Christy's Trip to Africa and Medical School Adventures

Pictures

2011-05-14T07:05:00.000-07:00

Baby post c-section being held by female relative of the mother. (Photo taken with permission).
Why you have to change into rubber rain boots before doing a c-section (frequently a bloody/messy procedure).
Before assisting with a c-section.
Catholicism and Medicine have never been combined so well as the crucified Jesus above an eye chart and patient intake table.

Picture from around Mua

2011-05-09T09:17:00.001-07:00

This is a picture that I took about a week ago while on a walk around sunset.

Antenatal Clinic prescriptions

2011-05-09T08:54:00.000-07:00

I have been struggling with uploading pictures to my blog (it takes a bit of time), but today I spent some time in the antenatal clinic at Mua Hospital. We saw so many pregnant women. Here are the prescriptions given out:
1) Iron+Folic acid (the little red pills). Women take 1 a day for the duration of the pregnancy to prevent anemia (a terrible problem with the amount of Malaria that is around) and promote proper development of the fetus.
2) Albendazole (one dose). Given to eliminate worms.
3) SP (3 pills taken twice during the pregnancy). This is part of the intermittent treatment of Malaria in Malawi. Attempting to reduce Malaria in pregnant women (who are very susceptible).

You can see a woman getting her blood pressure taken in the background. (They also get weighed).

At a different station the women can get 1 free mosquito net (paid for by UNICEF?) and immunizations. A different room provides confidential HIV testing and counseling (done twice during a pregnancy). A final exam room is where the abdomen is palpated and a fetoscope is used to listen to the fetal heart rate.

Arresting Jesus with an AK-47

2011-04-23T01:15:00.000-07:00

Yesterday I was privileged to go to a church services in the village in which they celebrated Good Friday by reenacting the Passion (the story of the how Jesus was betrayed, arrested, sentenced, abused and crucified). It was a very touching performance that was both very meditative and beautiful. It lasted for about 2 hours with the performance (in Chichewa, the local language) interrupted periodically with singing from the choir. There were some interesting cultural references and interpretations. One of them was when Jesus was arrested in the garden, the soldiers weren’t carrying spears or swords (perhaps weapons that Americans might view as more historically accurate for the time period), but the soldiers were carrying wooden cutouts of Ak-47 guns. I thought that this was hilarious and also an interesting cultural interpretation of what “a solider” described in the Bible is to them.

Another, perhaps more distressing, cultural difference in the portrayal of the Passion that I witnessed last night, was in the treatment of the actor playing Jesus. The other actors literally beat him up. While in the United States if there was play in which one actor is supposed to hit another, there might be some encouragement/understanding among the director and performers that you will just PRETEND to hit the actor. Not so in this performance. They had branches and were hitting the Jesus actor full-force. They also pushed him to the ground a number of times. I asked the priest about this later. He said that there is informed consent for the actor who plays Jesus – he knows ahead of time that he will be beaten up. In fact, the same actor has played Jesus a number of years in a row, so he knows what he is in for. Sigh. The cost of fame.

The crucifixion. Yes, they actually did tie the Jesus actor to the cross.

Judas betraying Jesus to the priests guarded by the AK-17 wielding soldier.

A nice kind of offering

2011-04-18T04:40:00.001-07:00

Since I am staying with the priests while I am working at MUA Hospital, I have enjoyed getting the opportunities to go to several masses in the rural community. It is a really beautiful experience. Since the services are in Chichewa, it can be difficult to follow what is going on at times.

Since most of Malawi is rural (something like 85% of the population lives in rural areas), a lot of the population engages in subsistence agriculture (meaning that they grow food for themselves and their families). With this knowledge it makes sense that many people don't have any money to give during the offering at church. So what they do in many churches in the area is bring an offering of some type of food. This usually takes the form of maize (the primary staple food) or groundnuts (peanuts). However, many other things can be brought such as tomatoes, bananas, other fruit. The priest blesses the offering that each person brings and then passes them to the alter boys to be put on the alter.

Children outside of a village church.

A picture of the offering. It was sort-of dark so the picture didn't turn out that well, but you get the idea of how beautiful the offering is.

Sorry about the long gap in posting

2011-04-16T05:25:00.000-07:00

Hi to all (2-5) of my blog-readers out there. I am sorry that it has been so long since I have posted anything. I am back in Africa for the 4th time and want to start blogging again. However, I thought that perhaps I should give you all a brief update since I last posted. My international rotation in Malawi is going to be my last rotation in medical school. During the end of third year and the beginning of 4th year, I wrestled with my top 3 specialty choices: Family medicine, OB/GYN and peds. I decided to apply to family medicine. After a long journey that involved 10 residency interviews and a impressive increase to my Alaska Airlines frequent flier miles, I concluded the residency application process and just had to await where the "Match." Would place me for residency. The match is a computer program that matches residency applicants and residency programs together based on rank lists that they have all created. The "Match Day" is when all the graduating medical students find out where they have matched for residency. This year it was on March 17th. I was very nervous, but I was thrilled to discover that I matched at the University of Washington for my family medicine residency. I think it will be a perfect fit for my interests and am really looking forward to meeting my fellow incoming residents.

After the match I just had to finish up my chronic care rotation (which I did through hospice), pack up and then I was off to Malawi. My original flight had be flying from Seattle to Paris, then from Paris to Ethiopia and then from Ethiopia to Lilongwe, Malawi. However, a last minute cancellation meant that I had to add to fly from Seattle --> Amsterdam --> Paris --> Ethiopia --> Malawi. It was a VERY long journey, but I finally made it! I am still a little jet lagged, but am looking forward to sharing my experiences with all of you.

More soon...

YAY! Going to Malawi spring of next year!

2010-07-25T08:58:00.000-07:00

Yeah! I recently found out that I will be going back to Africa during my 4th year of medical school! I applied for the international 4th year clerkship abroad program at our school. I requested that I go to Malawi (my first choice), Ghana, or Uganda for 5-6weeks in the spring of 4th year. I was just informed that I will get to do the clerkship in Malawi. Malawi is was my first trip to Africa in 2004 (during my undergrad years). Malawi is one of the 10 poorest countries in the world and has a higher HIV prevalence rate than Uganda. I think I will be going to an area in the more southern region of the country (possibly Mangochi district). I am sure it will be a great experience. It will be fun as I make preparations and try to brush up on some Chichewa (the official language of Malawi, which is in the same Bantu language family as Swahili). I try to give more updates as more information about my Malawi trip becomes available.

Despite having lived in Africa, My PPD turned positive in med school. BUT I DON'T HAVE TB! Whew.

2010-03-28T14:35:00.002-07:00

Recently I had my annual PPD test placed. The area became red and irritated, as always occurs for me, but then something truly horrible happened - it became raised. Not much, but there was a definite bump under my skin. I went in to have it read and to my utter horror it was read as positive. I was justly upset at the possibility of having tuberculosis and had much to ponder as I waited for my chest xray. It just seemed so ironic to me that despite having lived for a total of a year in Africa, that my PPD test would turn positive during the third year of medical school! I had not 1, but 2, negative PPD tests since returning from last adventure in Africa, so it would have to mean that got infected during med school. Still fuming at my bad luck, I went with much indignation to my TB treatment program visit. There I was offered a blood test to confirm that I actually did have TB before I had to take 9 months of a slightly nasty drug called INH (isoniazid). I got the quantiferon TB test, and it turned out to be negative. Today I got the bill for the test: $102.84. I wonder if that goes in the miscellaneous column of my medical education expenses.

A map of TB prevalence by country. Notice that the East African countries I have worked in have a MUCH higher rate of TB prevalence than the US. Good times.

A positive PPD test. This is not a picture of my arm (image from google image search), but the raised area is similar to what I experienced.

Temporary tattoos and teddy bears named 'teddy bear'

2010-03-28T14:35:00.001-07:00

On my pediatrics rotation I got to take care of some of the cutest kids. When I say cute, I mean cute. Some of these kids were so adorable, they put the Welches Grapefruit juice commercial kids to shame. One three year old girl had bright eyes, thick black hair and cute dimples when she smiled. When I went in to listen to her lungs, I found her carefully clutching a little Teddy Bear. She seemed shy, but also happy to interact despite being on oxygen. I tried to strike up a conversation by asking, "That's a nice Teddy Bear you have there. What is his name?" My 3 year old patient responded with a look that clearly indicated she thought I was a little bit stupid and said, "Teddy Bear." The little girl's mom smiled and said, "Yeah, we are going through a real creative period right now."

A couple days later I came in to check on this same patient. I asked my three year old patient, "How are you today?" She responded in very cute high squeaky voice: "Bedder." She was so cute I tried to go through the process of getting a picture taken with her to share (this involves a signed consent from mom as well as some other paperwork), but my patient improved so much that she was discharged the same day so I didn't get a chance to do the photo shoot.

A few weeks later I had a 4 year old patient who was very sick and hated being examined, taking her medications and getting nebulizer treatments. However, this patient absolutely loved temporary tattoos. So her parents had a very sizable selection of temporary girly tattoos (pink flowers, stars, happy animals, etc) that she could pick from after cooperating with a medical exam or treatment. It worked really well. After a couple days, I guess she started to like me because after I examined her in the morning, she asked her dad to show her the tattoo collection and picked one out just for me. (If you are wonder, yes, this was a highlight of my pediatrics rotation). I walked around the rest of the day as the proud owner of a pink flowers and stars temporary tattoo. The tattoo was cute on the peds floor, but it got some strange looks outside the hospital!

This is just a sampling of some of the cute-kid interactions I had.

The upside of having a family that is a festering cesspool of viral illness

2010-03-09T17:59:00.000-08:00

I always get sick when I go home and visit my family. Always! In the past I have found it very irritating. You have a free weekend a couple weeks before finals and go up to see the fam. You arrive and an adoring sister with copious nasal discharge gives you a huge hug and proceeds to use your jacket as a make-shift kleenex for her nose. 3 days later you go back to your house in Seattle, develop a sore throat, runny nose and a fever and you realize you have killer viral illness #8 of the season. 10 days later you feel better, but not before giving said killer viral illness to several classmates, undoubtedly resulting in the loss of a couple friendships. A couple months later, all is forgotten and you go home to visit the family again, only to have the process repeated.

HOWEVER, on my peds rotation it came in handy. And when I say handy, I mean really handy. The other medical student on my pediatrics rotation fell seriously ill, not once but twice. He developed a high fever resulting in the inability to get out of bed for several days, and actual hallucinations. During this time I also developed a little bit of a scratchy throat for a day or two which quickly resolved. It seemed like my body was fighting off a lesser version of something awful it had encountered before. (I don't mean to imply that I have a killer immune system or that I never get sick. I actually get sick a lot, it is just that pediatrics clinic can't hold a candle to the immune challenge you get from hangin' with a family that has 13 kids).

Apparently, it is very common for medical students to fall very ill during their pediatrics rotation. We were warned about this, and staff commented that the acquiring of severe illness from peds clinic seems to occur more often with people who are only children growing up or had fairly clean living environments. Well, not a problem here! :)
Here my (fun and terrific) family has been labeled by name. However, perhaps the could also each be labeled as "Immune challenge #1," "Immune challenge #2," etc.

Pocatello, Idaho, a place that makes Curling seem exiciting

2010-02-27T14:21:00.000-08:00

I am now in Pocatello Idaho for my pediatrics rotation. I am super excited about it because Pocatello is supposed to be one of the better rural areas to do your peds rotation. You get to see a wide variety of clinic patients, round on children in the hospital every day and also round on NICU patients. My old roommate, Melissa, did her Peds rotation here and had a very good experience (although she did warn me that they work you very hard here).

Despite being an ideal location for a pediatrics experience, Pocatello itself is perhaps not the most exciting town in the country. Many people have asked me how Pocatello is and what it is like. I have struggled with a way to describe it. Perhaps the best way to explain it is that Pocatello is a place that even makes the sport of curling seem exciting. Allow me to explain. The Olympics are now in full swing and there is a news channel that seems intent to play every minute of the curling competition despite it being perhaps one of the most boring sports played in the winter Olympics. In other locations I have been at during the winter Olympics, it seems to be a widely accepted fact that when curling comes on, the channel should be changed. Curling is perhaps even below commercials in interest-holding-ability.

However, in Pocatello it is a different story. In several patient rooms, parents sit holding their sick child watching curling in rapt attention. In the physician's lounge in the Pocatello hospital, curling has been playing on the big screen TV every day. It is even a item of discussion in the elevator (i.e. "Hey, Jim Bob [<-- made up name], How about Canada's Curling team? Aren't they something?"). Perhaps the scariest event of all occurred when I went home Friday evening after a very long week and found myself watching curling in a near mindless state. It was an almost out-of-body experience. How low had my life sunk? What had happened to me that I was actually exposing my brain to the neuron-atrophying affects of curling? Then I realized it could all be explained in one word: Pocatello. Indeed, Pocatello, Idaho is place so boring that it makes the sport of curling seem exciting. I have included a few pictures of the area of Pocatello, surrounding my apartment to aid in the illustration of what Pocatello is like.

This is the parking lot in front of the apartments the medical students life in. As you can see, it is jam-packed and parking spots are hard to come by (note sarcastic tone of this sentence). Did I mention I received an angry note after accidentally parking in another tenant's spot after coming come in the middle of the night after call. As you can see, he or she was right to be upset, as there was obviously no where else to park.

Here is the view out of my apartment window. Did I mention that the apartments are "in town."
Here is the prettiest picture I have of Pocatello. It did have its moments of beauty/charm.

Here is a picture of the road in front of my apartment after the snow had melted.
Now think back to the pictures posted above. Look at this picture of an Olympian throwing a curling stone (or whatever they are called). Doesn't it now put off an air of mystery and perhaps even excitement? Do you see how curling could captivate you if you lived in a place such as Pocatello for an extended period of time?

Peds in Pocatello, Idaho.

2010-02-14T21:36:00.000-08:00

First let me apologize to my blog readers about being so bad about updating my blog. I was so happy to be back in Seattle with friends and family after being in Alaska for 6 weeks that I didn't publish any of my blog posts that I started during my psychiatry rotation. I have now made a few edits and back published some of my tardy blog Jan and Feb blog entries. Just as a heads up: The date at the top of the blog entry is the date when I save the first draft of that entry, not when it is finally published to the blog. Thanks to Aunt Bev for reminding me that people still read my blog and that she missed my updates!

Now, for an update. I have now finished my psychiatry rotation. I made the 12 hour drive from Seattle to Pocatello, Idaho where I starting off my 6 week pediatrics rotation. I am very excited about the rotation. I love kids and am considering pediatrics as one of my specialty choices. Pocatello is supposed to be one of the best places to do the pediatrics rotation because you see a wide variety of pediatric problems in clinic, in the hospital and in the NICU. There are 10 different physicians we will be working with during the 6 week rotation.

Opportunities for personal enrichment outside of the hospital/clinic may be a little less varied. I did some research prior to departing for Pocatello, I did some research on things to do in Pocatello and I found the following website:
http://www.tripadvisor.com/Attractions-g35572-Activities-Pocatello_Idaho.html
Apparently the top things to do in Pocatello are:
1) Visit a museum
2) Visit a Fort Hall Replica
3) Visit Old Town
4) Visit an old church
5) Visit a mansion

"I wanted to clean out my bowels, so I ate soap."

