The trip to become a doctor

ticks!!

2010-06-09T21:16:00.000-07:00

So remember how I was not gonna turn into a hypochondriac?
Imaginary rash found today on arm (medical term: erythema imaginarians :) ). So I went to the doc with it, and he told me to take antibiotics just in case. Bc we all hate Lyme disease.

Ha.

And starting tomorrow, I am camping accross the country. (For which I am stoked, despite all those fucking ticks!!).

Not gonna turn into a hypochondriac. Not gonna. Nope. Not me. Nope...

Pinchot trail, PA

2010-06-07T18:38:00.000-07:00

Tick country

Summer started by drinking beer the day of my last exam (YAYYYYY for end of first year!!!). I did limit myself to less than 72 beers (which is what I craved) because I had that little marathon to run on Sunday. I followed CPS’ advice (who approved of the beer as long as I had water with it), and I PR’d!!! That CPS is something!

The marathon was fabulous (in Burlington, VT). I stayed with my friend Mike at his parents’ house, where I was extensively pampered by his mom. I think I wanna do more races in Burlington just to hang out with them :)
In all seriousness, the course was fantastic. Trees, lake Champlain, lots of cheering, lots of course support, great weather…the only very horrible thing happened at mile 23 (you couldn’t possibly hit the wall at mile 21 bc there was a steep downhill). On top of having to climb over that wall, there were no people from mile 23 to mile 25.5. And that sucks big time. But I recon that these miles aren’t particularly pleasurable in any marathon…
Mike was running for the March of Dimes and ended up raising a lot of money (he raised the most at this race), so that was awesome. He fed us (the people who gave money for this) as a thank you after the race…or rather, made his mom and bro feed us.

Then, during the week, I’ve been just chilling and getting ready for my next “backpacking across the States” trip. Have a book on Olympic Natl Park. Another on Glacier, and a better atlas. Not that I don’t trust my GPS, but sometimes I guess I like to actually look at a map.
And then last weekend my friend Tony and I went backpacking in Pennsylvania, kicking off my backpacking summer. The hike was somewhat similar to Pacific Northwest hikes in that colors were luscious green, and the forest was thick. It was different in how flat it was, but I had chosen that bc I was camping with a “newbie” (who turns out had less trouble going up the hills with a pack than I did) and bc, let’s face it, a year of med school has not done miracles on my fitness. So I thought I’d start the summer easy. No Walawas, no South Sister, and definitely no Grinell Lake. Still, it was beautiful and peaceful and rewarding…save for the million ticks I found on my body, (ok, make that 4, but after studying all the diseases they carry, it feels like 4 million too many!!!). We learned from another hiker that the ticks that were partying at my skin were not the Lyme disease carrying ones, so that made me somewhat at ease. But then again there are at least another 4 diseases that they carry. And if I remembered my Host Defense better, I’d bet that there are more like 10 that I need to worry about. Oh well. I remember telling myself that I wouldn’t let med school turn me into a hypochondriac nor a germophobe. And I am sticking to it!

Next in the agenda is Rochester-Olympic National Park through Canada. I am STOKED. More later…

0.25

2010-05-28T11:19:00.000-07:00

Quarter of the way done, yay!!!

(OK, so maybe not if you think of residency as still being in school, but I had to tell myself when I was re-entering the education system that this was just a 4-year program).

I crammed last night, crammed this morning, took one more of those disheartening, yet not completely heartbreaking tests, and year one of med school was suddenly over.

Today I had lunch with some friends (and yes, beer), will attend a birthday party later on, and tomorrow I am en route to Vermont to run another one of those insanely long runs that darn Joe Henderson has me addicted to. I feel out of shape, but very happy that, despite it all, I am still in shape enough to do it (I think!).

And "despite it all" ought to encompass the cyclic patterns of cramming/beer drinking, the cutting up body parts, the shadowing of doctors, the pediatric physicals, the baby measuring, the liver palpating, the rewards of geriatrics, the despair of geriatrics, the new bike routes, the living in Main st, Rochester (where congregations of police cars happen with somewhat an alarming frequency), the new, precious friendships, and the teratomas (I learned this last night, most disgusting thing I've ever seen so far).

It's sure been a rollercoaster, especially the first few months (until I learned how to memorize shit, which apparently I had been successfully avoiding despite being a professional student). And although I feel almost as ignorant about the science behind medicine as I did last August, at least now I don't feel awkward asking about someone's sexual orientation, habits, drugs, depression, and all that stuff. Everyone seems to pick what they really wanna retain in Med School (the surgeons were uncannily good in Anatomy, for example). I have worked hard in my primary care clinical work, have had a blast with it, and have predictably done better than in any other of my classes. They tell med students that they will change their minds about 10 times about what specialty they want to go into before they actually make a decision. But perhaps 35 year-olds don't change their minds so much. Perhaps we are more aware of whether we're in it for the thrill of the ER, the dollar signs of Dermatology, or the relationship with the patients. For me, the later is obviously the winner, and although I could still change my mind, I am enjoying the ride for the moment, having fun with the art of medicine (versus the science of it, which yes, is interesting, but not quite as thrilling to me).

Gotta get some sleep before the festivities tonite. More later, I have great plans for this summer...

A toddler in medicine

2010-05-14T14:58:00.001-07:00

My friend Aisha said some months ago that we were all like toddlers in medicine. That's how clutzy we are still with our tools, our interviewing skills, and our knowledge.

But it hit me cold yesterday how people expect me now to give them advice, be it fake patients or real ones at the doctors’ office. Both cases are un-scary in theory because, in the case of fake patients, they and I know that I really don’t know anything. And at the doctor’s office, the doctor is actually there, or follows me at some point to recheck my work.

