This Road

2012-02-12T14:23:00.000-08:00

I apologize for my complete lack of blogging this year. I'm still trying to figure out what to do with the blog. In the meantime, I'll share a picture I found amusing:

under the microscope

2011-11-30T09:10:00.000-08:00

Let me be the first to admit that I hate microscopes. As I move the glass slide back and forth and squint my eyes while adjusting the fine focus, each speck of dust comes alive and I struggle to distinguish normal from pathogenic. When asked what I see, my conditioned response is "normal cells," since the specks of dust rarely prove to be anything more. Yet when my Dr. P, my attending at Christ Community clinic, pushed me to reexamine my patient's wet prep, I saw something for the first time--a tiny flagellated organism called Trichomonas, a protozoa that is transmitted sexually.

Unlike the blood and urine tests used for STD's that always have a small chance of being wrong, here was indisputable evidence that our patient had an infection; I could not say for certain if her boyfriend of 2 years had cheated on her, but I saw her fight back tears as Dr. P delivered the news that suddenly made her question everything. I watched in awe as she listened to Dr P explain the emotional and spiritual consequences of sex and the benefits of abstinence. She left with numerous brochures on STD's and contraceptives and the kinds of probing questions that only surface when our personal lives are forced under the microscope.

hittin' the interview trail

2011-10-09T15:57:00.000-07:00

I don't think I can blog about the details of this, but I wanted to let you all know that from now until January I'll be traveling for residency interviews. In 7 months I will (finally) be a doctor and will spend the next 3 years training in pediatrics. This picture is from my first interview on the Texas coast--let the fun begin!

you, me, and the pigeon

2011-08-20T21:12:00.000-07:00

This week I met Zachary, a 5-year-old boy with a rare immune system disease that makes him prone to frequent infections and will likely shorten his life. Although his lungs were full of mucus and his bony chest heaved with each breath he took, Zachary bounced around the exam room, stopping only to hug my legs and grab my stethoscope. As I knelt down to listen to his heart, he threw his arms around my neck and asked me without reservation, "Will you be my friend?" When I replied yes, he informed me that I am his second friend--the first is a pigeon. Zachary then skipped around the room, singing a delightful chorus of "you, me and the pigeon."

seeing grey

2011-08-11T19:09:00.000-07:00

When I realize that 12-year-old Zachary is no longer getting his life-saving Xolair injections, it is easy to be angry at Medicaid for switching him to a new provider that doesn't cover his treatment. It is also easy to be angry at Zachary's father, who has chosen not to be part of his life and leaves his mother with six mouths to feed, stuck in a job that offers no health insurance.

To a certain extent this anger is healthy, even necessary if there is any hope of change in our society. Yet if I spend all my time being angry, I forget about the living, breathing patient standing in front of me and miss an opportunity to show compassion and learn from the amazing resilience of a child.

Too often we see the world in black and white, labeling people as good or bad so we can hold onto our deep-seated beliefs or simply get through the day without getting trampled by the world's problems. I know that if I want to keep even an ounce of my compassion, I must learn to leave room for the grey.

"God created the world for kids"

2011-07-14T08:47:00.000-07:00

This quote from my favorite pediatrician sums up my life philosophy. I've been especially grateful for the little ones lately during my study breaks.

another step

2011-06-24T15:24:00.000-07:00

As of today I'm officially done with my 3rd year of medical school! I got to spend the last two weeks on a maternity service taking care of pregnant ladies and babies, and I would much rather do that for the next month than start studying for Step 2 (the next part of my board exams). However, it does feel nice to say I'm a fourth year, and I can only stare in disbelief at the brand new third years in their bright white coats and nervous smiles. Crazy how much difference a year makes...

JDC

2011-05-23T18:42:00.000-07:00

On the surface, the residents of the Juvenile Detention Center are nothing like the teenagers I went to school with--arms covered by tattoos, hair spiked into greasy mohawks, the boys talking about their baby mamas as the girls covertly apply smuggled lip gloss and eyeliner.

They tell me their dreams--opening a tattoo parlor, joining the marines, doing anything to buy food and diapers for their already struggling families.

I overhear two of the boys waiting to be seen: "Hey dawg, you gonna try rehab? The food there is the s***. They teach you how to play baseball and stuff. They show you can have fun without drugs. And all the chicks is pretty hot..."

I realize that they are, in fact, just like other teenagers, thinking about food, girls, and ways to escape the life that constantly seems to entrap them.

health care reform

2011-05-19T18:38:00.000-07:00

Want to understand health care reform a little better? This video provides a somewhat cheesy but helpful non-partisan overview.

afternoon hugs

2011-05-01T16:48:00.000-07:00

I walk into the exam room, smiling at the family I met this morning, and take my usual seat on the exam table. Sammy climbs up next to me, and I wonder how this three-year-old boy will handle another hour-long doctor's appointment. I met him this morning in pulmonary clinic and was given permission to attend his afternoon GI appointment in a rare nod to continuity of care. I'm happy to see Sammy again but also grateful for the opportunity to zone out for a few minutes as the GI doctor obtains the history that I am already familiar with. Realizing that Sammy and I could both use a nap, I offer him my penlight as a distraction. After he has made shapes on the wall and repeatedly inspected every available orifice on both our bodies, Sammy sighs contentedly, reaching his little arms around my waist for a hug.

Happy Easter

2011-04-26T19:14:00.000-07:00

Doctor: "Have you been out in the sun?"
4-year-old patient: "Oh yes! His name is JESUS!"

babies having babies

2011-04-05T19:44:00.000-07:00

All of us in the medical field have seen teenage pregnancies, and I guess I should be "over it" by now. Yet this morning when I heard my resident tell our doe-eyed 13-year-old tonsillectomy patient to be sure to take iron pills in light of her recent delivery, my eyes darted to the wannabe punk gangster sitting beside her and I began to regurgitate my breakfast. I slowly peaked out into the hallway, making sure I was still on the safari-themed floor of the children's hospital and not back in maternity.

Later I went to play with my favorite 3-month-old patient, who was chronically alone and crying since her drug-abusing mother was banned from visiting. As soon as my hands reached her, she flashed me a brilliant smile, and I forgot to be mad at all the teenage mothers who give me patients to love.

confessions

2011-03-29T18:15:00.000-07:00

If I'm honest...

I haven't watched a single March Madness game this year but love getting recaps from my patients.

No matter how delicious they are, lattes and jelly beans are not meal substitutes.

It is no longer possible to stay awake during lectures.

I trip and laugh until I cry every time my teammate ties our sterile gowns together.

I'm not actually surprised when I run into my homeless patients at Starbucks.

I would be happy in any medical specialty (except surgery.)

a break from medicine

2011-03-27T18:43:00.000-07:00

Juan's tiny fingers encircle mine as his silky soft head settles into the groove under my chin. I take a deep breath, inhaling his warm powdery smell and marveling at the deep calm that this intimacy brings me.

I push Maria's tricycle up and down the hill, letting her squeals of delight overpower the sadness that threatens to invade each time she calls me "mommy."

Anthony's anger melts away each time I lift him up for a slam dunk, and this time I earn myself a hug on top of the usual high five.

I cannot give them better parents or new homes to live in, so instead I aim for smiles and laughter, knowing that the brief connection transforms us both.

Mr. V

2011-03-15T17:27:00.000-07:00

His bright blue eyes bore into mine as he shook my hand, gracefully guiding me towards his only chair and giving me no indication whatsoever that he was blind. He muted Patsy Cline as he offered me soda and candy bars, briefly showing off his "secret" stash of whiskey and cigars. The familiar nursing home sounds and smells quickly faded and I imagined us transported to my old college dorm room, two new friends enjoying a lazy afternoon. Within minutes my 95-year-old friend had me laughing to tears as he recounted enchanting tales of marriage, fatherhood, and friendship. It was easy to see why he had outlived his 6-month prognosis by 2 years--he had mastered the art of loving and living well.

Mondays

2011-03-14T18:12:00.001-07:00

All it takes to reverse my Monday morning attitude is a sly smile and fist bump from an 85-year-old after I successfully remove his IJ. It also helps when my grumpiest patient tells me I'm his favorite doctor. I don't bother to correct him. I am indeed blessed.

what's in a name?

2011-03-09T15:30:00.000-08:00

This year I have been called many names, mostly "nurse," "chica," and "hey you." I introduce myself as a medical student a dozen times a day, and my patients quickly learn that I am an excellent messenger with no real power over their daily care. Yet at 5:30 this morning when a nurse yelled, "hey doc!" as I passed through the hall, I turned without hesitating, intuitively knowing that she wished to speak to me. I answered her question and went about my business, inching a little farther along this journey through medicine.

clinic

2011-03-03T14:26:00.000-08:00

In the midst of medication refills and the suffocating aroma of stale tobacco smoke, there are moments of joy:

I say goodbye to Javier, a 67-year-old who lost most of his speech due to a stroke and most of his teeth due to inevitable life circumstances. I haven't understood half of what he's said, but I finally decipher through his fragmented Spanish that he is headed to his car to get me his Selena anthology--a small token of his appreciation for my time. I muster up my best poker face and tell him I already have the cd's at home, thanking him profusely as I stifle a grin.

professionalism

2011-03-01T18:37:00.000-08:00

For the past month, I've been rotating through various internal medicine clinics. It has been a welcome break from life in the hospital and has allowed me to meet some amazing and heartbreaking patients whose stories I'm still trying to process. The following story is part of an essay I wrote for a school assignment on "professionalism."

