How I learned about medicine this year

During my second year in medical school, I wrote an email to the rheumatologist with whom I spent some time during M1 year. I told her how I would more easily remember the insignificant, non-medical trivialities from my lectures rather than the testable, high yield, board-relevant material that I was spending so much time just trying to care about at times--let alone learn.

Today, as I prepare for boards, I find myself in a similar situation: fighting the urge to gloss over certain diseases, risk factors, etiologies of conditions that at times mean very little to me. Every so often I'll come across a condition that links to a friend I have, a patient I saw, or an encounter in the hospital. Myasthenia Gravis, Essential Tremors, Multiple Sclerosis are replaced with the faces of the friends and people who have played an instrumental and meaningful part in my life these last few years. For a brief moment, they become my daydream, my escape, an absence seizure from the world of medical terminology.

If you asked me about acute pancreatitis, I could not tell you Ranson's Criteria but I can tell you all about the homeless man that had it--how he was a boxer in his youth, could control his blood pressure with his mind, and how he would roam the streets at night living a life that you would only see in movies. If you were then to ask me about Meckel's Diverticulum, I could not tell you the specificity of scan to detect it (the sensitivity yes!), but I could tell you all about the anguish and cultural intricacies written all over the a Chinese mother’s face as she couldn't understand why the surgeons had performed the surgery on her son when there was no Meckel's to be found in the OR.

And so this is how it has been for much of the last year; it has seemed to me more of an experience than an education. I ask myself what exactly I did this year outside of accumulating a treasure chest of stories that I might one day dig out for the sake of good conversation.

Furthermore, in the back of my mind, I am terrified that this will not be enough--that these ruminations will be woefully inadequate for me to master the information I need to effectively convey to my future patients. I ask myself whether these reveries are but an expression of laziness that serve to convince me that I really am engaged with the material.

Having said all this I return to my letter to the rheumatologist. In her reply to me she wrote the following.

"I was always of the opinion that recall of all those meaningless trivial facts was the sure sign of a bright and inquisitive mind, one that had room for lots of stuff, not all of which came from books! I think it also means you recognize the humanity in us all, a good trait for a doctor to have! It helps to reinforce the concept that we take care of people, not just diseases, and that humanity thing is what keeps medicine interesting and relevant."

Looking back at her words, I take hope in the larger picture. For I am neither naive enough to believe that a better academic performance would have proved a greater personal dedication to my craft nor am I delusional enough to think that every mistake I've made is simply a product of a bright and inquisitive mind emerging from the chaos that is medical education.

The reason why I got into this was because of the people I met along the way. As much as I conceptualized what medicine should look like, the only reason why I am still in school is because of the people who showed me what medicine could look like. In the end, the latter is what I have to hold on to for now. With each new experience stones will shift, clouds will clear, and visions will change. That is to be expected.

For now, the words of my high school Spanish teacher ring through and through
"Lo que sera, sera..."

The Problem With Hipaa

From a patient care point of view HIPAA preserves the privacy of those within the health care system. It is necessary given the sensitive nature of the medical profession. For a physician, patient privacy is intertwined with the trust that is essential in the patient-physician relationship.

At the same time, HIPAA robs the patient of his or her identity. Violia Freeland becomes VF or "63 year old Caucasian female" when I try to describe her to someone else. The absence of the name reduces the subject into a collection of symptoms and attributes, many of which aren't particularly unique, but all of which together, forms a unique narrative and a special individual. It is within a person's name that everything becomes attached- chief complaint, history of presenting illness, past medical history, social history--all of this becomes significant because they comprise parts of this person's narrative. This is why the name is important; because without it, I must try to make sense of a faceless entity. Perhaps this is why so many medical students like reading cases instead of textbooks because instead of an outline of factoids, we are reading a vignette, a discussion about a story, how this story relates to others (a differential diagnosis) and a treatment that pertains to this specific case.

As this M3 year draws to a close, I find myself thinking about the many patients I came across throughout the year. I realize that there are many patients that simply became faces in a sea of daily activity and yet there are others whose names and stories will remain with me for quite some time. It comes to me as no surprise that I often have names to attach to the latter. This isn't to say that the former were insignificant experiences--there is still much value in them yet--but when it comes down to the core of medicine, I believe that there is a significance to beginning with a name, a face, a history before the physical. While the lab work and imaging studies receive much of the attention, money, and publicity when it comes to health care, I have to remind myself that the reason why I decided to stick it out this past year was because I hope to one day assist the Leonard Andersons, William Hartwigs, and Suzanne Bowens, to continue living their lives, no matter how long or short their narratives may be.