Nonetheless this is frigging scary. That I, with my highly defective short term memory (make that short, medium, and long), with my profound ignorance of all things medical, shall give a piece of advice to a patient, just plain freaks me out. I realized this yesterday at the doctor’s office. I’ve been working with a pediatrician, and rather than have me follow her around, she semi-randomly picks 3, 4, or 5 patients and has me do their school physical. This was painfully shocking the first time, like when your dad throws you (you being a toddler) in the pool so you learn to float. Yes, floating is awesome once you figure it out. But struggling for air maybe isn't quite as cool. And that is definitely how I felt. "Sooo...you want me to go in there and ask them about school and nutrition, and check their heart and lungs? Err...right? Their reflexes too?" And panic, panic, panic (as I had had zero warning that I was going in by myself!). My face must have been hilarious. If my doc had more of a sense of humor and a little more than 8 seconds to spare, she might have laughed her ass off. But she didn't, and threw me in the room instead, mumbling something about a form. Turns out that I did check a heart, a pair of lungs, of ears, of eyes, of feet (after laying my patient down), and then I sat her back up to look at her tonsils, and then laid her back down to listen to her tummy, and then I made her walk and then I sat her back down to check her feet pulses and then I gave up and did not lay her back down to palpate her tummy. Yeah. Your doctor makes this look like she's doing 5 things when you get a physical bc she's so smooth and experienced. Get a cluzty first year med student to do it. It will look like the 20 things that she is actually doing, and the thing is that she still will have missed another 10 things that she was supposed to do. But hey, it was my first time in the water. Thankfully, there is a form that I found after I had done all this, and I was able to do a more normal interview, "how's your sleeping, any problems going to the bathroom, any changes at home, do you exercise, what are your mile splits, where did you get that awesome tattoo, oh yeah, do you have any concerns for the doctor today" (accurately implying that I am pretty much useless and all I do is relay the info to the doc). So at the end, I floated, not gracefully, not skillfully, but I did it. And after her throwing me in the water like this so many times, I have kinda gotten used to it. It's sure stressful and, albeit forceful, an extremely good way to learn.

Granted, the school physicals are usually uneventful and if there is anything that needs attention (lungs that snore, golf ball-sized tonsils, babies with fevers and runny noses), I will defer to the doctor. But they still ask me/tell me about their issues, and I still need to be able to hear that snore in that lung, or to note that perhaps the size of that tonsil is somewhat not ordinary. And this is what makes me uncomfortable, because I am still a toddler who knows so very little...

The patients I am least comfortable with are babies, so fragile, their ears so little for me to come in with my otoscope, their heads so mushy still. On Wed, I did the check up of a 4 month old and a 6 month old. The exams turned out to be easy, but talking to the mothers was fairly stressful. They need lots of education/advice, especially if it's their first baby, and I just don't know! Do you introduce one veggie at a time at 6 months? at 9? 30 oz of formula a day? 40? mix it with cereal? Do you introduce fruit at 8 months? Or is it goldfish? pizza? And OMG. What boosters do you need at 6 mo? at 9? at 3? There sure are a zillion vaccinations for their tiny little butts to take.

But I digress. The point is, that despite being a wreck every Wed morning (in anticipation of the afternoon at the clinic), I also have a little bit of fun. Because, after all, that is what I wanna do when I grow up.

Spring break!!

2010-03-12T14:33:00.000-08:00

I am back!!
It's been a while, I know. Too much to study, too many miles to run, and well, life.
I've seen lots of patients since I posted last, gone for lots of runs, taken too many tests, drunk too much coffee and stayed up too late, too many nights, studying too many pathways. But today I get to enjoy the exhilarating hiatus of Spring break. Spring break. Med students (first and second years) get a Spring break. Do yall remember that? I had forgotten. What will I do with myself? Yea, I am smiling. What will I do with myself just sounds like an awesome thing to wonder, after not having a moment to spare in the last few weeks. Double workouts? A book a day? A movie a day? A beer a day? Two, THREE beers a day? And to think that in my previous life this was compatible with my occupation...(well, maybe just the workout/beer combo..)
So life is looking good. The sun has been out for the last week or so, and we are in the fifties now. I've run in shorts twice already, and although the weekend is going to be slimy and grey (maybe just to remind me of Oregon), I am really really really happy that the snow is melting. I do need to take my bike out one of these days...or it's going to hurt A LOT in September for the Iroman.

To wrap up the term, I could talk about the amazing (and terribly sad) experiences I've had with my geriatrics patients, I could talk about the night and day contrast between my Biochemistry class and my clinical experiences, or I could even talk some more about nutrition (yawn yawn, I know...).
Instead, I am just going to say that I am very very grateful to be sharing this experience with such an awesome group of people. As things go in med school, I end up spending about 12-14 hours a day with my classmates, more on the week of a test. And most is fun, but some days we have a bad day, and it just so happens that bad days are great to pull people together, and after only seven months in this very cold city, I feel very warm and un-lonely. I can go home and be quiet if I need quietness and silence, but there is certainly always somebody to listen to me rant, tell bad jokes, get coffee, or go for a beer when I need to. And it's only been seven months, and most of these people are more than 10 years younger than me. I certainly was not expecting to make good friends so soon. So yeah. Fifties out. 17 miles tomorrow. Party tonight. Beer. Still miss my friends, but I am very grateful of my new ones, and of life being so generous to me right now.

~e

Hope

2010-01-29T21:17:00.000-08:00

This week, I met a patient who made me feel really good about medicine, and about being able to really make a difference. NS is almost 80, and has had problems with his heart for all his life (many of his family members died before turning 50 from heart disease). NS had had a quintuple-bypass surgery, and had lived happily after that for many years. He was a ski instructor, a tennis instructor, an English teacher, a Sunday School teacher...he even retired and went to teach in parts of the world where almost everyone is illiterate (and no, he had surprisingly not heard of Three Cups of Tea!). He is also obviously in love with his "new" wife of 20 years, and simply has a lot going on for him. But a few weeks back, he came in the hospital with shortness of breath, and as he was being tested had a stroke. His doctors gave him TWO DAYS to live.

Tough, right?

He was released from the hospital on a weekend, and somehow he was able to get a hold of his cardiologist. After talking on the phone, the cardiologist drove an hour to NS' house on his day off so they could chat. The next day, NS had surgery. And now it's four weeks later, and he is getting ready to go home.
His cardiologist just knew that he would be able to survive yet another operation on his fragile heart, as he had treated him for years. And thus risks were taken, and NS has now the face of that who has faced death, who has been given a terrible lottery ticket with those bad genes, but who has, at least for once, teased death away. This is my first patient that has come so so so close to it. And I don't think I'll forget the depth of his eyes, so heavy with wisdom.

