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!!!!!

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.

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.

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!!!

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.

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.

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!

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!

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!

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

I'm no expert, and I don't get pregnant! - Medical Student Panel

Today was my first experience on a "medical student panel" for a conference that was being held at Tufts. I can remember being on the other side as an undergrad and wondering how the med students were so relaxed, settled with their life - I assumed that they must be so hard working, accomplished and at the top of their class. Now I'm on the other side of the panel, telling a group of undergrads about what I did to get to medical school, why I made the decision to take a year off of school after graduating, why I decided to take this route, how I'm adapting to life in Boston, and why I chose Tufts. I was not the top of my class, I wasn't some crazy smart kid who set the curve in my science courses, and I didn't know that I wanted to go into medicine until after entering college (I wasn't absolutely sure until my third year in school).

I have to admit, it felt pretty good to be viewed as an "expert" in the medical school application process, and it felt great to look back and realize that I've actually accomplished some pretty neat things. This is easily forgotten, with major exams every 2-3 weeks, and feeling like I'm just plugging away, constantly studying, with my head down, pushing through the hard science courses.

One of the undergrads, asked a question about family planning. She originally focussed the question on the women, but I felt that it also pertains to men, including myself (No, men don't get pregnant - I should know, I'm a medical student!). As med students, we all plan. It's no mystery to us that some specialties make it more difficult to be an active parent (surgery), and for that reason I have a couple friends who know when they want to get married, pregnant and how they will handle family life with residency. It's nuts - in the last 3 months I've had more conversations about family planning than I have in the last 3 years (I actually don't know if thats true, but it feels that way!). Whenever this question comes up I usually see myself in a specialty that allows me to be involved with my future family (whoever they end up being). That is one of the benefits to Emergency Medicine, you can work part time, set your hours, and when you leave the hospital you are not on call. That freedom, I feel, would decrease stress and allow my life to be more flexible... so we'll see if this is what I actually end up doing.

Time to put my head back down and hit the books!

(Photo is from my halloween weekend in SF - view from my friend's apartment that he recently moved out of)

Beginning to Learn from Patients

For the past couple months, I've spent thursday afternoons with 3 of my classmates to practice our interviewing skills in elderly homes and hospitals. It strikes me as absolutely amazing that we are allowed to walk into a room and ask a 66 year old woman, who is suffering from her third bout of cancer - who hasn't talked to her family about it and is awaiting a procedure - anything we want. Including why she hasn't told her family, if she is sexually active, the history of the diagnosis, is she worried or afraid?... Why are we granted that?
We are part of the club, we wear our white coat, and in a few years we will have patients of our own who rely on us... As strangers we hear a patient's deepest fears, hopes, desires, worries, we hear things that they keep from most of the world. Then, after walking into that room and sitting down to talk to the patient, we walk out, thank them for their time, and never talk to or see them again. We don't know what will happen to them, and we don't think much about it after leaving the hospital and riding the T back to wherever we are going. Sometimes it feels like we are more concerned with our "patient presentation" that we deliver to the group and resident supervising us. We stress out about our performance, making sure we include all the necessary details - the reason why they are in the hospital, their medical, surgical, familial, and social history. It's truly selfish, that the time we spend with the patient is so very much unbalanced, serving our education, while we have so little to offer. We are granted a luxury unlike anything I've ever experienced in my life.

However, through these experiences we have an amazing learning opportunity: To hear a patient's story. We may never see them again, but we will remember how they felt being on dialysis three times a week, and appreciation of a family member sitting through each 4 hour session they spent plugged into a machine to filter their blood the way their kidneys no longer can. We hear about their life, what matters to them outside the white walls of the hospital, and in these stories sometimes we get a glimpse of some of the issues we are all afraid to bring up... will they ever live a normal life again? Will they live to see this next new year? How are they coping?

I write this sitting on a plane headed to SF for the weekend, to see a few of my closest friends, to get away from the same med school crowd and to change up the pace. The constant studying, lecture, library, apartment, occasionally clinic or hospital, exercise/soccer when I have time, rarely cooking for myself... it's healthy to break that routine. On top of that, YOLO - you only live once. If it matters to you, find a way to make it happen.