Inpatient Medicine

In the morning, we round on patients and monitor their progress. In the afternoon, we make phone calls to track down patient records, call primary care physician offices to schedule follow-up appointments, update other physicians on the progress of their patients, and on top of that try to deal with the myriad of social issues that inevitably arise with our patients. In the morning, we do what most people would imagine a doctor to do. In the afternoon, we do all the crucial busywork in an attempt to ensure some form of lasting continuity to whatever clinical improvement is made during a patient's stay at the hospital.

The term that keeps coming up in the hospital in reference to some of our patients is the word "babysitting." We make calls to their doctors when they should be doing it themselves. We repeatedly try to convince them to take their insulin when they complain they don't like getting shots to prevent one or more of the innumerable consequences of diabetes. For all the complexity that goes into learning about obscure diseases and the latest evidence based medicine, playing the social game is often just as difficult and a hundred times more draining.

It would be easy to blame all of this on patient lack of education, but the reality is that the messiness extends to all levels of society. Richer people may be more knowledgeable and compliant (and even this isn't a guarantee), but this does not always guarantee gratefulness or the ability to cope with dire circumstances. The mix of uncertainty, anger and denial will make the most educated person irrational--and all it takes an already stressed-out intern or jaded senior resident to turn a normally workable situation into an intolerable one.

It is this afternoon work that often drives many residents to do everything they can to avoid the social mess that is the modern health care system and pursue careers in outpatient specialties or more surgically oriented fellowships. After all, why should one go 200K in debt to subject him or herself to rude patients, patient who won't take their medications, chronic drug abusers who abuse the health care system as much as they abuse the drugs, and have to spend hours calling hospitals just to track down some test that was done 5 years ago that may not even end up being useful in the end? Why wouldn't you want to go into a field where you can dictate the patients you see and only have to deal with patients who actually want to see you?

Inpatient medicine is not merely Patient X has Disease Y that must be diagnosed by test Z and treated by drug 1 or Surgery 2.

No, it is much more often Patient X with disease Y will not take Drug Z for his condition Q which causes him to come into the hospital with complications A,B, and C leading to hospital stays that require expensive testing 1,2,3 that are ultimately paid by the taxpayer because Patient X is on Medicare or unemployment.

The 12 Days of Trauma

Inside the hospital, the only sign of the season comes in the form of festive bake sales, the occasional floor decorations, and maybe the occasional Christmas music in the OR. For those on the trauma service, winter is most welcome because it marks a decrease in the number of traumas. Unfortunately, people will drop by for a visit. During my trauma rotation I have experienced the following:

Black people shootings.
Old people falling (while hopped up on coumadin)
Young women motor vehicles colliding (into trees, other cars, +/- intoxication)
Many bones fracturing
Much rectal examining
And healthy dose of X-ray/CT imaging.

General Surgery

Having wrapped up the general surgery portion of my surgery rotation, I'm pretty glad that I had decided to not join any fantasy basketball leagues this year. Having been an avid fan since junior high, I decided last year to start playing again when a family member enticed me to join his uber-competitive cash-incentive laden league. I won that league, marking a successful comeback from my three year hiatus from fantasy sports. This year, however, I didn't think I'd have the time to really invest as I would like so I had to painfully decline the couple invitations this year.

These days, I find myself myself jumping on my computer to check on how my patients are doing. Instead of points, rebounds, and assists, I'm looking at vitals, progress notes, test results. Admittedly, these aren't the most exciting stats especially since we're not really shooting for extremes. Still, I'd like to think there's a certain head to head match up going on with death or even just surgical complications.

So every night I watch in anticipation and the following morning, I go see the results first hand. I realize it's probably not the wisest thing to compare patient care with fantasy sports, but the more I think about it, there's probably a good number of similarities that could be made. That's another post for another time.

Three things

One of the surgeons came up to me today and told me that I needed to learn three new things about every surgery I attended so that by the end of the rotation, I would have accumulated a nice fund of information from which to draw.

Today, I had only one surgery--the ventral/umbilical/incisional hernia repair. This is what I learned.

1. Repair necessitates cutting through the falciform ligament
2. Mesh should have at least 5 cm around the hole to ensure stability
3. Suturing the fascia to the mesh helps with stability and hematoma development.

