OF THE SALE (it will note affect the cost of what you purchase, just help fund the clinic). THANKS!!!

Friday, January 28, 2011

Triaging

Med school has taught me how to triage...

No, I don't mean that in the sense of assessing a patient's condition and treating the most severe or critical first (Actually, I did learn that in emergency medicine, if there is a major distaster, a bomb or some sort of huge event, you usually leave those who are least likely to survive and treat those that have a better chance of pulling though...). I mean triage as in: You are getting tested on 4 subjects, the anatomy of the thorax, physiology of heart and lungs, pathology of circulatory issues and cancers, and physical diagnosis for the heart... and you have to decide which subject(s) will only get a short 5 or 6 hours of studying for. It's frustrating to realize that it's not because you aren't trying hard, or using your time effectively, its that you literally don't have time to study everything - there is so much content. With that, I put minimal effort into anatomy because it was only 10 percent of our overall anatomy grade, and lots of time into pathology because this test contained 50 percent of our path grade...

You might be thinking that it could be a problem that future physicians aren't learning everything they are expected to in their first year - but don't fret. Much of what we learn (or don't learn) comes back into play 2nd year, when we learn about all the clinical applications and pathologies of the topics we cover. Plus, the most important years are 3rd and 4th when you spend all your time in the hospital doing rotations and seeing patients.
On top of the core content continually coming back, we also have to take the Step 1 of the board examinations at the end of our second year. This is an exam that people start studying for a couple months in advance. It's pretty intense and covers all the subjects from 1st and 2nd year.

The terrifying part of the step 1 of the boards is that it can determine what specialty you go into. To pass you need a score of 180, but to be competitive for most specialties you need a 225 or above (average board score is about 220). For some specialties, a 235 is the minimum requirement to even be considered. Crazy. This means you need a backup plan.

Always have a plan B... Mine is family medicine, I think.

Monday, January 24, 2011

Boston Winter



Yep - It's 10 degrees outside, with wind chills of -15...

I have never been in temperatures that low... This is ridiculous.



On the bright side (literally) it's sunny!

I also found a new place to study - The Boston Public Library. The reading room, Bates Hall, looks just like the reading room at UW, aka the "Harry Potter Room," because it makes you feel like you're studying at Hogwarts!

Themes to take away: The northeast is cold. Studying in new environments makes learning fun!... actually what makes learning fun is understanding the physiology and pathology of the heart. I feel comfortable doing a basic cardiac examination, I've cut open and dissected a human heart, and I'm understanding many of the common diseases and mechanical and systemic issues that cause cardiac problems. I'm excited about it.

Saturday, January 15, 2011

Purchase a northface...


It gets cold in Boston. The wind cuts through your clothes way too well, which is why a month ago I purchased a wind-proof, water proof, insulated, awesome coat from northface. No longer am I a cold, stressed out, sober, and busy med student. Instead I'm a stressed out, sober, and busy med student! :)

I've noticed that my last few blogs have been an indication that I just completed an exam... With that, I in fact, just had an exam on the anatomy and physical diagnosis of the upper limb! That includes your shoulder, a few parts of your back and chest, and the entire arm, forearm and hand. Holy crap - the hand is amazing. Seeing the way muscles, tendons and nerves run down your arm, how they can affect movements in your hand, and just how it all works together is so cool. I definitely appreciate my guitar playing ability a lot more, and carry a new respect for how much damage can be done by seemingly simple injuries to your upper extremity. Classic example: Knife fight (Yep, that came up a few times in class, haha). If you get a stab wound in your arm you could lose sensation and muscle movement in much of or all of your arm, forearm and hand. Even just landing on your elbow and messing up your ulnar nerve (the funny bone) can cause damage all the way up your hand.

Funny bone (don't hurt yourself doing this, attempt at your own risk... just saying that so I don't get sued) - Lift your arm up as if doing a curl with weights, and bring your elbow up a little bit - then put your other hand under your elbow - find the main bump that you would think of as your elbow (the olecranon) and then find the little bump next to it on the inside of your elbow (medial epicondyle). You'll notice a little groove that is soft between the those two bony parts of your elbow. If you tap that soft spot you can feel a tingle or burn sensation travel up your arm to your little finger (sometimes you have to do it with a little bit of force). That's what happens when you hit your "funny bone." That's your ulnar nerve and damaging it can cause loss of sensation up to your little finger, and motor impairment in your hand - crazy.

Oh yeah - It snows here, a lot. Seattle shut down with a couple inches... Boston functions on a foot of snow. I can walk on sidewalks and streets the day after a snow storm in running shoes because they do such a good job of clearing and shoveling the snow. Fantastic!

Oh, also, if you visit Boston in the winter, bring long underwear. It's pretty rad, and warm.

Off to an improv show with some friends!

Wednesday, December 22, 2010

Too much has happened in the last month... so let chat about anatomy!

(Check out the picture I took of the church sign near my parents' house over thanksgiving!)

In the last month or so, I've started anatomy (lots of cutting and pulling at flesh/fat/tissue, exposing arteries, viens, nerves and defining muscle groups...), scored the winning goal in the graduate school soccer league finals , visited my god parents in Poughkeepsie NY with my girlfriend, studied harder than I ever have in my entire life, been completely destroyed by exams, and become the next director of the Sharewood Project , a free health care organization that Tufts med students run outside of Boston once a week. Simply put, its been really really busy and I've done nothing about blogging. Oh, I also had an amazing Thanksgiving weekend with family outside of Seattle.

Since that's a lot to cover, I'll just write about anatomy for now... maybe in the next couple days I'll start getting into some other topics.