And that right there is the power of medicine and the difference that one doctor can make. I honestly don't know what did the cardiologist know that the ER docs didn't. I don't care. I just know that thanks to a turn of luck, of right people at the right time, and of using and abusing our healthcare system, NS will live to teach his granddaughter how to ski, to read more books, and to inspire a few more people like me and like his Sunday School students.

So today, despite knowing a lot less about pyruvate carboxylase than I should, and despite missing teaching, I am very happy with my choice. Maybe one of these days I can actually help out. Make a difference on someone, on someones. That, right there, would be cool.

In the meantime, I just completed one of these cycles that go on in 1st year med school (and I just have a feeling this happens everywhere in the country). Test monday. Beers monday. Relaxed week. Today, movie and beer (and OMG have you watched The Single Man? I haven't watched such a good movie in a looooong time!!). Tomorrow, I learn to cross-country ski. And then there will be Monday, 2 weeks from our next test, and I will realize just how little do I know about the 100+ pages that our teachers have covered in lecture. Oh. Well.

~E

PS: Oh. And it's EIGHT Farenheit outside. How is a Spaniard supposed to cope???

More on Dr. Berk

2010-01-21T15:22:00.000-08:00

Dr. Berk is coming back as full time CEO of the Medical center. What do you guess that a job like that takes? 50? 60 hours a week? This man is amazing!

http://www.urmc.rochester.edu/news/taubman/?id=2742

AND to continue with depressing stories, my patient yesterday had MS, diagnosed in his early 40's. Severely disabled practically since diagnosis, and acc to Dr. N, without much hope for him to get better (he practically can't walk and even if he could he has absolutely no energy). From lack of activity he is gaining weight. And weight gain and chronic lack of activity make an excellent recipe for shit to happen. So that was another very upsetting day at the Rehab unit. I wonder if I will get callous at some point. I don't know if I want to, though. Will I loose my humanity?

Stroke and accidents

2010-01-17T21:56:00.000-08:00

This week we've been focusing on life after a traumatic accident or after a stroke. One of the patients I saw (who I interviewed for almost 2 hours) had just had a stroke. She's thin, looks healthy, and walks (make that walked) around. But she is 85 and just lost her husband of 60 years (!!). Did that give her a stroke? Why did her body decide this particular moment to fail a little bit in its blood supplying job to the brain, rendering her leg and arm a dead weight?

"My" patient was upbeat and hopeful, given that she has a little mobility of some fingers. But after talking to the doctor I realized that this upbeatness is out of blissful ignorance, as she probably won't be able to walk again without a walker or go up her stairs--among other things.

I realize that 85 is a great age to make it in good health. She's lived a long life and she told me that she was "ready." It's the natural course of life, and it is a matter of time, and not of whether, that "mishaps" are going to cause our bodies to fail us like that. But I still have trouble accepting it. I guess it goes back to death and our coming and going in the world...maybe I haven't thought of that as much as I should. I am sure I will have plenty of opportunities to face death and the natural path of life in the next few years...

On the other side of things, the unnatural courses, we had a presentation by the Medical Center CEO, Dr. Berk. He had a biking accident in June that fucked up his C3 vertebra. And there went his ability to walk, grab things, control his bodily fluids, sign his name, wiggle his toes. Dr. Berk was not a CEO for no reason, and his talk was eloquent, matter-of-fact, and devoid of any self-pity. He simply took the turn too fast and skidded and went over his handlebars to break his neck upon landing. And as he was laying there, beginning to pant, he realized exactly what had happened, how high his break had to be for his diaphragm to be out. And he felt the sensation in his limbs leaving him, some of it without return, as he was laying there. Scary, huh?

He is back to work now and has a superduper chair that enables him to be a little taller than me if he presses a button, which I guess is good if you go to a lot of fundraisers where people tend to spill their drinks.

And sure, he still has an amazing job and a wonderful family and many things to go for him.

But he broke his neck. Not at age 85, but while still youngish. And even though he is gaining some sensation and some movement, he is now faced with a life very different from the one he had envisioned.

With this also I have issues (who doesn't!). And with the cases we were presented with right after the conference, like a teacher who had a skiing accident while in his 20's. Yep. Wheelchair for the rest of his life. Now happily married, happily employed as a 5th grade teacher. Looks happy and hipermegaenergetic. So why does it depress me?

I went on a ride today because it was over 30 degrees (most of the snow on the roads is gone) and because I am physically addicted to my bike. But as I was coming down new, unknown turns, I was sure slowing down more than usual.

The soberness of our week doesn't end up here. We've also been learning about all these genetic disorders that can be really messed up (and are more frequent than I ever thought). Just like last week we had patients with disabilities that were obviously living a full, satisfying life, we had a parent presentation this week of parents of children with disabilities that seem more overwhelmed than happy with their kids. And that might just be my impression.

Ahh. The weight of knowledge. Time for some Twilight (what!).

Ice and First Patient

2010-01-11T17:24:00.000-08:00

So the ice skating was fun. My first lap consisted of very tiny steps, and many of my classmates stopped to make sure I was allright, held my hand, and gave advice. There was no rail or wall, and most of these people have grown up skating. I was of course the Southern Spaniard from Oregon who hadn't been on a rink before. But at the end of the night, I was "skilled" enough to compete in dives, which is when you go as fast as you can and then dive on the ice, and whoever goes further with their body wins. I had a blast, obviously.

But to more serious things. Today I saw my first real patient, at a hospital. We were briefly briefed in what to do and there we went. My partner and I were given 90 minutes to obtain a history and perform an exam. I thought at first that 90 minutes was gonna be a looooooong time, given that the doctor I shadowed spent an average of...I don't know, 30 minutes, with each hospital patient.
But time went by superfast. She had many things to tell, she was very interesting, and she had many many medical problems. I only felt frustrated when she sought reassurance from us and we couldn't provide it. First, we don't know anything. And second, even if we did, the news might or might not be good. That's gonna be hard, ain't it?
But anyways. It was an awesome experience. In the midst of all the textbook stuff, it is so wonderful to be able to actually get a feel for medicine.