I stared at Carla's gargantuan, wrinkled brown hands, mesmerized by the only things that clearly showed her biological gender. My eyes moved from the chipped magenta polish, down her fingers, to the dorsum of her left wrist, noting the site of her last abscess. I listened to her raspy voice and grating nasal “sniff,” adding tobacco and cocaine to a mental problem list. I forced myself to focus on Dr. M's succinct summary of Carla's health as my mind tried to spin in a hundred different directions--Health maintenance (colon, breast, prostate) were up to date. HIV viral load and CD4 count indicated good response to a new HAART regimen. A pulmonary nodule seen on CT was stable. Liver enzymes and hepatitis serologies were unchanged since the last visit. The only lingering problem was substance abuse, so Dr. M kindly listened as Carla halfheartedly voiced her desire to enter a methadone program. Dr M and I left to set up a meeting with the social worker, and Dr M voiced her concern that Carla was prostituting herself for drugs. Did we need to expand our work-up? When we returned to dismiss her, Carla mentioned “by the way” some painful lesions on her buttocks. Though Dr M had nine more patients to see that morning plus those of the resident and fellow, she inquired in detail about the lesions and sent me hunting for culture supplies. She let me “assist” with the cultures, keeping my hands far away from the sharps and gingerly applying a bandaid to each lesion. Carla caught Dr M in an awkward hug on her way out the door, flashing us a warm fuchsia smile and thanking us sincerely for our time. My stomach began to churn in step with my brain as Dr. M moved on to the next in a long line of patients who would shatter my ever-expanding perception of life and health.

snow day in fat antonio

2011-02-04T07:23:00.000-08:00

This is what a snow day looks like in South Texas. I'm a little worried about our semi-frozen pipes but very thankful that this cold weather got everyone a day off!

cold

2011-02-02T18:11:00.000-08:00

I don't have much to say about the recent 50 degree temperature drop except that white coats provide little protection against a wind chill of 4 degrees. Also, I'd like to thank my apartment complex for choosing this week to turn the fountain back on.

forgiveness

2011-01-31T13:29:00.000-08:00

They say Mr. S gambled his life away, chasing after women and cigarettes while his family suffered at home. They trade stories about how difficult he was in the ICU...Can you believe he was still smoking last month? The daughter lives in DC and can occasionally be reached by phone; no one has met the wife, but she was a nurse you know...They roll their eyes, telling me without words that they deem him unworthy of their heroic efforts.

These thoughts haunt me all night but flee each morning when I see Mr S--85 pounds of blood and bone that violently shake with each rattling breath yet tenaciously hold onto life. I ignore his fluid-filled extremities and heaving chest, looking above his oxygen mask at the only part of him that is really still Mr S. His piercing blue eyes meet mine without wavering, reminding me that he is very much aware and very much alone.

I can neither judge him or forgive him and do my best to fight back tears at the thought of his haunting loneliness.

When at last his wife comes to visit I am unconvinced that she will forgive him but unspeakably comforted that he is not alone.

thankful

2011-01-16T16:30:00.000-08:00

The other night I was talking to a friend of mine who is a young doctor in Nicaragua. When I met her she was training to be a pediatric cardiothoracic surgeon, a difficult feat for anyone in any country, but an especially difficult one for a Latin American female whose training was constantly interrupted by political strikes and lack of resources. Much to my delight, she eventually finished her training, and I envisioned her brilliantly sewing up tiny hearts and saving young lives everyday. Instead, due to a heightened political climate, she found herself without a job. She studied for the US licensing exams with hopes of joining family in Florida and practicing there but was denied a visa. Currently, she works for the missions organization that facilitated my Central America trips but has not performed surgeries in months. I'm not sure what to do for her except pray for her and think of her as I wake up every morning and begin my silent litany of complaints about how tired I am, how much I don't want to work on a weekend, drive in the rain, see smelly patients, take out more loans...May I remember that what I do is a privilege, one I must stop taking for granted if I want to be half as good of a doctor as my friend.

ob-gyn clinic

2010-12-06T19:41:00.000-08:00

This morning I grinned from ear to ear when I felt a baby's head through his mother's partially dilated cervix. Then I felt my insides rip apart when I saw a 5-year-old girl with genital warts.

There is no amount of joyful discovery or intimate reassurance that can negate the existence of an abused child.

What kind of world are we bringing these children into?

It is a deeply flawed one--one in which we must store up moments of hope and joy to give us the strengh to combat the heartbreak we inevitably encounter.

2010-12-02T14:54:00.000-08:00

She slumped in her wheelchair with her head pointed towards the floor, her stringy silver hair barely covering her wrinkled neck. I gently pressed the waxy skin over her swollen shins and tried in vain to bend her basketball sized-knees. I lifted her shirt to reveal her distended belly--a tense fluid-filled balloon that surely would burst at any second. After 6 rounds of chemotherapy and radiation, her cervical cancer continued to obstruct her blood vessels and one kidney was now failing. She had just started more chemo for metastasis to her breast.

The doctor explained that her cancer could not be cured. The best she could expect with chemo, radiation, and surgery was 3-6 more months.

At this point I imagine I would have said no--no to the nausea, vomiting, infections, and endless hospital visits that this "treatment" might bring.

Without a moment's hesitation, she looked him in the eye and said yes, whatever it takes, showing me life's exquisite worth.

new favorite nap spot

2010-11-15T16:52:00.000-08:00

Thank you, dear Mom & Dad, for getting my windows tinted.

the most shocking part of ob-gyn...

2010-11-12T15:37:00.000-08:00

"It's ok if you hurt my baby a little...just take my gallbladder out!"

"I'm not pushing til I get my methadone!"

And when all the pushing is done and the mess is cleaned up, I am still surprised to see teenagers yelling at their toddlers for daring to misbehave at the grocery store.

Walter

2010-11-05T13:47:00.001-07:00

I saw him approaching from the corner of my eye, but found myself speechless when he stuck out his hand, jubilantly exclaiming, "Walter Williams, mam'm! Pleased to meet ya!" This mischievous 13-year-old was a daily topic of conversation during morning report--just minutes ago, I'd heard about his latest attempt to drink from the toilet. Swallowing my pride, I shook his hand and introduced myself as a medical student. "Are you going to work here someday?," he asked excitedly. "You should definitely work here! I'm going to live here 'til I'm 18!" He skipped off towards the bathroom, and I later heard that he turned it into a slip-n-slide.

So long to all my psych patients--I will miss you!

crayons

2010-10-22T20:42:00.000-07:00

After ten minutes of tearfully evading questions about the famous musician she was stalking, the 28-year-old patient finally looked the doctor in the eye, angrily exclaiming, "I didn't come in her to talk talk! I came in here to get some freakin' crayons!"

elopement risk

2010-10-13T19:41:00.000-07:00

Mr. F came to the hospital from jail, saying nothing but the bizarre string of words that prompted his psych consult: "bars, bounds, shackles, cuffs...speak, spake, spoke."

After 10 days of taking his meds, Mr. F is a new person, smiling for the first time as we comment on his marked improvement in both mood and hygiene. He playfully introduces himself to us, laughing as he states his full name and age.

Three hours later he "elopes," while in transit to the barber shop, effectively running away from the staff, a much-needed haircut, and his chance to be "cured."

glow

2010-10-07T14:41:00.001-07:00

She sits across from me in her faded t-shirt and extravagant triple-stranded pearls, captivating me with tales from a life of privilege and adventure. Though her thoughts are tangential and her memory is clearly impaired, I attribute this to dementia. She is 76, after all. She's not sure that she belongs here, among those who mutter nonsense or scream for hours on end, wandering the halls day after day with no purpose. I'm inclined to agree, and I make a mental note to ask the doctor when she can go home. As I stand to leave, she beckons me closer, saying she has one last thing to tell me. "Sometimes I glow. I'm not an angel, but I glow."

so long, surgery

2010-09-25T19:28:00.001-07:00

Farewell, surgery. For the most part I will not miss you--the overwhelming odor of blood mixed with dirty feet; the un-shakeable chill that hits my bones at 2 am; the sterile air in the OR that sucks away the smell of burning flesh. What I will miss is the intimacy--wordlessly communicating around the table, learning what the other wants from the briefest glance or brush against a finger; knowing from one glimpse of a liver what a thousand words could never tell you.

What not to do in the hospital: #1

2010-09-09T14:33:00.000-07:00

Mistakenly believing that clear skies meant tropical storm Hermine had finally blown over, I was less than thrilled to be caught in a torrential downpour as I walked from my car to the hospital. By the team I reached the trauma pit, I was drenched from head to toe and had turned the entire sub-level into a falling hazard. I sloshed and squeaked my way to the scrub machine, devastated at the thought of wearing wet socks and shoes for the next 12 hours. I snagged some patient socks from the supply closet and desperately wracked my brain for a way to dry my shoes.

Suddenly, one of my teammates offered a brilliant idea: put the shoes in the blanket warmer! The practical voice in my head told me the nurses might not like this, but my devious side took over as I rushed to sneak them in behind a stack of blankets. No staff was around to witness my indiscretion, so I reasoned that it was ok since I couldn't even possibly ask anyone's permission. I triumphantly returned to the pit, silently praying that the pager wouldn't go off until my shoes were dry. Ninety seconds later the trauma phone rang, and I felt the blood drain from my face as the pit boss looked at my feet and told me I'd better hurry up and grab my shoes if I ever wanted to see them again. The conversation that followed with the ER tech who discovered them taught me many things, most importantly to always have an extra pair of shoes.

2010-09-04T18:39:00.000-07:00

Pulseless, cold, already stripped of all her clothes...I don't see any blood, but inside she is shutting down. Her heart has stopped, and no matter how hard we push, it will not start again. The patient services rep rushes in, anxious to take her break. This is the 13-year-old right? She needs to verify her identity because some family is here. We search in vain for any remaining shred of her identity to show the parents, finally recovering a few scraps of belt.

Just as she as the chief decides to call it ("time of death 1:42"), the pagers go off again--a 16-year-old football player with a shoulder stinger is coming our way. I run to meet the stretcher, desperate to get away from the cold stink of death. A nurse wearily trudges after me, ordering me to treat him like any other trauma patient. Unsure if I'm about to laugh or cry, I cut through his uniform and wrestle with thick, sweaty football pads, inspecting every inch of his healthy teenage body. As I pull off dirty socks, the smell of adolescent boy overwhelms my senses, and I can think of nothing but the privilege of being alive.

2010-09-02T12:39:00.000-07:00

"32-year-old female, 35 weeks pregnant. Assault. Airway patent." The nurses grumble as they copy down the cryptic page, cursing whoever accepted a pregnant patient. The med students look at each other, our hearts racing--she must be really bad to come to trauma instead of the obgyn floor. I fill out orders for x-ray and CT and try not to think of all the harm this could do to the baby.