2010-01-29T23:52:00.001-08:00

As part of the psychiatry rotation, you spend several weekend and weekday nights 'on call' with the resident until 11:00pm or so. You split your time between seeing patients in the psychiatric emergency room and answering questions about ward psychiatry patients from nurses. On one afternoon with the resident we got a question from a nurse about a patient on the wards who was complaining of "bowel distension" and some mild abdominal pain. I recognized the name of the patient as one of the patient's my team was following so I offered to go upstairs and talk to the patient first. The resident said he thought this was a great idea and said he would be arriving about 10 minutes after me. Here is a summary of our conversation (at least as good as I can remember):

Me: "Can you tell me about your abdominal issues?"
Patient: "Well, I know my abdomen is very distended, and I am really constipated."
Me: "Tell me more. When was your last bowel movement?"
Pt: "I have had two bowel movements today and they were both pretty loose and I had two bowel movements yesterday too, but I know I am constipated. Look how big my abdomen is."
Me: "Some people might think that if you have 4 loose bowel movements in the last 2 days, that you probably aren't constipated. Can you tell me if you have changed anything about your routine or what you have been eating recently?"
Pt: "Well, I really wanted to clean out my bowels, so I ate soap."
Me (confused, and trying to keep a straight face): "Uh, allow me to clarify. You ate soap?"
Pt: "Yeah, soap. You know, it comes in a bar."

Hmmm... I wonder what the source of her loose stools and abdominal distention/pain was?

When you think about on a very basic level, it sort-of makes sense. If you want to clean your hands, you use soap. If you want to clean your dishes, you use soap. If you want to clean out your bowels, wouldn't you also want to use soap?

Oh so good. Soap. Deliciousness in a bar. Maybe those food scented soap bars really have a market.

A couple people I have spoken to had their mouths washed out with soap when they were younger after saying some bad words. They say that it actually doesn't taste that bad. I wouldn't know.

Voices.

2010-01-29T23:50:00.001-08:00

In psychiatry you learn that a surprising number of people hear voices. Many people can successfully go through day to day life hearing voices (aka auditory hallucinations) and frequently without other people finding out. When we talk to patients who have auditory hallucinations sometimes they like the voices. It may be the voice of their mother telling them comforting things. Sometimes it is their own voice which is telling them positive self talk saying things like, 'don't be sacred' or 'you can do it,' etc. However, perhaps even more frequently, the voices are degrading and cruel. They may say things to the patient over and over again such as, "You are worthless. You are worthless. You are ugly." One patient said the voices said to her, "Eat, eat, eat, and die." Others have voices that say, "Kill yourself." Over and over again. Perhaps the most horrific, are the voices are those that state that if the patient does not kill him or herself that something terrible will happen to the rest of the world (the world be destroyed, all the children in the world will die, etc). Usually the patient has some sort of understanding (however small) that voices do not indicate reality and that if the person does not kill him or herself that the world will not come to an end. However, this led me to the question: What if the patient actually believed that if he or she didn't kill him or herself that many other people will die?

In Biblical philosophy it is said that there is no greater love than to lay down one's life for one's friend. Likewise, it is also considered by many to sacrifice yourself in service to your country. In some religions it is considered a sin to commit suicide which may even result in the person committing suicide going to hell. But what if the patient truly believed that if they didn't kill him or herself then many other people would die? In that situation, although it is of course a terrible tragedy that the individual has tried to end his or her life, is it not also an incredibly selfless act? Although their reasoning is flawed as they have been given incorrect data, they are acting along one of the most noble of moral codes of our culture. Just food for thought.

Reading notes every morning - better than a best-selling mystery/adenture novel!

2010-01-29T23:47:00.000-08:00

I am now in the depths of my psychiatry rotation in Seattle. It is a great and truly memorable experience! Medical students are divided into teams that round on patients in the hospital fr psychiatric reasons. For the most part, patients are being held against their will for their own safety (either for suicidal thoughts/plans or psychosis or something similar). The teams usually consist of an attending psychiatrist, either a psychiatry resident (psychiatrist in training) or a psychiatry physician's assistant, 1 or 2 medical students, a social worker, a pharmacist, and occasionally a pharmacy student. The teams are generally a lot of fun and are very dedicated to helping patients.

In the morning, the students get there a little before the other members of the team and look up labs, medications and read nursing and other notes from the team's patients from the team before. Then before rounding the medical students can update the team on what is going on with the patients before team interviews the patients each morning. This is a very similar pattern to what happens on other rotations in the third year of medical school. However, what is different about psych is WHAT is written in the notes. On other rotations, the notes usually have the patients blood pressure, heart rate, how much fluid they consumed and how much the urinated, how they slept, how much pain they are in, etc. In summary, overnight notes in other third year rotations are just a touch boring. Occasionally something exciting happens (your patient worsened and might have to be sent to the intensive care unit or something else sad or upsetting), but generally not the most exciting part of your day. Psych notes have a lot of this medical information too, but they also have descriptions of what the patient said or did the previous afternoon and night. By almost every definition, psych notes are almost never boring. In fact, opening up psych notes in the morning was one of the my favorite parts of the day. It was even better than opening up a best selling adventure or thriller book because you never knew what patient might have done over-night.

My pictorial version of psychiatry notes - they are better than an adventure/thriller book or movie. Even more exciting and unexpected.

I loved OB, now I am on my psych rotation!

2010-01-29T23:46:00.001-08:00

I had a blast on my OB rotation in Anchorage. It was a lot of fun. I got to see lots of deliveries, numerous surgeries, and work with some very cool people. I had such a good time on ob, I actually started considering at a specialty choice. (We will see what the rest of third year has in store for me surrounding my life decision making plans). OB had some wonderful moments. Mom's and babies are lots of fun.

Despite our enjoyment of OB, at the end of our stay in Anchorage, the cold weather and the very short number of daylight hours made us pretty happy to get on the plane and come back to Washington State.

Here is a picture of the OB students I was with in Anchorage. From left to right they are Jonathan, Lindsey, Kristin, and me. This was taken after our final exam on the very few hours of day light. By the time we were about to leave a large portion of our conversations focused the fairly depressing topic of astounding lack of daylight hours. Here are just a few of our sample conversations:

Jonathan at 1:30pm, "Hey, guys look at the beautiful sunset outside." We looked outside, and indeed there was a brilliant red sunset behind the snow covered mountains. It was indeed beautiful, it perhaps would have been even more touching if it was occurring at 5 or 6pm instead of 1:30.

Lindsey, at around 11am a couple days later (just a couple days before the shortest day of the year), "Hey, guys, look! It is another beautiful sunset." Me, "That is beautiful, but it is before noon, so that would make it a sunrise." Lindsey, "Uh, that looks just like the sunset a couple days ago. Are you sure it is not a sunset?" Allow be to explain this conversation. Towards our last days in December, the days became so sort that the sun essentially rose as a sliver of light from behind the mountains in the south (around 10am), and set as sliver of light a few hours later as a sliver of light coming behind the mountains from the south. Thus, other than the time of day, the sunset would be difficult to differentiate from a sunrise.

After a brief, but well needed break for Christmas, I am now on my 6 week psychiatry rotation in Seattle. I am looking forward to some unique experiences and catching up with people in Washington.

Enough with spam comments on my blog!

2010-01-03T15:00:00.000-08:00

I curse you internet junk-mail spammers!!!!!! (earthquakes, thunder and lightening sound). No more spam comments on my blog! No, I don't want comments trying to sell Viagra on my blog posts about learning Swahili in Tanzania. Anonymous comment posting has been eliminated due to abuse by spammers. You must now have a Google account to make a comment.

A quick Tour around the Alaska Native Medical Center

2009-11-29T15:40:00.001-08:00

Although we don't actually get to do any OB/GYN work there, several people have strongly recommended that we take a tour around the Alaska Native Medical Center (where native Alaskans get their medical care). It was a really nice hospital with AMAZING artwork. If you are ever in Anchorage I strongly recommend visiting. Just a couple pictures here. It is an excellent reminder of the cultural heritage of the area/state. Lindsey took these pics because my memory card was full.

View from the top of the ANMC. The medical complex was pretty impressive and quite modern. I was very impressed.

Walrus Ivory carvings abounded. They were really good. There were several larger whale-bone carvings as well.
Lots of artwork adorned hallways and entryways into the hospital. The main entry is actually a sitting area in large circle to symbolize community and sharing between the different Native Alaskan people groups.
This was a basket display on the second floor. The plaque next to the basket says that sometimes seal gut is used assist with decorating the baskets.

The information sign beside this display said this traditional coat is made out of squirrel fur.

Hangin' with the other 3rd year med students in Anchorage

2009-11-29T15:23:00.000-08:00

There are actually a bunch of 3rd year medical students here in Anchorage right now: 4 students on OB/GYN, 3 students on pediatrics, 2 students on psych, and 2 students on internal medicine.
Some of the students flew back to Seattle for Thanksgiving. Others had their husbands/significant others fly up here to meet them. Anyway, the medical students and partners that were here had a great time putting together a combined Thanksgiving meal.

Many concerned individuals have asked if I had to spend Thanksgiving by myself. Rest assured, that did not happen. Here we are with other med students having our Thanksgiving meal together. To my left is another third year named Erika and her husband, Mike, to their left is a 3rd year student named Chris, and to his left is third year student, Alison, with her boyfriend.

This is a picture Lindsey took of me. About 100feet behind me was a moose eating a bush. Lindsey joke that you couldn't see the moose at all, but you could see that was scared for my life (moose can trample people if they get too close).

Here is a family of moose that we ran into one night when Lindsey and I went to pick up the car. They look cute, but they are huge and dangerous.

For Erika's birthday we went out to Sushi. It was really good and a lot of fun. On the left we have Lida and Erika (on Pediatrics) and on the right it is Lindsey, me and Jonathan (all on OB/GYN).

Here is a picture of Lindsey hanging out at our kitchen table. We have a nice little apartment.

A drive around Anchorage

2009-11-29T15:00:00.000-08:00

There have been a number of humerus things we have seen while driving around Anchorage. I thought I would share just a few of them with you here.

One of the dilemmas in the area seems to be: what to do with the snow? Seen here it was made a decorative part of a court. The bulldozed all the snow into a big pile in the center of the court and made a path to drive around the outside and built a snow man on the top. Thanksgiving cheer all around! Note that in this picture it looks pretty dark, but it was taken around 9:30-10am.

Typical driving on the main roads. You can see the mountains, etc in the background. Apparently, the mound of snow at the side of the road after snow ploughing has a name, but I can't remember it right now. I will have to get back to you on that.

I have never seen so many Hummers, Pickup trunks, and Subarus in my entire life. They are (very understandably) quite popular here.

The phone number for the local Anchorage cab company is 222-2222. I think they made it so that even if you are really drunk you can easily call a cab.

The "Community Minded" liquor store is one of our favorite signs. Our question is: how is a liquor store community minded? We decided a sub-slogan could be something like, "We keep our prices low to keep you drunk. Truly thinking of the community."
This is another one of the many liquor stores. It sort-of reminds me of how Seattle has lots of coffee stands, but here they sell alcohol. Alaska does have a very high rate of alcoholism compared to many other states, and it can be a pretty big problem, particularly out in the more rural areas.

Anchorage pictures (finally)!!!

2009-11-29T14:27:00.001-08:00

My classmate, Lindsey, and I spent the morning taking in the beautiful scenery around Anchorage. Here are some pictures that we took.

View of Anchorage from Earthquake park. Thanks to Lindsey for taking this one!

Another view of the Anchorage shoreline.

A view of both water and mountains!

Lindsey and I had breakfast at the Snow City Cafe. It is the beast breakfast and brunch in Anchorage. Highly recommended if you ever visit. I had the Crabby omelet. It was delicious.

Here is Lindsey standing outside of the Snow City Cafe.
Cold. Walking on the trail in Earthquake Park.

Lindsey on trail in Earthquake Park.

Darn Power lines. They always ruin my pictures. It looks like the sun is rising or setting, but this is at noon. The sun just doesn't rise very high in the sky here this time of year. Crazy!

Lots of moose crossing signs.

Lindsey and I worked very hard to get this picture. Our car almost got stuck in a little unploughed turnout. Then we had to wade through about 8 inches of snow in not-so-good shoes. I couldn't feel my toes after wards.

Lindsey used my camera to take this video. It is beautiful, isn't it?

Brrr. Cold weather

2009-11-22T02:03:00.000-08:00

This last week we had some cold weather. It reached down to -10 to -15 degrees F. It was by far the coldest weather I have ever experienced in my whole life. It means a lot of dressing and undressing when you have to go outside throughout the day. We have a few inches of snow, but according to one of our classmates, it isn't enough to cross country ski in.

Here I am all bundled up. Good times. If you walk all the way to the hospital (about a 6 minute walk) when it is really cold outside, your nose hairs freeze and sometimes your eye lashes freeze.

This is the Alaska Magazine issue that was for sale when we first arrived in Anchorage. Apparently, what small birds and animals to shoot during the fall is a hot-selling topic.

I keep forgetting to go outside and take pictures during the daylight hours, but here is picture of the pathway between the University of Alaska Anchorage Housing (where we live) and the Student Commons area.

I will try to add more pictures later. So far I have been pretty bad about taking my camera with me when I go out.

So far, I am definitely having a positive experience. People have been really nice and I am learning a lot.

Don't bother voting in my lame poll

2009-11-17T00:46:00.000-08:00

ORIGINAL POST:

To my blog readers, please vote in my poll about whether or not I should allow Google advertisements on this blog. I have been very resistant to it in the past - I didn't want to subject my blog readers to the unpleasant words of corrupt corporate America. However, I decided I should put out a poll to see how you all feel about it. What do you think? Are my witty words and stories strong enough to overcome the irritation of annoying advertisements (doubtful), or do you reject buckling under corporate powers for a couple of dollars every month? I would like to settle it all in a democratic vote (which is apparently going to be heavily favored towards those with more advanced computer literacy because you have to have a gmail account to vote in the poll). However, if you do not have a gmail account, feel free to leave an anonymous comment at the end of this entry and I will add it to the final tally.

Thanks!
Christy

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UPDATE:
Apparently my poll is completely defective and I am the only one who has been able to vote in it so far. This was my first attempt at setting up a poll so I probably did something wrong, but it doesn't stop be from sending some bad thoughts towards Blogspot and Google. Sorry about the technical difficulties. Feel free to post comments if you have strong feelings either way.

Baby Feet

2009-11-15T09:09:00.001-08:00

The other night I had one of my first overnight labor and delivery shifts. It was a lot of fun and I had some very good and interesting learning opportunities. It turned out to be a fairly quiet night as far as labor and delivery usually goes. I took a woman down to get an ultrasound and then I ended up following a woman who was in labor. The woman delivered towards the end of the shift and the delivery needed a vacuum (attach suction device to baby's head so the OB can assist with the delivery). It was a good learning experience because I had not seen a vacuum delivery before. After the delivery the baby's family was very happy and crowding around the new infant and mom. After cleaning up a bit in the room, I was sitting at the nurse's station and a nurse was walking by and asked if I wanted to 'help make baby feet.' I knew that part of the post-birth paperwork was to create a paper image of the baby's feet using this weird powdered ink stuff, so I assumed that this is what we were going to end up doing on our newly delivered infant. Being my normal enthusiastic self, I said I would be delighted to help and jumped up to follow the nurse.