I'm gonna stay out of her story for many reasons, but I can tell you this: when I introduced myself, she said, "Oh, Esther, biblical!!," not knowing that everyone in Spain had to name their kids with names out of the Bible or fear being boiled in oil by their in-laws/parents/neighbors... So she later asked me what church do I go to. I was able to hide my chuckle. I wanna say it's been a couple of years since the last wedding (and thus the last time I went to church). Then she lectured me a little, that we have to care for our spiritual self. I got out by saying that I didn't need to care for my spiritual self at church, that I could do it elsewhere (I did not tell her that I did it in my once-a-week 15 minute yoga routine...).
But yeah. Good thing that I am going to go by Dr. CM. Otherwise this might get tricky...

Time for some Genetics...
~e

2010-01-07T20:09:00.000-08:00

Oh. And IM training started this week. Which meant running in 16 degree weather that felt like 6.
Only my toes felt cold. And it was a bit tricky to run in slippery snow.
But now i think i might have a frigging cold. Maybe I caught it on the airplane, no? Can't possibly be from running!!!!

Week 1.

2010-01-07T19:25:00.000-08:00

I know it's still thursday. But darn, Med School moves so fast!
So from break we dived right into 8 hours of lecture on Monday. And on it goes. The good thing is that most lectures are done by an amazing teacher/pediatrician. The bad thing...EIGHT hours of lecture (which translates in 8^200 hours of studying).
We're learning Genetics (labs are done, YAY!!), genetic disorders, chromosomal abnormalities. And the very cool thing is that every 3 lectures or so, we get a patient presentation. Say, for instance, that we learn about cerebral palsy. That day a woman with the disease comes in and tells us what it is like live with a disability that makes her speech and gait appear like she is drunk, and that makes her motor coordination so poor that writing anything is a real hardship for her. This woman was as alert as you and I (well, at least the day that she presented, more alert than I am), and at least as intellectually capable as anybody in my classroom. Yet, she was sent to a "special school" when little, was told that couldn't get a degree, and had a hard time finding love and praise in her life. Just because she sounds drunk. But stubbornness and a bit of luck allowed her to find a fulfilling career path (as a social worker) and she has been blessed with what it seems like a wonderful family (who seems a lot less bothered by her disability than she is). And she is able to come to med school to teach us all about focusing on what she, and all people with disabilities CAN DO, rather than on what they can't. Focus on my abilities, she said, not on my DISabilities.

We're also preparing for next week (when we start working with real patients) by having pediatrics clinical examination presentations. That is, they bring a few kids and their parents, and they show us some tricks to examine a terrorist (that is, a 15-18-month old) without causing an uproar. Or they tell us that part of caring for a kid is to schedule an anti-terrorism policy appointment with the parents (ie, have a talk about the terrorist's behavior, what's normal, what to expect, etc). This is far from a classical classroom setting, as our teacher is doing this in front of 100 of us, while the kids are being supercute and crazy, and the parents are telling us how they cope (and what do they think of their pediatrician...). Even though I am not really into pediatrics, I have to say that it was an awesome conference. All of us had a smile on our face for at least 80% of the presentation. Kids sure can be cute!

And here is the other thing. We were studying chromosomal abnormalities that might lead to, say, a person with male genitalia but that has boobs. Conveniently, i have just finished Middlesex (the story of an intersex person). And I have a good friend that has posed many many questions about sex versus gender. So I go and ask the teacher what does he think that determines sex identity. He says sex chromosomes. Your other genes. Your anatomy. But then he says that really what matter is our attitude. That we need to keep an open mind. That it doesn't matter whether Calliope is raised as a girl or as a boy, as long as her parents love her, as long as if there is a point in which she decides to switch genders, it comes in a loving environment where she feels supported. Open mindness, he keeps saying.

So for this week I have been taught to keep an open mind about "dis"abilities. And about gender.

Man. I love med school!

Oh. And I am going skating tomorrow. Will let u know if I loose my teeth :)

Gotta get to bed. Week 1 still has 4 more lecture hours!!!
~e

DUN!

2009-12-24T09:11:00.000-08:00

First semester of med school is over. That´s an eigth of it, and I´d like to say of tests too but you have to count the countless tests I will have to take once I am a physician (they never end, apparently).
Classes turned hard, I had to focus on memorizing a zillion facts, shapes, clinical correlates, nerve endings, nerve beginnings, arteries, veins, lymph nodes, muscles, brain compartments, brain injuries, highlights of brain development. And then liver (origin/anatomy/arteries/function/compartments/clinical correlates/how to drink wisely...). And then kidneys. And lungs, and heart, and gut, and that whole pelvic area, including a day in which the spotlight in lecture was turned to the G-spot and its erectile muscle (we have awesome teachers!).

Anatomy had the funniest days but it was the hardest to endure. When we took the eyeball out and cut it in half, I thought that the worst was over and it was going to all be downhill from there. But then, there was this day when we cut the pelvis in half. With a saw. And then the day that we had to cut the rectum in half. And no, it was not magically empty (nor were the seminal vesicles!!). I think it´s great we get to dissect a body, now I even know what side of the body the liver is at (what!). But that smell, that smell I am not going to miss at all. Yay for being done with Anatomy forever.

I did not get to say goodbye to my cadaver though. I saw her last in the Anatomy final, where her pudendal nerve had been tagged with a yellow pin. I´ll get to say goodbye to her spirit, if it will travel from the nasty-smelling room of the fifth floor to the chapel, where we will hold a memorial for all 26 cadavers. Those talented classmates of mine that sing will sing, those that play an instrument will play, and I will probably just bake a shitton of cookies.

We haven´t just been cutting body parts though. We also spent some time at the Histo lab (Histology is a newly discovered phobia for me), where we have supposedly learned to differentiate the esophagus from the vagina (some of us might have had extra trouble with the distinction...). We´ve also learned the basics of doing a physical. I can now listen to your heart in the places where murmurs should be heard, I can listen to your lungs in places where fluid should be detected, and I know where to check for a pulse in your foot. Can I actually detect a murmur? Can I actually find those distant pulses? Can I tell that there is fluid in your lung? Probably not. I am just a toddler with medicine now...I don´t think I even know enough to be dangerous. But it is exhilarating to me that I am learning about all this. So, like a toddler, I am very very excited about my new set of toys. I just wish I could stay excited forever...

