A Rite of Passage for All in Medicine

Medical students have the fortune of dealing with gore, germs, and gas.  It’s part of the unwritten law when we sign on to roam the wards in the beginning of 3rd year.

Now, I survived most of my clinical years without getting urinated on or blood squirted at.  I did have the grand luck of scrubbing into a gyn-oncology case involving a pelvic mass that was most likely metastatic ovarian cancer.  The surgery involved a massive tumor debulking with an exploratory laparotomy.  This woman had 11 liters of ascitic fluid in her belly due to metastatic disease.  All of that poured out and no suctioning could keep up with the overflow.  Of course, from my standpoint, I bore the brunt of this overflow when the suction failed me.

Flash forward to my 4th year now.  I’m on a trauma surgery elective.  There is a patient on the floor under the general surgery service who has a small bowel obstruction (SBO).  He hasn’t been passing gas (aka. farting) or making bowel movements.  Plus, he started vomiting again.  Clearly, he was obstructing.  The next step in management would be decompression via nasogastric placement and suction.  The nasogastric tube (NGT) is inserted through the nostril into the nasopharynx and oropharynx, and hopefully down the esophagus into the stomach.  The suctioning helps to decompress the bowel and allow the bowels to ‘untwist’ to relieve the obstruction.

I’ve placed one NGT before at the Peconic Bay ED.  It was painful seeing the patient gag, vomit and suffer.  Last month in the ED, I observed an NGT placement for a man with a high-grade SBO.  Even with the lidocaine anesthetic spray in the throat, the poor guy was gagging and swallowing really hard to push that tube down.  Simply witnessing an NGT placement makes ME hesitate, choke, grimace and tear!

Well, opportunity presented itself this week on trauma service.  Hey, I signed up for this elective to DO stuff, right?  A surgery resident was next to me.  The nurses attached the tubing to suction. I put on a pair of gloves and mercifully lubricated the NGT.  The bucket was strategically placed in front of the patient.  I looked at him, put my hands on his shoulder as I looked him in the eye and apologized profusely for what I was about to do.  By far, it is the most uncomfortable thing to witness and perform, but most certainly to experience first-hand, awake.

My resident assured me, “Make sure you keep going and do it quickly.” Okay, I braced myself, armed and ready to go.  Before I went for it, I said, “Sorry sir, it’s going to be a little uncomfortable, but I’ll make it quick.”  I lied.  It was not quick.  The tubing went in and struck the back of the nasopharynx.  It was plastic tubing, so I was banking on it to cooperate and just bend.  But the tube kept hitting a dead end!  I just needed to push it a little harder to get past the impediment.  In the meantime, my patient was gagging and tearing in discomfort.  My resident stepped in and pushed the tubing down like a pro.  This all happened in a matter of 5 seconds, which is not very long in layman times, but at the bedside, it felt much longer.  Boy was I tense, sweaty and wide-eyed.

Oh, and as he was lying in discomfort after getting a tube down his throat and I was at his bedside patting away his misery, he vomited smelly green fluid all over my left hand.  He missed the bucket and bulls-eyed my hand, and white Swatch.  I should have been smarter with my positioning and gowning.  I mean, my hand should not have been in the path of potential vomitus nor over the bucket.  Still, I did not leave his side and continued to reassure him that he was okay and the worst part was over.  Unless, he thought the worst part was vomiting on me ….

After I washed my hands (and watch), he apologized profusely.  I do not know if he was red from the embarrassment, the vomiting or the nasogastric experience.  The next few days on early morning rounds at the bedside, he continued to apologize for puking on me.  No matter how much I smiled, saying “It’s okay, really…,” he would greet me with, “I’m sorry again for what happened last time… really really sorry.”

Well, he was a very nice patient.  But I like to have a “lesson learned” tidbit at the end of an entry.  The next two nasogastric tubes I did on the floor were great successes, meaning no projectile action or embarrassing moments.  And those times, I armed myself with a blue gown for added protection.  Just in case …

Boo Ya, Anesthesia

As a 3rd year medical student, life and work can be demoralizing.  You are a perfectionist by nature; you dare not succumb to failure.  To you, failure could mean the inability to stick a vein, not being able to spit out the criteria and numbers for different stages of sepsis, or simply being … average.

Popping my bubble

It’s hard to admit, that I’m simply mediocre now.  I’m no longer the magna cum laude student, rockstar laboratory extraordinaire, artistic organic chemist on paper, or master calculus calculator.  I can excel on the hospital floors, writing the perfectly organized (and legible) SOAP progress notes and spending quality time talking to the patients, taking their histories, and doing a very thorough physical exam.  I can attain the perfect clinical grades and positive evaluations, on Surgery, Ob/Gyn, Pediatrics, Psychiatry, and Medicine.  And you know what pops my blissful bubble and leave me deflated like a breathless balloon?  That’s right, the dreaded shelf exam.  At Stony Brook, your final course grade practically depends on the final shelf exam.  Each rotation is very variable. In Ob/Gyn, the shelf exam is worth 10%, versus in Surgery, it’s a whopping 30% and the main determinant.  Heck worse, in Pediatrics, which I totally should have attained an Honors, the shelf exam is  not even factored in; it’s a mere qualifier! That means, no matter what your final tally is, if you don’t reach a certain percentile, say 50th percentile, you absolutely cannot get a High Pass!  And these shelf exams are long, stupid, and arbitrary, where you are compared to the whole nation of medical students taking the exam.  Many times, I learned more about patient presentations and management on the floors, and not from these stupid shelf exams.  If you are a good subject test taker, the odds of doing well are in your favor.