When the stretcher finally rounds the corner, I breathe a sigh of relief. The patient moans relentlessly, a sign that her airway is still intact. As we palpate her from head to toe, we find no external injuries, but she seems to be tender everywhere. When I ask her what happened, her face darkens and her heart rate quickens. "That b*** started punching me. If I'da seen her comin', I woulda beat the s*** outa her."

Welcome to the world, baby.

2010-08-27T10:16:00.000-07:00

Your shell crumbles as they cut away your clothes, and I cover your emaciated frame with a warm blanket, willing your chest to stop heaving and sputtering with each gasping breath. They bandaged your wounds yesterday at the other hospital but did not think to drain the lung that is now drowning in blood. No one has come to cry for you this time, so I hold down your arm as the intern fumbles with the scalpel. You say it doesn't hurt as they push in the chest tube, but no amount of scars and tattoos can mask your misery. Your body betrays you as your hand reaches for mine, squeezing until I begin to feel your pain. We both focus on breathing in and out, and I promise not to go numb.

scissors and a smile

2010-08-19T14:44:00.000-07:00

"Scissors and a smile" is all a medical student needs for trauma call according to the Pit Boss, the PA who runs the show when we take our 12 or 24-hour shifts in the ER. Every time the pager goes off and gives us the cryptic details of the next trauma patient who will soon arrive by ambulance or chopper, we dutifully check our front pockets and join the 20-person crowd that assembles in the trauma bay. Organized chaos sets in as the patient rolls towards us, and we rush to complete our only clear duty--cutting off the clothes. We step over each other to get out of the way as all the tubes and lines are placed, not daring to speak or move until someone looks us in the eye and says, "You! Get the ABG results!"

It gets harder to smile as I lose count of how many MCCs (motorcycle crash victims) are wheeled in spiking temps of 107 from a bad meth hit, their clothes falling to the floor as their blood covers everything in sight.

At 5:36 all the scans have been ordered and lab results documented, and four sets of medical student eyes stare at the clock in silent desperation, willing the pager not to make another sound. At exactly 6:00 am, we tentatively begin packing our bags, and the resident casually mentions that Mr. M's wounds need to be cleaned and stapled. Mr. M screams like a toddler when my classmates' shaky hands attempt to inject the lidocaine, and I know he wants to crawl out of his skin as his last high wears off. Too tired to be angry, I fight back tears of exhaustion and reassure him that it will be over soon. It many not be a smile, but it's the best I can do.

you are really nice

2010-08-04T19:59:00.001-07:00

There is more crying than I expected at pedi ortho clinic. Instead of being overjoyed to get their casts off, most children are traumatized by the electric saw and subsequently scream when I try to examine their newly healed limbs. I've adjusted to the screaming and am surprised to realize that these kids actually do not bother me nearly as much as the quiet ones--the ones that moments ago were laughing and climbing all over the exam table but freeze and become mute when I enter the room. Usually a concerned mother more than makes up for her child's silence, but it's more difficult with Sara, who comes with her teenage aunt. Neither 5-year-old Sara nor her aunt can tell me anything about the mysterious leg pain that prompted mom to make an appointment, and I'm selfishly relieved when my attending has similar luck. Sara does not say a single word in response to his questions, poking and prodding, and stares into the distance with boredom as he explains to her aunt that her x-rays are totally normal. He tells them to come back in a year if the pain persists, which leaves me at liberty to tell Sara that she probably has "growing pains." I show her how her mom can rub her leg every night to make it feel better, just like my mom and dad did when I was her age. As I turn to leave, I feel a small tug on my coat and hear Sara speak for the first time. "You are really nice," she whispers, smiling as she runs past me out of the room.

2010-08-02T14:50:00.000-07:00

I watch Sofia's eyes widen as she sees her femur x-ray and takes in the 13 cm area of bony destruction, whispering that "nubes" (clouds) have invaded her knee. This teenage girl came to the doctor for a scoliosis check, hopeful that Dr. M would tell her she didn't have to wear her bulky brace to school anymore. Instead, she listens as Dr. M explains to her mother that Sofia will need surgery to remove the lesion and replace it with bone graft--the sooner the better. I reach for the box of tissues just before Sofia's tears spill out, knowing that she will respond as I would. I awkwardly offer her a tissue and place my hand firmly over her knee as she curls the rest of her body into a rigid ball. I wait and wait for Dr. M to offer some hope or reassurance, knowing that he cannot since he doesn't know what the invading clouds are any more than I do. While Dr. M answers her mother's questions about school, sports, and the risk of fracturing her leg before surgery, I ask Sofia what sports she plays, and she manages to laugh through her tears, admitting that she hates sports. At this moment her 8-year-old brother, who has been pointing to the x-ray and pestering me for anatomy lessons between the flurry of tears and Spanglish conversation, hops up onto the exam table. He offers Sofia his cheese crackers and places his hand over her other knee, squeezing tight.

real doctor

2010-07-25T20:27:00.000-07:00

I begin the long uphill walk toward the Other Hospital, grumpy because I was hoping to spend a few quiet minutes with my NICU babies after rounds instead of rushing across town to witness a left hepatic lobectomy on a two-year-old. The chance to scrub in on this rare procedure should excite me, but I dread the suffocating hours spent wedged between the extra people and machines that it will undoubtedly require. I enter the maze of unfamiliar hospital territory and follow promising signs toward the OR. I'm painfully aware of my overstuffed backpack and bright green scrubs that clash with the powder blue ones worn by the Other Hospital's staff. I quicken my pace, making a mental note to change as soon as I find the locker room. With relief, I spot a sign for pre-op holding and burst through the double doors, my backpack thumping angrily with each step. As I rush through, I hear a small squeaky voice exclaim, "Look mommy! It's a real doctor! One of the real ones..." I flash her a grin and feel my step lighten as I hold my head up just a little bit higher.

embracing my littleness

2010-07-18T18:31:00.001-07:00

Most of the time the surgeons ignore me. Occasionally they whimper in frustration at my lack of knowledge, and I fight my reflex urge to whimper back. When they glare at me with disdain for failing to correctly identify the obscure song blaring from the ipod, I attempt to embrace my littleness.

All too often we bemoan our imperfections rather than embrace them as part of the process in which we are brought to God. Cherished emptiness gives God space in which to work. We are pure capacity for God. Let us not, then, take our littleness lightly. It is a wonderful grace. It is a gift to receive. At the same time, let us not get trapped in the confines of our littleness, but keep pushing on to claim our greatness. Remind yourself often, “I am pure capacity for God; I can be more.”

- Macrina Wiederkehr

surgery surprises

2010-07-11T19:09:00.000-07:00

A few things that surprised me during my first week in the hospital:
1) The robot that delivers all the food trays. I wish I could have seen my face as it zoomed out of the elevator and beeped out a methodical chorus of "excuse me" in English and Spanish.
2) My ability to hear a heart murmur missed by an attending. This is not such a special accomplishment when said attending only spends 30 seconds on a physical exam.
3) The instant connection I felt with the NICU baby born on my birthday. Although her intestines are currently outside her body, I know she is destined for great things, and I told her so when none of the nurses were looking.
4) My amazing team of residents that has never once gotten mad at me and unanimously decided to stay late on Friday for some team bonding in the cafeteria.
5) The smile I got from 13-year-old José during morning rounds the day after he was informed that all his organs are on the wrong side of his body.

no, sir

2010-07-07T11:37:00.000-07:00

This was my only response to the unjust barrage of questions, thrown at me by the brilliant surgeon I volunteered to scrub in with this morning in an attempt to conquer the fear that had grown inside me each day as I heard more about his reputation. None of the procedures were laparoscopic, so there was no screen to distract me from the misery of helplessness. I had prepared for the hernia case the night before, but the hours I spent reviewing anatomy gave me no answers to questions about Russian surgical history or pediatric dosage of bupivacaine. I was even speechless when he asked my opinion about Macs, since I assumed he was talking about a surgical tool rather than my beloved computer.

All in all, it was a good day. I faced my fear of the Dreaded Surgeon and lived to tell the tale. My residents made me feel like a rock-star for having a penlight and scissors on morning rounds and cheered wildly as I performed my first solo procedure: removing the tag from the chief resident's shirt. I'm told it was a beautiful incision.

surgery, day 1

2010-07-06T16:52:00.000-07:00

I stand directly beneath scorching beams of light, one foot higher than everyone else thanks to the sympathetic nurse who found me a step stool. It reminds me of anatomy lab except that I am drenched in sweat and covered from head to toe by disposable accessories that somehow make me sterile. The smell of live burning flesh is different from formaldehyde and further reminds me that I am somewhere new. I squeeze my gloved hands more tightly against my chest and force myself to sort through the anatomy on the screen while halfheartedly attempting to follow the surgeons' banter. Are these doctors who casually trade obscenities really the same ones who moments ago taught me the importance of swaddling a baby like a taco?