I also present three things from the OR discussion relating to the implementation of new CT scans/pat downs in airports and the needless radiation exposure/invasion of privacy that this will generate.

Surgeon: I shouldn't have to subject my children to this (pat downs) just because I don't want to expose them needlessly to radiation.
OR nurse: If it wasn't the government doing this, these would qualify for sexual abuse.

OR nurse: I'll take the pat-downs over the X-ray any day. Heck, I'll even do it twice.
Scrub tech: Yeah, and while she's getting them, she'll probably forget why she's even getting them in the first place.
OR nurse: Everything I've learned I owe to you.

Nurse: my (Caucasian) friend recently got patted down at the airport while a 25-year old fellow Arab passenger got through untouched.
Indian Doctor: In that case, I'll be expecting my rectal exam when I go through one of those lines.
Nurse: Yeah, you'll be like, "Hey, that's not your hand..."

Fences and Elbow Room

Today while waiting for a cholecystectomy, my team of one attending, two residents, and two medical students sat in the physician's lounge chatting about various subjects. My attending raised the issue of how everyone in his affluent neighborhood was putting up fences around their yards. It was silly, my attending bemused, how our relationships with our neighbors were becoming increasingly defined by such a strict sense of privacy.

Sometime later in the conversation, my attending went on to share this story.

"So I took my kids to Disneyland and my son was all up in people's butts the whole time. I had to finally pull him aside and tell him that part of what defines Americans is how we want our elbow room," He propped his elbows up accordingly to show how he symbolically demonstrated to his young toddler the concept of privacy.

"And," he continued, "for the rest of our time there, my son was walking around with his elbows like this," he repeated the gesture a second time.

Thinking back to this conversation, I realize that the hospital is the exact antithesis of the coveted privacy that Americans pursue. Here, a patient is stripped down to their most basic needs (pain, passing flatus, urinating, ambulating, and appetite). In order to receive help, he must be examined, poked, prodded, cut open, and assisted in rudimentary clothing (the hospital gown) by strangers not of the patient's choosing. He is furthermore forced to trust strangers with their most intimate details (sexual history and social history) with really no way to ensure that their confidentiality will be preserved (nurse gossip anyone?). This is both uncomfortably alarming and yet intrinsically necessary to the current health care process (because even the nurse gossip becomes a way to preserve the sanity of the participating parties).

If people were willing to subject themselves to such treatment for the sake of personal health, how different our society would be if we were willing to place ourselves in similarly compromising situations for the sake of our fellow man?

The efficiency of social medicine

Yesterday I spent time at the free clinic that the ob-gyn residents run for indigenous patients. The last patient we saw that day was a post-menopausal elderly woman who presented with chronic cystocele and rectocele issues. This patient had already had significant spinal surgeries in the past and was wary of the complications involved in the post-surgical healing process. My resident showed a remarkable amount of tact over discussing the option of surgery. From a physician point of view, it's easy to take such delicate matters lightly when discussing patient options. It would be nice to believe that the decision is a simple yes or no decision or as medical people like to put it, "a matter of doing what's best for you," but the cost of surgery is more than a financial one; it is also an emotional and social one as well. Several times over the interview, my resident repeated herself to the patient regarding treatment options and quality of life issues. On one hand, this took more time, but on the other hand, I believe it also played a role in helping the patient make her decision. In the end, the patient still had to weigh her options.

Today, I went to see an ophthalmologist in town to discuss possible cataract surgery. The group here in town has a cushy facility that is a stark contrast to the clinic I spent time in the day before. The place was packed with the elderly. Having had to deal with congenital cataracts growing up, this was an all too familiar setting.

Somewhere in the large waiting room, an elderly lady voice asked a nurse,"Excuse me ma'm. Did they forget about me?"

As I ran through the litany of eye exams--the measurements, the letter charts, the dilation drops--I became increasingly impatient over the whole process. These were the things I had gone through my entire life, but over the past couple years, my failing eye sight had become a bit of sore topic whenever it came up among my classmates who really never understood quite what I was going through. "You really should get those checked out," they would say, or "I think you need glasses or something." These were the words of future physicians of the future. Beware of such "sympathies."