For me, I suck at taking tests.  I’m at a clear disadvantage already.  With each rotation, I go in with enthusiasm and determination; I come out slumped and slugged.  I cannot say I’m satisfied with my mediocre passes, because I know I could’ve achieved high passes and honors.

I did make one simply, yet playful promise to myself:  the first clerkship you get Honors is the field of your destiny.

Guess what?  It finally happened today!  Interestingly, the two fields I’ve been debating between happened to be the ones where I’ve attained the highest grades this year.  Both happen to be my elective clerkships, where, surprise, you don’t have shelf exams and heavily based on clinical experience!!

Time to Celebrate! All I wanted to do was top of a fine day with ddukboki, kimchi and rolled eggs, but it’s always the cork and my nonexistent biceps that defy me!

So destiny has spoken … ANESTHESIA it will be!  I did 2-weeks in January, and absolutely loved it.  I was very much involved in patient care, took initiative to do procedures and ask questions, and worked hard to study the basics of anesthesia.  Even after my 2 weeks, I was still attending the Wednesday morning Grand Rounds (I was not there simply for the morning coffee and muffins).  It is a specialized field with a set knowledge of physiology and pharmacology you apply to patients of all kinds, from young to old, sick and healthy.  You learn to take care of sick cardiac patients, see through the delivery of healthy babies and care of the mother, manage pain, and much more.  With so much diversity in patients and cases and opportunities to jump into emergencies, you become the master artist of resuscitation.  That’s what I realized I loved.  It feels mighty exhilarating to finally see the light at the end of the tunnel, the light that you can reach your potential and succeed, personally and academically.

Here’s a snippet of my clinical evaluations, which has also helped boost my self-confidence that I am making the right decision for myself, and not anyone else:

“Connie was enthusiastic and eager to learn about anesthesia.  She was a bright student.  She had excellent interpersonal skills.  She was engaging, inquisitive, and personable.  She was always behaved in a professional manner.  She was well prepared.  She was successful to perform careful endotracheal intubation  in the operating room. She also successfully mask ventilated patients in the OR , and place ivs. in the OR as well as oral airways, nasal airways, LMA, spinals and epidurals.  She also particpated in the pre-procedural time out.   She was a great team member-always helping out and was attentive to her patient.  she showed great enthusiasm in procedures and “hands on” patient care.  she was actively engaged in discussions of relevant clinical topics.”

Now popping my precious balloon

My mother has always been tough on me.  She wants me to enter a field where I can accumulate the moolah.  She wants me to do hematology/oncology.  Never has she supported me.  She’s been good at poking a needle into my blissful bubble and making me feel inadequate and terrible.  She’s good at pointing out my mistakes and saying, “See, you have a terrible memory… you can’t be a good doctor, let alone an anesthesiologist.” It hurts when I don’t have her support and confidence and she doesn’t listen to my interests.  Publishing compliments and gloating over my first Honors are not to boost my ego or show off; it’s to prove to my mother and myself, that I am capable of realizing and following my dreams.  I can be good with procedures because I’m not clumsy all the time.  I can be good with patients because I like to talk and comfort people.  I can be successful because I believe in myself.

Be Aggressive

That’s what the doctor said to me today… I finished my Pediatric Gastroenterology sub-specialty rotation this week with Dr. Daum of Winthrop. I enjoyed Gastroenterology out of all my courses in my first two years. Essentially, I am saying I love dealing with poop. Because all this week, almost every patient I saw with Dr. Daum in the office, was a constipated child. Even when I was in the endoscopy center, I thought I was going to see some crazy Crohn’s disease, ulcerative colitis, esophagitis, gastritis, or other gastrointestinal problems. Nope, I only saw a boy with perfectly clean intestines and apparently “very beautiful” villi in the small intestines because his mother wanted him scoped and checked from mouth to anus. And of course, he was just another constipated child with abdominal pain. Completely behavioral and functional in children and adolescents.

So why did Dr. Daum say I was a smart and fun kid who should “be aggressive.” That morning during NICU rounds with the chairman, he was there as well because one of the babies in the NICU was getting worked up for meconium plug. So that morning by the computer, my classmates and I gathered in the discussion about meconium plug and the differential workup to rule out Hirschprung’s disease. The doctors pulled up chest X-rays and asked us, the students, what we saw. Someone said “there’s a boot-shaped heart.” Then, long silence as the doctors asked us for any other observations. I pointed out the collapsed lung from a pneumothorax, where you can see air between the pleural surface and the rib cage. Ah yesss… very important observation.

That evening as the day ended and Dr. Daum had to run to a staff meeting. He said to me, “It was smart that you picked up on that pneumothorax this morning. Don’t be afraid to speak up. You’re a smart kid… Be aggressive… Because at the end of the day, you’ll be remembered.”  With these words coming from a doctor I felt intimidated in the beginning based on hearsay, I was knocked off my saddle.  In the beginning, I was avoiding any interaction with this particular doctor because he gave negative evaluations and was not very nice. Well, I experienced the opposite. He was an old-fashioned fellow, but he was thorough and kind with his patients and me. So I’m glad I made a positive impression.

Though he was running late, he spent a good 10 minutes telling me another important aspect of life as a doctor:  family is priority, medicine comes second.  Always. He was always available to his 5 kids. He said, “My kids will never say I was not there for them. Never.” And this is important for me as a future female doctor. I hope to be married by 30, settle down with my significant other, and have a happy family. From my experiences thus far in Ob/Gyn and Pediatrics, I just cannot wait to have babies, and I’ll want to be there for them from milk to milestones to merry-go-rounds. And with the lasting words of Dr. Daum, I can be assured it’s possible.