What would have become of me in The City

Sitting in grand central I'm waiting to meet up with my friends for the drive back to boston. The second I get off the train I feel the pulse of the city, the way that if you pause you notice the world rushing by you, it's like being a rock in the rapids, it's calming and exciting at the same time. I wonder what life would be like had I chosen to go to nyu. Would I become a different physician, find different hobbies, make as many new friends as I have in boston, would school be more difficult or easier? What would it be like, and what would I be like. I chose tufts for the community, support, faculty and adminstration. I'm happy with my decision, but I will always wonder what would have become of me in the city.
Standing in the middle of the concourse, i hear 3 different languages at the same time. I love it.

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What I see is normal to me...

On the train headed back into the city from a weekend in poughkeepsie to visit my god parents. Along the hudson, the trees are a mix of orange, yellow, red and brown...i understand that this is why so many people love fall and the change of seasons, however I can't appreciate it. I have an x chromosome that limits the wavelengths my cones can pick up on... put another way, matching ties to shirts is a struggle for me, which is why I insist on shopping with women, who have 2 x chromosomes, and rarely are color blind for that reason. After just a few months in med school I have a stronger understanding of our genome, how and why many birth defects occur, and I've effectively become paranoid about my future children being negatively affected by the dna I may or may not know I'm carrying... Thanks genetics!
On my last exam, one of the courses I was tested on was molecular biology. On one of the questions, I was given the description of a virus im not familiar with (but I understand how the general class of virus it belongs to functions), applied concepts i learned, and essentially described how a virus can cause cancer. Yes, thats right, we learned how certain viruses can cause cancer. I imagine 10 years ago med students did not learn this... Meaning that 10 years from now students will be learning things well above what I know now. They say that the majority of the science that you learn in medical school is discovered to be no longer valid, or just completely incorrect 10 years after you graduate. Crazy to think that but also amazing that our collective medical knowledge is developing so quickly.




The girl sitting next to me is on the phone and having a personal conversation, making it tough to focus on what I'm texting, yeah I'm on my cell phone right now, how cool.
Cheers

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Trying something new... first blog from my phone.

If you want to know how soon my next exam is, ask me to tell you today's date.... the further off my response, the closer the exam. This morning i thought it was the 9th. Then I quickly corrected myself and stated that it's the 11th! proud of my amazing memory, even under times of high stress I was impressed by how quickly time has gone by in medical school.... That's when I was told that it in fact is the 16th.... as I write this, I'm on the T (subway) headed to school for another 12+ hour day of studying. Realizing that med school is probably the most time consuming and challenging thing I've ever done, I've decided to try something new. In order to keep up this blog, I'm going to attempt to write shorter and more frequent entries when I have "forced" down time, such as when I'm commuting to and from school, clinic or hospital, which means I'll probably be on the T while doing this. My idea is also an excuse to spend more time using my amazing new phone. It's all touch-screeny, light-weight, super fast and neato. :)

Time to finish up... Next stop, Tufts Medical Center.

You see some crazy stuff in the Emergency Department, and every now and then a good film on a Saturday night...

The T (subway car) smelled like hard alcohol... it was the last one of the night, which meant it was just before 1am, and filled with a lot of people leaving the bars and heading home to skip out on paying for a cab fare. I just got out of seeing the movie "Waiting for Superman," a documentary about our public school system, the impacts of teachers unions, politics, effective teaching, social issues including income levels and neighborhoods surrounding schools... and a lot more... and how this is all affecting the education of kids in our country...

It was very well done, told engaging and powerful stories, and sent many necessary messages, but it was also incredibly frustrating and sad to be reminded that education is not equal in the U.S. Not every student has access to a great education, and the repercussions of that affect all of society. I'm not going to get into the details, I want to go to bed and it's late, so instead I'll say you should definitely see this film.