I begin to relax as the attendings teach and pimp the resident in between assigning nicknames to the interns. Surely they won't be pimping me anytime soon. As I stare at the screen, transfixed by their minute laparoscopic stitches, I realize that one of them is expectantly handing me the scope. I awkwardly reach for it with my left hand and order myself not to shake. For 20 minutes I am stiller than I ever imagined I could be. Dr. #1 tells me to pull out the scope while informing me that I will help him "close." Too embarrassed to admit that I've never sutured, I let him guide the needle into my hand. He allows me to do one stitch while subtly ordering me never to bait my own fishing hooks. Then he kindly restores my confidence by handing me a syringe of disinfectant. The resident helps me clean and bandage the incisions, and my brain quickly switches gears as the patient transforms from a surgical specimen into the four-year-old girl whose mother ran down the hall to give her one last kiss before we wheeled her off to surgery. She shudders awake as the anesthesiologist removes her tubes, and I gently pin down her legs. The OR empties, but I am unable to leave her side, so I press my gloved hand into hers, willing her not to be alone.

one last reason to visit fat antonio

2010-07-04T19:37:00.000-07:00

Although the "Reasons to Visit Fat Antonio" series has been sloppy and random at best, I wrote it knowing all along what the top reason would be: the Alamo! As a child I visited the Alamo several times as part of my duty to Texas and my family (legend has it that an ancestor journeyed to Texas with Davy Crockett to fight in the glorious battle of the Alamo; however, I'm also descended from a Cherokee princess....). I've been waiting to write about the Alamo until I could visit it again as a San Antonio resident, but for some reason this fell toward the bottom of my priority list for the last two years. I finally took action today as I enjoyed my last free weekend before starting surgery. Although Hurricane Alex threatened more rain, some friends and I set out this morning to bike the historic San Antonio Missions trail, a beautiful ten mile ride along the San Antonio River that ends at the Alamo. We leisurely explored the first four missions, feeling like we were in the middle of the Spanish countryside rather than inside a bustling city. Most of the buildings have been restored over the years, but the art history nerd in me was excited to see some original frescoes on the walls at Mission Concepcion. We rode a few more miles only to discover the trail was blocked, so we navigated some of downtown's busiest streets to reach our final destination, which turned out to be quite the tourist spot on the 4th. I'll spare you the details but can promise as much (or as little) Texas history and a unique look at my favorite part of San Antonio to anyone willing to explore the trail.

halfway there

2010-06-01T16:42:00.000-07:00

Now that I finished step one of my boards, I feel like I can officially say that I'm halfway through medical school. I've had a week off, most of which I spent with my goddaughter, Elizabeth. On Monday I go back to school for two weeks of classes that will attempt to teach me how to not be totally useless in the hospital. After that it's three months of surgery, followed by pysch, ob-gyn, internal medicine, pediatrics, and family medicine. Look out, Fat Antonio!

surprise reunion

2010-05-29T21:03:00.000-07:00

I wanted to write a quick post to prove (mostly to myself) that I am maintaining some semblance of a "normal" life as I study for my boards and to remind us all of what a pleasantly small world it is. This weekend I was delighted to be briefly reunited with Lisa when she came to San Antonio for a conference. I totally forgot she was coming but was thrilled to escape the books and meet her for dinner at the Riverwalk. We had a great time catching up, and I was reminded of how blessed I am to have you all as friends. I usually try not to let my sentimental self come out too much on the blogosphere, but my mushy brain can't resist this opportunity to thank you all for your friendship. Much love from Fat Antonio!

life directions

2010-05-13T16:25:00.000-07:00

I've entered a new world of studying all day everyday (this wasn't exactly what my life was like before) in preparation for my boards, so I apologize for not having much to blog about. Today I took a practice exam at St. Mary's University where I'll take the real thing in a few weeks. I had never been there before and was pleasantly surprised to see red brick buildings that reminded me of W&M. I was further surprised when I finally stumbled upon the testing center--a stucco square surrounded by palm trees named the "Center for Life Directions." Although I wish I never had to go back there, I'm hopeful that it will help lead me in my true life direction.

strawberries

2010-05-05T14:43:00.000-07:00

Yesterday I officially finished my second year of medical school. It doesn't feel like a huge accomplishment since I'll be studying for my board exam for the next month, but I was very excited to give myself a few days off from studying. This morning a few of us celebrated by driving to Fredericksburg to pick strawberries. You got a discount for picking 12 pounds or more, and I was pleasantly surprised when we got 13.5! It was back-aching work, but these strawberries are by far the best fruit I've ever tasted. The orchard owner assured us that they are delicious frozen, so now we'll be able to enjoy them year- round (or at least for a few weeks).

My celebration continues with a banquet tonight followed by two days at a friend's lakehouse. At the moment, life is pretty great :)

an encounter

2010-04-22T20:58:00.000-07:00

I slowly walked to my car in the Walgreens parking lot, in no hurry to return home to my GI notes. I was filled with equal parts annoyance and curiosity when a shaky voice coming from the car next to me asked if I knew how far it was to McCallen. I called out that it was about 5 hours away and then walked closer to the small Hispanic man whose face was etched with despair. I asked why he needed to get there, and he began to choke back tears as he explained that his daughter was in critical condition in a hospital there following a car accident. He wanted to get to her "in time" but feared he wouldn't because his gas tank was empty. He had driven to San Antonio from Leon Springs and spent the last few hours asking for help from various agencies, all of which had turned him away...much like I might have on another day. A few long seconds passed as he pressed his face into his hands, drained of all hope and expectation. I walked back to my car and got out the $10 I'd withdrawn from the bank that afternoon and the "snack pack" I'd placed in my car that morning to assuage my guilt the next time I encountered a homeless person. I awkwardly offered these meager gifts as I searched my brain for a better way to help a desperate man with a dying daughter. His face lightened momentarily as he offered his hand for a shake. I asked if I could pray for him and his daughter, and he said he would like that as he began to cry again. I cried too as I placed my hand on his shoulder, praying for Gabriela and the grief-stricken father who had managed to break through my suspicious defenses and touch my soul. Afterward I frantically apologized for being unable to do more, but he simply shook his head and drew me into a brief hug. "You are the only one who has done something," he replied.

I climbed into my car with a heavy heart and immediately checked my purse to make sure nothing was missing. For several minutes I argued with myself about whether I had done something stupid and whether I should have done something more. I'll probably never know. What I do know is that sometimes we are called to do something.

when psychopath makes you psycho...

2010-04-20T21:29:00.001-07:00

Earlier tonight as Paige and I began reading our psychopathology notes to each other (always our last ditch effort to stay focused the night before a test), she lamented an overwhelming chocolate craving. Never one to turn down a baking opportunity, I found a recipe for microwave chocolate cake. The texture was a bit strange due to our 1970s microwave, but it really did cook in 2 minutes. I covered it in gooey chocolate icing and sprinkles, and it washed down great with some milk. Here's to hoping for happy brains and stomachs in the morning!

fat antonio friday

2010-04-16T14:16:00.001-07:00

Today started out like any other Friday, but a few fun twists made it blog-worthy:
First, I had a laughing attack during this morning's small group case conference. I can't explain exactly why it happened, but after a few arrogant remarks from a high-profile classmate and a snicker from my former roomie, I was gasping for air with tears in my eyes. I spent a good five minutes calming down with my head on my binder. This hasn't happened since I was 10 years old with my head on the church pew trying to avoid my brother's mischievous gaze.

Next, I saw a small herd of deer prance across the baseball field on my way to the gym.

Then I decided to go to zumba instead of doing my usual solo workout. It was an excellent decision. We sweated our way through a delightful mix of salsa, hip hop, and the Cotton Eye Joe. My laughing attack almost resurfaced, but I kept things under control.

Finally, I received a note and gift card from a mystery friend thanking me for the study guides I've shared with the class over the last two years. She signed her name but acknowledged that we've never met (and she's not on Facebook so I couldn't stalk her). I can't wait until she is revealed to me at graduation in two years!

bluebonnets

2010-04-08T20:11:00.001-07:00

Reason #2 to visit San Antonio: the bluebonnets! I was planning on writing about Fiesta as your #2 reason, but unfortunately I won't have time to fully explore it because of exams. Instead, I decided to save Fiesta for another year and write about the bluebonnets that have exploded in patches of grass everywhere I look. For as long as I can remember, spring has been my favorite time of year because of the wildflowers and beautiful weather that so briefly grace us with their presence. Although several types of flowers grow, bluebonnets are generally the most beloved since they are the official flower of Texas. I have no idea of the history behind the bluebonnet other that what I learned in The Legend of the Bluebonnet by Tomie dePaola (author of Strega Nona and other children's classics.) I don't have anything else to say about bluebonnets other than I hope you can all see them someday in person. Hope everyone is enjoying spring!

healing touch

2010-04-04T13:53:00.000-07:00

For the most part, the idea of the healing touch remains unclear to me--an illusive gift that is part physical, part spiritual. I'm not sure exactly what it is, or if I have it, or if I'll ever get it. What I do know is that I have to touch my patients. Most of the time it is an unconscious part of my routine--my left hand on your shoulder as I listen to you breathe, or a light touch on your back as I guide you to a chair.

Sometimes the need to touch screams at me and I lose control of my hands...Like when 10-year-old Roberto shows me his left wrist that has been broken for 6 months, and my fingers gently reach for the mangled mass of bone and blood beneath his smooth skin, knowing they cannot heal him but desperately trying to convey how much they want to.

Sometimes the need to touch is selfish--like when 2-year-old Daniel runs by me and I rub the top of his shaved head (his mom thinks he has lice, but it is just dry skin)...he grins at me with twinkling brown eyes, and my heart lightens.

flyin' first class

2010-03-23T16:35:00.000-07:00

This past week I celebrated my last official spring break with a trip to Virginia. I had a great time seeing some of you and getting to know my beautiful new goddaughter.

This trip began as it usually does with a painful early morning flight. The major difference was that I flew first class! (I had to use double miles because I flew on a popular date, and this automatically got me an upgrade.) I slept through my first flight to DFW but stayed awake every minute of my flight to Richmond so I could report on some highlights:
1) Breakfast was served, which surprised me due to recent airline stinginess (it was a HUGE meal...my main course of oatmeal and fruit was accompanied by all-you-can-eat bagels and biscuits)
2) The flight attendant addressed each of us by our last names, each time we interacted
3) The tray table comes out of your armrest. This was the source of a full 10 minutes of embarrassment and confusion for me. At first I was bitter at the frequent first-class flier sitting next to me for not helping me out with this. Later, after she ordered a Bud light at 10:30 a.m. and told the flight attendant she went to UT, I realized she was friends with my brother and we got along great.

the cost of being green

2010-03-08T18:31:00.000-08:00

Paige and I love to recycle. Every week we pat ourselves on the back for filling up our green container and preventing the accumulation of approximately 1.5 bags of trash. Since we don't have a curb on which to place our curbside container (our neighborhood seems to be strictly recycle-free), we have to take our recycling somewhere. This was easy enough in the fall when our apartment complex had a recycling dumpster next to the garbage one. In January, the recycling container was defiantly replaced by a second garbage dump, making our green passion more difficult. Now we employ a complex schedule that involves taking the recycling to the various containers at school and my parents' house whenever I go home. This is slightly annoying, but worth the instant do-gooder feeling one gets once the green container has been emptied.