Making a Difference

Today was a full day in Family Medicine. I go to Bethpage Primary Care with Dr. Arcati, who has been a holy preceptor. The entire office is absolutely spectacular; everyone’s just super nice. I love them and they love me =) Dr. Arcati usually previews me which of his patients are “cuckoo” if I go see them and surprisingly, several of his most “cuckoo” were on their better behavior whenever I was with him for the day. I guess that as a guest, I temper his patients down a couple of notches.  And many days, I get taken care of with lunches from the various pharmaceutical representatives – Mexican, Italian, pizza, salads, munchkins, you name it.  It’s a love/hate relationship with these drug companies; it’s hard to curse them when your mouth’s full of gourmet pizza =/

Most likely, I will not be making a career out of Family Medicine, but I want to maximize my experience nonetheless and enjoy it like a roller coaster ride. When I was on Surgery and Ob/Gyn, I looked forward to a break from daily 5am wake-up call. At the same time, Family Medicine every 2 weeks has been rather, disruptive, to the flow of a rotation. Take Pediatrics now. I’m enjoying this rotation and I look forward to my day. However, each day has been interrupted with lectures and lectures and lectures… stick in Family Medicine in my week of Pediatric Gastroenterology that is already stripped of a productive week, now I have close to nothing. Needless to say, I am not a fan of Stony Brook’s brand new Family Medicine longitudinal clerkship; it’s just plain intrusive.

Now, my complaints aside, I have been lucky with my Family Medicine site. Dr. Arcati makes me feel like I’m part of his family of workers. He lets me see patients with chief complaints, take histories, do physical exams, and formulate an assessment and plan. He also knows how much I love sticking people with needles, so I have the almighty privilege to draw blood and administer flu shots and make people happy and healthy.

People who come into the office have bread-and-butter cases:  fever, sore throat, congestion, cough, abdominal pain, etc… Simple. It’s the winter season; many people are succumbing to upper respiratory infections and asthma exacerbations. Nothing interesting.

Two weeks ago, I achieved a diagnostic milestone, times 2!  Neither of them were too shocking, so here are the stories. In the first case, a 60-something-year old woman comes in with a “lump on chest.” First thing I thought was, “Oh gosh, I have to do a breast exam…” It’s still awkward for me, as a female AND a medical student, even after doing breast exams and Pap smears not too long ago. I got her history and proceeded to exam the ‘lump.’ Okay, it wasn’t even on her breast; it was smack in the middle of the chest over the sternum. And when I palpated the mass, it was soft like fat tissue. Diagnosis?  Benign lipoma. Done.

Next case, a guy comes into the office with his girlfriend because he’s concerned about a “bump on the lip.”  Before I went in the room, I turned to the nurse, Rose, and we both nodded our head thinking it’s herpes.  So I enter the room and greet the couple. I take my history, and no surprisingly, stumble over sexual history. It’s been 2 years already, and I still can’t bear to bring up a real patient’s sex life.  With the girlfriend there, imagine how awkward THAT would be… Needless to say, I bumbled through without uttering anything remotely close to sex, though I was itching to do so because it’s relevant. I took a quick look at the guy’s red ‘bump on the lip’ and inside the mouth too. It did not look like a herpetic lesion (which is a very painful vesicle) or any serious skin infection. Diagnosis?  Pimple. Yes, a simple pimple.  I presented the case to Dr. Arcati, and I swore he laughed a little on the inside too. This guy comes in worried over a raging red bump on his lip, because we all make assumptions about what lesions on the lip mean… and in the end, it was a simple pimple. His treatment? It got popped. Oomph.

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Awkward lumps and bumps aside, today was a unique day. Amidst today’s many appointments of URIs and sickness, one patient came in presenting with “anxiety.”  I was sent in to talk to this young women, Foundations-style. For the first time since I started my clinical rotations, I was told I made a difference talking to a patient. I spent a good 15-20 minutes listening to her story:  30-something year old female has been experiencing headaches, crying, difficulty breathing like an “elephant on her chest,” and difficulty sleeping in the past several weeks. The root of her health complaints is coming from marital problems; she complains her husband has become more flat and unloving. They are seeing a marriage counselor to hopefully save the marriage. Her two children have picked up on the tension between the couple. In recent weeks, she has been affected by Hurricane Sandy with the power outage and some stress from work because of possible shifts in the business and lay-offs.  During my encounter with her, she started to break down and cry. This is the second time I’ve been left with a crying patient, and I’m not the best at comforting. Today, simply listening to her story and being supportive really helped her situation. I felt a sense of accomplishment as I told her she’s doing the right thing by seeking therapy.  But I also added that communication seems to be a key issue in recent years, and that needs to be resolved and maintained. Spending time with her husband when they’re not working or on weekends or with the kids is just as essential.  She is lucky to have support from family and friends; she’s doing a good job reaching out to her in-laws for advice and assistance. Most importantly, I told her simply, “Make sure to focus on yourself. You need to be healthy in order to have a healthy relationship with your family.”  She needed to relax and rest to be healthy and happy. And she took that advice to heart.

This is an aspect of medicine that is losing ground in the 21st century. Doctors do not have 30 minutes to be with a patient. I’m lucky to have worked with doctors who do spend adequate time with patients, but there are plenty out there who do not, at the expense of patients’ well-being. Today, I experienced the impact I made on patient by simply spending time talking to her. Dr. Arcati even said, “See? You really made a difference with her.” There is hope that patients will get the attention they deserve. You simply cannot let vulnerable people who can be helped to slip out of your hands. In every small way, even as a medical student, you can improve someone’s quality of life =)

Sharing the Joy of a Birthday

2012 – Year of the Dragon… Go Dragon Babies!!!