I made a visual illustration to emphasize what I thought we would be doing when 'making baby feet' before entering into the experience:

I followed the nurse into a room where we set up some tables and started getting out supplies. There were some bowls and materials to make a dough like substance and plaster. At first I was a little puzzled as we were getting the supplies out of a cupboard called "bereavement supplies," but in my sleep-deprived state, I didn't put any more energy towards thinking about the issue. The nurse explained that we were making two sets of baby feet by pressing the dough flat into the bowls, then we would press the baby's feet and hands into the dough to make and indentation, and then pour plaster over the dough to make an impression of the baby's feet. Then when the plaster was almost dry you could engrave the baby's birth date and name in the back. The nurse gave me a sad little smile and said it is a really nice thing to help the parents remember the baby by. It was then I realized through my sleepy haze, that no one had actually told me that we were 'making baby feet' on a living baby. I looked around the room a bit more and saw a carefully arranged pile of flannel Mickey Mouse baby blankets on the end of the bed. I quietly asked the nurse if she could tell me the story behind the baby. She explained that it was a baby that was born many weeks before the age of viability (age of viability is around 23-24 weeks gestational age) and there was no way they could save the baby. The nurse explained that many years ago, medical personnel thought that a woman should not see a child that was miscarried/stillborn, and that every one should just sort-of pretend that it never happened. However, now they have found that mothers/parents have better closure and actually heal better after the loss of a child if they have many different ways to remember the baby by - pictures, naming the child, a baby feet plaque, counseling, etc. So the hospital helps parents with the grieving process and remembering the baby in many ways including making baby feet impressions to give to the parents.

Even after having a couple minutes to prepare myself, I think my face still whitened a little when the nurse carefully brought over the pile of Mickey Mouse baby blankets and removed a very small dead baby. Using gloved hands she gently pressed the feet and hands into the dough, and then handed the baby to me. I was shaking a little as I held the cold body (it fit easily in one outstretched hand), but was able to repeat the process and create impressions in my bowl of dough as well. The nurse then carefully took the baby back and dressed him in some premature infant clothes and took him back to his parents for holding/pictures. Although it was a bit of an emotional experience, I felt very privileged to be part of it. I also think that it is an important point that when new parents experience a loss such as this, they want the existence and death of their child to be acknowledged. A very good lesson, but hopefully not one I will have to utilize frequently.

6minutes X10 = 1 hour

2009-11-11T20:12:00.000-08:00

When we arrived, we were told that the sun sets 6 minutes earlier each day this time of year in Anchorage. At first we didn't think it sounded like much, then we realized: 6 minutes a day X 10 days = 1 hour! Every ten days we are here it gets dark 1 hour earlier! Yikes. So if it gets dark around 4:45pm when we first arrived, it is going to get dark around 3:45pm in just 10 days, etc. (Ok, sorry for saying the exact same thing 3 times). Apparently by the time we leave daylight will extend from around 10am to 2:30pm or something crazy like that. Fortunately the clinic I have been assigned to has lots of windows so I will get to see the sun for a little while each day.

I hope you all are well. If you live in an area with lots of sun now, soak up some rays for me!

Arriving in Alaska, quick update

2009-11-10T23:37:00.000-08:00

I arrived in Anchorage on Saturday. The flight was fairly uneventful other than being an pretty sparsely populated plane and it seemed to have a slightly higher percentage of red-neck type personalities on board. I was slightly horrified to discover that the largest airport in the largest city in the entire state only had one baggage carousel. While waiting for my luggage, I discovered a well dressed and articulate man waiting for luggage. I took a chance and asked if he was a medical student. He was indeed a medical student who had taken time out to get his PhD, hence why I did not recognize him. We were taken to the University of Alaska Anchorage campus where were placed in the wrong apartment. After some more adventures and the arrival of our 3rd OB/GYN student (Lindsey), we found the correct room and moved all of our baggage. It snowed 3 inches on Sunday night and we were awoken frequently by the grinding of snow plows. Today they put the studded snow tires on our all-wheel-drive Subaru and we seem to be in pretty good shape as far as transport goes. Lindsey, one of the other girls on the OB rotation, used to be ambulance driver for 5 years and is really good in driving in all weather conditions. I have driven here once, but gladly defer to other more experienced snow drivers. Tonight it is 14 degrees F, but according to the weather report it feels like 5 degrees F. It stings a little when the air hits your face, but we have marveled at how little the natives seem to wear despite the chilly temperatures. We must seem like people visiting Seattle decked out in rain boots, rain coats, rain pants, and umbrellas when it is just slightly sprinkling.

Monday and today were both days of orientation to the OB/GYN rotation. Today we had a suture workshop where we practiced cutting and suturing up placentas and tying surgical knots. It was fun, but once again I was faced with the realization that I am coordination-challenged.

Everyone keeps asking, but, no, I have not seen Russia yet. :)

I will try to keep updating when I can. Lindsey and I saw a moose tonight, but I didn't have my camera with me, so I didn't get a picture! Better luck next time.

Dog Dash 10 K

2009-10-23T23:49:00.001-07:00

Last week I was going to go visit my family, but they were all sick (probably with H1N1) with fevers up to 102F, vomiting/diarrhea, and cough. I decided that I didn't actually love my family enough to exchange a 1 day visit for a 10 days of swine-flu nastiness. So last Saturday I went to buy a new pair of exercise/running shoes. At the shoe store they had a place to sign up for the Dog Dash 10K. The trauma and body-aches of running the Beat the Bridge 8K were just distant enough in my memory for me to think that running the 10K Dog Dash sounded like fun. On an impulse decision I decided to sign up for it, and showed up bright eyed and bushy-tailed for the run the next morning. During the run, I decided that the 10K somehow completely defied the rules of physics - it felt AT LEAST 3 to 4 times longer than a 5 K. How is that possible? I was trying to decide during the race if it was because in the past I have always running with people and during the 10K I was running by myself, but in the end it didn't really matter. It is still a terrible thing to put your body through. I got an email about a week later saying that there was a picture available of me during the race. Here it is:

However, if the camera had been a James Bond x-ray camera that could see my thoughts at the time of the picture, the photograph may have looked a little more like this:

I find the phenomenon of running in organized events/races very odd. The entire race you can be thinking: "What an absolutely terrible experience. I will never never do that again." But then, somehow at the end of the race you get this rush of adrenaline and finish feeling great. Strangely at the finish line your twisted ego-boosted mind comes up with the thought, "That wasn't so bad. I could totally do that again and probably run longer." Then months later, the feeling at the end of the race is the only thing you remember and you stupidly sign up for another. A very strange phenomenon indeed. With this phenomenon in mind, I will say that I had fun time running the 10K dog dash and being a low-achieving jog-walk-runner I was pleased with by final average time being around a 9 minute mile. Perhaps after a suitable amount of time passes so I forget the body pain I experienced this week, I might run another race. We will see.

I goin' to Alaska!

2009-10-16T23:39:00.000-07:00

Allow me to say the title of this blog in pictorial form:

Alaska now.

Alaska in a few weeks!

That is right! I am going to Alaska for 6 weeks for my Obstetrics and Gynecology rotation! I am really excited about it. I hope it will be loads of fun and that I get to help with the delivery of lots of babies (hopefully not rectangular shaped ones). Plus it is my first time going to Alaska. I will have to buy some warm clothes first!

The "UC." (The "Ultimate Christine")

2009-10-16T22:57:00.001-07:00

During my first 2 years of medical school I lived with another medical student named Melissa. She is very close to her cousin, named Betsy, who lives in Seattle. Betsy came over to the house and did lots of activities with Melissa and me. In the Spring of 2009 Melissa graduated from medical school and moved far far away for residency. Betsy and I had a we-miss-Melissa-and-Jon (Melissa's boyfriend) pity party and decided we still wanted to be good friends and hang out together even though Melissa was no longer with us in the Seattle area.

A few weeks ago Betsy asked if I would teach her how to make a dish that I had made for her before and she had really enjoyed. I readily agreed and we had a fun time hanging out and cooking. It was during our cooking adventure that Betsy told me about her "UB" project. The "UB" is short for "Ultimate Betsy" and apparently what the UB project entails is envisioning the person you want to be and then taking concerted steps towards becoming that person. For example, Betsy informed me that the UB goes to yoga several times a week and runs several times a week. In addition, the UB is a cooks good healthy meals, and does countless other admirable activities. Betsy explained that the cooking lesson was her taking steps towards becoming the UB.

A picture of Betsy and Melissa on Melissa's graduation day. Betsy is on the left.

Several weeks ago I started my Family Medicine rotation at an amazing location. It is a community clinic and serves a wide variety of underserved, uninsured, and minority patients. I had been excited about doing my rotation there for months. On my first day in the clinic I discovered a huge portion of the patient population at the clinic speaks Spanish. There is a Spanish interpreter on site everyday. However, most of the providers speak Spanish very well and are able to communicate quite well without a need for the interpreter. I speak almost no Spanish, and at the end of my first day I in the clinic I had never wanted to speak Spanish so desperately in my entire life.

So of you may be a little puzzled as to why, if I want to work internationally and with under served populations, why I to this point speak almost no Spanish. It is a long story. However, it begins in my stubborn (and slightly rebellious) teenage years. Being home schooled, you are sometimes frustratingly limited to learning what one of your parents knows or what you are able to teach yourself from a book. My mom took Spanish in Junior High school, and explained that this was my high school foreign language learning option. I had spent a week in Honduras, and saw the value of learning Spanish as a second language. However, when I first stated that I wanted spend a significant part of my life overseas working with underserved populations and that I felt particularly drawn to sub-Saharan Africa, no less than 5 people came up to me and said something to the effect of, "Africa is so far away. You should just learn Spanish and work in Central and South America. Then you would be closer to the US and could come back more frequently." It happened so frequently, that it really started to get on my nerves. Being a generally non-confrontational person, instead of being angry or arguing, I just smiled and gave a non-committal response and then quietly vowed to myself never to learn another word of Spanish.

(I have just realized the next paragraph is completely unnecessary to the point of this blog entry, so please feel free to just skip it. Sorry for all the extraneous words. If I was a good writer and considerate to my blog readers, I would just delete the next paragraph, but I am neither of those things and it was a lot of work to type up the paragraph, so I am leaving it in).
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Thus my language learning journey began. I quickly discovered that I loved learning new languages and particularly I enjoyed learning about different cultures through the conduit of the language. When our family adopted the my two brothers from Russia, my mom and I borrowed the Learnables tapes from a friend, and together we learned ~500-1,000 words in Russian. Mostly just nouns and verbs, we didn't learn grammar or how to conjugate anything, but it made it easier once the boys arrived with their non-existent English skills. Years, later I have forgotten most of the Russian I learned, but if passe people speaking Russian on the street I can still pick out the occasional word. After our family encounter with Russian, I started off during my home school years teaching myself a little American Sign Language. I was particularly interested in this as my adopted sister, Rachel, had difficulty speaking but found signing much easier. When I started college at 16, I signed up for a couple ASL classes and loved them. After this experience, I decided to start working on some of the languages spoken in sub-Saharan Africa. Before my last year at Skagit Valley College, I discovered an Intensive Swahili course at the UW and took it over the summer as a non-matriculating UW student. I loved the course and found Swahili to be a particularly fun language to learn. During my last year at the UW I was accepted to the Tulane University International Health and Development MPH program which required proficiency in a foreign language for graduation . I was fairly troubled - which language should I choose? They said ASL didn't qualify. I could not find any resources to continue my studies of Swahili to the level of proficiency and Russian probably wouldn't help me that much with my work in sub-Saharan Africa. Therefore, I decided to start learning a mainstream language spoken in Africa with lots of resources available to assist me in gaining proficiency - French. I signed up for another summer intensive language course at the UW (an entire year of the language in 1 summer) even though I had already graduated. This course was an excellent experience for me, mostly because I got to experience what it was like to be the "dumb kid" in the class. It became apparent that I had absolutely no aptitude for learning French what so ever. The only phrase I truly learned how to say well was, "Je ne comprends pas!" ("I don't understand!") As I endured the impatient looks of pity from other members of the class who seemed to be able to grasp the fundamentals of speaking French easily. Even though my French learning experience was pretty much an abysmal failure, I still hoped to continue learning french in New Orleans during my MPH studies. However, as many of you know (because I still complain about this to anyone who will listen), I carefully packed up all of my French books, French CDs, and my other most precious books, into a box (that weight 39 pounds) and mailed it to my new address in New Orleans via "media mail" without insurance on August 15th, 2005. Shortly after arriving in New Orleans, I had to evacuate for Hurricane Katrina and ended up spending a semester at a University in Texas. After returning to New Orleans in Jan of 2006, I went to the post office to inquire about my box of books twice, but the post-office employee just gestured to dumpsters of moldy packages and said that since I hadn't insured the box there was nothing they could do. On top of the loss of my language learning resources. All the French tutoring/learning places went out of business. I took my innate inability to learn French, loss of all my books, and closing of all French language programs in New Orleans as signs from God that I should not become proficient at French at that time. I was planning on going to Uganda for a number of months for my capstone project for my MPH anyway. When I was accepted to medical school, it turned out that I had some extra time to be able to go to Tanzania to an intensive language school for 2 months and work on my Swahili again. I ended fulfilling my language proficiency requirement for my MPH in Swahili, so it ended up working out well in the end anyway.

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Anyway, back to my first day in clinic and regretting my decisions that led me to have no knowledge of Spanish, even though it is arguably the most useful language a health care provider working with underserved populations in the United Sates could speak. I couldn't believe my teenage self was so stupid to not have learned Spanish and I thought to myself that this point in my life, I would pay money to be able to speak Spanish. Mid-way through wallowing in my self-pity, I thought about Betsy and her "UB" concept. I wondered if there was an "Ultimate Christine", what would she do? I came to the conclusion that the "UC" does many things the current Christy does not do. However, one thing the UC does do, is make an effort to learn the language of her current patient population no matter where she is working. I drove to the bookstore that night and purchased some Spanish language learning tapes and started listening to them daily. I was surprised that although the French language by definition hates me, many of the words in Spanish sound vaguely familiar because of my study of French years ago.

I have now try to utilize by fledgling Spanish with my interactions with patients in clinic. This has has resulted in some awkward situations. Several times I tried using the word "Encatada" several times in clinic to mean "nice to meet you" as instructed by the Spanish learning tapes. After getting some strange looks I decided to ask the interpreter how to say "nice to meet you." Apparently, in clinic, the best way to say this is "Mucho Gusto." The interpreter informed me that saying 'encantada' to a patient is super creepy (apparently it is more appropriate for if you wanted to impress or seduce a man/woman at a formal dinner party) and that I should no longer say this. Good times. What is a visit to the doctor without the clueless medical student saying something creepy to you?

What the "Ultimate Christine" does - working towards learning the language of her current patient population.

"Comfort Care"

2009-09-19T12:01:00.000-07:00

During my internal medicine rotation I had the opportunity to meet a wonderful woman and her beautifully strong family. I have changed many names and details of the case due to patient privacy laws, but hope that the emotional influence will come through.