Tonight, while recovering from an exam and pretending to gear up for the next one, I stopped watching The Office long enough to realize that Paige was cleaning instead of studying. Recognizing that we were both desperate, I suggested the ultimate distraction--operation recycle. We are probably the only people who feel satisfied after sneaking into school late at night to empty the recycling, but I can't help but smile as I look at the empty green container beside me.

my life is average

2010-03-04T15:07:00.000-08:00

Just in case you need some extra laughs in your day and haven't discovered this website, let me recommend My Life is Average.

These are some of my favorite posts. They aren't always grammatically correct but have made me lose my breath from laughing, so I thought I would share:

"Today, I got into the shower and started to shampoo my hair. My legs started to feel really really weird. I looked down, and saw I was still wearing my pants. MLIA"

"Today, the Jehovah witness people came to my house. When they asked me, "do you have the time to hear the good news." Deciding to be nice I said, "sure, come on in." after sitting on the couch in my family room for about 30 awkward seconds, I said, "well aren't you guys going to say something?" they replied, "we have never made it this far". MLIA"

"Today, I went farther with my girlfriend than I ever have before. We walked five miles. MLIA"

"Today I realized that kids today have it so much easier. They did not have to wait years for the next Harry Potter book to come out. MLIA"

If you ever have an average moment, I would encourage you to think about posting and brightening the lives of people like me. If you don't feel very average, you should think about posting to My Life is G instead.

six flags

2010-03-01T13:19:00.000-08:00

Reason #3 to visit Fat Antonio: Six Flags Fiesta Texas. This amusement park has many standard attractions but is also known for its elaborate shows and water rides. Many of the rides have unsurprising names, but some of my favorite Texas-themed ones are Texas Tumble, Lone Star Lagoon, and Big Bender. Fiesta Texas is home to countless roller coasters and water rides that I successfully battled during my teenage years with much pride. One ride I have yet to conquer is the Rattler, which used to be the world's tallest and fastest wooden roller coaster. I always intend to ride it, but then I hear it creaking and head for Superman, Poltergeist, or anything made of plastic and metal. Maybe one of you will inspire me to conquer the Rattler someday.

Although Six Flags now has parks throughout North America, it started in Texas and took it's name from the six flags that have flown over Texas during it's history. Can anyone guess what they are without using the internet for help?

"Please relax. You are going to feel some pressure."

2010-02-19T18:13:00.000-08:00

Each year I try my best not to laugh or cry as my ob-gyn tells me to relax and warns me of the "pressure" I will feel as she invades my pelvis with a giant metal speculum. Although she is one of the kindest, smartest doctors I've ever met, those five minutes are more painful to me than my most difficult exams or grueling workouts.

So today when I learned how to do my first pelvic exam, I was less than thrilled by the prospect of inflicting such pain on another person. Although I'm told these exams are much less painful for older women, I was disappointed when I opened the door of the exam room and saw my favorite standardized patient waiting in a gown. How could I do this to Ms. M?! I was the only female student in my group, so I nervously took pity on the boys and volunteered to go first. I will spare you the rest of the details, but I'm happy to report that the exam went as well as possible, and I visualized and felt all the appropriate structures. I'm pretty sure Ms. M still likes me, and I'm hopeful that my new understanding of pelvic exams will make my own ob-gyn visits more pleasant.

2010-02-16T17:09:00.000-08:00

Today my friend Meghan handed me this amazing gift (See my "Pet Peeves" post if this doesn't make sense):

Thank goodness for creative friends with a great sense of humor! My life is much better because of you all.

burg nostalgia

2010-02-15T18:45:00.000-08:00

For all my fellow Tribe alumni and anyone who has visited Colonial Williamsburg:

http://www.youtube.com/watch?v=NbnxUXtzc6k

pet peeves

2010-02-11T19:26:00.000-08:00

Last year I discovered that I am not a "class-goer." Since effective learning in medical school means reading a 500 page syllabus four to five times, I usually prefer to spend all my study time learning on my own. I still go to class fairly often if a lecture sounds particularly interesting or if I find myself in need of social interaction. When I do go, I try to be as respectful as possible and have made it a rule never to leave in the middle of a lecture. Yesterday when an obgyn resident disinterestedly mumbled through 3o pages of syllabus that she had copied verbatim from her powerpoint, I vowed to stick to my rule. When she made fun of her scared teenage patients, I began to lose my resolve. When she put up a graph demonstrating that female fertility declines with age (which we've already seen 17 times), I noisily packed up my things and stormed off to the library. Apparently she struck a nerve.

What are your pet peeves?

prescriptions

2010-02-10T20:14:00.000-08:00

Today I had wards, which means after class I put on my white coat and dragged my gargantuan backpack over to the hospital to practice my physical exam skills on a willing yet unsuspecting patient. Though it was my third wards day, I felt conspicuous as ever as my backpack bumped into nurses on the elevator and my doctor tools jingled in my pockets as I tried to avoid the onslaught of bodies running past me towards a code blue. I panicked when I realized my patient was still asleep following surgery but brightened when his real medical team came in to wake him up, sparing me the discomfort. I had a pleasant visit with Mr. G and only briefly berated myself when my Spanish wasn't on par with his English. I did very little for him except check his blood pressure and reassure him that his heart was fine even though I couldn't feel his pulses. After an hour, I left Mr. G to his lime jello, feeling moderately dissatisfied and extremely awkward as I swapped my white coat for my fleece and prepared to face the "wintery mix" we've been enjoying. What was the point of dressing up and playing doctor? What had I done other than delay a patient's first post-op meal?

Then I thought back to 7:50 this morning, when my friend Meghan sat down next to me and declared she was having "respiratory issues." She sounded congested, so I recommended Mucinex, a wonderful drug whose stock my family should have bought years ago. I wrote down the specific type I wanted her to get on a post-it note and passed it to her. Meghan passed it back and asked me to sign it. "You just wrote your first prescription," she said. Playing doctor is fun after all.

Meghan, I hope you are feeling better!

Mr. C

2010-02-05T11:11:00.000-08:00

When I was twelve, my guiltiest pleasure was staying up late on Thursday nights to watch ER. I loved hearing the doctors spout off complicated medical jargon and gave myself a mental pat on the back each time I decoded their cryptic language. I also started telling my younger brother to do things for me "stat." I still remember the night that I watched the horrifying episode where Carter and Lucy, my two favorite characters, were attacked by a schizophrenic patient. Schizophrenia became synonymous with evil, and I dreaded the day that I might see a patient with that terrifying disease.

Yesterday was my first opportunity to see such a patient. Mr. C was a well-groomed hispanic man in his seventies who had been in the hospital for 40 days, about four times longer than the state-recommended stay. I watched for half an hour as a psychiatric resident interviewed him and then threw in a few questions of my own. He answered us politely yet incomprehensibly as he swung from side to side in his swivel chair, telling us that he could predict the future and warning me to be careful because my chair sat on top of the county line where his name was written. He explained that he clearly was not schizophrenic since he did not have cancer or high blood pressure, but he was agreeable to his doctor's wishes to be hospitalized.

Mr. C was indeed agreeable, and I hope that my experience with him will make it easier when I see a patient who is not so well-medicated. Like all my perceptions in middle school, I think this one may have been just a tad overly dramatic.

trivia

2010-01-29T08:05:00.000-08:00

After seeing the recent Sherlock Holmes movie, I have to confess that I am in awe of Sherlock Holmes. My alternative career choice has always been CIA agent, so someone with a combination of superb detective skills and medical knowledge (not to mention a nasty right hook) ranks high on my list. Recently we had a lecture from a neurologist who started his talk with a bit of Sherlock Holmes trivia. Apparently Arthur Conan Doyle (the author of the Sherlock Holmes series) was an ophthalmologist who based the Sherlock Holmes character off of one of his medical school professors--a doctor named Joseph Bell who was famous for bringing strangers into class and describing their occupation and medical problems by observing their appearance. This made him a pioneer in the field of forensic pathology, since crimes were solved using observation rather than technology.

Joseph Bell should not be confused with Charles Bell, a famous anatomist who discovered "Bell's palsy" (facial nerve paralysis).

I hope this gives you plenty to talk about at your next party...or perhaps your next game of trivial pursuit :)

how you doing?

2010-01-28T14:43:00.001-08:00

Every female medical student lives in fear of inappropriate encounters with male patients. I'm sure sexist, condescending attitudes will be annoying, but what makes our stomaches churn is the idea of anything out of the ordinary occurring while we blunder our way through an exam of the lower body. Unfortunately some of my classmates have already had such encounters and are now overly sensitive to any kind of flirting. Since I haven't had such an encounter, I still welcome the flirting as a healthy self-esteem boost.

My favorite kind of patient (other than a perfectly-behaved child) has always been the "sweet old man" who thinks I'm pretty in a grandfatherly sort of way. That's why yesterday when I went to my neurology lab, a three-hour small group session with neurologists and their patients, I was thrilled to see that most of the patients were 60-70 year old men. We spent the three hours rotating in groups of 8 between the various patients, taking turns performing various parts of the neuro exam. My first patient was a 65-year-old retired NFL player who suffered from a condition called limb-girdle dystrophy that had greatly weakened his muscles and ended his football career when he was 30. In spite of this, he seemed kind, jolly, and grateful for his life. I was last in line to examine him, and when I walked up to introduce myself, he raised his eyebrows and said, "How you doing?"

I thought about my frizzy hair, wrinkled coat and puffy eyes hidden behind smudged glasses. I told him I was doing great and proceeded with the exam. Without a doubt, he was my favorite patient of the day.

insurance bummer

2010-01-25T12:59:00.000-08:00

I promise this will be my last post about healthcare-related topics for a while. In the midst of the national healthcare debate, I thought it would be good to look into my personal insurance situation. I was always under the (misguided) impression that I could stay on my parents' insurance plan as long as I was a full-time student and was pretty sure we had confirmed this when I started medical school. I'm turning 25 this summer, so I thought it was time to look into this for myself, just to be sure. When I emailed our insurance agent (who is my amazingly helpful cousin), he told me that I will, indeed, be kicked off the family plan this summer. The good news is that my school offers a tolerable insurance plan. The bad news is that I am unemployed, single, and in an environment where I'm constantly reminded that my 25-year-old eggs are getting older by the second.