August 31, the big day of 2012 when I turned the almighty 24.  For the past 23 years, my birthday has not been that spectacular or worthy of shows like My Super Sweet Sixteen.  But his year’s birthday was like none other I’ve experienced yet.

I just started my Ob/Gyn rotation at Winthrop University Hospital this week. Lucky me, I kicked off my first week on Night Float, status post Surgery rotation and grueling shelf exam.  It was a rough transition. This entire week, I was floating on Labor and Delivery and seeing lots of babies come out of vaginas. I was fortunate to have a great intern, Cheryl, take me under her fledgling wings as we floated from triage to the ER to laboring rooms. For a change, I really felt like I was part of a team; she taught me well and I adapted to the field quickly. I took histories from women getting admitted for labor pains and put on my catcher’s mitt for the babies and placentas.  I was given the opportunity to help with the ER consults and observe vaginal exams. It was a productive and fun week because I enjoy performing procedures and just doing something, despite the long, tiring hours.

I showed up for sign-in at 5pm. At first, I had birds and stars spinning around my head from all the abbreviations rapidly tossed about.  I was in a complete whirlwind from how fast the residents were talking about patients and the squiggles on the computer commonly known as fetal heart tracings and how slow I was writing notes I could barely fathom. Thank God for Google for carrying me back from the sea of OB/Gyn lingo. From 6pm-6am, a full 12 hours, I would be attached to the intern’s hip as I traversed the floors and ER whenever she was beeped. Nights were slow and quiet, but when deliveries or emergencies happened, you had your hands full. And I liked it that way.

Early in the week, I was not adjusted to the night hours. I have a tendency require heavy doses of sleep, with bouts of narcoleptic moments by day; otherwise, I crank up the crank-o-meter. It was 5am and the floor was quiet. I was so sleepy and cold that I wrapped myself in a warm blanket like a burrito and plopped on the bed in the resident call room. Before I knew it, I curled up into fetal position and dozed off. Next moment, I shook awake and shuffled out of the room. Who knew that within 30 minutes, I would miss out on two births… TWO BIRTHS!!!  Two births I was waiting for ALL FREAKING NIGHT!! Gone in the minutes I drifted into the clouds… I learned a couple of lessons that morning:

1)    Do not venture into resident territory and sleep on their turf

2)    Do not sleep on your shift, especially as a medical student; I was not aboard a 24-hour shift and it just makes you look like a bum

3)    If you do feel sleepy, sit in a chair, turn your back to your audience, tilt your head down as if you’re concentrating on a paper, and then doze off. Just don’t fall off your chair, because that’ll make you look like a fool.

By 7am, I was a zombie by day.  It was odd, walking through the hospital as people drifted in to start their day and I was off to bed.  By day, I was sleeping in the tiny, boxy, and gray call room in the basement, designated just for the medical students.  You may ask, why the hell would you stay in this box when you could go across the street to your apartment and sleep under your own snuggly blankets? People did not get me, but here’s why.

1)    I’m Asian. I don’t sleep in my own bed unless I’m washed and clean.  I was so tired by 7am, I did not have the energy to shower. That was how sleepy I was. I would rather stay in the call room and sleep in a clean bed there than get my personal bed dirty. After all, I am working in a hospital…

2)    Even if I showered back at my apartment across the street, I did not want to wait for my hair to dry.  I did not have the energy to dig out my hair dryer and use it and I did not have the patience to let my hair dry naturally.  It’s an Asian thing:  you simply do not go to bed with your hair wet or else you’ll ‘catch a cold’ and have some negative energy about you. Honestly, I’ve broken that rule many times in the past, and you know what I did? I would sleep on my tummy, face buried in the pillow.  Times I did roll onto my back with my hair wet, I would end up with bad headaches.

In that gray box I slept in for a week, I did not know day from night, rain from sunshine. I would roll out of bed and gather my stuff to head back to my apartment and be blinded by the sun. Around 2-3 pm, I’d head back to take a refreshing shower, watch some TV, grab some food, and start my shift all over again. This schedule was set on repeat six times this week. Good thing it was only a week, because the residents do it for a month at a time.  Poor gals.

Let’s get to the highlight of my week.  How awesome is it to catch babies (and placentas) on your birthday?! How cool is it to say to the parents, “Dude, congratulations… your baby and I share the same special birthday. We’ll be forever connected!”  A once-in-a-lifetime opportunity to experience the joy of a new baby and a birthday spent on night float in the hospital.  Unfortunately, I missed the early hours just after midnight on Friday because I had to catch some sleep for my lectures. And of course, I missed most of the daytime because of lectures. Needless to say, I missed some births I was anticipating to happen since my Thursday night shift. It only left me 7 hours on Friday evening to physically catch a baby.

There were two families I made that special connection with.  One family, the Demartinos, were just plain awesome.  I met them on Wednesday night when Carol, a very sweet Filipino lady, was admitted for observation for high blood pressures.  Her 24-hour urine turned up positive for protein, which suggested preeclampsia. The baby was close to term and she was induced for labor.  Too bad I missed her C-section, since I followed her labor from beginning to end and had long chat sessions to occupy my time and their stay.  But I did manage to visit them on the maternity ward and say hello to their baby boy, Stefano. They were a pleasant couple with an adorable bundle of joy!  They were very excited to hear their son shared the same birthday as the medical student who followed them for the past 3 days.