Margaret (not her real name) was a relatively young woman who had moved to this area to care for an elderly relative. Recently she was diagnosed with a very aggressive type of cancer. She was scheduled to start chemotherapy which was hoped to extend her life a few months, but a cure was understood to be impossible. She was admitted to the hospital and I was assigned to be her medical student because she had some mental status changes/few falls. Our team's mission was to figure try to get her into shape so she could start chemotherapy. I met Margaret and performed a history and physical exam. During our conversation I was impressed by how friendly and witty she was. Her thinking was not completely clear, but her personality came through the interview. I was also privileged to meet members of Margaret's family and realized how close her family was. Our medical set out optimistically trying to find the cause of Margaret's mental status changes and ways make her feel better and strengthen her for chemotherapy.

We ran many many tests, and started giving Margaret several medications. However, the next day her thinking was worse and her symptoms such as nausea had become more severe as well. We tried changing/adding more medications but every day her mental status and body seemed to deteriorate. We racked our brains trying to come up with ideas, but nothing seemed to help. Days passed. Soon her interaction was limited due likely to a combination of her declining function and her pain medication. It felt like watching a car crash in slow motion - you knew what was going to happen and you desperately wanted to change it some how, but there was nothing we could do.

We asked the palliative care (pain control/end of life symptom management people) for help. They saw Margaret and told us that her symptoms and confusion were typical of someone who was dying of cancer. We had a family meeting with the palliative care team present and had to break the news to the family that chemotherapy was no longer on the table and that Margaret was likely to die soon. It was heart breaking to see the grief of the family, many of whom I had gotten to know. The palliative care team did a good job at trying to make the meeting hopeful - focusing on our ability to control Margaret's pain and other symptoms and making her as pain free as possible. Days passed and the family decided to put Margaret on Hospice. She was switched to comfort care before leaving the hospital. I wrote out the order: switch to comfort care: no more blood draws, vitals, unneeded injects, etc. After my intern signed the order I went to put it in her chart. As I was putting it in the binder, I almost broke down sobbing in front of all the nurses and personnel around the charts - I so desperately did not want my patient to die. Switching to comfort care almost felt like defeat to me. I managed to pull myself together long enough to make it to my car before breaking down into tears. The truth is that comfort care is not defeat, is the providing the best possible care to Margaret that we could provide - making her last days as pleasant and as pain free as possible.

Shortly after being transferred to Hospice, Margaret passed away. Her family called me to let me know and our team sent a card of condolence. Her family said that Hospice did an absolutely amazing job of making her last days as peaceful as they could. It was one of my first experiences with a patient that I was following closely dying. It was definitely a challenging experience, but as I reflect more, I realize that it was actually incredibly fulfilling as well.

It is definitely more difficult support a dying patient and their family, as it is easier to be liked as a medical student/physician when you are giving good news and seeing improvements instead of daily decline in a patient. However, even though you do not have the ability to cure the patient/make them better, you can still be a good health care provider by supporting the patient and the family as much as possible as they go through the decline, palliative care, death, and grieving process.

All in all, it was a challenging, but very rewarding experience that I am very grateful to have been able to take part in.

Sick patient to me: "You are my favorite nurse"

2009-09-19T11:33:00.000-07:00

A couple weeks ago I was chatting with a patient and I praised one of the nurses who was on the team taking care of him. The patient responded by telling me that he did like that nurse a lot but that I was, "His favorite nurse." I decided to translate that in my mind to "You are my favorite female member of the medical team" which was still quite the complement. This patient had been pretty sick when I first admitted him and explained that I was a 3rd year medical student and that would be taking care of him while he was in the hospital. The patient's brother ended up quietly correcting him by saying, "Pst.... She is a medical student, not a nurse. She is going to be a doctor." The patient made a quick recovery by stating that I was his favorite person on the medical team taking care of him and that he thought I was going to be a really good doctor. It was a heart warming interaction, and I really liked the patient and wouldn't have minded if he had called me a nurse every day. However, it does not change the fact that female medical students, residents and physicians routinely get called, or mistaken for, nurses while male medical students and physicians do not. Over the last couple months, I have probably been called a nurse on average about once a day. For this reason, I decided to educate my blog readers with the following news flash:

Having breasts and being a physician/student physician are not mutually exclusive. :)

This is something that really gets to some female medical students. It doesn't really bother me that much, I just see it as part of the history of medicine (a typically male dominated field) that demonstrates it self in day to day interactions with patients.

Are you a really really sound sleeper? Please tell your doctor/paranoid 3rd year medical student!

2009-08-24T22:52:00.000-07:00

Today was a semi-stressful day in the hospital. I had a patient with lots of fairly serious chronic medical issues who was in the hospital to treat some infections and acute medical problems. All-in-all he was a pretty sick guy the day before his blood pressure kept fluctuating sending flurries of anxiety through our medical team. However, today he induced new levels of stress in my slightly-paranoid 3rd year medical student-ness when I went in to check on him this morning and he was unarousable. I kid you not - this man was dead to the world, in fact he seemed to be in some sort of coma-like state. I tried shouting, shaking his shoulders, a sternal rub (a maneuver to cause somnolent individuals to wake up by painfully rubbing their chest bone), but my patient would not wake out of his slumber. He had not received any sleep or pain medications that could make him more sleepy, and he seemed to be working harder to breath. When we rounded on my patient later, my anxiety over my patient's sleepy state seemed to infect the rest of the team and my attending doctor told me to call the patient's decision maker for health care to clarify whether or not the patient would want to be placed on a respirator if he became more ill. I made the call and put in some more orders. I kept checking on my patient throughout the morning and was disturbed to find him as unresponsive as ever. As I left for a teaching conference I passed by his bed and gave him another anxious look and several "Please don't die" wishes/prayers/jujus/brain waves. After my conference I went straight to his room to check on him. From the hallway I was surprised to hear cheerful voices and laughing coming from his room. Upon entering I found my patient sitting up, breathing normally and chatting happily with a nurse who had come to visit him. He looked as healthy as ever cracking jokes and he and the nurse were laughing up a storm. I was about to cry foul and ask just what was going on - had someone injected my patient with superman juice while I was gone???!?!?? Just then, his family members come in, worried because I had called earlier asking about the respirator, and told me that he is a really, really, really sound sleeper and that once he goes to sleep they can never wake him up at home either. So word to the wise - if you are a very sound sleeper and ever end up in the hospital, tell the paranoid 3rd year medical student taking care of you and save him/her from getting a few more white hairs and stress wrinkles.

Yup, the picture pretty much says it all.

Rock Climbing and hiking

2009-08-16T22:12:00.001-07:00

They have been keeping me pretty busy at the hospital. On my last call shift (where you stay overnight at the hospital) I didn't sleep at all. It has been very fun/educational though and I am learning a lot. Some times I wish I could be more help to my team, but I such is life. I guess the more I learn the more help I can be.

I still have some time for fun (occasionally). Today I went rock climbing for the first time. It was harder than it looks! On the plus side, I had a very good and patient teacher to guide me through my first rock climbing attempts. Despite being surprised by the difficulty, I had a really good time and look forward to trying my hand at climbing again.

View of Twin Falls during a recent hike.

Taking off my tight (and remarkably uncomfortable) climbing shoes after my very first climb.

I am sure this is exactly what you all wanted to see while reading my blog on your lunch break - a delightful shot of my hind-end. Whatever. The important thing is that I manged to very slowly climb and have a positive experience!

Wait, figure 8 knot?
Shoes... off... feet... resting... (happy sigh)

Very demented old man in the hospital: "Your beauty took my pain away."

2009-08-08T10:22:00.000-07:00

Earlier this week I was assigned a patient in the hospital with very severe dementia. When he first came in he was pretty sick and could only give one word answers to questions. However, as he started feeling better he also started speaking in more complete sentences and the extent of his dementia became more apparent. He would point to objects not present, etc. A few days ago I went in to check on this patient before rounding with my team. I started asking him about the various kinds of pain he had been complaining about the day before and whether or not the pain was any better. He responded by saying that before I had come into the room he had been in some pain, but that I was so beautiful that his pain went away as soon as he saw me. It was quite the humorous comment, particularly since this patient was older than my grandfather. I decided to focus on trying get information from him about his symptoms, but he kept insisting that he had no pain and seemed to be making attempts to ask me out on a date which I politely ignored. Frustrated, I went to look up some lab values before rounds. During rounds, I gave my presentation and informed the team that the patient seemed to be feeling better this morning. However, after my presentation the patient started going on and on about all the pain he was experiencing, including a new pain that had not been present the day before. I thought about sending the patient a nasty look - I would much rather have been called ugly and been able to present my team with accurate information, but it was clear that my patient no longer remembered our previous conversation. Apparently my stunning looks only function as a temporary analgesic!

"Of course you can ask me that, you are my almost doctor person!"

2009-07-26T18:32:00.000-07:00

I just finished my third week on outpatient medicine in Seattle. It has been so much fun, but I have been really busy (that is why I haven't posted as much recently). For outpatient medicine I am with a really nice girl named Ana that I actually know fairly well from my anatomy group. She is very smart and organized and is also very helpful and kind to every one around her - in short, a perfect person to have a rotation with. Our first day of the rotation was spent trying to get an ID badge - would you believe it took us 6 hours? I was joking that the id badges are so precious and take so long to get that if you got mugged on the way home from clinic you would probably say, "Take whatever you want, just PLEASE let me keep my hospital ID badge!" Maybe a little bit of an exaggeration, but not by much. :)

As far as what we do in the hospital on our outpatient rotation, we go from seeing patients in the primary care clinic to seeing patients in the ER (the medical side, not the surgery side), to observing physicians in the hematology/oncology clinic, to seeing patients in the renal clinic, etc. Some of the other really helpful clinics we observe/see patients in are the endocrine clinic, the movement disorder clinic (aka neurology), and the musculoskeletal rehab clinic. When we see our patients the sequence sort-of goes like this: We quickly review the chart and or the complaint that the patient is coming into address. Then our attending physician/teaching fellow introduces us to the patient and says, "Christine is a third year medical student and she is going to take a history on you and do a physical exam. Then she will present your case to me and we will come up with plan together." So you chat with the patient and collect the history of why they came into the hospital. Then you perform a focused physical exam - as pertains to the thing(s) the patient is complaining about. Then you take a few moments to collect your thoughts and present in about 3-5 minutes what the patient just spent a considerable amount of time collecting from the patient. At the end you tell your preceptor what you think the differential diagnosis is and what you plan for management is (this is the part that I am by far the weakest on right now). Then your preceptor/attending physician tells you all the things you missed or should have thought about and tells you the parts of your plan that are good or need improvement/more thought. You go back in with your attending physician and he/she checks some of your physical exam findings and asks a few questions and lets you present the plan to the patient. Then you or the attending put orders (such as tests, labs, etc) or consults into the computer which have to be signed by your attending doctor. Then you write up a "note" about the encounter including the history you took, the physical exam findings, and your assessment and plan. This may take 20minutes - a couple hours depending on how complicated things are and how clear your thought process is. Then the note goes to your attending physician who has to read it and sign it (and/or make corrections) before the note is finally part of the patient's file. Then sometimes you get to call the patient later on with the results of lab tests, etc. All-in-all, it is really interesting and a lot of fun. I learn so much everyday!!!

This last week I had patients that I got to see twice (so some continuity) it was nice to see how things were going with the medications that my preceptor and I suggested. It is also nice to get a taste of what it would be like if you were seeing the same patients over and over again if you were a real doctor. Last week I needed to ask some sensitive questions to a patient that I was seeing for the second time. I asked him if it was ok if I asked these questions and he responded with a huge smile and said, "Of course you can ask me that, you are my almost doctor person!" I is so amazing to me that someone considers me to be their "almost doctor." Wow, 3rd year is awesome! It is challenging, but by far, 10 times better than first and second year.

I will try to give up dates and stories as time and medical privacy laws allow.

I passed!!!!! board studying craziness

2009-07-02T23:02:00.002-07:00

I just found out that I PASSED the USMLE step 1!!!!!! I took some pictures for this blog post before I found out my score, but I thought it might be sort-of depressing if I told you all about how much I had studied for Step 1, and it turned out that I had actually failed. I was a little bit disappointed in my score (I was secretly hoping to do better), but I passed which is what really matters!

My technique to studying is that if you are producing something or actively engaged somehow, it helps you learn so much better. I dedicated myself to taking volumes of notes from various sources and making study sheets which I plastered all over our house (I think my roommates are glad that I am done with Step 1 too). :)

This is my freak-out picture. I tried to capture some of my inner feelings about the whole studying for boards thing. The First Aid Step 1 book is sort-of the bread and butter of board studying and I supplemented it a lot with listening to some board review audio lectures, going through cases and practices questions and some other subject based board review books. All in all I think that I probably bought/tried to use too many books, but I think it is a common mistake.

The outside of my bedroom door and my bedroom walls were covered with study sheets. It is nice because you can review material when you are just brushing your hair or whatever.

Some more pictures of my bedroom wall.
After available wall space in my bedroom was expended I moved the the bathroom (with my roommates' permission, of course). Andrea said she enjoyed reviewing material while brushing her teeth, etc, but I think she may have just been saying that to be nice.

The pen/highlighter graveyard. This isn't even all of the pens and highlighters I used while studying for Step 1. I decided to start saving the pens/highlighters about a week and a half into my studying.
Now you can get the picture of how messy my room was while I was studying. I had a pile of books and note-taking supplies that I moved around with me as I studied in various locations throughout the house. good times. Now I am off doing my clinical rotations.

Birthday hike and other pictures

2009-07-02T23:02:00.001-07:00

A lot has happened since the end of spring quarter. I decided to give the photographic tour of the last couple months.

Med school graduation for the 4th year class (it will be me in 2 years!): I know several people in the fourth year class so I decided to go and take pictures to be supportive. It was a nice ceremony, and inspiring that they all got to take the Hippocratic oath, but if any of you plan to come to my ceremony - bring pillows! The stadium chairs are something to be desired.

This is Andrea, or I guess as I should call her now, Dr. Andrea, one of my roommates for this year.

Melissa, my roommate from the previous 2 years, also graduated last month. Here she is with one of her sisters and her cousin Betsy. Although Melissa has left me, Betsy is still here and we get to hang out sometimes which is fun.
Here I am with Katja on her birthday. Katja is a friend that I know through my classmate and friend Sarah. Sarah and I organized a birthday picnic for her (but Sarah did most of the work - baking the cake and the main dish).

Katja holding her birthday cake.
At the end of second year we gave our ICM II mentor, Sam, gift at our end-of-the year breakfast. We gave him a pretty funny coffee mug.
Here is another picture of our ICM II group (I am sure my blog readers are tired of seeing them by now). ;) They are all such cool people.

The next big thing was that my older brother came up for a surprise visit for my mom's hip surgery. We have a couple pictures from surprising mom. She had no idea he was coming - it was great!
My little sister, Monica, during the surprise.

My brother, Aaron, with our mom. She was pretty happy.
This is me with one of my favorite elderly women at our church. She is so sweet - she sends birthday and anniversary cards to every one in the church every year. It is pretty incredible.

Me with my momma.

Me hanging out with my bro' waiting for mom to arrive for the surprise.