The ophthalmologist was a middle-aged male physician. A brief greeting without the handshake tipped me off that he might have been in a hurry, and as the interview progressed it became even more apparent that he was probably thinking more about the long line of people in the waiting room. He took a look at my eyes and asked me the purpose of this meeting. i told him my concerns and he presented with the surgical options. Somewhere in the conversation, the "doing what's best for you" cliche came out. When I had concerns about scheduling and financing, he referred me to his nurses. When I asked him about recent studies over new lens implants, he said they were "very good." As the conversation progressed, I began to feel hurried in my questions and concerns and increasingly irritated as well. I found myself repeating similar concerns because I sensed a growing anxiety within myself, but the hurried doctor sensed none of this. The interview ended with him getting up before me and having his nurse guide me out the door.

The moment a physician begins to feel or act hurried, regardless of how behind he or she is, you lose the essence of what it means to be a physician. What you essentially tell a patient through your body language or lack of explanation is that your time and comfort is more important than their well-being. Emotions are messy; they are, by definition, inefficient. They do not fit in your 15 minute blocks that a physician constructs in his or her schedule. I have little sympathy for doctors that take on heavy schedules to make more money at the cost of quality of patient interaction, especially in a private practice setting.

Driving home, I realized two things. One, I was going to find another one of his partners to do the surgery. Two, if I ever became a physician, I hoped that I would never conduct myself in such a manner. I understand stress makes people do things they might not normally do, but the doctor left a sour taste in my mouth. It's encounters such as the one I had today that make me even more cynical about the medical profession. Fortunately, for every doc like this one, I have had the chance to be with others, such as the ob-gyn resident, who demonstrate the ideals that I struggle to hold to as I continue in my medical training.

the shrink's office

Perhaps the most depressing part about a psychiatrist's office is that it has become a medical McDonald's serving medication. The time constraints compounded by the medical profession's inherent inability to deal with social problems makes this one of the saddest places to visit. Psychiatry has essentially reduced human suffering to the brain because it is much easier to throw medication at the brain than it is to deal with the complexity of people's lives. The most insidious part of all of this is that patients and physicians alike come to believe in the power of medication.

I try not to be so pessimistic about this but this is what psychiatry has become. You can speak of genetic predispositions, chemical imbalances, or even the glory of psycho- and behavior cognitive therapy but in the end, you are still dealing with a spiritual creature. Psychiatry categorizes disorders with nice lists. Meet 5 of 8 of these conditions for 6 months and you have this episode or that personality disorder. People were never meant to be viewed in this manner. But, psychiatry protests and fights back. It tries to defend its validity with more diagnostic criteria, more brain studies, and more drug trials that show "progress." It kicks and screams while its progeny stare back with their flat, constricted, ghost-like affect.

"home"

I went back up to Chicago this past weekend to spend time with other people's families. One of my high school buddies has to move back to the burbs this weekend to take care of his sick mother. Ironically, his dad and two older brothers are all doctors/doctors in training but for various reasons are unable to be home that weekend. So, my friend, the high school English teacher, was ironically the only one that was able to make it home to fulfill his filial duties. I am thankful that I don't need much to be amused and so I have no problem catching up over running errands for his mom, ping-pong wars, and even the obligatory basement poker night with high school acquaintances. In addition to playing many games of rummy with his mom to help keep her mind off her illness, we even have time to scurry downtown to play some ball with his city friends, which turns out to be an excellent opportunity to remind myself of the extent of my physical decline. Yes, it is 90+ and humid but even I can't blame that for the tightness I feel in my hamstrings.

The next stop this weekend was at my college roommate's parent's house in Naperville, IL. The reason why I am here instead of his place in the city is another family matter--his seven year old cousin from India needs baby-sitting. I am able to spend time not only with my college buddy but also get to see his younger brother and girlfriend who are here for the summer. Not that my friend anticipates having children any time soon, but watching him and his girlfriend take turns reprimanding, teaching, and playing with him gives me that eerie feeling of how fast time has flown by--and as if I didn't need any more reminders, my college buddy's younger brother is going to college next year.

Third stop takes me about 15 minutes south to my another friend's parent's place to meet more college-bound siblings and another girlfriend/fiance. Dave's family has always been pretty fun to hang out with, but at this point of the weekend, this theme of family (and the absence of my own) is starting to gnaw at me. It's hard to precisely define the exact feeling, but even if I am the type that is always trying to not get boxed into a specific category or group, growing up these last couple years has precipitated a sense of isolation that has caused me to yearn for familiarity and withdraw from initial discomfort of new experiences.