This movie reminded me of why I'm here in Boston studying more often than not, and spending my weekends in the library... because like education, health care is not equally delivered in this country. Both systems are broken, and I've spent most of my adult life engaged in both of them. During the last couple days in the emergency department I've seen a toe nearly cut off by a chainsaw, metastatic lung cancer so far developed that an untrained eye like myself can immediately see it on an xray, infected hands that require multiple operations to clean out, broken bones, chest pain, heart attacks, head injuries, people without homes who drink so much they arrive unresponsive, and a lot more... This experience is amazing, thrilling to be a part of, and a privilege to learn from, but I wonder, when I become a physician, what will I be doing to change the system, to have a positive effect on the patients who don't have the resources to be treated and don't have the voice to advocate for themselves... Luckily I'm in my first year and have plenty of time to figure it all out (I need to put more worry into passing my exams before I try to save the world), but I'm still not sure how I'll do this.

In the mean time, I'll be mildly upset and frustrated that the Huskies are about to lose to Arizona... not cool.

Damn Brits...

I have a love-hate relationship with british soccer players. Today was the Tufts grad school team's first game, and we played Harvard's business school... I'd say 80 percent of their players were from the UK, something I appreciate - growing up with british soccer coaches, but I'm also not a big fan of playing against them. They tackle so tough... I walked away from the game with multiple knocks on my knees and ankles. Limeys know how to play hard, which I respect, I just hate being on the other end of the tackle. It felt good to play hard, to win and to compete on the soccer field again. Oddly enough it reminds me of why I'll never be a surgeon. What does that have to do with soccer? Good question, I'll tell you:

I've broken my hand twice. Both times playing soccer. Imagine doing seven grueling years of residency after 4 years of building up debt in medical school, breaking your hand and then losing your money makers... Not a good place to be. For that reason, I will never be a surgeon.

Now that I'm on a consistent soccer team, I'm starting to feel a little more settled in Boston. I wonder when it will become "home"... There are a few things, however, that I will never be happy about in this city...

1. Drivers/driving in Boston. The roads are a mess and regularly lack signs, but that's nothing compared to the sh*t-show caused by the way people drive. I watch accidents almost happen every day on my 3 block walk to the T station (subway). I've seen pedestrians almost get hit and watched a lot of drivers shout and flip each other off. Chill folk.

2. Boston is an awesome city, but it lacks landscape. If you've been to Seattle you understand. After moving I realize how beautiful that city is. FTW.

3. This isn't particular to boston, but the amount of damage done to my ears on a daily basis... The T is super loud. What amazes me are the people who listen to their ipods on the T... especially when its loud enough for me to hear what they are listening to... when I'm not even sitting next to them. I can't say it enough, invest in companies that make hearing aids now... you'll be able to retire quite well if you do that. Us kids is losing our hearing from all our ipods and our crazy rap music and technology!

The photo is from the Blue Scholars show I was at on Wednesday. They are an amazing hip-hop group from Seattle, and also went to UW. Fantastic.

One-year anniversary...

Exactly one year ago I met one of my current medical school classmates (who is now one of my closests friends) at my first interview, which happened to be here at Tufts. It's amazing to think of the chances, that we would end up here together and then become such close friends. I remember sitting at the table during lunch, nervous, eager, excited, stressed… basically full of emotion… talking to a current Tufts med student and listening to his experiences and take on life in medical school.

Today, exactly a year later, my friend and I are on the other side of the table…. one might say "the tide has turned," or "the winds have changed…" what I mean by that is we are back at that same table but this time eating lunch with interviewees who are asking about our experiences in medical school and our take on Tufts. A lot has changed in a year. I have an entirely new set of friends, live in a new environment, switched from the West to East coast, officially went into major debt, and have even seen patients who take my clinical advice as if I were a physician…. silly.

With our first exam behind us followed by an awesome night of dancing and partying, we are back in the mix. Starting at 8:30am the next day, we had a patient presentation on Lupus, followed by more dull science-heavy courses, and now preparing for the start of my shadowing experience in the emergency department at Tufts med. The amount of time to unplug and chill is essentially zero. During lunch with the interviewees, we were asked how med school compared to being an undergrad…. as much as I want to say its not a huge change… it really is. Imagine having a midterm in Genetics, Biochem, cell bio, and molecular bio on the same day (a 3.5 hour test), but instead of having plenty of time to study, you don't because so much is going on… clinic, other activities, soccer, seeing friends, sleep, cooking food, exercise… yep, it gets to the point where you actually factor in how much time you will spend cooking… I rarely cook anymore. It's sad.