I´ve also started working in a migrant health clinic. We went out in the fields and gave flu shots, checked blood pressure, and offered HIV tests. The migrant workers are Mexicans who come to pick apples near Rochester, who live in humble mobile homes for weeks at a time, and who obviously have no health insurance. This year, raids were being conducted to send them back home. Because, you know, all of us Americans really want to pick apples in those conditions. But I digress...this is the field I think I want to get into when "I grow up," so it was really pretty cool to be able to help somewhat while I am still a toddler.

Sooo overall a pretty hard beginning. Lots of work. But I do love medicine, I love how useful all I learn is, I love learning about the beautiful human body and all the things that go wrong with it. And no, I don´t just study and cut body parts all day. I also have made a bunch of friends, have given a fair chance to East Coast beers (but nothing has come close to Ninkasi!), have run for a bit, have traveled for a bit. And I´ve even gone to a reggae concert by a Hasidic jew from Brooklin, down from my house (and got a little high by second-hand dope).

I miss the best state there is, and my friends, and my students (who were on average older than my average classmate!). But I am telling myself that it is all worth it, because honestly, learning about the G-spot´s erectile muscle is a lot more interesting than that Schröedinger equation and all of its variations. And it makes better dinner conversation :)

So long. More later. Have to help cook now...
E

Corazon, corazon

2009-10-08T16:16:00.000-07:00

Hoy le hemos sacado el corazón a Mary. Tiene (tenía?) un corazón pequeñito, con una aorta bien grande y un poco calcificada. Uno piensa en películas de vampiros, o en El Silencio de los Corderos, o en chorradas por el estilo. Pero la verdad es q es una pasada tener un corazón humano en las manos. Y si una se pone a pensar en que sólo en Estados Unidos hay 80 millones de personas con enfermedades cardiovasculares, de las cuales casi un millón muere al año, no se puede pasar por alto el hecho de que este órgano, tan pequeñito en Mary, es tanto una maravilla de la evolución como el talón de aquiles de nuestra civilización. En Mary, la calcificación de la aorta (q es simplemente q está un poco dura) ya daba a entender q la mujer tenía problemas de corazón. Y fue lo que la mató, según el certificado de defunción y lo morado de los músculos alrededor del tórax (pues le dieron primeros auxilios).
Tras identificar los nervios, arterias y venas importantes alrededor del corazón, me he metido en la biblio y cdo he mirado el reloj me he dado cuenta de que llevo casi 5 horas aquí. Se me ha pasado el tiempo volando estudiandome el recorrido de la sangre del cuerpo al corazon, del corazon a los pulmones, de los pulmones de vuelta al corazón, de donde, a pesar de ser tan pequeño, es capaz de bombear sangre hasta el dedito pequeñito del pie...Una pasada. En un minuto, el mio hace el recorrido unas 50 veces. En un colibrí, pueden ser mas de mil.
Joe. Es q es chulisimo!

Ah. Y ayer aprendí a oscultar. Q yo me creía q la respiración se iba a oir superfuerte. Pero no, hay q pegar la oreja bastante! En fin. Aviso q ahora voy a todas partes con el estetoscopio, x eso de practicar un poco. Asi q cuidadin, q a lo mejor te ausculto!

Today we took Mary's heart out. She has (had?) a tiny heart, with a large aorta with signs of calcification. I thought of vampire movies, or The Silence of The Lambs, or stuff like that. But in reality, it's really cool to hold a human heart in one's hands. And if one considers that just in the States there are 80 million people with cardiovascular disease, from which almost a million dies a year, it's hard not to think that this organ, so tiny in Mary, is both a wonder of evolution and the Achilles Tendon of our civilization. In Mary, the calcification in the aorta (that simply felt hard) already suggested that she had some cardiovascular issues. And indeed it's what killed her, according to her death certificate and the bruising around her thorax (thanks to CPR). After identifying the important nerves, arteries, and veins around the heart, I submerged myself in the library and when I looked at the clock, I realized that I've been here almost 5 hours. Time just flew while I was studying the path that blood takes from our limbs to the heart, from heart to lungs, back to heart, from where, despite it being so little, it can pump blood all the way to our little toes...It's just awesome. In a minute, mine does its lap 50 times. In a hummingbird, it can do it over 1000 times... Oh. And yesterday I learned how to auscultate the chest. I thought it would be loud and clear (as I heard it on my textbook's website). But no. It's nice and faint. Oh well.

Back to the heart :)

First big test/ El primer examen

2009-10-02T17:39:00.000-07:00

Aghhh. I have not studied like this since undergrad in Spain. Sooo much to memorize. Sooo little time. I like it all. I wanna learn it all. It is all interesting. I like the teachers. Oh. Wait. Did I say I like it all? I still don't like the formaldehyde. And I did about pass out when we pulled the towell off the face of our cadaver. And I don't love histology. But I still think it's interesting. Then again, so much stuff, so little time. Our first big test is next Monday, and there is, oh God, SO MUCH I haven't gotten into my little brain. The cool thing is that I can already tell if an EKG is abnormal, and maybe even tell you what kind of arrythmia it's showing. Ain't that awesome?

The uncool thing is that I know NOTHING about all those microscope slides. And I think there are 100 of them. Soooo...uhmmm...more on this later :)

Ahhhhhh. No he estudiado tanto desde Quimica. Taaanto q aprenderse. Tan poquito tiempo. Me gusta todo. Lo quiero aprender todo. Todo es interesante. Los profes molan. Oh. Un momento. He dicho q me gusta todo? Todo, todo, no. Todavia no soporto el formaldehido. Y casi me da un jama cuando le quitamos la toallita de la cara al cadaver. Y la histologia no me mola. Pero aun asi es interesante. Asi y todo, tanto q aprenderse, tan poco tiempo! El primer examen es el lunes, y hay TANTO q no me he metido en la cabecita!

Lo chulo es q ya puedo leer un electrocardiograma y decirte si indica problemas, y hasta decirte el tipo de arritmia. Lo no tan chulo es q no se NADA de todas las muestras de microscopio. Y creo q hay unas 100. Asi q esto...hasta luego!

Anatomy; ICM; sleep.

2009-09-17T12:48:00.000-07:00

"Identify the teres major and suscapularis but do not clean them at this time." "Describe arterial anastomoris around the shoulder, list the terminal branches of the brachial plexus."

Suprascapular nerve.

Quadrangular space. Basilic vein. Medial cubital vein. Antebrachial fascia. Spinous fossa. Glenoid cavity. Supraglenoid tubercle. Infragenoid tubercle. Coracoid process. Greater, lesser tubercle.