Dear Liz, welcome to reality.
Dear Mom and Dad, thank you for all the years you've helped me with insurance and everything else!

healthcare continued

2010-01-23T19:56:00.000-08:00

I totally agree with Ashley's comments about the government's efficiency. There is no way i would endorse a plan that is run like Medicare, and I have no doubt that the "public option" plan that is currently on the table would only add to the current waste and inefficiency. What I would ideally support is a single-payer plan in which all Americans would be covered while regaining the right to freely choose their doctors and doctors would reclaim independence over patient care. I was initially skeptical of single-payer until I researched it for a college class and realized how well it works in other countries. Surprisingly, my research showed that a national plan could save us $350 billion a year if it was run efficiently and effectively macro-managed. I'm not so out of touch with reality to think that this is likely if my lifetime, but I will continue to advocate it until I see a better option. Even if we could give everyone the most basic level of primary care, we could save $100 billion dollars in unnecessary emergency room visits (which we currently help hospitals pay for through our tax dollars).

It has long been a struggle for me not to think about the number of uninsured people in this country or worry about my little cousins who are too "wealthy" to qualify for CHIP. Recently, however, my anxiety has become more selfish as I am faced with serious questions about my future: How will I pay off my student loans? How can I make a living when so much of my income will go to insurance companies and the employees I must hire to file claims? Can primary care doctors really make a living any more? Is it possible to "help the poor" and still take care of a family?

I'm not going to become a plastic surgeon or radiologist just because I have these fears. I might, however, be forced to join the military, live in an underserved area, or work for a crowded practice that rushes patients in and out and orders unnecessary tests on kiddos. Whatever I end up doing, I promise to keep my phone number available to a selected group of loyal blog readers...as long as you're on my good side ;)

healthcare heartbreak

2010-01-21T08:32:00.000-08:00

Yesterday I got a phone call from a friend of mine who surprisingly apologized for judging me because of the views she believed I had about certain issues that differed from her own. I wasn't truly offended by her professed judgement, but this conversation caught me off guard and led me to examine what some of these views might be. I imagine that I'm more "liberal" about several issues than she is, but the issue that I would like to briefly discuss today is healthcare.

I've been conflicted about our healthcare system since I was old enough to begin to understand it, but my heart has grown increasingly heavy as I've been further exposed to its realities in medical school. Yesterday's news has prompted a fresh wave of debate and speculation about healthcare reform, which has only served to further confuse and sadden me.

As a middle class American, I've been fortunate to grow up with access to healthcare, albeit through insurance that has become nearly impossible for small business owners like my dad to afford. Others I know, like my cousin Steve, enjoy the privilege of a shoddy insurance plan that does not cover his wife and three kids and has decided to deny him coverage because of his unforgivable medical conditions. Still others go without insurance at great cost to themselves and society.

There are no easy answers for fixing healthcare. Statistics about cost have been so distorted that it is hard to know what to believe, but I personally support a national plan as the most ethical and financially responsible option. Regardless of what you think, I encourage everyone to approach this issue with an open mind free of fear. If we can move beyond the anger and paranoia that drive so many of our nation's decisions, perhaps real reform can occur. As someone who is devoting much of my youth and happiness to healthcare, I have to believe this is possible.

"Perfect love drives out fear" 1 John 4:18

reasons to visit Fat Antonio: the weather!

2010-01-18T14:33:00.001-08:00

Reason #4 to visit SA: the weather! Although it's not always perfect (beware of July and August), we have a beautiful fall and spring that seem to blend into the relatively few cold days of winter. Today I was fortunate enough to have the day off but was bummed to have to spend it studying. Our apartment was pretty chilly from the "cold snap" we've been having, but when I checked the weather, I was delighted to see it was 70 and sunny. I opened the windows and enjoyed a nice breeze as I learned all about anti=psychotic drugs on the porch. Life doesn't get much better than that for a medical student.

advice i hope you never need!

2010-01-16T14:59:00.000-08:00

I promised myself that I wouldn't become an obnoxious medical student who gives out unsolicited advice, but I learned something this week that I couldn't resist sharing with all of you. I'm sure all of you know someone who has suffered from a stroke, a relatively common but devastating disease that frequently occurs in elderly people. What you might not have realized is that strokes can also occur in young people due to drug use, trauma, or something as innocent as visiting the hairdresser (the awkward position of your neck during a shampoo can cut off blood flow to your brain). We also heard from a young woman who had a stroke after visiting a massage therapist who manipulated her neck. I don't want to make anyone unnecessarily paranoid about strokes but would ask you to keep the following in mind if you are ever suspicious: WALK (Is your balance off?), TALK (Is your speech slurred?), REACH (Is one side week or numb?), SEE (Do you have any vision loss?), FEEL (Do you have a severe headache?). If the answer to any of these questions is yes, get to the hospital! It's much better to arrive in an ambulance so you can be treated immediately rather than waiting for hours in the ER.

More cheerful blog posts coming soon :)

back to school

2010-01-11T08:20:00.000-08:00

I'm wearing my red boots today as a colorful attempt to fight off the back-to-school blues. I had a wonderful break full of tex-mex, play dough, and reunions, and it has been hard to say goodbye to my life of leisure. Thank you to everyone who fed me, entertained me, and took time to see me over the holidays. It was great to catch up with you all!

What do you do to make Mondays more bearable?

my great discovery of 2009

2009-12-27T18:59:00.000-08:00

Recently I invited myself over to my friend Lizzie's house, which is conveniently located next to a magical grocery store called Fiesta that I will save for another post. We decided to cook dinner together, and as I was chopping onions, Lizzie showed me a delightful gift from her mom--chopping goggles! These goggles are way cuter than anything I wore in chem lab but do an equally good job of protecting your eyes from irritants. Lizzie graciously posed in the goggles (which match her outfit) and took over chopping duties for me. I'm not as sensitive to onions as I once was, but rest assured that I will purchase chopping goggles if I ever see them in a store.

reasons to visit Fat Antonio: the Riverwalk

2009-12-19T09:06:00.000-08:00

Reason #5 to visit San Antonio: the Riverwalk! Although primarily a tourist attraction lined by hotels, restaurants, and gift shops, the Riverwalk is a beautiful place to walk around and enjoy a nice evening. It is especially mesmerizing at Christmas when all the lights bounce of the water and the mariachi singers add a few Christmas classics to their repertoire. We celebrated the end of exams by eating dinner at the Iron Cactus, searching for the best place to take pictures, and listening to a surprise fiddle concert (which included Joy to the World and Deep in the Heart of Texas, two of my favorites). It was the perfect ending to a long semester!

reasons to visit Fat Antonio: my roommate

2009-12-12T12:08:00.000-08:00

#6 on your list of reasons to visit Fat Antonio: my roommate, Paige! Not only is she kind, tall, and gorgeous, but she's also extremely patient and will undoubtedly forgive me for this invasion of her privacy. She shares many characteristics with my college roomie, which is probably why we get along so well. Recently I discovered that in addition to being an excellent cook (last week she spoiled me with homemade tortilla soup, spiced tea, and banana bread), she's also very crafty. She made that Christmas wreath all by herself and even vacuumed up the glitter afterwards. Although they don't realize it, Paige and Maggie jointly kept Michael's in business this year. Other things you should know about Paige:
1) she drives a red pickup
2) she wants to be an ob-gyn, which means she will literally save babies!
3) she can shoot hoops and whiskey better than all the boys at our school
4) she helped me clean out Jorge's unmentionable parts in anatomy lab last year even though she belonged to a different tank

When you visit, be sure to thank Paige for putting up with me!

pale is the new tan

2009-12-10T18:50:00.000-08:00

This week as I've learned about the various types of skin cancers, I've tried harder and harder to convince myself that pale is the new tan. Even though someone mistook my not-so-well rubbed in sunscreen for leftover toothpaste, I am determined to keep wearing it every day. I've been conscious of skin cancer and wrinkles for a while now but in the past have resorted to self tanner to combat my pastiness. Today I've decided to ignore our society's bizarre obsession with tanning and embrace my ivory complexion. I salute others who have done the same. Though the Twilight stars look anemic and creepy, I hope they'll inspire teenage girls to ditch the tanning beds. I think I'll shoot for more of a Nicole Kidman look.

thoughts from the week

2009-12-05T13:17:00.000-08:00

Random thoughts from this week:
1) Have you noticed that your appetite changes when it gets cold outside? I've been drinking mug after mug of hot chocolate and tea and only want to eat soup or stew. Somehow I can still convince myself to eat unhealthy things that aren't necessarily warm while my fresh fruit and yogurt never leave the fridge.
2) Medical students CAN occasionally be spontaneous. Snow was in the forecast this week, and although none ever came, I decided to give myself a snow day on Thursday. I got a massage, ran some errands, and threw a last-minute Christmas party.
3) Snow in the forecast apparently gives everyone license to leave work at 2:00 and head to the grocery store. HEB ran out of chips and salsa in record time, making my party planning somewhat difficult.
4) Famous people have blogs, too. I recently discovered Donald Miller's blog, and recommend his Christmas list for a quick laugh. Number 4 is my favorite.
5) I wonder if the Twilight phenomenon will make pale skin trendy. Thoughts?

more Austin

2009-11-29T14:53:00.000-08:00

Even more reasons to visit, written by someone much more talented than me!

reasons to visit Fat Antonio: Austin!

2009-11-28T15:15:00.000-08:00

This week the best reason I can give you to visit San Antonio is its proximity to Austin. The longer I live outside of Austin, the more I appreciate it, and spending a relaxing holiday here while the weather has been 60 degrees and sunny has put me in the mood to gush. These past few days as I've sipped margaritas at Gueros, watched the Longhorns get one step closer to a national championship, and attempted to burn off Thanksgiving dinner at the hike and bike trail, I've realized there really is no better place to live. Where else can you watch bats take off at sunset or be outrun by grandmas in spandex [note: I am exceptionally slow]? Even the water tastes sweeter here--just come visit and I'll prove it.

reasons to visit Fat Antonio: toilet seat museum

2009-11-23T12:44:00.000-08:00

#8 on the list of reasons to visit SA: Barney's Smith's Toilet Seat Art Museum. I was hoping to visit the museum with my parents last weekend but ended up spending most of my free time shopping and seeing Twilight (yes, I feel like I'm 13). I think I'll let you all read about the museum and postpone visiting until someone is brave enough to go with me. It will undoubtedly be a once-in-a-lifetime experience.

fashion forward?