Before entering anatomy the lab (a large cold room lit by fluorescent lights with light blue cement walls covered with cabinets with bones, organs in containers, and other samples, and lined with sinks to wash up with) many people worry about the shock of seeing a dead body. That was not a factor for me. Instead, my biggest gripe is that it SMELLS. It smells like formaldehyde and whatever else dead bodies smell like... It's also juicy at certain points. Our body - the youngest one in the lab, which has roughly 40 cadavers - was a woman who died of an aggressive metastatic cancer in her 40's and she was not frail and weak. She had plenty of extra fat and tissue to be cut away. I'll say other than the smell, yellow human fat is my other least favorite aspect of the lab. Along with my other group members, I equate the fat and other tissue to food almost every time we are down in the lab, and for your sake, I will spare the details... it can seriously make eating certain foods on lab day difficult... for example smoked salmon after my first day in lab... ANYWAY... no seriously, some stuff legitimately looks like foods human consume... moving on...

The point I'm trying to get to is that at first anatomy is slightly uncomfortable for everyone on some level, but you get over it very quickly. You have to. The first day one of my group members accidentally had a piece of fat flung into his face, and some more in his hair (I imagine he showered as soon as he had the opportunity to). For the reason of getting covered in juice and tissue as well as the smell, we wear scrubs and a set of shoes that we know we can throw out at the end of the course. You also get over being uncomfortable because effectively learning the material and doing well requires spending lots of time with the bodies. We've covered the lower limb, which is the most simple part of the body, and already I must say the body is amazing and pretty complex! Who would have thunk it? There is a lot to learn!

The knowledge I gain from anatomy is incredibly relevant to health care, but more importantly, working out! During this break I've finally had the opportunity and time to work out consistently. While at the gym, I was using the rowing machines and one of my butt muscles became really sore - my gluteus maximus to be precise (its the big one on your butt). For this reason I wanted to stretch it. "How do I stretch my gluteus maximus?" I wondered to myself, which was when I remembered, "the glut max is used for hip extension and lateral rotation! Ah, just do the opposite to stretch the muscle!" So I pulled my leg up toward my chest and rotated it in. BAM! Stretched! Doctored! Awesome!

On a more professionally relevant note, anatomy is important, especially if I pursue a specialty like Emergency Medicine where I need to make rapid physical diagnoses (along with anatomy we are taking a course called physical diagnosis, the content of which corresponds to anatomy). For that reason, I'm always trying to think in terms of, "A patient walks in with this hurting, what is the diagnosis?" The great part about Tufts is that the exam questions are clinically oriented. For example, "A 24 year old med student was walking across the street and tripped while walking onto the curb causing her ankle to invert. She limps into the emergency department with complete sensation on her foot, but pain with inversion. What might she have damaged?"

Seeing as its christmas eve, I'm going to get back to hanging out with the family. We had our traditional fondue dinner:

First course: Cheese fondue with veggies and bread to dip
Second Course: a broth for cooking small pieces of chicken and steak
Third Course: a soup made from the broth with raman noodles and veggies
Fourth Course: butterscotch fondue with fruit

I hope you're having a great holiday season!

Wednesday, November 24, 2010

Sobriety, a dish best served in med school...

Last May, while getting my immunizations and screenings to enroll in med school, I came back with a positive PPD test - I've been exposed to tuberculosis... In case you don't know much about TB, you can wikipedia it if you want to know what it's all about (side note: I recently donated 5 dollars to wikipedia, mostly because I appreciate how almost all of my questions during 1st year of med school can be answered on the site. ANYWAY, I was exposed to Tb, mostly likely in Venezuela two years ago. After testing positive I was immediately sent to get a chest x-ray, which came back clear. Good news, for the most part - It's not an acute problem, and I can't give TB to anyone else.

Normally nothing happens after this, and the patient with latent TB is just routinely checked to make sure they dont start to develop active TB, which can be spread to others, and must be treated with a ridiculous amount of powerful antibiotics. However, I am involved in health care so it is important for my safety and the safety of others that I rid my body of this obnoxious bacteria, meaning I take 9 months of a drug called Isoniazid (you can wiki that too if you like). This is an antibiotic I take daily, along with a vitamin B supplement to limit the chance I get nasty side-effects like neuropathy.
Now that I'm taking this powerful antibiotic I have to get my liver enzymes checked every month to make sure my liver is functioning alright and not being damaged, which also means I should avoid anything that can lead to liver damage like alcohol or the active ingredient in tylenol (acetaminophen).

This littles story of mine leads me to the original inspiration to write this: As I sit in the Boston airport, ready to head back to Seattle, I really want something I can't have - a beer from the stupid airport sports bar 20 yards to my left. This is the first true craving I've had since starting my antibiotics almost a month ago. I recognize the reason for this is probably because I haven't been bored in the last month - school, constant exams, studying, cutting up cadavers, having a girlfriend, studying, studying, cooking a meal here and there... this all adds up to almost no free time and hence no real opportunity to enjoy a drink. With that I'm pretty happy that now is the time I'm doing this treatment. The only major downside is that the holidays are starting up, which means family, good food and great wine, the latter I will be abstaining from... because I don't want liver failure.

Cheers!

Sunday, November 14, 2010

The Sharewood Project

Here is a link for a segment that nbc news aired on the Sharewood Project - a free clinic run by tufts med students that I've been volunteering at since I arrived this summer. Yep, a lot of people in the video are people I know pretty well. How neat is that!?!

http://www.msnbc.msn.com/id/3032619/vp/40182965#40182965