In June I turned 25! To celebrate the big birthday, I went on a hike with my good friend Sarah from med school. We hiked up Mount Bandera. It was beautiful as well as good exercise and a lot of fun!

Me at the pseudo peak of the mountain (the real peak was just a few feet away and blocked by a snow slide).
The view from the top of the mountain. It was pretty!
Even though it was a warm day, our path had snow towards the top. You have my permission to be impressed. ;)
More pictures of the view.
Me standing in front of a waterfall. The water was nice and cool.
Here is Sarah in front of the same waterfall. It was a really fun day!

Whooooo! Second year is OVER!

2009-05-30T00:01:00.001-07:00

So as of this afternoon, at 5:30pm, it looks like second year is officially over and I passed everything. Now I just have a few things waiting for me before third year rotations start such as STUDYING FOR STEP 1 (AAAHHHHHHH!!!!), turning 25 years old, catching up with friends, oh yeah, and taking Step 1.

White coat ceremony pictures

2009-05-24T19:27:00.001-07:00

This last Friday we had our clinical transition ceremony. It was really fun to get our white coats and look ahead to working in the hospital wards next year.

I put the best picture at the top. This is me getting my white coat from my ICM II mentor, Sam. (See previous blog posts about ICM II mentoring system). Thanks to Jo, one of my classmates' husband, for taking this picture!

This is me with Raye Maestas, my underserved pathway mentor and inspiring person (see previous blog posts). It was really nice to be able to introduce my family to some of my teachers/mentors at school

Our mentor, Sam, is super healthy and bikes everywhere. Here he is duded up in his biking gear and meeting some of my family including my mom and my Aunt Deborah.
Here is me with my white coat on.
This is me and my friend Sarah (and our white coats!) with mentor, Sam. It was a fun evening!
Here is another shot of me walking across the stage. contrary to the look of the picture, I was not striking a random action pose. There was someone just out of the picture that I was about to shake hands with.

So, apparently I waddle when I walk. Who knew? I think it is one of those things that you are surprised when you hear a recording of your voice or see a video of yourself, because it is not usually how you see yourself. I did not imagine myself waddling, but now I know the truth.

The USMLE step 1 (JAWS THEME MUSIC PLAYS)

2009-05-18T22:22:00.000-07:00

In less than two weeks, the second year of medical school will be over and studying for the USMLE step 1 board exam will begin. Technically you are supposed to be studying for it all throughout your second year, but medical school keeps you so busy you can guess how much that happens. Step 1 is an 8 hour computer-based test over pretty much everything you should have learned over the first two years of medical school.

According to the USMLE website:

"Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning."

'The content areas of the USMLE step 1 include:

anatomy,
behavioral sciences,
biochemistry,
microbiology,
pathology,
pharmacology,
physiology,
interdisciplinary topics, such as nutrition, genetics, and aging.

The specific systems covered include:

hematopoietic/lymphoreticular
nervous/special senses
skin/connective tissue
musculoskeletal
respiratory
cardiovascular
gastrointestinal
renal/urinary
reproductive
endocrine'

http://www.usmle.org/General_Information/bulletin/2009/content.html
------------------------------------------

The USMLE step 1 is sort-of scary for three reasons. First, it is really hard. Second, you have to pass it to continue on in medical school. Third, your score is important for applying to residencies and you should really try to do well on the test if you want to be competitive for residencies.

One of the review books for the USMLE step 1 is called "First Aid for USMLE Step 1." It is sort-of a funny pun, but I started thinking about it today. I don't need "First Aid for Step 1," I need, "Emergency Trauma Care with Defibrillator for the USMLE Step 1." I am serious, it is going to be several weeks of not so pretty studying in preparation for this thing.

I decided to give an artistic representation of how I felt about Step 1 right now. Yeah, that is pretty much it, except I probably don't have that good of form when I swim.

Although I might be scared out of my mind by the Step 1 exam, I am going to take a card out of Braveheart's book and give it my best (and yell 'Freedom!' a lot). Well, in the very least I think I might put some blue war paint on my face on the day of the exam so I will feel like Braveheart even if Step 1 does kick my ______.

Here is a chart that they keep showing us medical students about the average USMLE step 1 scores and the specialties you can match in. A score of 185 is usually the minimum passing score for step 1. Here I have circled the specialties that would be most likely for be to end up in at this point (generally not the most competitive, which is nice). Still, it is a very SCARY chart!

Roommates for next year. I am going to be living with my friend Andrea!

2009-05-18T21:52:00.000-07:00

To my extreme sadness, my fourth year roommate, Melissa is leaving at the beginning of June. She matched to a Med/Peds residency in Michigan where she will be moving in just a few weeks with her boyfriend. In addition to the sadness of having to deal with Melissa leaving, this left me with another issue: I had to find two new roommates for the next school year. I really wanted to live with some girls who are nice.

With stealth and precision, I picked out my first roommate target several months ago. Andrea, one of my good friends from undergrad is also graduating this year. She told me earlier in the year that she was hoping to match in medicine in Seattle for her residency. I started immediately with the nagging, telling her that if she ended up matching in Seattle, she just HAD to live with me. I continued to remind her for several months what a wonderful house I lived in and would drop several not-so-subtle hints about how much I thought she would enjoy living there next year with me. She kept saying that she was going to look at other places, and that maybe she wanted to live in a different area, but we both knew they were heartless excuses.

In the end, Andrea match in medicine at UW in the Boise track. This means she will do her first year of residency in Seattle, her second year in Boise, ID, and her third year back in Seattle. She looked at some other apartments, but in the end she decided that she does want to live with me for the next school year! I think we are going to have loads of fun together (that is when we are both not crazy busy in the hospital, which probably won't be too often).

This is a picture of Andrea and Me taken last year. Andrea rocks.

But wait! The story is not over, because the search was still on for a third roommate. We finally found her in the form of an unsuspecting incoming first year med student named Liz. I have only met her once, but she was really nice and I think she is going to make a really fun third roommate for the next year. It will be fun to hear her experiences of first year as I am going through my thrid.

Beat the Bridge!

2009-05-18T20:55:00.000-07:00

On Saturday I ran into one of my classmates who had just registered for the Beat the Bridge to Beat Diabetes event. She told me it was an 8k (5 mile) run and that she was was going to run/jog (slowly) with another classmate of ours. I thought it sounded like fun so I stopped by the Husky Stadium and registered. I met up with my classmates in the morning who were part of a larger fundraising team. There were thousands of people there and they closed off the streets to traffic for the race. It was sort of like a big fair. During the race my classmates and I stuck together which made it more fun than just running with a group of strangers.

This is the course map. We went across the Montlake bridge and the University Bridge. The University bridge is the bridge you have to beat because they raise it up 20 minutes after they release the third wave of runners and it is at the 2 mile mark.

Here is a picture of the finish line/area at Husky Stadium. There were tables of water, sports drinks, and fruit for you at the finish line. It was a warm day and I was pretty thirsty at the end of the race. They had these water stations along the race course where you could get a cup of water and drink it while you were running, it is a cool concept, but I wasn't very good at it.
Here was their little logo thing that I downloaded off the internet. The event was sponsored by Nordstrom and raised over a million dollars for type 1 diabetes research.

Here are some pictures of me all sweaty after I walked home. I got my "results" back today and did better than I thought. Our group of med students averaged about 9 minutes per mile (we took around 45 minutes to run the 5 miles) which is pretty good, I think. I never would have run that fast if my classmates weren't running with me and encouraging me. Peer pressure/team spirit is the keep to motivation!

Another sweaty post event picture. It was a lot of fun.

Whoo, only 4 more days of class and 2 weeks of finals until the end of second year!

2009-05-12T21:58:00.000-07:00

During our (delightful) 5 hours of class every afternoon, we get brief 10 minute breaks between (enthralling) lectures. During these breaks the small number of us who are actually still coming to class at this time of year have started standing outside in the sun during our breaks if it happens to be sunny outside. Today while standing outside for our typical 8 and a half minutes, we realized that we only have four days of class and two weeks of finals between us and the end of the second year of medical school! Exciting times! Of course, after that we have to immediately start studying for step 1, and after step 1 we almost immediately start our clinical rotations. However, despite the negativity, in a mere 2 weeks and 3 days the joy that is the dreary first and second year medical school classrooms is no longer to be ours!

To celebrate our final (tearful) goodbyes to the medical school classrooms. One of my classmates, Olga, took some pictures of our typical classroom scene. Good memories.

People chatting and setting up their computers before class starts.

Our row. This is Jessica, me, and Sarah.

The mac laptop rainbow seen during class. black, pink, white. I think there might even be a green one somewhere.

Here are more people setting up their laptops and checking their email before class starts. Daniel from my mentoring group is on the left and Ryan is on the right.

This is one of my classmates illustrating the typical medical school library study toolkit: 1) big desk 2) not so comfy chair, 3) coffee, 4) laptop with a power source, 5) a book/syllabus, 6) highlighters, 7) pencils/pens, 8) food or something of an edible nature that resembles food.

Clerkship Schedules!

2009-04-10T12:54:00.000-07:00

Yesterday we got our clerkship schedules for 3rd year. It is really nice because it gives us something beyond the end of second year and boards to look forward to. In general I am really pleased with my schedule and got a lot of my first and second choice clerkship locations.

After I take boards, I will be spending 12 weeks doing adult medicine in Seattle at some combination of Haborview, the UW med center, or the VA. Then I do 6 weeks of family medicine i the Country doc clinic in Seattle (I am very excited about this because this clinic serves a lot of underserved populations and it was my first choice for family medicine). Then I do 6 weeks of obstetrics and gynecology in Anchorage, Alaska (should be cold, but fun!). Six weeks of psychiatry in Seattle and then 6 weeks of pediatrics in Pocatello, Idaho. I have an elective period and then I finish it off with 6 weeks of Surgery in Tacoma.

I think third year is going to be so much fun!!!

Lunch with Lynn

2009-04-07T00:17:00.000-07:00

My Grandpa was a instructor for decades and he loved every minute of it. I think one of the most rewarding parts of teaching for him was his relationships with his students and the feeling that he made a lasting impact on his student's lives. He is retired now, but he still gets countless Christmas cards and letters from his former students (who are starting to retire themselves).

I have now been in school for 9 years (yikes! that sounds like a long time), and I think one of the things I have enjoyed the most is meeting and learning from amazing people. You really have to be dedicated to the greater good to go into teaching and I respect almost all professors immensely.

Today I had lunch with one of my professors from Skagit Valley College, Dr. Lynn Dunlap. She is an excellent teacher who puts a lot of energy into her students as well as helping design/improve Skagit's learning communities. She taught my film as literature class that I took linked with a science class at my last year at Skagit. I think the class really improved my writing/analytical skills, but more importantly it was fun (you got to watch movies and call it homework)! I have really enjoyed keeping in touch with Lynn over the years and she has become a good friend. She enjoys traveling and birding and I keep teasing her that one day I will get her to east Africa.

Family Craziness

2009-04-06T23:32:00.000-07:00

It was beautiful weather here this weekend and I went home and saw my family on Saturday. Here are some pictures from the family visit.

Here is my 20 year old brother Tesfaye. He is going to community college and working.

This is my brother Tadele. He is in high school and on the soccer team.

This is Carmen, our Golden Retriever, who is not dead (see previous posts) and being tortured by my 9 year old sister, Rachel.
Here is Rachel taking a nap on the (still not completely house trained) puppy named Princess. By necessity, dogs learn to be kid-friendly pretty early in the house.

This is me with my 12 year old sister Sarah (yes, yes, this is the one who is beating me at Scrabble). She is a lot of fun to hang out with.

This is Monica, the little 6 year old live-wire sister, and me. She has more energy than a case full of Duracell Batteries on Red Bull. Our family has been desperately trying to find constructive ways to channel Monica's endless energy supply. One of the things we have tried is gymnastics. Although sometimes she can have trouble following directions, she has done very well in gymnastics. Despite having just turned 5 (so she is kindergarten age), she is in level 3 gymnastics with 8 and 9 year old girls.

The requirement for entering level three gymnastics is being able to do a complete back flip on the trampoline, which Monica has mastered quite well.

Other stages of the back flip.

Other gymnastics moves. Hey, I'm impressed because I can't do any of that.

Monica showing off her medal and ribbons from her first ever gymnastics competition.

The MAC imposter!

2009-04-04T00:25:00.000-07:00

Here is a picture of my side of our med school classroom at break. I want you to look hard at the picture and see if you find anything peculiar or odd in the picture. Keep looking.

Keep looking.

Keep looking.

Do you give up? The peculiar item in that picture is a mac imposter! Specifically it is my black HP computer with an Apple sticker on the front.

So, macs have long been the oppressed minority in our society. However, with the invention of the IPOD, the Apple company has finally started to make money and now the mac notebooks are cooler than ever. I would say about 1/2 of our med school class has an Apple laptop. Which is fine, I have nothing against Apple. However, during last year and for part of this year almost every single visiting professor (who nearly always has a mac him or herself) says something to the effect of: "There are a lot of laptops out there. I am really glad to see that macs have become popular and now out number the PCs. Well, I guess they are the better computer!" (or something like that). Some professors don't go as far as to claim that macs are better, but somehow they communicate that they clearly think that macs were the cooler computer and that they would be the laptop that the more evolved and intelligent members of the human species would possess.

During a phone conversation with my older brother, Aaron, I ranted about the Apple superiority complex that many visiting professors had going on and said that I wished I could put an Apple sticker on my good old PC for just fun. A short while later, my brother was cleaning out a desk and found a couple Apple stickers which he mailed to me. The next day, my inside joke was complete. It makes me happy and I routinely burst out laughing when I think of my Apple camouflage.

I hope you all enjoy my joke too, even though it may seem strange.

My computer. There, I just cracked myself up again!

The image of the mac computer I am trying to copy. On first glance, the Apple sticker serves the purpose well.

The mac computer typical of the visiting professor.

NOTE: Please don't get me wrong, I have nothing against macs or people who own macs and I think I might want to buy one someday (if I can afford it). I am merely having fun lightheartedly mocking the superior attitude of some mac owners.

1/4 life crisis, my 12 year old sister is creaming me at Scrabble

2009-03-31T17:42:00.000-07:00

I enjoy the occasional game of online Scrabble with my Mom, my sisters and some of my friends. Unfortunately, my pride has taken a major hit recently as my 12 year old sister, Sarah, has started to routinely creaming me at Scrabble. Today I received an email that it was my turn on our online Scrabble game with the following score summary:

Score Summary:

Player	Score
Sarah	167
Christy	88

This is a picture of the game, only a few moves later. Now the score is: Sarah 297, Christy 204, and it is Sarah's turn. You can see that both Sarah and I try to make good use of double and triple stacking words to get as many points as possible out of each letter. Sarah is much better at it than I am. [Oh no! Now Sarah can look at this picture and know which letters I have for my next turn! darn. Does anybodyhave any advice on how to gain back some of my points?]

I am double Sarah's age, but she is wiping the floor with me in Scrabble! How embarrassing is that?

A couple minutes later I got another email about the other Scrabble game we are playing against each other, where I haven been desperately trying to catch up. Not to worry, she is beating me in that game as well:

Score Summary:

Player	Score
Super Sarah!	287
Christy	263

This is a picture taken of Sarah when she was about a year old. She liked to play the recorder while I played guitar, but she always played the recorder upside down. Little did we know that she was a future Scrabble genius.