Last stop is to see my nephew and niece. I find myself almost envying their ability to play all day with few worries. Watching them grow up gives me the ultimate sense that time passes quickly My nephew is beginning to cry when it's time for people to leave. He hugs my leg repeatedly and I have to stop my own tears as I turn to leave to drive back to Peoria. I hate to say it but I'm not enthralled about third year--perhaps this is why weekends like this one are so bittersweet.

A book opens itself as much as it is read

As a mentioned in my last post, the phlebotomist at the clinic I spent time at was a memorable character. To me, she was a hidden story tucked away in a room between the kitchen and the area where patients were seen--a quiet yet bubbly woman who waddled in and out to get her blood draws. She would spend her free moments burying herself in a novel or knitting a pillowcases as wedding gifts for friends. Whenever I came by, I would trade pictures of my nephews and niece for her children. She always had stories to tell, beginning them as if they were a continuation of a previous conversation. What always struck me was how surprisingly detailed her succinct stories always seemed. Perhaps it was my vivid imagination that gave pictures to her words--images not drawn from prior experiences but perhaps conjured from a separate life that had merged with a collective conscience.

One story that struck me in particular was one that she shared about her mother when she passed away. She and her sister had decided to live with her mom during those last weeks trying all the while to hold themselves together emotionally. Alcohol was as as abundant as the grief. Mom used to bake pastries and pies all the time for the family, it became a family tradition of sorts. So during those last days, the two daughters baked pies for mom and when alone drank in the melancholy of the moment.

When I hear stories like this, my somber soul insists that somewhere therein lies a serenity that supersedes sadness. I can't quite grasp how this is logically possible, but if sacrifice can surrender to salvation, then something about this must be true.

Perception of Competency

During my M1 year, I shadowed a local rheumatologist in the area. She was pretty good at explaining concepts, most of which I wouldn't learn until my second year. I remember talking to her secretary and how she said that this doctor could have done anything she wanted: surgery, other medicine specialties...she was that good. Based on what I saw and heard from my personal conversations with her, I could believe it.

This past year I was able to spend some time in clinic with one of the FPs here in town. He worked at the federal clinic, and though I spent most of my time with my preceptor, I also had the chance to talk to the staff around the office. During my first week in clinic, the phlebotomist (who actually let me stick her because I needed practice drawing blood) remarked that "nothing seemed to faze him." Throughout my three weeks in clinic, however, I couldn't shake the feeling that there were many times where he wasn't sure what to do with certain patients or when I had questions, he didn't have an answer. To be fair, perhaps some of these questions were more geared towards specialists (I mean this is why they have extra training, right?) or the patient he had was indeed a difficult case. I could think of a plethora of variables to consider (town vs. gown, indigenous population, etc.) but the bottom line is that I began to realize that just like any other profession, there exists a wide range of competency when it comes to medicine.

I think this fact disturbed more because, to me, this seemed to insinuate that there are doctors out there who might be better off not practicing. I think about my own classmates and I see a wide range of ambition, competence, and motivation. I look at myself these past years and wonder where along this spectrum I will fall. I sometimes think that if people knew where doctors came from, we wouldn't be nearly as trusting of the medical profession as we are.

The second thought about all of this was the different levels at which people view their doctors. The FP had plenty of patients that had been with him for a long time and loved the guy. Certainly, this not only suggested that he was helping people medically, but that they saw something either about his personality or professional demeanor that led them to believe that he was doing a satisfactory job. The phlebotomist felt like the physician was always on top of things or at least in control. I, on the other hand, saw things differently.

the problem with blogging

I remember the first time I started this whole online "journal" thing it was like I found the golden ticket to meaningful mind dumping. Unfortunately, I soon realized that like most forms of electronic correspondence, this can easily translate to babble or really. bad. writing.

In addition to general negligence, I think part of my reluctance to write here is the ever present anxiety that comes with being vulnerable to an unknown audience. Context is so crucial when writing about anything meaningful that it can be the difference between generating incendiary remarks and constructive dialogue. I had a wake-up call a couple summers ago when one of my former co-workers said that my summer job boss came across one of my blog entries about my work experience. Of course, it was pretty much a harmless, feel-good post at the time but it has made me much more wary of the type of things that I talk about.