2009-11-22T14:29:00.000-08:00

I've talked to a few of you about this, so I just wanted to share that I finally gave in and bought black boots! I am possibly the least fashion-forward person I know, so this is a huge step for me. Now I may finally have to break the promise I made to myself to never wear leggings. Have any of you had any fashion adventures recently?

laredo

2009-11-15T18:16:00.001-08:00

Highlights from this weekend's medical missions trip to Laredo:
1) Pretending to study on the drive down by listening to recordings of heart sounds with the base turned up. Probably the closest experience I will have to being inside a beating heart.
2) Working at an awesome clinic site (with indoor plumbing!) that had already decorated for Christmas. Feliz Navidad!
3) Talking with the family that ran the site--former missionaries with 9 kids (7 of their own and 2 adopted from Ethiopa). In the last year their church has adopted 17 kids, mostly from Ethiopia and Guatemala. It was a beautiful thing to see a multicolored herd of children running around all day speaking their own hybrid language.
4) Getting pulled over...and not getting a ticket! On the drive back, I suggested we stop for dinner, but the exit we took turned out to be a dead-end, and we had to make a 10 mile circle to get back on the highway. The border patrol found this to be quite suspicious but believed my pathetic explanation and told us which exit to take to find food. We were annoyed but grateful!

reasons to visit Fat Antonio: world's largest cowboy boots

2009-11-08T19:09:00.001-08:00

Reason #9 to visit: to see the world's largest cowboy boots! These concrete boots, 40 feet tall and 35 feet wide, sit in front of North Star Mall, affectionately known to my brother and me as "the boot mall" throughout our childhood. Apparently these boots used to reside in Washington DC before moving to a more appropriate home. I haven't been able to find out anything else about their history but would love to know more--can my favorite history buff help me out?

Further proof that everything really is bigger in Texas.

gym embarassment

2009-11-06T08:48:00.000-08:00

All the recent posts about gyms have inspired me to share a brief embarrassing moment I was planning on keeping to myself. Every night I pack a gym bag to bring with me to school so I can work out when I'm done with class. At the beginning of the year I occasionally forgot to put something in my bag, like my hairbrush or headphones, but lately I've been doing pretty well. Yesterday at 4:00 I left the library, dragged my gym bag out of my car, and tried to tell myself that I would rather work out than take a nap. I changed very slowly in the locker room and thought about curling up on the floor. I barely convinced myself to keep going with the promise that I could watch Friends on the stairmaster. I slipped on my socks and reached into my bag for my shoes. I reached again...and again. No shoes. I briefly considered working out shoe-less, but thoughts of a real nap overpowered this foolish thought. Too tired to change, I shoved my feet back into my gold flats and shuffled out of the gym, hoping no one would recognize me. When I came back at 8:00 to watch the Office, I was delighted to see different faces behind the front desk.

reasons to visit Fat Antonio

2009-11-01T19:10:00.001-08:00

In case the King Kong Nachos and rattlesnakes haven't convinced you, I'm going to give you 10 reasons why you should visit San Antonio. I will give one each week in no particular order, and at the end you can all vote on your favorite reasons.

Reason #10: San Antonio is home to the best NBA team in the country, the Spurs. Even if you disagree with this, you should at least concede that the Spurs are entertaining and uniquely skilled, as evidenced by Manu Ginobli's recent bat encounter. That is some serious hand-eye coordination.

life in fat antonio: don't pet the snakes

2009-10-30T16:37:00.000-07:00

In an attempt to counteract the effects of the King Kong Nachos, our medical school recently created a 2-mile running trail around campus. For me, this trail is a much-needed oasis from the traffic and concrete that enclose our medical center bubble. Though most of the trail is surrounded by a sparse layer of trees through which you can still hear and smell all the joys of urban living, there are a few denser spots that help you feel at one with nature. Yesterday as I slogged through some mud and spotted fresh deer droppings among the empty soda bottles and condom wrappers that littered my path, I really felt like thanking Father Sky and Mother Earth for such a delightful experience. If I had seen any animals, I definitely would have wanted to pet them. Luckily, I spotted this helpful sign that kept me from getting carried away. It turns out that most doctors do not carry anti-venom kits with them when they run, so the school does not endorse petting snakes on the trail. However, the hospital is close enough that I would encourage petting them anyway if that's what you need to do to relax.

life in fat antonio: king kong nachos

2009-10-27T17:58:00.001-07:00

Tonight in zumba class as I shouted olé and narrowly avoided a slap in the face from my exuberant neighbor, I realized it's time to share a little bit about life in my current home, a city I lovingly refer to as Fat Antonio.

Although it's only 80 miles from Austin, Fat Antonio seems worlds apart from the smoothie-drinking hike-and-bike town I grew up in. I learned this the hard way when I went running last year and was berated by multiple women driving by for my apparent lack of womanly body parts.

According to Men's Fitness, SA currently ranks as the 3rd fattest city in the US, but it's doing all it can to reclaim its rightful place as numero uno. Although numerous taquerias and the lunchtime crowd at the Pollo Loco are doing their best to fight the good fight, I believe our beloved Chacho's will be the crucial factor in bringing home the gold. As its website explains, this popular chain is a favorite because of it's delicious ritas, multi-lane drive through, and fairly generous portions (see King Kong nachos above, which can feed an entire African village or approximately 3.5 SA natives). At Chacho's, "Self-service style means you can relax & eat/drink slowly because of in no pressure from pushy waitstaff" and "Food served on real china with cloth napkins at most locations." If that doesn't convince you to hop on a plane to Fat Antonio, I don't know what will.

kidney talk

2009-10-21T16:05:00.001-07:00

Hands down, the phrase I've heard most often in the past week is, "I wish the kidney didn't exist!" This is undoubtedly a stupid thing to say, but it reflects the general sense of frustration and panic as we approach our renal exam on Friday. Here are some other comments from my classmates that aren't especially witty but have amused me during this time of drudgery:

“I’ve been sipping on this 2-liter Coke Zero for the last 13 hours. I'm making steady progress.”
“If you look at the electron micrograph, it’s just like Bart Simpson when he dyed his hair.”
“Dinner was good. We talked about renal tubular acidosis for 45 minutes.”
“I pee over 4 liters a day. That’s some serious polyuria.”
“Diabetic nephropathy: a.k.a. Christmas Ball disease”
“Doing the Briscoe disco” (code for: going to the library)

beware of speed traps

2009-10-12T19:15:00.001-07:00

On Friday night as I drove to Eagle Pass, TX for a medical missions trip, I fell victim to a small town speed trap. The officer who got me was unimpressed by my tears and idealistic devotion to free medical care and somehow managed to convince me I was going 46 in a 35 zone when, in fact, it was a 45 zone sitting a few feet from a 55. Luckily for him I don't have the time to drive to the Sabinal County Municipal Court to appear before the judge, so I will do penance for driving one mile per hour over the speed limit.

In spite of getting off to a rough start, the trip was an amazing time full of unexpected connections with patients who have forever touched my heart:
-Reyna, a 40-year-old Mexican immigrant with kidney failure and uterine cancer who lacks access to healthcare because she is not a US citizen. In spite of this, she joyfully serves as a pastor's wife and praises God for his mercy and blessings.
-Silvia, a 55-year-old woman who is also without healthcare because she is not a citizen and cannot go to Mexico for fear of not being allowed back in. She was fired from her job because she suffers from depression and has gone without treatment for years. We cried together and read the bible until I could compose myself enough to ask the doctor to write her a prescription for an antidepressant on Walmart's $4 list.
-Crístian (in the picture), a delightful 10-month-old who spent the first month of his life in the NICU in San Antonio but is now thriving and eating everything in site.

where have our manners gone?

2009-10-09T14:53:00.000-07:00

Yesterday afternoon I sat down at a review session next to one of my classmates who I don't know well (or really at all). She immediately looked at me nervously and said she had a question for me that she was scared to ask. I told her to spit it out, and and she bluntly asked me if I was pregnant! In response to my shocked expression, she proceeded with a full five minutes of word vomit about how I was really thin last year and seem to be filling out my clothes more this year but not to worry because it will be a good thing when I do get pregnant someday, blah blah blah. This girl is pretty weird, and I weigh the exact same as I did last year, so I wasn't too offended by her comment...just shocked. One of my professors consistently points out how rude our generation is, and I'm starting to believe him.

Later that day I volunteered at a health screening fair and was asked to run the BMI scale, which calculates all kinds of information about your body composition. I was not pleased when the nurse in charge asked me to get on the scale to demonstrate but was relieved to see that I am perfectly healthy. It was actually a confidence booster because if your percent body fat is below the upper limit of normal, the machine tells you how much fat you "should" gain! Most of the people who came to use the scale were obese, so I left the fair feeling very blessed that I am in good health and NOT pregnant.

well-rounded

2009-10-05T20:32:00.000-07:00

Today I did something I've been dreading since the first week of medical school: the male genital and rectal exam. I'm not sure how to describe it except to say that we had to "inspect and palpate" everything in the front and the back. We divided into small groups, and my group got to practice the rectal exam on plastic models before performing the entire thing on a standardized patient (SP). Our SP, Roy, was a delightful 71-year-old man covered in tattoos and flashy gold jewelry. He nonchalantly lifted his gown so our TA (a 4th-year med student) could demonstrate the exam and then calmly allowed the rest of us to poke and prod him, kindly confirming that we reached all the correct structures. The entire process went by quickly and wasn't nearly as difficult as I'd feared. In case I'm ever your kids' doctor, rest assured that I know how to do this exam even though I will never use it.