The scalpel is mainly for skin incisions, reflecting the skin...Fine disection should be done with your scissors, probe and forceps [...] Blunt dissection is best done with your fingers. With your fingers.

Show proper respect for each cadaver.

Hypertrophy. Hyperplasia. Metaplasia. Neoplasia.

Zonula occludens. Adhering junctions. Dermatome. Intervertebral foramina. Spinal nerves have arabic numbers. 12 Cerebral. 31 Spinal.

My hands smell (make that reek) of formaldehyde. I will double glove tomorrow for sure. Or whenever our next anatomy day is. I do think that finding the nerves, arteries, and muscles help with the memorization. But do we really need to memorize all that? I mean, I am 80% sure that I am forgetting 80% of all this coming December 19th (that is the day after my final), to be never remembered again.

So I almost despise Anatomy. Make that I hate it. BUT I love learning clinical skills. My standardized patient yesterday said I did a really good job with the interview, he felt very comfortable with me. That matters more to me than retaining where profunda brachii artery is. I just think that it is so much more interesting to learn about things that make you think, rather than plain memorization. For instance, we learned to transmit information to the patient yesterday. As in, do I tell Ms. Doe that she has a 70% chance of relapsing if she doesn't take the drugs, that she has a 30% of not relapsing if she doesn't take the drugs, that I think she should take the drugs given her family history and symptoms, or that it is very likely that she will relapse if she doesn't take the drugs? How much is TMI?

We are also learning to engage the patient in her own care so she complies, learning to show empathy and that is OK to show sympathy--if it's honest.

We are also prompted to think of pro-bono work, of what would happen if we decided to treat that one friend of ours that doesn't have insurance (for free), and he went and told his buddies, and eventually our clinic became a madhouse. How would we deal with that?

I just learned today that if I am to convince a surgeon to take up one of my patients pro-bono, it will be more effective if I make the call. Funny, I always thought it would be more effective to have some PR/fundraiser specialist do that. I am horrible at asking for favors. Guess I better learn...

I think constantly of the two doctors I shadowed, of all the real-life situations I saw with them, of their mastery of medicine and of how artful they were in being humanistic, philanthropic scientists.

And I think of my students, of how they must have struggled with the Chem new vocab as I am struggling now with all this Latin. At least you can derive Chem equations. Latin is just plain nonsense.

So between now and December 18th, I see myself studying and studying and studying just to stay afloat. I do have really bad memory. Since I am not willing to fore go all my social/workout activities, this translates into less and less sleep. O well...that's what Med School is all about, right?

Time for some hillwork.

The freckels

2009-09-08T16:11:00.000-07:00

Today we were introduced to the bodies that are to serve as our anatomy "hands-on" models. Each group of 4 "gets to" dissect a body that has been very generously donated by someone that has passed on, and that thought that our trampling with their tissues, bones, and who knows what else, is worth it for the benefit of a greater good.

I think I have a woman (she was facing down and partially covered), I am guessing 60's, a little plump. Her skin is mostly tight (which wasn't true of all bodies), and because of the stuff they put in when embalming, she has reddish skin in some areas. She is also grey in other areas, and in some spots the two are mixed. So I couldn't tell if her complexion was yellowish, tannish, reddish, pinkisk, or simply pale by looking at her. But I could tell that she had a few freckles in her thighs and her calves. They were large, round freckles, a darker shade of gray than the rest of the skin. I thought they were unusual because there were none in her back. Maybe she got more sun in her legs than in her back?

And as I looked at the palm of her hand, ackwardly facing me while her body faced the table, I wondered if in a few weeks I will be this curious about her life, her death, and her reason to let us do all we are going to do to her body. All in the name of medicine.

I've been queasy since then, and my stomach was ready to bolt. And we haven't even started dissecting. That, too will pass. Right?

~e

Week 2

2009-08-27T18:02:00.000-07:00

Sorry it's been so long. Med school turns out to be busy from day 1. Our first week was "just" an orientation week, but still full of events and lectures and seminars and socials, which added to the effort by most of us, the 104 memebers of the UR class of 2013, to mingle with each other and get to make new friends and identify who we might have something in common with, who is cute, who speaks our language, who wants to go for this or that...left us tired at the least, exhausted for the elders like myself.

Perdon por la tardanza, Medicina me trae muy liada desde el primer dia. La primera semana fue "solo" de orientacion, pero asi y todo llena de clases y reuniones y seminarios y cenas, que anyadidas al esfuerzo por todos nosotros, los 104 miembros de la clase de UR del 2013 (asi lo llaman aqui), en conocernos los unos a los otros, ver quen tiene cosas en comun, quen es mono/a, quien habla nuestro idioma, quien quiere apuntarse a esto o a lo otro...lo cual nos dejo cansados a los que menos, muertos a los viejos como yo.

Ahora, en la segunda semana, nos estamos acostumbrando al horario superocupado que, a diferencia del del doctorado, es el mismo para todo el mundo y llena las horas de casi todos los dias. Tb a diferencia del doctorado, la mayoria del tiempo la pasamos en practicas o en grupos pequenyos, y no en clases aburridas. Hemos estado dando Estadistica (que si, q es facil matematica, pero los detalles son endemoniados!), la cual es aburrida y no la preferida por ninguno de mis companyeros. Pero tb hemos aprendido sobre el aspecto Psicosocial de la medicina, aprendiendo a empatizar con los pacientes, a escuchar, a tratar de percibir mensajes no hablados, a escuchar, a crear una union con el paciente, y si, a escuchar. Leemos articulos sobre todo esto, atendemos seminarios cortos, y luego un profesor q es medico general simula una situacion con un paciente simulado. Los pacientes son actores entrenados xa esto que se parecen mucho a ti y a mi cuando vamos al medico y que curiosamente tb parecen incomodos cdo tienen q hablar de, por ejemplo, un caso extremo de diarrea.

Hasta ahora, lo unico q hacemos es hablar con los pacientes. No se yo, cdo este haciendo la residencia, cto me voy a acordar de la empatia y la simpatia si estoy trabajando 80 horas a la semana...Quiza me salga natural, quizas no...