On the note of time, I've run out of it and will have to write/blog some more stuff later. Off I go to the emergency department to get a taste of life in the fast lane!

Stick it.

The room was warm, but that wasn't why I had to wipe my forehead with my arm to keep the sweat from dripping on my patient's left arm where I was about to put a needle into her vein. In a moment like this you have to be confident, hide the fact they are the first non-medical student that you will be drawing blood from, and not doubt for a second that you will succeed... even though you can't see her vein... That's when the confidence kicks in. Relying on tactile senses, I felt for the vein, stuck the needle in, saw the flash of blood in the first chamber, and with a little bit more maneuvering (mostly putting the needle in a little deeper), we filled the test tube with dark red, minimally oxygenated, venous blood. After that, I became the first 1st-year to be certified to draw blood at the free clinic that Tufts students run. I stuck it.

You wouldn't think it, but the first couple times you put a needle into someone else is actually quite stressful. A few weeks ago, the first student to practice on me, one of my friends, was shaking so much that she had to pause and collect herself. We then talked through and reviewed the steps she would take, and after settling herself, she got back to drawing my blood. Now that I've drawn blood a handful of times, I can't stop touching my veins, or noticing when one of my friends has superficial veins. It's strange.

I wonder, what will it be like the first time I assist in a surgery, or even just place a chest tube, or drain fluid from someone... will I be feeling the same way I felt when I first drew blood? Does it get easier? Does it get more or less exciting?

As you can see, the clinic experiences are the ones that carry the most weight for most medical students. In class, we get wrapped up in details and stress about the next exam which happens to be a week from now. We will be assessed on our knowledge of a combination of the courses we are currently taking, biochem, genetics, cell bio... They'll give us 3.5 hours, and after that we'll be that much closer to four years from now when we become what the outside world considers "competent..." This material is simply not my thing, which makes it that much more frustrating that I've spent roughly 20 hours since friday studying this stuff (its monday right now). I'm looking forward to neuro and anatomy, which both come later in the year. Until then, I shall keep on studying (this was my study break).

I am now two days in to my second week of medical school. Unfortunately it is true; this process consumes your life and eliminates much of your free time. When you aren't in class, clinic or hospital, you are studying, and if you're not studying you are eating food or working out, and if you aren't doing those things, you feel guilty. As I write this I'm deciding which of the classes I have tomorrow that I'll make time to study for today, because I know I won't be able to cover them all. I'll do a quick skimming of the biochem lecture after writing this, then eat some food, then breeze through one of the cell bio lectures while riding the crowded T (metro/subway, which will be full of people leaving work and headed home) as I head to the free clinic I'm volunteering at. If there is any down time there, I'll consider reviewing some notes, but most likely end up talking with 2nd years and practicing blood draws, taking blood pressures and listening to heart and lung sounds... With that, it means that I won't go over any genetics and lack time to read for the second cell bio lecture I have tomorrow. Shucks... at least we have a 3-day weekend coming up!

Luckily, not all of school is hard science. Tuesday I work in the clinic, and Thursday we have patient interviewing. This is where I discovered that I never want to age past 30... it sounds terrible. The course gives us the opportunity to interview patients about their life, their experiences with the health care system and understand their medical history and current state of health. Many of the patients are of an elderly population, and it is simply amazing to hear all the medications they take, specialists they see, surgeries they've had, and other chronic and acute diagnoses that they've dealt with. I simply can't imagine having to keep track of all that for myself. When asked about their health, often the response is, "I feel great. I'm 83 and still staying active." Then after a few more in depth questions you come to find they recently visiting the emergency department for an injury, are taking a handful of medications for chronic illnesses, and are limited in what they are able to do in their day to day life due to surgeries or other diagnoses. It was incredibly eye opening to hear their stories and understand that its not a rarity to be so tied into the health care system as we age...
*Apparently the fastest growing population in the United States is currently that of 85+

On a much lighter note, the photo above is what I see after walking about 20 yards outside my building. It's a great way to start my day, walking to the T to go to school, a view like that can't hurt. For the sake of my sanity, I'm going to retire to study. I was told by a friend that they actually read this blog, so I promise I'll make an effort to write more entries.