_________________________________________________
An update on my Scrabble humiliation. Today I got the following email update about my Scrabble game with Sarah:

Score Summary:

Player	Score
Sarah	262
Christy	147

Messages:

Sarah : Mom just showed me your blog about me beating you at scrabble. It is really funny.

Step and Tone

2009-03-16T23:25:00.000-07:00

In concert with the 'balance' concept and trying to stay healthy, I decided to sign up for a 'Step and Tone' class at the UW's gym during winter quarter. Little did I know that I was really assigning myself concentrated doses of humility in 1 hour intervals twice a week.

I think that being home schooled through high school and not being used to group PE exercise, might be contributing, but I also think that an innate level of uncoordinated that I have never been fully aware of, is finally being completely expressed.

The Monday night sessions were a step class where complicated instructions with strange names were shouted out to a room of us over a track of upbeat music from the 90's. The instructor would say something like, "V step!" or "Indecision" and apparently the other class participant's cerebellums already knew what those instructions meant. The fact that I had absolutely no clue what I was doing, was made even worse by watching the rest of the class execute each move perfectly. One of my medical school classmates also took the class with me and I was astounded as she improvised and modified the step moves with the grace and glory of a ballerina. It turns out that she had taught a step class in Alaska, before moving to Seattle for medical school. I couldn't help thinking: Where does medical school dig up all these perfect people? When I talk to my classmates many of them have done absolutely amazing things before entering medical school - played professional basketball, gone to Nationals in figure skating, published tons of papers, etc. Anyway, I digress. Back to step and tone.

On Wednesdays, the "tone" part of the class commenced where we engaged in lifting some weights and different strength training type activities. One of the activities we do on the flour towards the end of the hour is "the plank" for 1 minute. I have included a couple pictures for educational purposes:

"The plank." I downloaded this picture from a Google image search and I thought this looked a little too peaceful, so I decided to edit the image to give a more realistic picture of what really happens (see below).

This picture explains it a little better, I think.

My very first AA meeting

2009-03-01T00:21:00.000-08:00

Some of you may be confused. "Did I read the title of this blog correctly? Did Christy really go to an AA (Alcoholics Anonymous) meeting? That just doesn't make sense." Others may be thinking, "I knew it! She has been a closest drinker/alcoholic all this time! Every time she refused a drink it was merely a facade trying to cover up her underlying alcohol addiction problems." Still others might think that I am just, "pulling your leg." Let me put that worry to rest right away - yes, I did in fact attend an AA meeting recently and I am not pulling your leg. If you want to know more than that, you will just have to keep reading...

I attended the AA meeting as part of our ICM II course requirement to have us learn about substance abuse. We had a couple class sessions on alcoholism and other forms of substance abuse on it and we are required to go to an Alcoholics Anonymous (AA) meeting. I actually really enjoyed going to the AA meeting and found it very insightful in many ways. Just in case you are interested, here is a little bit about my morning:

__________________________________________

I was dreaming a happy dream, I don’t quite remember what it was about, but it was definitely happy, when I was awoken suddenly by a very irritating beeping noise. It sounded like a dying fire detector with a battery that was about to run out. I realized in my sleep-deprived daze that it was my own alarm clock. I hit the light and looked at the time – 5:30am. Why in the world would I be getting out of bed this early when my first class wasn’t until noon?!?!?!? This definitely wasn’t part of the happy dream. I suddenly remembered that I was meeting some classmates for an early morning AA meeting as a requirement of our ICM II course. I hauled my lead-weighted feet to the bathroom and stared at my face in the mirror. A haggard med student with blood-shot eyes and very bad morning hair looked back at me. Two things were going through mind: 1) I should go back to bed and reschedule for an evening AA meeting and 2) I couldn’t believe people would voluntarily get up and go to an AA meeting once a week at this time in the morning. The other med students and I would probably be sitting in a practically empty AA meeting hall trying to talk about our own alcohol consumption history (our professor threatened that this would happen if we waited until too late in the quarter to go to our AA meeting). I really hoped that I wouldn’t have to share something. That could be awkward. What was I going to say, “I’ve had wine in communion?” or “I tried a sip of beer once, thought it was gross, and have never tried any kind of alcohol since?” Hmmm…. It would probably be like that scene with the sharks in Finding Nemo, and everyone would probably assume I was in denial if I couldn’t cough up any alcohol consumption history. Well, I guess I’ll have to cross that bridge when I come to it. I really hoped there would be at least a couple real AA members there. I tried to rally enthusiasm and soon I was out the door heading to my first ever AA meeting.

I decided to be as authentic as possible I would not drive to the AA meeting (trying to simulate the experience of someone who may have had their license taken away because of DUI). I took a bus about 2/3^rd the way there and then walked the rest of the way. About halfway there it started to snow lightly. It wasn’t sticking, but it was definitely enough to be considered “icky” weather. The thought that no one was going to show for this meeting solidified further in my mind.

I was slightly surprised when I arrived at the AA meeting that there was someone standing outside the door welcoming people. He greeted me with a big smile, opened the door for me, and said that he was glad I could brave the weather to come to the meeting.

I entered the room and was surprised to find about 50 chairs spread in a giant circle. Hmmmm… they must be hoping for a good turnout despite the weather. I timidly took a chair and started to unbundle my many layers of coats, sweaters and scarves. More people continued to arrive. As more and more people started to trickle in, I became enthusiastically curious about what sort-of experience this would turn out to be. I smiled and introduced myself to a couple people and soon I was surrounded by a group of talkative alcoholics all eagerly sharing part of their life stories. It was so fascinating to hear about people’s lives. Some people came to their first meeting with a friend and others just stumbled upon a meeting while walking downtown. Others were ordered by the court to attend their first AA meeting.

As the start-time for the meeting got closer, a couple other second year med students joined our group and were immediately surrounded by friendly AA members. When the meeting started I scoped out the room. Despite the cold weather, at least 50 people had come to the meeting. It was amazing how diverse the group of people was. There were people in business suits who looked like they were about to walk into their office at a law firm. There were men who were dressed as mechanics. Someone who looked like they were head to the gym, someone else brought their dog. After the opening rituals, they introduced us and then some people announced how long it had been since they had any alcohol. For some people it was just a couple days and for others it had been decades. During the discussion someone said they had been coming to this AA meeting every day for 11 years. EVERY DAY for 11 YEARS that person got out of bed at an obscenely early hour to go to this AA meeting. That was how important the meeting was to this person. I feel like it also demonstrates the challenges that an alcoholic has to face on a daily basis. Other people said similar things – that 90% of their friends were people they knew through AA, and that they think about what the group means to him when he is tempted to drink alcohol. AA really is its own social support structure. The struggle with alcohol brought all these different people together and they were incredibly encouraging to each other.

Although I was surprised that some people come to the meeting every day, the OVERWHELMING emotion I got from the meeting atmosphere was that it was a safe place. Perhaps it was even the definition of safe place. It was completely open, non-judgmental and supportive. People could say anything and the group would listen quietly and supportively. It felt like a safer atmosphere to share scary and intimate personal information than perhaps any other venue – with your doctor, at church, even with your friends and family. I spoke with the other medical students after the meeting and they all said that it was such a positive, friendly and safe place to share, we almost want to go back even though we don’t necessarily struggle with alcohol use. During the meeting, several people said, “AA gave me my life back.” Now I can totally see how going to this meeting, and the support structure could literally change someone’s life.

The AA members had a very positive response to seeing us. They thanked us for coming and said over and over again how important they thought it was for physicians to have an understanding of alcoholism and AA and what it can do for people. I think I will be much more likely One woman told us how hard it was for her to tell her physician that she thought she was drinking too much. Her physician just dismissed the comment and said, “Well, just cut back then.” The AA member told us that it is so hard to say that to someone and that if a patient ever says that to us as physicians we definitely should not ignore it and probe into the issue further. A different person told us that she asked her doctor if she should try AA and her physician said that she didn’t like AA because it used God and religion and the physician thought this was unnecessary. Later this AA member went to an AA meeting on her own and found it to be exactly what she needed to help her. She said that if AA works for some people, doctors and other people shouldn’t dismiss it no matter what methods it uses. This AA member told us that many of the people who attend this AA meeting are not religious and many don’t believe in God, however, the AA program still works very well for them.

Practicing the knee exam

2009-02-28T23:52:00.000-08:00

I thought I would share some fun pictures with you all. I have discussed in previous blog entries how our ICM II small group is our little med school family that we go to the hospital with and practice parts of the advanced physical exam with.

This quarter the second year med students are taking the musculoskeletal system (basically the anatomy and the most important stuff that can wrong with the arms and legs). Coinciding with our musculoskeletal course, last week we learned the "advanced knee exam" in our ICM II small groups. It was quite humorous in many ways. However, one of the most entertaining things was some of the positions you have to take with your "patients" to examine their knee for stability, etc. In one test you have the patient lay on their back with their knee bent and you have to sit on the patient's foot while you pull forward on their knee. In another test (the Apley Compression Test), you have the person lay on their stomach while you get up on the examining table with them and place one knee on their thigh while you pull and rotate their foot and then push and rotate their foot (looking for mensical injury). It made for some pretty fun pictures:

Here is Tara performing the Apley test on Sarah and Linnea performing the Apley test on Daniel. It was pretty funny.
Here are some close ups of Linnea and Daniel. Daniel's face is priceless!
Here is another pic of Linnea and Daniel. Again, the face!

Carmen

2009-02-24T23:19:00.000-08:00

I went home to see my family over valentine's day weekend and our family's golden retriever, Carmen, was very sick. She was bleeding out her rectal/vaginal area, and her stomach was bloated and tender. She wouldn't get up, eat, or even wag her tail when you scratched her head. I was sure that she was about to die. Although there are many other things to be upset about in the world, I was really sad that our family's best pet was going to pass on - she was a really good dog. I made an appointment for Carmen to see the vet and told my mom to make sure that all the kids got to say goodbye to her before they took her in to the vet, because they were probably going to have to put her to sleep.

However, the vet examined Carmen and determined that she had an infected uterus (apparently is fairly common in golden retrievers who have never had their uterus removed). Although she was really dehydrated and ill, the vet thought the could still save her. They put Carmen on an IV, performed a hysterectomy the next day, and put her on some strong antibiotics. Now she is doing great and back to her normal happy self. My family sent me this video of Carmen so I could see how much better she is doing. As you can see from the video, even recovering from surgery (a little over a week ago), does not stop her from wanting to play fetch all the time!

(OK, I know that I am totally turning into an old grandma type when I start putting videos of our dog up on my blog)...

The best ICM II small group ever

2009-02-23T15:00:00.000-08:00

Months ago I promised I would post a picture of my Introduction to Clinical Medicine II small group. Well, here it is (better late than never). Every second year medical student at UW is part of an Introduction to Clinical Medicine (ICM) small group. Once a week you go to the hospital with your group and practice interviewing patients (some weeks you get together and practice parts of the advanced physical exam instead of going to the hospital). The ICM II small groups are sort of like your own little miniature medical school family. About 5 or 6 ICM II small groups make up a College - a larger group of Med school students and faculty that do functions together and have peer advising together. (I think that some of this is a real effort by the university to make sure that med students don't feel lost in the med school system). The ICM II group's mentor is each student's own personal clinical teacher for each second year student within the group. Our mentor, Sam, is an awesome mentor/clinical teacher. He is nice and encouraging, but good about giving feedback when you need to improve on something.

Here is a picture of our ICM II small group (our miniature second year med school family). In the very back (with his face being blocked by my head) is our mentor, Sam. In the next (standing) row from left to right we have: Avi, Linnea, Sarah, and Me. In the next row from left to right we have: Julia, Daniel, and Tara.

Last year I posted a picture of Sam, Avi, Sarah, Tara, and myself. This year has been even more fun because Daniel and Linnea joined us as second year students from Alaska, and Julia expanded to our class from the third year class. It is so much fun spending time with them. We really do have the best small group ever!

Underserved pathway mentor, and all-round inspiring person

2009-02-10T19:51:00.000-08:00

Do you ever meet someone really inspiring? I mean, really, really inspiring? I meet inspiring people all the time: teachers, volunteers, members of my family, there are tons of people who are dedicated to making the world a better place. I written in the past about people I find inspiring (check out my blog entry that I wrote last year 'Milly, my newest hero'). Since beginning medical school I have meet even more inspiring people. In particular, I have found people who are dedicated to providing medical care to Seattle's poorest and most disadvantaged populations very inspiring. Last year, I posted about how much I enjoyed my preceptorship with Dr. Huntington at the Haborview Family Med Clinic. A large portion of the population the Haborview Family Med clinic sees are immigrants (particularly from Somalia and Ethiopia), some homeless individuals and some poorer African American and Spanish speaking populations. Anyway, another physician who also works at the same clinic as Dr. Huntington is Raye Maestas. Dr. Maestas is the head of the Denali college and helps teach the Introduction to Clinical Medicine I course that med students take during first year. From these situations I already thought of Dr. Maestas as an incredible person, but as I learned more about what she did with the underserved I was even more awed.

Over half a year ago, when I started second year, I decided that in addition to the Global Health Pathway, I also wanted to do the Underserved Pathway because of my amazing experiences at the Haborview Family Med Clinic. When I filled out the Underserved Pathway application I asked if I could possibly get a mentor who works with immigrant populations or was from the Haborview Family Med Clinic and I included Dr. Maestas's name along with Dr. Huntington's and some other physicians who worked in the office. I was so incredibly fortunate that Dr. Maestas agreed to be my underserved pathway mentor. She is so inspiring. I have really enjoyed talking with her more and hearing about her advocacy work that she has done on behalf of the disadvantaged (she has done a lot with domestic violence and several other similar areas) and how she worked to influence policy on a larger scale.

Throughout recent experiences and seeing what amazing things family physicians can and have accomplished within poorer communities, I find myself being drawn more towards family medicine. I still might do peds (let's face it - kids are awesome!), but I really enjoy spending time with elderly individuals as well. There is something so calming and fun about seeing older retired people and hearing stories from the Great Depression and World Warr II. Also, it seems like it would be nice to be able to take care of an individual's entire family. Although it is not as high status, family medicine is also completely compatible with international work and being able to handle a wide variety of situations overseas. In another fun experience, we had a family physician come talk to our class from the Country Doc clinic in Seattle (it is a community clinic that also serves a poorer population). He was enthusiastic about what he does and told us that many people think that family docs don't specialize, but they are wrong. He said that as a family doc working in that clinic he become a specialist in poverty medicine. Which was a fascinating concept. I think that if I do have to split my time between working internationally in Africa and here in the States (for licencing requirements,etc), when I work in the states I want to work with poorer immigrant populations such as those seen at Haborview and the Country Doc Clinic.

We will see as I enter clinical rotations next year if I am still leaning towards family medicine. I am still keeping an open mind to all residency possibilities. I just thought I would update you on where my current thinking is.

A picture of my underserved pathway mentor, Raye Maestas, and me. She is also the head of the Denali College which our ICM II small group belongs to.