Now, on week 2, we are starting to get a hold of our busy schedule which, unlike that in grad school, is the same for everyone and fills up most days. Also unlike in grad school, most of the time is spent hands-on or in small groups, and not in a lecture. We have been learning about Statistics (yes, easy math for me, but the devil remains in the details), which is boring and not really anybody's favorite subject, but we have also been learning about the Psychosocial aspect of Medicine (did any of you listen to the interview to Lisa Sanders in Fresh Air?). We are learning to empathise (as important for doctors as for Supreme Court Justices), to listen, to try to key in non-verbal messages, to listen, to not talk too much, to listen, to create a partnership with our patients, and yes, to listen. We read papers that describe what to do, then we get a minilecture, and then one of the family practice faculty does a 20-min simulated interview with a patient. The simulated patients are trained actors that look just like you and I when we go to the doctor, and curiously might have similar responses to what you and I might do when, say, we are uncomfortable talking about our diarrhea. Right after that, we are divided into small groups and we practice with our very own simulated patient. So far, we have just been talking with our patients a lot. I just wonder how much of what we are learning now I'll remember when I am working 80 hours in residency. Think I'll remember to empasize when somebody comes with chest pain? Tough call. Maybe it will come all natural. Or maybe not...

So that's why I am loving it, I love the interviews. I love learning about the art of Medicine. The stats...I guess they are a necessary evil. Por eso me encanta la facultad, me encantan las entrevistas con pacientes. Me encanta aprender sbre el arte de la medicina. La Estadistica...supongo q es un mal menor y necesario.

Rochester...lemme just say that I miss OR, but that I am adapting. I am now not wearing shorts, but a frigging skirt. It's frigging because I am in a cafe literally 2 minutes from my house. But I feel self-concious wearing my Oregon attire (which doesn't even include Birkenstocks!). I once wore a headband, shorts, and my Teva's to school and was told that I looked very Oregonian (most women wear dresses and high heels even on days that we don't have to dress professionally, is that a NY thing or what?). I will keep wearing shorts to school, but maybe not to the hip cafe near my house, not in the evenings...Rochester...pues la verdad es q echo de menos Oregon, pero me estoy adaptando. Por ejemplo, ahora llevo puesta una falda en vez de pantalones cortos (q es el uniforme oregones), xq es q aqui se arregla mucho la gente. Tb tengo ya amigos xa correr, ir en bici, nadar, y el paisaje es bonito. La vida es facil aki, como en Eugene. Pero como cdo estaba en Italia, todavia creo q Oregon es el sitio perfecto. Seguido por Montana, puesto q en ella esta el Parque Nacional de Montana...

I have done a close-to century ride that was prettyish, there are several parks to run and even do hills at, and apparently I am going to go open-water swimming soon. I have a range of workout buddies for my different addictions, and some friends to cook for from time to time. So not bad. Life is easy here, like in Eugene. But like when I was in IT, I still think of Oregon as the perfect place in earth. Closely followed by Montana, home of Glacier National Park. I just have a lot more friends in ORegon :) (and yes, in many many other places).

Time for Twilight...(YES, again!)

Med School, Week 1

2009-08-11T14:18:00.000-07:00

So here I am, day 2 of orientation. Aqui estoy, segundo dia de la orientacion.

Every hour or so I seem to meet 4 or 5 people. There are about 100 students in my class, most of them about the age of my students last year (or slightly older). THAT feels weird. But everyone is very nice, and the faculty seems really committed to help us succeed. Cada hora o asi conozco a 4 o 5 personas nuevas. Hay unos 100 alumnos en mi clase, la mayoria son de la edad de mis alumnos el anyo pasado (o un pelin mayores). Lo cual es un poco raro. Pero todo el mundo es muy simpatico, y los profesores parece que quieren realmente ayudarnos a q nos vaya bien (en lugar de jodernos...)

I get overwhelmed at times, when I hear about how much work we have to do, how much memorization is required (there is a reason I chose PHYSICAL chemistry, where equations are derived), and when I think of how long I have to wait to actually be a doctor in a place I want, practicing at my own pace. Hay veces q me agobio, cuando hablan de la cantidad de trabajo q tenemos q hacer, y toda esa memorizacion! (yo que eleji Quimica FISICA xa poder DERIVAR ecuaciones), y cuando pienso en todo lo q tengo q esperar para convertirme en medico en el sitio que yo quiera, con una consulta a mi manera...pues eso, agobia.Pero vamos. Lo importante es disfrutar del del camino a ser medico, no?

I think that the key is to enjoy the trip to be that doctor, right?

Gotta go. I am proud to say that I have organized the first run for our class, which starts in 15 mins...

~e

2009-07-28T18:50:00.001-07:00

http://picasaweb.google.com/ecaballe07/ArchesAndCannyonland#5363691629250848770

Arches and Cannyonland

2009-07-28T17:04:00.000-07:00

Well, the sight seeing is over, at least as far as National Parks go.

I went to Arches, as I had been instructed to. I liked it, it was spectacular. Crazy how those rocks can stand the way they do. They reminded me of the Roman Forum in how small I felt next to them, and how some things will crumble with time and still leave a beautiful and majestic structure. And some of them reminded me of the balconies in the Alhambra of Granada, where a beautiful window frames a yet more beautiful landscape.

It's all about associations...

Bueno, este viaje ha terminado, por lo menos por lo que se refiere a parques nacionales.

Fui al parque de "Arches", como me habian dicho. Me gusto mucho, espectacular. Hay unas rocas muy chulas como suspendidas en el aire. Me recordaban al Foro Romano en como me senti tan pequenya a su lado, y como algunas cosas se derrumban con el tiempo y aun dejan una estructura preciosa. Y algunas de estas estructuras, al ser una ventana preciosa rodeando un paisaje aun mas precioso, me recordaban a la Alhambra.

A balcony (like in la Alhambra) Balcon (como en la Alhambra)

Cool evening sky, the La Sale Mountains (sp?) in the back

Atardecer chulisimo en las montanyas de la Sal.

Indiana Jones. Seriously! No?

Cool rocks. Rocas chulisimas

Balconies. Balcones.