The other family, the Connollys, were just as funny and incredible.  I met them in the beginning of the week for a labor check.  They were scheduled to come in Saturday (today) for an induction of labor. I did think I would be that memorable, but I was surprised they remembered me still today.  I also must add, my positive experience with them was partly due to their awesomely charming obstetrician, Dr. Lazarou.  I must admit, I had a crush on the doc; he had the hunky looks (it’s the Greekiness), the personality (chill, chatty, and charming), and the brains (he attended NYU, my alma mater, for a few years).  Anyway, Mrs. Connolly apparently told him over the phone that she met a very pleasant medical student and her birthday’s coming up on Friday, so he better be nice to me. Come the end of the week, both doctor and patient were still crystal clear who I was =D

Unfortunately, baby and me did not end up sharing a birthday; it was darn close.  It was the night of September 1, just a few hours after midnight, the Connollys welcomed a baby boy to the world, and I experienced the mirth with them and Dr. Lazarou. Baby boy and me were not birthday twins, but close enough!

There you go, the celebratory culmination of my otherwise tiring, tough week on nights! I met some amazing families and their babies, who will happen to be my birthday twins.  They won’t remember, but I certainly will.  When their parents tell them the story of how they came into the world, I will be forever tied in and a part of their family.

Med School: US vs. India

I found an interesting article on Medscape, titled “Inside India – The Path to Becoming Doctor”:  Click Here

It got me thinking about my recent summer experience in India. The article pretty much summed up the stark differences. A mere first-year medical student, I learned from the doctors there how their medical training was like.

• Entering medical school is based completely on entrance exams – No traveling expenses, no interviews, no need for lists of extracurricular activities, no questions about your motivation for becoming a doctor, no personal essays, no criminal background checks, no die-hard & extensive application process. In the US, the applicant is under insane stress, from taking the daunting MCAT (Medical College Admissions Test) to conducting revolutionary research to passing the interviews. I clearly remember the last years of college dedicated to research, volunteer work, and academics. After the grueling MCAT trials, I wrote textbooks of personal essay drafts, a general one and supplemental ones that were school-specific. Finally, I completed all the components of my AMCAS application, assuring myself everything was perfect to the bone. Then, I prayed for interviews, the final leap into medical school. And a reason to shop for nice business attire and take a break from school to travel, from Niagara Falls to Chicago.

• Medical school begins right after high school – Which means, I’d be a doctor already if I were in places like India. Or China and Taiwan.

• Just over 5 years of training and you have your MD – Yep, I’d be a doctor at 22 already, and not 26. That’s not including at least 4 years of post-graduate training =/ At least in the US, medical students come from an array of backgrounds. Four years of undergraduate studies and college life allow for diversity, maturity, exploration, and fun, because medical school is a serious commitment. It will become a trial of endless studying hours, exams, and clinicals. For me, I had the best time at NYU; I loved the social scene, the vibrant city life, and my friends. As much as I worked hard in the laboratories, the classrooms, Bobst library, Palladium gym, shopping in Union Square, or running down Broadway for class, I had fun and also wanted to get a job. I balanced multiple student jobs, and I wanted my first real pay check. That would only come after another 10 years under the institution known as medicine. I am falling into the smaller and smaller percentage of students going straight to medical school after college. More and more are taking time off to do research or volunteer work. I managed to do everything I needed to do during college; I was ready for the next chapter. I have more personal growth to do still, as I find myself naive and innocent many times. And I don’t think I can imagine myself beginning medical school at the virginal age of 17 … That really is young. To conclude, while I would like to be a sprouting doctor at a young age, I am happy with the American system of medical education.

• Classes are mandatory – The surgeons and doctors in India laughed when I told them classes aren’t compulsory. For first year at Stony Brook, only Biochemistry and Anatomy were mandatory. It was frenetic, coming in early and sitting through stupid Biochemistry clicker questions. Then the afternoons were Anatomy lectures and dissections, which usually did not end until 5pm, or even longer depending on review sessions and pinnings. The rest of the year, because classes were not mandatory anymore, people started disappearing and snoozing at home. Still mandatory were Foundations lectures, which were the “How to Be a Good, Compassionate Doctor” lectures. They were entertaining and relaxing, for I mostly lounged on the Internet =) I became a victim to my demons, sleeping more than studying. I attended lectures here and there, when I felt motivated, which was most days. Second year will unleash my worst demons; apparently, lectures are not as organized or interesting, and of course, not mandatory. I’m seriously contemplating on self-studying at my leisure next year and skipping early classes. And also fitting in work, gym, TV, dramas, and food. I’ve already bought simplified, review-type textbooks with silly pictures and mnemonics and notecards for Microbiology and Pharmacology, the killer classes of second year, aside from more Pathology. Yay =/ Oh yea, and there’s also the looming shadow known as the Boards.

Oh Boy... I need picture books for med school

We Got Married (Korean reality) - All 100++ episodes (and ongoing), and more Asian TV =/ Bad distractions...

• Lucky ducks, clinicals start 2nd year – At Stony Brook at least, clinical rotations start 3rd year. American medical schools offer electives, specifically catered to students’ personal interests and endeavors. India… no electives. They’re missing out on the interesting stuff…

• On anatomy dissections and cadavers – Where do the bodies come from? Are there donation programs and anatomical gifts? The flashing answer is no… Back to the first question, then how do students in India learn anatomy? Well, according to the doctors there, cadavers come from unclaimed bodies of beggars usually. India’s culture and religion values keeping the whole body intact for journey into the afterlife. Same idea in most Asian countries. There’s no benevolence in donating one’s body for the name of scientific research. There’s only the grief and wish that loved ones have a safe trip into the next life. So in India, the police turn over dead bodies found on the street. I think back in the old days, there were also grave robberies, like in the US during the 19th century. Perhaps it still goes on now too. Either way, there’s a shortage of cadavers for anatomy dissections, so normally 20+ students take turns on a single body. At Stony Brook Med, we have tight-knit groups of 4 students per body, while at some schools like Buffalo, it’s more like 8, the capping limit. Here, the learning is more interactive, as everyone has a chance to be up close with a scalpel and dig through fat.