Side note: Last week we got an email saying that thank-you cards would be placed in our mail boxes to give to our patients. Most of us forgot about them, but one of my classmates asked our instructor how to give the note to the SP. She gave him a strange look and replied that the notes were only for our real hospitalized patients, adding that SP's got thanks in the form of cash. I know the SP's for this exam are particularly well-paid, but I still think they deserve our gratitude!

lies

2009-09-28T13:03:00.000-07:00

These are a few of the things I tell myself during exam week:
1. It is acceptable to wear pajamas all day as long as you wear different pajamas at night.
2. Caffeine and advil can’t actually hurt you.
3. The Braveheart soundtrack never gets old.
4. Each module requires a theme song (i.e. hematology: Bleeding Love), so you should spend time looking for the perfect one.
5. You learn better by writing with multicolored pens and highlighting excessively.
6. Progressively worsening handwriting indicates that you will be a great doctor.
7. It is ok to eat breakfast foods for 3 meals, as long as they are different. Rice krispy treats may be substituted for any meal.
8. Picking the longest line at HEB is all about letting others go first, not reading the gossip magazines.

saving grace

2009-09-28T11:51:00.000-07:00

This week, as I have struggled to memorize chromosomal translocations and make sense of words like myelophthisis, I have realized the importance of humor in getting through life. I have watched this dancing baby video at least 10 times in the past 3 days, and my abs have become unbearably sore from laughing. I am also newly addicted to the show Glee and highly recommend it to anyone looking for a laugh, especially if you think the Office may be beyond it's glory days.

liver fertilizer

2009-09-14T13:53:00.000-07:00

Have you ever wondered why people make such a big deal about birth control pills and blood clots? According to one of my professors, estrogen acts as a "liver fertilizer," causing the liver to synthesize more of its proteins, including coagulation factors that help your blood clot when you are injured. During pregnancy a woman's body makes a whole lot of estrogen, which stimulates the liver to make a whole lot of clotting factors to get ready for the big event of delivery. This is a great thing that allows moms to successfully give birth without bleeding to death, but it also puts pregnant women at a higher risk of developing blood clots. This is one reason why mild exercise is encouraged and flying is discouraged during pregnancy. All of this is true to a lesser degree for women on birth control pills that contain estrogen. The dose is usually low enough not to be problematic, but some doctors suggest taking aspirin (which prevents blood clots) if you plan to be immobile for a long period of time (i.e. a transatlantic flight).

blood loss

2009-09-11T13:20:00.000-07:00

Today I overcame one of my biggest med school fears: drawing blood. Instead of our usual two hours of looking at slides in pathology lab, they told us to collect blood samples from each other and look at them under the microscope. I'm pretty good with pain so I wasn't afraid of someone else taking my blood so much as doing it myself and messing up. I paired up with Daniel, one of my anatomy tankmates, and he decided I should draw his blood first. I followed a strict list of instructions: insert needle into holder, apply tourniquet, select vein, clean skin with alcohol in circular clockwise motion...Sticking the needle in was surprisingly easy, but I struggled to hold it in place as I removed the tourniquet and inserted the collection tube with shaky hands. Luckily after some slight adjustments the tube filled with blood and I breathed a sigh of relief. Success on the first try felt good.

Daniel and I switched places and he proceeded to follow the same steps. He got the needle and tube in and we both watched in confusion as it remained empty. After some painful jiggling, the tube began to fill, and a few seconds later, Daniel pulled out the tube and needle in one quick motion. I watched in horror as my blood squirted out all over his clothes. Realizing he'd forgotten to remove my tourniquet, I yanked it off and grabbed some gauze. I then gifted him with one of my most prized possessions, my Tide to go pen, and sent him to clean up. That pen got out every last drop of blood and I felt a doubly satisfied with our achievements.

On another note, many of you have asked me my opinion on health care reform. If you're interested, this article says it better than I could.

mistakes

2009-08-31T18:08:00.000-07:00

Today I added to the never-ending pile of drug flashcards I must learn for my next pharmacology exam. I made one for Celebrex, an anti-inflammatory drug, and under side effects I wrote, "significantly slows the rate of healing of fractured bone." That seemed odd since my orthopedist prescribed it to me after I broke my arm, but I wasn't too worried since my arm had healed fine. Next I made a card for the inhaled steroids used to treat asthma. The long list of side effects for these included osteoporosis, which suddenly made my childhood years of inhaling nasty yellow powder validate my current doctor's ominous pronouncement that I have "decreased bone density." Should I blame future hip fractures on the doctor who put me on steroids?

I'm really not angry or even surprised by these discoveries. Instead I am overwhelmed by the knowledge that I will sometimes be wrong. Being a physician is an enormous responsibility, and I will spend my life trying to earn the respect and trust that will come with my M.D. In the meantime, I pray for grace to accept the mistakes I will undoubtedly make.

a glimpse of humanity

2009-08-29T21:44:00.000-07:00

Today was a special day, if not an annoying one, since I was forced to abandon my usual jeans and t-shirt wardrobe for a starched white coat. Today was our first chance to interact with real patients instead of the actors they usually hired for us to practice on, and the prospect brightened my day considerably as I tried to keep up during the seemingly endless hours of antibiotics lectures. This module we were learning about the respiratory system, so our instructors asked several lung doctors to bring patients for us to examine.

We divided into small groups and rotated through the exam rooms, taking turns listening to the patients breathe and offering increasingly eager opinions about their diagnoses. It turned into a perverse scavenger hunt as we mentally checked off diseases from a list of what we had studied. By the time we got to the last patient, Marta, my group was feeling confident, and we smugly reported to the doctor that we heard crackles over her right lower lobe. "So what?," he asked, and our minds scrambled to think of all the diseases Marta might have. While my classmates had listened to her lungs, I'd inspected Marta from the corner and noticed her fingers. They were rounded or "clubbed" at the end, something that is seen in Idiopathic Pulmonary Fibrosis, a chronic disease that can only be treated with lung transplantation. Not wanting to hurt Marta's feelings (what if she just had weird fingers?), I timidly asked the doctor about this. He looked at me sharply and then grinned, saying that I was the first person to notice this. "What's next?," he asked, and my group chattered excitedly, trying desperately to put the symptoms together. "We should talk to the patient," I offered, and the room fell silent as Marta smiled and began to tell her story.

Soon it was time to leave, and as I offered Marta my hand, she pulled me in and whispered "well done." Though it was I that should have congratulated her for surviving her disease, I grabbed onto those words and walked away contemplating our encounter. That day I saw that I wasn't the smartest or funniest or hardest working medical student, but I knew I could survive if I held onto my instinct--my core desire to look and listen and know people's stories. Though this instinct will be tested every day, I pray for more patients like Marta to show me what it means to be a good doctor.

sleepy much?

2009-08-29T12:32:00.000-07:00

Approximately 70 million Americans have clinically significant sleep problems and about one-third of adults have insomnia. One increasingly recognized disorder is Obstructive Sleep Apnea (OSA). When we sleep, our airways tend to relax. Snoring occurs when the upper airway tissue relaxes, sags, and vibrates during sleep. If the tissues sag together and completely block the throat, you stop breathing, a condition known as sleep apnea. If this happens 5 or more times per hour, you have OSA. This disorder is commonly associated with other medical conditions like high blood pressure, heart disease, and diabetes. Symptoms include excessive daytime sleepiness, morning headaches, trouble with concentration and memory, and snoring. Treatment includes weight loss, avoidance of alcohol and sedatives (these worsen apnea), use of CPAP (continuous positive airway pressure--kind of like an oxygen mask), and surgery. Now don't worry if you're really tired during the day or have ever been told you snore. I'll post more about snoring when I understand it better. Just keep this post in mind in case your future spouse stops breathing in his sleep. This happened to our professor, and after she completely freaked out, she made her first diagnosis of OSA.

those pesky ears

2009-08-23T19:26:00.000-07:00

(top: infected) (below: normal)
After spending a summer with a pediatrician and hearing about the ear troubles of a favorite friend, I feel that it's time to post a bit about ear infections. Classically, we think about ear infections (known as otitis media) as a childhood problem caused by bacteria that invade your ear, causing an inflammatory response accompanied by redness and fluid buildup. In reality, the pain and pressure that we often associate with ear infections may also be caused by allergies or viruses. All kinds of otitis media will usually resolve on their own, and the official guidelines for doctors reserve the use of antibiotics for infants and severe cases. I'm not sure what exactly defines a severe case since anyone who has had an ear infection knows how much it hurts!
Otitis media is different from otitis externa, an infection of the external ear that we usually think of as swimmer's ear. This kind of infection can occur after swimming or showering and is usually cured with antibiotic drops. My favorite way to distinguish between otitis media and otitis externa is simply to pull gently on the patient's ear. This will be very painful with otitis externa!
We haven't learned about this in school, but I'm researching other possible causes of ear infections, including fungi. According to wiki: "Fungal ear canal infections, also known as otomycosis, range from inconsequential to very severe...If for any reason the fungus begins active reproduction, the ear canal can fill with dense fungal debris, causing pressure and ever-increasing pain that is unrelenting until the fungus is removed from the canal and anti-fungal medication is used. Most antibacterial ear drops also contain a steroid to hasten resolution of canal edema and pain. Unfortunately such drops make fungal infection worse." Stay tuned for more info about these fungi...

need a new career?

2009-08-10T14:47:00.000-07:00

According to the forensic pathologist who lectured us last week, you are eligible for an exciting new career as a coroner. What exactly is a coroner? I don't know all the specifics, but according to my notes, a coroner is someone who "conducts inquests and certifies deaths." A coroner can request autopsies but may not perform them unless he happens to be a doctor. In contrast, a medical examiner is a pathologist whose job it is to perform autopsies to determine cause and manner of death. The pathologist who gave our lecture serves as the medical examiner of Bexar County (where I live) and invited us to shadow her anytime. Somehow that seems different from other shadowing I've done. So, if you want to be a medical examiner you have to go to school and get your MD. If you want to be a coroner, you technically don't need any medical experience. In Texas, the justice of the peace serves as coroner. In Indiana, the position is filled by an 18-year-old . Does anyone know which beloved member of Peace Hill once served as coroner of Charles City? I'm willing to bet he did an excellent job and would have some great stories for us...