On the other side of things, I did get lost in my silly 7-mile hike. They put these pile of rocks on the trail and I lost them a couple of times (I think I am just spoiled from all the other trails I have followed in this trip, which are impossible to miss). The first time I got lost, the wind started picking up and I got sand stuck to my skin thanks to the sunscreen. I was looking for tracks for maybe 15 minutes, and got just a little bit nervous. I thought of taking one of those survival classes...The second time, I just didn't believe that they would have me walk on top of a rock fin. A "rock fin." I tried it for a bit, and the wind almost blew me over. Well, I thought it did. I am sure it was not that bad and that my fear of heights has more to do with it. So I just couldn't believe that this was really the trail. But I teamed up with another hiker, and we figured out, slowly and steadly, the way back. And we circumvented the stupid rock fin.

Por otra parte, me perdi en my caminata de 11 km. Marcan el sendero con unas montanyitas de rocas, y las perdi un par de veces (probablemente porque estoy acostumbrada a todos los otros senderos por los que he ido andando, en los q es casi imposible perderse). La primera vez que me perdi, se empezo a levantar una ventolera combinada con arena q se me pego bien con tanta proteccion solar. Me pase un cuarto de hora buscando el sendero, y me puse un pelin nerviosa. Creo q voy a apuntarme a una clase de esas de supervivencia...La segunda vez, es que no me creia q quisieran q andara por encima de una "aleta de roca." Ua aleta de roca! Lo intente, pero el viento casi me tira. Bueno, esto seguro q es una exageracion, y mas q todo fue el vertigo. Al final, me acople a un hombre q se ve q tenia mas idea q yo y entre los dos, lentos y seguros, encontramos el camino de vuelta. Y dandole un rodeo a la puta aleta de roca.

So Arches was cool, but Cannyonlands, another national park just north of it, was even cooler. I went there in the morning, and there was NOBODY there, it was absolutely fantastic. Me, the cannyons, and the green river. Quite an experience. Not that I hate people, but there is solace and serenity in solitude...

El parque de Arches fue chulo, pero otro parque, Cannyonlands fue incluso mas chulo. Fui muy temprano por la manyana, y no habia NADIE. Fantastico. Yo, los canyones, y el Rio Verde (no es conya, asi se llama). Una experiencia extraordinaria. No es q odie a la gente, pero hay paz y serenidad en la solitud...

The only car in the park. AWESOME.

El unico coche en el parque. GUAY.

Tetons

2009-07-25T22:35:00.000-07:00

Here, I did do a little bit of homework. But I also stopped at the visitors' center, where two men in their 70's fought for my attention telling me where I had to go. On one side, they were appalled (and yet impressed?) that I was going ALL BY MYSELF to the "backcountry" (backpacking, that is). On the other, they wanted to send me in this 20-mile loop, 5,000 ft elevation gain. And it was already 4 pm. And there was a wall of ice to climb, and I was gonna have to use an ice ax (which obviously I don't own). I ended up deciding, with the help of the park ranger, on doing just a 5-mile hike into the Cascade Cannyon fork. The ranger particularly liked this hike bc it was in the back of the Tetons. And OMG did I find out what she was talking about. I might be in love again. Not as deeply as with Glacier NP, but at least infatuated for sure.

yellowstone and the tetons

2009-07-25T21:45:00.000-07:00

Sooo not so impressed with Yellowstone. For wildlife, all I saw was a moose, lots of crazy trout, and two swans. Oh. And a million tourists, about 8 out of 10 in either an SUV, minivan, or RV.

I made the mistake to ask a cranky park ranger for a good place to backpack, and he sent me to mosquito-lake, to which I had to hike through a few miles of burnt forest. That will teach me to do my homework...
Yet, I have to admit that the swans and the ducks were kinda cool. And the lake was nice and warm to swim in...

The day after this, I did go and check out the geisers, nicely placed in an amusement-park style with kazillions of tourists with no walking etiquette (yes, I was cranky!). So after navigating through them all, I followed a friend's advice and went south to the Tetons...oh the Tetons. Wish I were still there...see the next post.

Glacier

2009-07-23T08:42:00.000-07:00

I am speechless. This is probably one of the most beautiful things I've seen in my life. Literally breathtaking.

I have to say that having my tent sniffed by a grizzly has scarred me a bit. And hiking by myself after seeing ginormous bear tracks (see below). But I did practice with my pepper gun today. Turns out the pepper is red. Who knew?

I am on day 6 of sleeping on my Thermalite, last nite under the stars. Day 3 w/out a shower. You'd think I crave a bed. But I am so stoked about checking out what Yellowstone and Arches have to offer!

niagara

2009-07-11T15:43:00.001-07:00

Niagara falls, even on the Canadian side, was predictably full of tourists. I just have issues with that (and with the 20 bucks they wanted for me to park my car). So I parked illegally (I still have some Italian in me) and took this:

But not to despair with the crazy tourists, there are greener pastures very near the falls. I went for a little hike that was quiet, except for the birds...

And there were even little tipis by the trees. Kinda looked like someone wanted to light the forest on fire...

Yes, pretty. Yes, green. But next time, I am going to the Fingerlakes...

ROC, day 1

2009-07-10T20:54:00.000-07:00

Ok.
So I came to Rochester to look for an apartment, which was incredibly easy. My place won't be fancy but it's within 2 min-walk of restaurants, 5-min walk of the nightlife (which I saw today, it does exist!).
BUT:
1) There is no Trader Joes. Srsly. How does anyone survive without TJs?
2) I've been here for less than 48 hrs and already have been flipped off. By a mini-van driver. And I didn't even deserve it (trust me, I also have a quick finger, but this was not justified!).
3) You ever listen to the Portland city club? Well. I listened to the Rochester equivalent. Instead of sustainability and bikers versus drivers, they talked about prostitution and meth. I just found it depressing. Made me miss Oregon. MUST EMBRACE THE PRESENT. MUST EMBRACE THE PRESENT...

But I also saw fireflies. I thought those were only in Peter Pan. And Niagara Falls. More about the falls later...

~E

The map

2009-07-06T12:27:00.000-07:00

Hey,

Thanks for the suggestions and the emails. Hope you had a great weekend.

I went on my very first canoeing trip EVER. It was awesome. And I went up Kelly butte in Spfd to watch the fireworks. The view looked familiar...guess it's from seeing it in The Simpsons!

Soo here is my planned route so far. What do yall think? (there is a link below to make it bigger)

View Directions to Rochester, NY in a larger map