25% Doctor Already

Today officially marks the end of first year medical school at Stony Brook. I look back and can’t help but feel amazed at how far I’ve come.

I finished my Pathology exam early this morning. School technically ended last Monday, but 2 full days were dedicated to studying before 3 mega-exams, all for one class. That’s the reality of medical school: you have one course block that leeches your energy and sanity. This year, I started off first semester with Molecular Foundations (Biochemistry & Genetics) and Gross Anatomy. Subsequently, I had blocks of Neuroscience, Physiology, and Pathology. Seemingly simple right? You would think so. It’s true that there’s only one class at a time, every freaking day. Neuroscience was pretty crazy, nearly every day brains for 5 hours. It became more entertaining to equate cross sections of brain to animals, like a sad puppy. Who knew that one organ system (the brain and nervous system) could be squished into one week, but also be the most complicated part of the human body.

Don’t get me started on Physiology. As much as I loved learning about how the body works like a biological machine, every week was hectic. One organ system a week and a stressful OSCE session/mini-exam every Monday. When the second-years warned us that we were going to have no lives during Physiology, they meant we had no lives. Small group conferences landed on Fridays and weekends were dedicated to studying up the week’s organ system to prepare for Monday’s OSCE case and subsequent ‘quiz.’ Glad that was over with.

However, once Pathology hit, I was burnt like a brisket. I was so lazy for a good 2 weeks, until it hit me that I had an Immunology midterm worth 15% of my grade coming up. Even after that, I cruised through the semester, going to classes and doing my own thing. No stress, no sense of reality, and no angel on my shoulder poking me to ‘study study STUDY.’ As a matter of fact, I don’t think I worked THAT hard, because I managed to work out, eat well, sleep soundly, and hang out with friends. That is, until perhaps the week before an exam where I jam crammed my noggin into the wee hours. Not good memories >.<

However, it has been an easy-breezy two months. I never left vacation mode after finishing Physiology and coming back from Spring Break. Now, everything’s over. I attended classes, I studied in the library, and I caught up on all my lectures on cancer and anything that can grossly go wrong in the human body. And yet, I feel like I had too easy of a time through these last months. The important thing right now, is that first year is OVER. I am a quarter of a doctor now, and only half way done with dry books and mechanisms. The fun jungle-gym time through rotations have not even begun.

My summer has officially kick-started. Technically, it started weeks ago when I started sporting my summer dresses and hitting the tennis courts and running Circle Road. Today after the shelf exam, I bumped into some friends. We were all standing at the library lobby and chatting up a circus. The crowd got bigger and louder as students shuffled out of the computer lab. High fives and high hands, we were letting the freedom sink in. I don’t think anyone realized how excited they were getting with this grand finale, because the librarian/student at the desk climbed on a chair and shouted on top of her lungs at us. She said, “Hey Hey, HEY. Please BE QUIET! THIS IS STILL A LIBRARY. IF YOU WANT TO TALK, TAKE IT OUTSIDE OF THE LIBRARY…” My friends and I shuttled out. Later we heard that students still did not quiet down, and she started banging on the bell that’s supposed to be used to get the attention of the librarians. Instead, ironically, it was used to shut up the jovial medical students. Let’s be serious, who else would be studying in the summer? We were the only people seriously studying our souls out for the last round of Pathology exams. Now that we were done, who else would be as studious as us, except for the second years studying for their Judgement Day. Whatever, med students pissed off the library again and it was epically funny.

I am ready for my oncology rotation in India. I am ready for this HEATING summer! BUT, some things get in the way of my happiness… Bugs. Idiotic bugs. I woke up this morning to a major itch on my forehead. I was sleeping like a lion cub, rolled up under my blankets. I scratched my forehead, thinking it was just some allergic reaction or random itch. Then I heard a familiar buzz. A damn mosquito. I whacked it away, but by then it was too late. The buzzing bugger already made a feast out of my forehead. I looked in the mirror and found a pattern of red, itchy bumps. If you connected my 6 bites together, it’s like a trapezoid. The most prominent 4 bites form an irregular square. It’s mad itchy and I really want to scratch it. However, it’s uncomfortable to scratch, because my forehead is not very fleshy; I just feel underlying bone and I’m rubbing on a smooth surface. Since the morning, the bug bites have just puffed and ballooned, red and butt ugly =/ Why mosquito must you be gluttonous with my face?! It took bites out of my forehead, only to die later when my mom killed a bug with lots of blood. My blood! The damn mosquito died at the expense of my face! I’m rubbing my swollen forehead now like a genie bottle and wishing it would just go away. Painful, hot, and itchy… what else can I do?

While I recover from my massive reaction on the forehead, I will enjoy the beginnings of my free summer and plan to have a good time in India =)

I can go to India’s Regional Cancer Center and say this with gusto:

Donor Remembrance Ceremony

Yesterday was a special day. I was part of the committee organizing a memorial service for families of body donors for our Gross Anatomy class. For months, we put together the program, the logistics, the theme, RSVP, food, decorations, and etc… I was head of the RSVP committee, the main contact for the families and friends of the donors. My partner worked with the Deans and faculty members of our school. All together, so much work went into the management and organization of the whole ceremony. I was glad I played a significant role in the service, specifically acting as the liaison between the class and the families. I had the closest connection with the donors’ families, since everything is kept mostly anonymous for privacy and we will never know who our cadavers were.