Still, in weighing the pros and cons of spilling out details of my life on the internets, I have decided that I would like to make a more concerted effort in keeping this thing going. This doesn't necessarily mean I'll be posting about that girl that I'm currently dating (because if I did, it would be, among other things, a total fabrication at this point) or like a twitter account.

Another reason for starting anew is that I will most certainly always find myself behind when it comes to corresponding to people individually (email, phone calls, etc). For those of you to who are waiting (or have given up on reaching me), my lack of responses have been due in part to a paucity of words these last few months. I find that especially this past year, written words are hard to come by. I won't blame school on this one but there is something about a style of learning that embraces study books and bullet point memorization that has squashed my expressiveness. Even when I journal on occasion, mind dumping comes at a much reduced flow rate and with much higher resistance--a "literary constipation" if you will.

So where to begin? I have finished my second year of medical school and am preparing for national examinations on the 24th. I won't bore you with all the details, but I have lost count of how many times I have asked myself if medicine is really for me. School starts almost immediately after boards and as of now, I am giving myself another year before taking any drastic action.

I have occasionally found myself at church on Sunday mornings, but usually sneaking out pretty soon after. It's been a unique experience for me in terms of the interactions I've had with the people there. The church is small enough that everyone is aware of me, but I think three of them actually have spoken to me or know my name. I recall the weekend of Palm Sunday where they were handing out palms during the last song of the service and one of the ushers got to my row with the palms (I was the only one in that row), stared at me somewhat awkwardly, and then moved on to the next row. The couple in front me of me actually got a palm for me, but looking back, I think this epitomized the type of detached relationship I've had with this congregation. Considering that the church is so small, I'm sure I am known as "that Asian guy that sporadically shows up."

hello, there, still in Peoria...quite so.

I've been admittedly poor about updating this thing and I'm not sure who still reads this. This will probably be the easiest medium to write to the largest number of people, and since I've come to realize that my one email to one person ratio is becoming increasingly impossible, I'll have to settle for this. Hey, at least I haven't settled for constant one liners on Facebook.

Concerning this whole keeping in touch thing, I've realized that the combination of my introversion with the excuse called school has provided a ripe environment for scarce updates. I'll do what I can in the next few months leading up to boards (another wonderful excuse) and see how it goes.

I just had my History OSCE this morning which is an examination of our history taking skills. Aside from running out of time at one of the stations (I didn't get a chance to take the woman's temperature), I was able to get through each patient with varying degrees of accuracy. I realized sometime in the last few days that it will be difficult for me to really polish any sort of bedside manner until I've become comfortable enough with the basic skills involved in history/physical exams. I find that I either spend too much time trying to be friendly that I overlook certain details or that I become too business like to really crack a smile of some sort. And, I'm okay with that for now, because, I need to get good good at figuring out what's going on with the patient before trying to show them what an awesome person I am.

Second year has been admittedly difficult in terms of learning large amounts of material. Part of that is discipline, and part of it is trying to figure what's really important. I've been fortunate to have some friends here without whose help I could be really struggling--even more than I am now. I these last few years have taught me anything, it's that I've become more comfortable finding help.

I'm currently waiting to find out where I'll be doing 3rd year. I signed up to do my rotations in a rural community somewhere in Illinois. The pros are that I would have a specific preceptor who i work with (Family Med) on a day in day out basis, and that I would get a lot more hands on learning which I am finding is much more effective for me. I'm even finding that my most effective learning this year has come from discussing topics with friends and that my efficiency from reading has quite literally gone down the tubes (scary).

At the same time, I am also wary of moving to an even smaller town especially since my time in Peoria has been a mix of both lonely at times and busy. Of course if I got to know the people there and found a niche, it could be great. Many possibilities. I'm supposed to hear back about whether there will be enough spots to do this next year. Either way, I've come to a certain degree of peace about the whole situation, even if I can't completely understand it.

I'm thinking primary care, but am also interested in medicine. There is a part of me that thinks that I would need to work even harder if I were to go into primary care precisely because it is the gateway from which all referrals are made. Specialists (at least in medicine) seem to have a more focused spectrum of topics to deal with. This kind of makes things exciting, but given my ability to grasp material this year, it's also intimidating. As for surgery, I'll just wait till next year.