Among many other accomplishments she was recently honored in the University of Washington Libraries Women in Medicine Exhibit as a "Local Legend." Here is the link if you are interested:

http://www.nlm.nih.gov/locallegends/Biographies/Maestas_Ramoncita.html

"U.S. Assisted With Attack on Ugandan Rebels"

2009-02-06T15:52:00.000-08:00

Here is a NY times article about the US helping the Ugandan army with an attack on the Lord's Resistance Army (the one that was attacking northern Uganda). This attack went awry and resulted in more civilian deaths. Here is the web address:

http://www.nytimes.com/2009/02/07/world/africa/07congo.html?_r=1&hp

This is a quote from the article:
"No American forces ever got involved in the ground fighting in this isolated, rugged corner of Congo, but human rights advocates and villagers here complain that the Ugandans and the Congolese troops who carried out the operation did little or nothing to protect nearby villages, despite a history of rebel reprisals against civilians.

The troops did not seal off the rebels’ escape routes or deploy soldiers to many of the nearby towns where the rebels slaughtered people in churches and tried to twist off the heads of toddlers."

Sigh, I guess some things don't changes (look at my earlier blog entries in 2007 to see what I think about the violence caused by the Lord's Resistance Army).

Carmel: Brother, Grandparents, Presentation and the Beach!

2009-02-02T23:04:00.000-08:00

This last weekend I went to Carmel, CA to present a powerpoint presentation on my shoe project in Uganda. As you can tell from the pictures below, I endured terrible agony down there. (Did I mention that it snowed briefly the day before I left Seattle)?

This is the view from the hotel we stayed in. It was 65 degrees and sunny most days. UW paid for all of the student's airfare and hotel stays to encourage us to present our abstracts.

Saturday, after I presented I went for a 20 mile bike ride with some of my classmates down "17 mile road" and back. We were riding along the beach almost the whole time and it was really beautiful.
UW also put on a welcome dinner for us at Mission Ranch (Clint Eastwood's restaurant in Carmel). As you can tell from the picture, the food was pretty as well as delicious).

This was our program for the conference. OK, so I know this is a lame picture.
I also got to see my older brother and my grandparents while I was down in California. Here is a nice picture of Granny and Spiro.
Granny and me. We had fun walking outside even though granny had knee surgery recently.
sSpiro and me. I really enjoyed talking with Spiro again and hearing some more of his stories from the Great Depression. It is crazy how much our grandparents have been through/seen!

Thinking outside the “Balance Box”

2009-01-27T20:00:00.000-08:00

In med school, they spend a lot of time trying to emphasize the importance of "balance." The emphasis on balance has kept growing during second year, and here are some of my thoughts on the issue:

For most of last year and the beginning of this year, whenever I heard the word “balance,” the first word that came to me was “blah.” They were essentially paired in my mind: Balance, blah. Balance, blah. Balance, blah. At first I think my frustration surrounding the discussion of ‘balance’ stemmed from my perceived irony of it all. During orientation, they kept telling us to make sure our lives were balanced and their description of a balanced day for the typical medical student was ridiculous: attend all your classes (5 to 7 hours depending on the day), studying at least 1-2 hour outside of class for every hour in class, get enough sleep (8 hours a night), making sure that we exercised (30min-1.5 hours a day), making sure we ate healthy (at least another 1 hour a day for food preparation and acquisition), making sure we maintained relationships with significant others, friends and family (an unspecified amount of time), and making sure that you had fun sometimes (also an unspecified amount of time). If you added together all the time required to follow the med school’s instructions on how to live a balanced life you get a day that is much greater than 24 hours long! It was impossible to follow, and the instructions felt downright silly. It felt like they were just threw us an unsolvable 3D puzzle called ‘balance’ and said, “So welcome to medicine, you really need to start working on this balance puzzle thingy. There actually isn’t a complete solution to the puzzle – we just thought you should get started on it now so that you will be a little closer to the non-existent solution before you die. Here are the pieces that WE think belong in the puzzle, but we don’t know how they fit together. Good luck.”

However, I did realize the importance of trying to take care of myself and I am glad that the medical school was interested in our well-being. I did make an effort to exercise, cook good food, and sleep enough. During fall quarter of first year I got caught up in some family responsibilities, and became very stressed out trying to juggle my family and my med school course work. I ended the quarter feeling unsatisfied with medical school, and despite my attempts to stay healthy, I felt “unbalanced.” I was worried that I might not be able to make it through even the first year of medical school. However, in the winter quarter of my first year I signed up for a family medicine preceptorship at Haborview and it was amazing. I loved going to clinic and meeting patients and hearing their stories. I loved seeing what practicing real medicine was like and being reminded why I wanted to go to medical school. Although I had taken on even more things in winter quarter and was even busier with school than I had been in fall, I was much happier and had more motivation to study. The model of balance presented by the medical school during orientation might imply that winter quarter I was “less balanced,” because I spent more time with school related work. However, I think that perhaps I was more balanced in winter, because I got to see the side of medicine that I enjoyed.

Then I realized that the reason I was so frustrated with the school’s definition of balance was because I was thinking inside the “balance box.” I actually love balance. I really want balance in my life. I just don’t define balance the way perhaps some of the medical school staff here envisioning when they first presented it to us. I would say balance is “doing what you need to be fulfilled and happy with yourself and your life as a physician.” That could mean skiing on the weekends and taking a month-long vacation through Europe every summer with your family or it could mean making less money and working longer hours to serve the needs of the poorer immigrant population in your area. Different people want to get different things out of energy they are putting into their medical education.

I didn’t decide to go to medical school so that I could have a good stable income and have a comfortable family life. I decided to go to medical school because I want to change the world. I know that sounds cliché, but I really do want to do something meaningful with my medical education.

Honors, blah.

2009-01-10T16:17:00.001-08:00

One of the additional stresses of the second year of medical school at the UW is honors. During the first year classes were just pass or fail. You either got above 70, or whatever the passing score was in the class, or you didn't. Of course, you tried to do the best you could, but there wasn't the pressure of having it labeled on your transcript. However, for second year, most of the classes are scored according to pass, fail, and honors. Honors means very different things in different classes, but it usually means you did extraordinarily well in the class. Usually you have to put forward some extra effort, either writing a paper, or taking a second, harder exam, to qualify for honors. Everyone keeps telling us, "honors don't really matter," and yet, all of us obsessive compulsive med students can't keep our selves from trying get honors. All in all, it results in a very messed up mind thing going on.

Allow me to give an example. In first year if you got 89% in a class you might say to yourself: of course I could have done better, and I always strive for my best, but med school is really hard and I learned 89% of the material in that class! Go me! In second year, when honors is an option, it totally changes the way you think about your grade. For example, in one of my classes I got an 89% and missed honors by 1 point. Instead of congratulating myself on learning most of the material in a challenging class, all I could think was, "I can't believe I missed honors by one point. I can't believe I missed honors by one point." It creates a very frustrating, and to be honest, pretty unhealthy mental atmosphere. sigh. such is life.

Christmas pictures

2009-01-10T15:00:00.000-08:00

I had a good Christmas break and I got to spend a lot of time with family. I decided to see exactly how boring my blog could get, and post more Christmas pictures. Between only posting every 3-4 months, and putting up boring posts and pictures, I will be surprised if my blog gets any hits this year. Anyway, in going with the boring theme, here are so pics over the last month in 2008:

I spent most of the break visiting my grandparents in Northern California and my grandparents in New Mexico.
I took this picture on Christmas morning in California. This was from the Arcata Marsh Project. It was a nice day.
This is my Grandpa (Gramps) on Christmas morning. He likes to complain a lot, but I think he had fun in spite of himself.

Gramps and Grams have had a year of increasing stress due to medical reasons. They told us they were not going to 1) decorate for Christmas and 2) they were not going to go shopping for Christmas presents. As you can plainly see from the above picture, these were blatant lies.

This is my Dad. We went out picture taking after Christmas. It was fun to get out of the house.

Some of the northern California beachscapes.

I also went to visit my Grandpa Lew and Grandma Ti in Albuquerque, New Mexico. I had never been to their house in Albuquerque. It was really fun to hang out with them and get to talk some.
A map of New Mexico, with Albuquerque highlighted. They used to live in Santa Fe, but moved a few years ago.

This is one of my favorite Christmas pictures. It is of me with my Grandpa Lew on top of the Sandia Mountain (we took the Tramway to the top).

This is me in the tramcar on the way back down the mountain.

The view on the way down the mountain in the tramcar.
The other tramcar and tower as we passed (is this getting excessively boring? I thought so. Sorry about that).
This is the ski slope on the other side of the mountain (the side facing away from Albuquerque).

Grandma Ti and me.
Me. It was cold at the top of the mountain.

Meanwhile, in Western Washington, it snowed around 18 inches and my family was snowed in for about 2 weeks! It was a crazy winter!

Poster presentations, whew!

2008-12-05T22:56:00.000-08:00

I am very sorry that I haven't posted for a while. I have been very busy, but there really isn't any excuse for not updating my friends and blog readers on what has been going on in my life. We are coming to the end of the quarter now and approaching final exams craziness, but there have been many other events speckling the fall quarter of our second year.

I have now presented my IHOP (International Health Opportunities Program) poster about my project in Uganda twice. Both times I was slightly dreading the experience, but I actually enjoyed it quite a bit. It was nice to talk to people and share some experiences in Uganda as well as talk about some rising health issues in Uganda. Oh, and it also gave me an excuse to dress up in some of my Uganda clothes, which was really fun.

Here are just a few pics from the most recent poster session:

This picture didn't really turn out very well, but I was poster 3.

Here are some of the IHOP participants. Annie and I went to Uganda, but others went to Peru, Madagascar, and India.
Annie and I haven't seen each other as much since going back to school, so it was nice to catch up a little during the poster session.

Here I am with my poster. It was fun.

Brain Flop: Multiple Causes of Chest Pain?

2008-10-19T15:41:00.000-07:00

Second year of med school at the UW has a lot of book learning, but the school also does a good job of trying to ramp up our clinical skills in preparation for spending 3rd and 4th year in hospitals on various rotations. The Introduction to Clinical Medicine course is class that tries to guide us on the path to becoming good doctors, and it is through this course that our second year clinical experiences take place. The Medical School has 6 different "Colleges" or sort-of families that students get randomly assigned to when they start medical school. They are:

Denali = my college (which is, of course, the best!)
Rainer
Columbia River
Snake River
Wind River
and Big Sky

Within the Colleges, students also get assigned to a "College Mentoring Group" with about 5 or 6 other students. Your College Mentor is an experienced physician who guides and supports you through you medical school and who plays a large role in your clinical learning in second year. Throughout second year we go to a hospital with our College mentor and the other students in our mentoring group and interview patients and practice our physical exam skills. Each student completes 2 completely histories and physicals a quarter, presents their patient to their group, and completes a write-up about the patient. (It is a lot of work, but we learn SOOOOO much through this experience).

This is a picture (off the school's website) of Sam who is our Denali College Mentor. Sam is awesome. He is really good about giving very helpful feedback, but in a kind and supportive way. (I will try to post an update picture of our entire college mentoring group next quarter. I kept forgetting to take pictures this quarter).

Anyway, towards the beginning of the quarter I interviewed a very nice patient who had been admitted to the hospital because of chest pain. I didn't get through everything, but I finished as much of history and physical as time would allow. Then I presented the case to my mentor and mentoring group classmates. I was really nervous and my mouth was dry and my hands were shaking while I was presenting the case. Then we got to the end and our mentor asked me: "So what are some of the most likely causes of the chest pain?" I froze and I couldn't think of anything to say other than a possible myocardial infarction (a heart attack). My mentor smiled and asked with an inquisitive look if I could possibly think of anything else that could cause chest pain. I swallowed slowly and quickly tried search my brain, only to find that it was completely void of any useful knowledge. In fact, the only thing present seemed to be the word, "uh?" echoing through my skulls empty chambers. I looked at the floor and said that I couldn't think of any other possible causes of chest pain. I was embarrassed then, but it was nothing to how I felt once I got home and looked up "Chest Pain" in my physical exam book. The possible causes of chest pain and almost countless. Just a few that I found were:

-myocardial infarction
-cardiac arrhythmia
-aortic dissection
-pericarditis
-pulmonary embolism
-pneumonia
-lung cancer
-pneumothorax
-pleural effusion
-hyperventilation
-anxiety
-depression
-reflux esophagitis
-esophageal spasm
-peptic ulcer
-gastritis
-pancreatitis
-biliary colic
-cervical arthritis
-costochondritis
-herpes zoster

I can't believe that I couldn't think of just one more from the list. I guess we are still a long way from becoming doctors. Hopefully, we improve a lot this year!

A shameless fundraising plug: EEP - Orphan Sponsorship Program

2008-10-17T21:05:00.000-07:00

When I was in Uganda in 2007 I volunteered for a Canadian organization called Working to Empower. One of the activities I helped with while I was there was their orphan sponsorship program. The program helps female orphans attend secondary school which increases their status in society, breaks the poverty cycle and makes it less likely they will be infected with HIV. I wrote a couple articles about the program while I was in Uganda and got to talk to some of the girls going to secondary school. They really are good kids and have a lot of hopes and dreams. Anyway, if you are looking for a good thing to donate to, check it out:

http://www.givemeaning.com/project/wteeep

(GiveMeaning site is hosting the fund raising efforts for the program)

Still some time for some fun...

2008-10-13T23:44:00.000-07:00

Although I may spend many hours studying, I still have plenty of fun. In addition to seeing friends and family, I enjoy spending time with my roommate, Melissa, and her cousin.

I thought this picture was pretty funny. Melissa is a fourth year medical student and she made blueberry muffins for her call team that she works with at the hospital. However, she put the muffins in containers too soon after getting them out of the oven, so the next morning the muffins were a little on the soggy/moist side. I was cracking up as Melissa used a hair dryer to dry out her muffins. I think many years from now this picture will symbolize the good times I have had in this house.

Sorry that I haven't posted for a while, second year is kicking my ______

2008-10-13T21:31:00.000-07:00

I am sorry that I haven't posted anything on the bl0g for a while. The only (extremely lame) excuse I can give is that the second year of med school is kicking my______(this word has been omitted in an effort to keep my blog G-rated and family-friendly). I am currently in a state of post-test euphoria so I will spend a few minutes giving you a quick update on my life.

I just started the 7th week of our 15 week "quarter," and we have already completed 2 classes! We have 5 hours of class Monday-Friday and our classes are divided up into quarter-long classes and block classes. Pharmacology and Introduction to Clinical Medicine II last the entire quarter while other classes only last a few weeks. The first class, the Skin System, we completed in only 2 weeks. The second class we just finished was Endocrinology and that class lasted about 4 weeks. Some good news: I passed both classes! Whew! Those of you who talk to me (which we know really means listening to me freak out) regularly know that I was particularly concerned with passing Endocrine. In the end I passed the course and decided that I really liked the material - endocrinology is absolutely fascinating! Now we are studying the Cardiovascular System and the Urinary System as block classes.

The REALLY good thing about second year is that the material we are studying is much more interesting and is directly applicable to taking care of patients which makes studying it more fun. Learning in detail about different aspects of the human body is fascinating and it makes you feel smart too! Therefore the 4-6hours you have to study each day to stay caught up seems much more bearable than the study load last year even though we have more work.