The night was a big success. The event took place at the Wang Center, a beautiful center on West Campus. In the back, so much food littered the tables, everything from fruits to muffins and munchkins to Sole Mio garlic knots to amazing bit-sized sandwiches. Yes, it was quite a random assortment of refreshments. The bulk of the ceremony featured speeches, musical performances, and student reflections. And boy do we have a multi-talented class, whether it was acapella singing, the string ensemble, serenades, or guitar jamming. I almost felt, untalented and inadequate. The last time I played my fiddle was over 4 years ago, when I tried out for the orchestras at NYU and got trampled on by better, more sophisticated players. I’ve played in the orchestra since I was a wee child in the 3rd grade and well into high school. Then came college, and I was not that talented anymore. So I gave up and pursued other things, like being pre-med and a crazy runner. However, I was very happy to see the spectrum of talents in our class. People are able to pursue their passions while in medical school, maintaining their sanity and favorite pastimes amidst hours of classes and coffee runs.

I was very happy to see our Dean of the School of Medicine, Dean Kaushansky, make an introductory speech on behalf of our class. Well, I was also happy that I stayed in contact with him throughout the preparation months and got him to speak at our event. He’s a very cheery man, and he really anticipated this event because in his years as a medical student and physician at multiple institutions (UCLA, University of Washington, and recently UCSD) he never experienced a memorial service for donors. I was very glad he was so enthusiastic to make an appearance and share this experience with us. Together, we will be beginning our medical career here at Stony Brook.

The front table displayed beautiful vases decorated with a navy blue ribbon. We decided to make the theme a flower ceremony. Each member of the class walked up with a white carnation and placed the fragile flower into each vase, while Canon In D was playing in the background. It was a memorable and beautiful procession. I was the first to go, since I was up front with the families, so I had to set the example and not be the usual klutz I am.

I was most touched with the families. We made a record since the commencement of this ceremony 6 years ago, with 8-9 families, totaling over 40 members – children, young adults, mothers, fathers, in-laws, husbands, wives, and many loved ones. I introduced myself to everyone of them, sharing my love and appreciation. Looking around the audience, they were truly touched by the performances, the speeches, and our deep gratitude. The ceremony was emotional particularly for them, and I feel for them. At the end, when we presented the vases with overstuffed white carnations as gifts, they expressed their hearts to us. I was moved myself, for their tears were of sadness, longing, and hope. The anatomical gift meant a great deal for us medical and dental students, and we put our soul into this service for the families. I was glad I met them personally, shook their hands, and gave them my biggest smile yet.

Molecular Happiness

Crunch time

It’s finals season, the same frenzied cycle as undergraduate. The last few days have been hectic:  long and cold nights of cramming wacky cell signaling molecules and disturbing genetic diseases, shutting myself in the library surrounded by fobby undergrads, getting hooked to cappuccinos and Lipton-based milk tea from the physician’s lounge, feeding glucose to my noggin at awkward times of the day, and just stressing out for a simple PASS. I’ve been getting my sleep, until a few days ago when I realized how little time I have left for the avalanche of topics I need to study and review. Two days ago, I slept for 3 hours, and that was miserable. In college, I usually felt fine on study marathons and pulling late nights, maxing out with 3-4 consecutive nights of minimal sleep; I just caught up on my sleep after the big exam. However, this week, I barely lasted a day, because the next day, I felt fatigued. Last night, I had a disjointed sleep session, taking a much-needed nap that lasted 2 hours and struggling to keep my eyes open until 3am when I was felt at little accomplished for understanding ADP-ribosylation in cholera and pertussis toxins. Being sick amidst finals is no walk through a blissful dream; my brain felt like gooey pudding.

Early this morning, I was still cramming last minute before my afternoon exam. I’m realized I never feel ready for exams, using ever minute possible to stuff important facts, just in case they come in handy; it works like a miracle in bygone days. Nucleotide metabolism, check. Autosomal dominant diseases like osteogenesis imperfecta and Marfan’s, double check. Receptor tyrosine kinases and Jak-stat pathways, oy! Cancer, DNA replication, homologue recombinations, holiday junctions and chiasma, ooph! Imprinting and epigenetics, oh lala… Antibiotics that do battle with prokaryotes, rock on!

Nap time

The computer lab was an oven, more than just an easy-bake oven; I felt like baked chicken. Maybe that’s why I got dizzy in the middle and started nodding off. I told myself, “Okay, at least make it halfway through your 100 multiple choice questions, and maybe you can snooze.” I ended up zipping through all 100, marking a bunch that I did not feel like pondering at the moment. I fell asleep a few times during my test. My mouth felt dry and my eyes kept drooping; the levator palpebrae superioris was not doing its job. Seriously, what kind of model medical student am I when I can barely stay awake during a major exam?! I took a ‘bathroom’ break and dashed to the physician’s lounge for a quick cup of hot coffee to wake myself up. I came back, full throttle, and went through the exam 3 times before my time expired =)

Then, a surprise email from my professors; we all passed! During an anatomy review session, someone in the class read the email and shared the happy news. I checked my grade later, and once again, I did about average. Average for the exam was 85; on the midterm, it was an 88. I have a tendency to miss the mark, so nowadays I’m just an average student. I’m content; I’ve accomplished so much through college and now I’m in the final years of schooling. Numbers and A’s are not as important as they were for me in high school, since the pre-med mentality through college and a blooming social life mellowed down my fire. All I want to do is learn and do what I love- work in health care and heal sick people.

Right now, I’m drained. My mind is still swimming with genetic diseases. They are so interesting to learn, and yet, frightening. I appreciate my life, because 1) I’m thankful I’m not a mutant, and 2) so many things can go wrong at the cellular level before birth. Yes, mutations are rare, and that’s why we have complicated, well-regulated mechanisms to combat mistakes. We are typically born healthy, but we are error-prone and anything can seriously happen, at any time.