It goes without saying but I miss the familiar faces whether it's family or old friends. I know that it becomes harder to really get to know people as one gets older. I am not in any hurry to date anyone but I acknowledge the perks of having a lifelong companion. I realize that there's still so much to learn when it comes people and that I have a tendency to want to fit people into stereotypes not simply because it simplify things, but because somehow it becomes a sort of stabilizing pillar in my attempt to make sense of the world around me. With my parents in California and one of my sisters soon to be moving to Hong Kong for a couple years, I have been increasingly aware of my solitude (even if it is only a perceived one) and no doubt that this has contributed to this loneliness.

As for my faith in God, that continues to be a sort of mystery. I wish things could be much simpler in this regard. If it is not possible to straddle the fence, then i do not know where I am. I am well aware of my own limitations, as well as other peoples limitation, and I know that I can never fully depend either on own strength nor on the infallibility of otehrs. If God is that stabilizing force (and much more I presume), then I can only trust that he will find me in all of this.

Immunology

Many of our lectures involve discussion of various experiments that have been aimed at determining what causes a particular disease. Different treatments will aim at blocking particular mechanisms so that the body doesn't respond detrimentally. While there is no doubt that some of this research has lead to remarkable progress in treatment (for example, rheumatoid arthritis). I often wonder how much of these new drugs/therapies, while precisely targeting the molecular causes of a disease, are also merely addressing the symptoms of greater lifestyle issues. I know that saying that a person has disease "x" because he eats Oreos everyday isn't altogether true, but by the same token, I wonder if for the individual, the sandcastle of medical research is only as good as the periodic tides of social ills allow it to be.

In other news, school wraps up on the 22nd and it looks like I'll be spending some time in Detroit, the city that everybody is fleeing, and Irvington, IL, a rural town where few live to begin with. In between, I'm looking forward to spending time at home before heading out to Peoria in August.

Grocery Shopping Win

Today I went to Schnucks to get some groceries and saw that Kashi had come out with new flavors of TLC bars. My mom used to buy large 24 packs from Costco that included the honey flax, trail mix, and peanut butter varieties. It turns out that there are now three new flavors: pumpkin spice, dark chocolate coconut, and chocolate raspberry. Excited, I decided to get the latter two because they were on sale (3 for 8).

However, when I looked at my receipt, I noticed that they had mischarged me for the Kashi bars so I went over to the customer service booth to get a price check. Of course, Schnucks was wrong. Furthermore, I was pleasantly surprised when the girl behind the counter told me that because of the incorrect scan, I would get the first item back for free. Elated, the first phrase that came to my mind as I walked out to the car was "Grocery Shopping Win." The second thought that came to mind was "Man, too much Failblog."

med school bracket

Some people in our class have a pool for March Madness, five dollar buy in. I was looking over the current standings and noticed someone had entered two brackets. The first thought that crossed my mind was, "Dude, this guy really wants to win." Then I looked at the name. Turns out this guy is a graduating MD/PhD student who is going to Brigham and Women's for Emergency Medicine. A bright guy to say the least. Having had this guy as a TA for physiology and knowing him to be a bit uptight (and that's being generous), I can't say I was terribly surprised.

And if you're curious, I had UConn winning it all.

sleight of grammar

Two friends of mine enlightened me today about how they received help during anatomy dissection.

"We used to just clean everything out, get Martha (the anatomy guru/prof), and say, 'So Martha, what do I got here?"

Eventually, Martha got fed up with this display of academic laziness and told them to look in the book for themselves. Undeterred, my friends adopted a new strategy:

"So what we did was clean everything out, get Martha and say, 'So Martha, I think I found {insert anatomy part} but I'm not sure..it looks abnormal...it looks like..."

And in-between these false expressions of conjecture, Martha would eagerly jump in and say "Oh yes, this is a great example of..." and so on.

Talk about playing the system.

"they're just haters"

A friend of mine told me today that instead of telling his mom to pray for his schoolwork, he should just tell her to pray for the rapture.

"What about the other people," I ask.

"The rapture won't happen until everyone has heard the gospel," he says. "Besides, they had their chance. They're just haters."

a rarity in the lecture hall

Recently, my histology professor made a comment during class for which, if I hadn't been so startled that he made it, I would have applauded. The lecture dealt with the reproductive system (testis, vagina, etc.) and he was talking about the increasingly strange cases that he had seen over the years as a pathologist. He said that we should be more concerned about all the different chemicals and substances being used in industry (food, specifically) which are absorbed into our tissues than about global warming. And on days where temperatures are hitting in the low teens in mid-March, I think I'd have to agree.

But still, whatever was in that Italian sausage that I had today was pretty tasty.