Boom

Programmed cell death, or apoptosis, is just as essential as cell growth in life. Mutations occur all the time, but with all the cellular checkpoints during replication and repair pathways, we bypass the harmful effects and disease. Many diseases lurk in the depths of human biology, and I only learned a handful (okay, 2 inches of color-coded index cards). Fragile X, Neurofibromatoses, Cri-du-chat, Down’s, Patau, Edwards, Marfan’s, Turner’s, Kleinfelter’s, Lesch-Nyhan syndrome, etc… it’s mind boggling to learn all the inheritance patterns and the molecular intricacies of each disease. What’s scarier is the fact that quite a bit of diseases result from spontaneous, or “de novo,” mutations. Once it happens, it’ll be inherited. And genetics is rather complicated, more than just Mendelian dominant vs. recessive. Let’s take autosomal dominant disorders are characterized by variable expressivity (the degree of symptom manifestation), incomplete penetrance (all or none phenotype when you have the genotype), high recurrent mutation rate, and late-onset. Then there’s imprinting, or gene silencing, mitochondrial inheritance, mosaicism, and trinucleotide repeat expansion with anticipation (the more repeats and subsequent generations, the more severe and the earlier onset of disease). I’ve only wet my feet in a puddle so far, but I also feel more like a doctor.

Eh, I change my mind… I feel more like a zombie right now. I’ve been fortunate enough to be sick the entire week, sneezing and wheezing. My nose has been bipolar, running one moment and clogging up the next. My sinuses have been filled with mucous, which shouldn’t happen in the first place because infections can spread and drainage is blocked; naturally, we are airheads as our head has many holes and passageways for draining and neurovascular bundles. I hate popping drugs, so I let my T-lymphocytes patrol my bloodstream and kill the invaders of my immune system. Throbbing headaches have been tiring me out, particularly the sinus ones that emanates from the occipital region. When air goes up my nose, there’s a fuzzy, sharp pain entering the back of my nasal cavity. Breathing never felt like such an effort, except maybe during yoga.

Now, 1 final down, 3 more to go… FOR ONE FREAKING CLASS. It’s the bane of my existence, a medical school horror show called Gross Anatomy. Three more exams: lab, written, computerized.  I’m taking a breather today (yes, my nose has recovered its function). I’m going to sleep early after this late-night blog. I’ll wake up tomorrow, go to the gym, and kick some final ass at anatomy =)

Ever get rejected twice?

My little sister is applying to colleges now, and as the big sister, I am along for the ride by default of biology. She’ll be going for accounting/business school and hopefully making the big bucks before I can see my first real paycheck again. Both of us fulfilling the average Asian dream- becoming 1) doctor and 2) something with business; if only we had a brother, he’d probably be the lawyer.

I was an expensive child. My sister complains I went to NYU, and now I go to medical school; that’s not a stroll through the forest to grandmother’s house. Now, she feels Ivy Leagues and private universities, what she terms ‘brand name schools,’ are out of the question because tuition keeps hiking. Though her grades are strong and I set an auspicious impression for her with my old teachers, she still feels inadequate for good schools. She seems to feel, her dream schools are just dreams, fleeting and far away.

Take NYU’s Stern School of Business. It’s nearly pan-Asian, it’s NYU, it’s Manhattan, and it’s illustrious. I have friends who studied economics or attended Stern. You get pampered with good food and networking events. I’ve even studied at the Stern school, and it’s beautiful after a year of renovations. Plus, there is a 5-year combined BA/MA program at Stern for accounting, and she has the opportunity to combine majors, say finance. She can study unique languages exclusively offered at NYU (ahem, Korean) and have a good time like I did. Parfait!… Except, she feels her previously pre-med sister took that away and did not take all the opportunities offered at NYU that she would like, because my parents also cannot afford to pay for 8 years of NYU education, one of the most expensive universities in the nation (#2 ?).

For now, she’s accepted to Niagara University, SUNY Albany, and College of St. Rose. I asked, “What? You have so much potential… but huh?” Okay, SUNY Albany apparently has a great accounting program and it’ll be state tuition. I told her “No! It was the #1 party school a few years back, I refuse to say my sister is going to a party school.” College of St. Rose had free application fee, so it was just a ride. And Niagara U, it’s by freezing cold Buffalo, but she wants to have a chance working in Toronto, Canada. Plus, there’s a 5-year BA/MA program that she got into; it’ll be a cramped curriculum, but she can finish school more quickly and probably go to Canada. In the meantime, she’s waiting on Northeastern and USD in California, competitive schools I pray she can get in and receive significant scholarships for her hard work.

I look back on my college application process, I should have expanded. Instead, I was stuck on Cornell, and a few Ivy Leagues (Harvard, UPenn). Other schools I applied were Johns Hopkins, NYU, University of Michigan, and Binghamton. Rejection sucked; I wanted to cry when I read the online rejection letter from Cornell. It also sucked when I got rejected by Harvard twice, first time was Early Action and second time was Regular. Who gets rejected twice?

Harvard = Hogwarts, I like... too bad though

How about, Who gets rejected twice, TWICE?
Yes, I’m raising my hands now because the lucky goose I am, it happened to me. It happened with medical school next round of applications. I applied NYU Early Decision. I had the competitive GPA, but I bombed my MCATs first time around. Even when I improved and entered the regular applicant pool, NYU still did not want me and wrote a general rejection message on the webpage. I thought working at the medical center for 2 years as a volunteer and research assistant gave me a special connection to the school, maybe like a fistula. I wondered if my picture in a feature story on patient-centered care in the medical center’s newsletter wound up on the admissions table next to roasting coffee. I hoped I made some impression, but clearly that failed.

Smilow- I did my cancer research here