In addition to coursework, I have had a few other things on my plate. My laptop I use to take notes on everyday, gave up the ghost and is currently being repaired (thanks to the Staples warranty). Also, for my trip to Uganda last summer I had to create a poster about the project I conducted in Kumi making shoes for diabetic patients. The poster was due earlier in the quarter, but I will be presenting it at the School of Medicine Poster Session in November.

Here is my poster. It might be hard to read on the blog, but you can probably get the gist of the information. It is a lot of work to try to line up all of the boxes on the poster!

As far as my study methods go, I am probably don't have the most efficient methods possible, but I have been doing anything I can possibly think of to help me learn the material. Recently this has taken the form of using many different pen and highlighter colors with my studying to keep things interesting.

This photograph is the current artistic representation of my life - studying a lot! Featured here are my Endocrinology notes, my pens and some of my highlighters. When I put a full day of studying, I go through an average of a highlighter a day or a pen every other day. I know, I live an exciting life.

Here are the coursepacks for the two conquered subjects so far - Skin and Endocrine. A long time ago I used to have this reverence for textbooks. I somehow thought that it was wrong to write in them, highlight excessively or otherwise defame such a precious source of knowledge. Now I have a completely different approach - textbooks are my slaves! Their purpose in the scope of the universe is to help me learn and therefore should be abused in anyway possible that can help me understand the material. These abuses may include, but are not limited to: highlighting, annotations in the margins, scribbling in frustration, or the writing of sarcastic commentary/mnemonics. In case you were wondering, my highlighting color scheme does have a rudimentary logic: yellow is mildly important, green and blue are moderately important, and orange and pink are extremely important/pay attention! If a figure or concept is very important or hard to grasp I write a summary statement in the margin. Therefore, when it is time to review for an exam I can go through and read the orange, pink, green and blue highlighted text, review figures and read by notes in the margin and come away with a pretty good review. OK, now you probably know way more than you ever wanted to about my study habits...

How do I feel these days? Well, a picture is worth a thousand words... :)

Reentry

2008-09-18T23:22:00.000-07:00

Washing machines are amazing. No, really. Washing machines may be one of the best inventions of modern society. This is my third time coming back from east or southern Africa and each time I amazed by how effective washing machines are at getting clothes really clean with minimal human labor required. During most of our time in Uganda this summer we paid a local Ugandan woman to wash our clothes. However, towards the end of the summer she went to a different part of the country and I decided to tough it out and wash my clothes myself. I tried various techniques all of which left my clothes remarkably still dirty and still smelly. My increasing desperation to get my clothes clean climaxed in me trying to perfectly simulate the actions of a washing machine. I pre-soaked my clothes in a large bucket of cold water. Then I boiled water on the stove and agitated my clothes with hand washing soap in a bucket of hot to warm water. I rubbed the soap into each garment paying particular attention to any stained or smelly areas (wash cycle). Then I drained the water and wrung out each garment (spin cycle). Then I actually repeated the warm wash cycle again as well as the ringing out of the clothes. Then I rinsed my clothes with warm water and then once again with cold water (ringing the clothes out in between rinses). I hung the clothes on the line and once they dried I was dismayed to find that they were still dirty. The orange hue of Ugandan dirt stubbornly remained and none of the stains had been removed. It seemed like a physical impossibility. I left about ½ of my clothes in Uganda. However, I decided to bring back some of my particular favorites. The day after I came back to the States I put my (still dirty and stained) Ugandan clothes in our washing machine, put in an appropriate about of laundry detergent, pressed start and 40 minutes later my clothes came out vibrantly clean and stain free. It is amazing.

Of course, washing my clothes might be a stupid thing to write a huge paragraph about, however, it does illustrate how insanely easy so many things are here in the United States. It took me all day and probably about 500 Calories to try to get by clothes “less dirty” in Uganda. However, in the States “doing laundry” is something you do on a whim while talking to your mom on the phone and takes very little energy. Just getting water piped into your house is a huge luxury that many of us take for granted here in the States. In Kumi it would take women all morning to pump water from the local well and carry it back to their homes 20 liters at a time for cooking, drinking, washing dishes, bathing, laundry, etc. Reliable electricity? Hot running water? These are privileges reserved for only the wealthiest of the upper class in Uganda. Here they are just expected like people expect the sky to be blue and the grass in their manicured lawns to be green. We really do live in a privileged society.

The day after I came back from Uganda I opened internet explorer on my computer and opened a book to read while I waited for the gmail page to load. I only read a sentence or two before I realized that I was back in the land of technology and highspeed internet! Oh, the bliss of typing in a webpage and having it pop up suddenly! Think of how much time you save with the instant, virtually free, communication and access to information through the internet. It is spectacular. However, there are disadvantages that come with our technology and internet information age. When was the last time you just sat down with a stranger and talked to them for 3 hours? In Uganda, I was able to spend a lot of time getting to know people and hearing their stories because technology, electricity, and internet were so inaccessible. When we were in rural Kumi I got to spend a lot of time with a physician and his wife learning about how they met, the courtship and marriage traditions from their ethnic group, what they thought about Ugandan and US politics, how the Catholic Church was run in Uganda and corruption in the Ugandan medical system. These are conversations and information I might not have gleaned if the internet, electricity and other forms of entertainment had been readily available.

I think my re-entry shock hit a high last week when I was at my pediatric infectious preceptorship in Children’s Hospital. I will be doing this preceptorship all of fall quarter and I think it will be very fun and interesting to compare the infectious diseases we deal with here in the States compared to those I saw in Uganda. Anyway, during the first preceptorship session at Children’s, the physician had to do a lumbar puncture on an infant who was only a couple months old. They placed a path of gel on the baby’s back, there was a whole sterile lumbar puncture kit that had been laid out by the staff, there was a little pacifier with sugar water for the baby to suck on during the lumbar puncture, there was a pack of three iodine swabs to sterilize the area, 3 clean collection tubes, various extra (sterile) equipment, a sterile paper sheet to put the baby on and a clean blanket to wrap the baby in after the lumbar puncture was over. It was such a contrast to the lumbar punctures I had witnessed or helped with in Uganda where frequently there weren’t even materials to sterilize the baby’s back, needs of the correct size or collection tubes available for the cerebral spinal fluid. The Children’s lumbar puncture experience made me marvel all day at the resources we have in the US medical system and how it compares to the needs of so much of the rest of the world. How unjust is it that a child treated in Uganda for meningitis is some much more likely to suffer and die than a child born in the States? It isn’t because of anything the child did or any other reason than that the child was born to parents who happened to be poor and happened to be living in a poor country in East Africa which happens to be at a huge economic and medical disadvantage compared to the United States and Europe. It is not fair, but what can be done?

Camano Island State Park

2008-09-01T20:44:00.000-07:00

I am back from Uganda and I spent Labor Day weekend with my family on Camano Island. My brother, Aaron, also came up to visit and it was very fun to see him. Sometimes the exuberance of the house can overwhelm. Since it was fairly sunny one of our favorite activities was to go to Camano Island State Park which is only a few minutes drive from our house. I thought I would post just a few pictures from your walk/hike for you to enjoy and admire the island-lifestyle.

Sarah took this lovely picture of the beach.

The park has lots of educational materials such as this sign which is being highlighted by Aaron. Apparently, "Falling can be deadly." Who knew? I am really glad I went to the park so I could learn this important fact.

This picture was taken by the fabulous Paul. From left to right: Me, Sarah, Aaron, and Kalkidan. We had a lot of fun.

A pic of the loop trail. We went on Roy's trail first and it was super lame - it just led to a RV circle with a bunch of people playing horseshoes. If you ever go hiking in the park stay away from Roy. The loop trail isn't really a loop though, it dead ends on a road and you have to walk on pavement for the last little bit, but it is still fun.

My brother Aaron works as an outdoor educator and so we learned a lot on the hike as he taught us about various plants and animals we discovered.

Window seat adventures, again

2008-08-24T14:46:00.000-07:00

I am back from Uganda! It is nice to be home and start seeing family and friends again. I really want to see everyone before I start the second year of medical school (orientation starts Wednesday and classes start in earnest on the Tuesday after Labor Day).

Many of you long-term blog readers will remember my window-seat trouble my last trip back from Africa. (To see the previous entry visit: http://christystriptoafrica2007.blogspot.com/2007/08/my-trip-home-emotional-and-frustrating.html )

You may find it entertaining that the window-seat drama continued on this trip. After successfully packing my ridiculous amount of stuff in two 48.5 pound bags (the max is 50 pounds) with the help of Andy's portable scale, I arrived at the Entebbe Airport in Uganda. I made it through the security, etc and was waiting with a room full of people for the Ethiopian Airlines plane to come. It was about an hour late and when the plane landed the airline attendant announced in Amharic (the national language of Ethiopia): "something something something something something something something something something something something something something something... (several more minutes) ... something something something." Then she said in English, "We are now boarding all rows." My first response was that it either takes a lot longer to say a statement in Amharic than in English or that I, as a non-Amharic speaker, had not received all the information that had been recited in Amharic. I stood up and started walking towards the door when I was literally flattened against the wall by a stampede of Ethiopian passengers. The non-Ethiopian-looking passengers were not stampeding and had a bewildered expression. As I was drawing near suffocation from the mass of people pinning me to the wall I thought it was a very good thing that I hadn't fallen over because I might have been killed with the sudden vigor of everyone trying to reach the plane at once.

When I finally freed myself from the wall and started to move towards the plane I noticed there were two sets of stairs going into the plane - one towards the front and one in the very back. My seat was 11L which I thought would be fairly close to the front, so I decided to go up the front set of stairs. However, I was abruptly stopped by an airline attendant who asked if I was First/Business Class. I said I wasn't and he said that I would have to use the back set of stairs. So, I reluctantly joined the shoving throng of people pushing towards the back set of stairs. Once I made it in the back door I started on the arduous journey towards the front of the plane and my seat in 11L. With only the thought of my window seat to drive me forward, I cintinued on row after row after row. I finally arrived at row 11 which is the row DIRECTLY behind first/business class. (Side note: The first set of stairs is actually attached to the plane behind row 11, so it would have made perfect sense for me to use the front stairs, but no). To my horror, a woman was already sitting in my window seat. I politely told her that I thought that I had the window seat, but to my surprise she responded with several sentences of rapid French. I didn't understand most of it, but I thought I got the gist of the message: "This is my seat!" Still speaking French she showed me her board slip which had "11L" clearly typed on the bottom. A flight attendant came over and said, "Oh, didn't you hear the announcement? We had a problem with seat assignments so it is just open seating - sit where ever you want." Apparently "Open seating" was part of the Amharic announcement that they decided not to repeat in English. By this time almost all of the seats in the plane were full and I ended up sitting on an aisle seat in the same row as the French woman. I guess I had it good because apparently they ran out of room for the last passenger - perhaps that was another part of the Amharic message too. I don't know.

I was guardedly hopeful that I might get the window seat for the next flight from Ethiopia to Washington DC, but it was not to be. When I found my row, I discovered an Ethiopian woman sitting in my window seat. With a sigh I decided to start the sad ritual that I knew could not end happily. I said very respectfully that I thought I had the window seat and maybe she could have the aisle. The woman's English was very poor, but she managed to say, "My seat" while point at my window seat she was sitting in. I decided that maybe she just really wanted to sit by the window and that I wouldn't try to fight this battle again. After taking my aisle seat the woman abruptly closed the window so we could see anything and pulled a blanket over her entire head and went to sleep. Thus, I concluded that she was not too excited about looking at the window.

While the final passengers were boarding an American girl came on the plane and stopped a couple rows in front of me. After storing several bags she walked up to a man sitting in the window seat in her row and said, "Sir, I think that is my seat." She repeated the phrase a couple times and seemed dismayed as she could not get the man to budge and let her have the window. It was so similar to my past experiences that I couldn't help laughing - never try to claim your window seat on an Ethiopian Airlines flight returning to the United States!

After I stumbled off the plane in DC, I tried to sleep for a bit and then watched the news to discover that neither Obama or McCain had selected Vice President running mates yet. What had they been doing the entire summer I was in Africa? When I left the big news was that Obama and McCain were the nominees and everyone was trying to guess who their running mates would be and when I came back that was still the top news story. I guess I didn't miss much by not getting to watch the news over the summer!

I boarded my flight to Seattle and was delighted to sit in my precious window seat. I hunkered down wrapped myself in a blanket and prepared for a 6 hour flight of sleeping, looking out the window and relaxing. I was only slightly concerned when a couple and a child passed my row and I feel asleep during the rest of the boarding process. While the plane was taking off, I awoke to a high pitched noise and a shock wave rippling down my back. Confused I opened my eyes and tried to figure out what was going on. Another shock wave hit my back and I realized what had disturbed my slumber - a child of about 4 years of age was seated directly behind me and was screaming and kicking the back of my seat. I decided to try to ignore it, and look out the window. However, several minutes later an announcement came that we were supposed to close our windows so people could enjoy the in-flight entertainment or sleep. I obediently complied with the closing-of-the-window request and resigned myself to a less than perfect flight as the child continued to scream and kick for the duration. I think that little boy probably has a future in sports because that is a long time to continually kick a chair. I thought about turning around and giving the kid a piece of my mind, but the parents were already really embarrassed about the child's behavior and apologizing to everyone nearby so I didn't want to make them feel worse.

Whew! Now you know about my window seat troubles. Perhaps it is better not to request a particular seat...

Window seats -the impossible treasure on international flights with Ethiopian Airlines.

"The Rank Inn" and other pictures that make me happy...

2008-08-15T07:43:00.000-07:00

This is Annie making a piece of rubber talk. We were waiting for the tire shoe guy to make a pair of shoes in Kumi and Annie entertained all of us by making various inanimate objects talk or make random noises.

This infinity media sign makes think of calculus and Buzz Lightyear.

This is the chapati man across the street from our apartment making a Rolex. A Rolex is eggs with cabbage, tomato and onion that are rolled up inside of a chapati. It is cheap and delicious.

Her is another shot of the chapti guy and his Rolex stand.

This is the fruit lady named Rhoda. She has a small shop in the little market area near Mulago Hospital. She picks the best fruit from the market and then sells fruit salad and fresh fruit juice from her little sand. I stopped by a couple of days ago for my last fruit salad and took this picture. Rhoda is extremely nice and likes to talk while she is making the fruit salad. She says she really wants a white husband and offered to marry my older brother if he would take her to America.

"The Rank Inn." This sign makes me smile almost every day. We pass it on our way to the hospital in the morning. A couple of days ago I decided to walk to the hospital so I could get a picture of the sign. I wonder what the Inn is like. Would you stay there?

Babies!

2008-08-15T06:52:00.000-07:00

Now that Annie is gone and I am all by my little lonesome, I am playing catch-up from past pictures and stories. I really wish that I had taken pictures of the babies I delivered in the OB ward. However, the night before Annie left we visited a friend that we met in Kumi and his wife that had a 7 day old baby. He was so cute! I decided to post a few pics from this visit to stimulate your imaginations on how cute little newborn Ugandan babies are.

This is our friend's week old baby. I didn't deliver him, but imagine some slightly smaller babies that are just as cute, and that is what the babies looked like.

Ahhh... Here I am holding our friend's baby again.

Two of the midwifes from the delivery ward. They were so nice to me and taught me a lot about the delivery process.

Today I went and said goodbye to all of the lovely midwives at the maternity ward. It was really nice to see them again and we snapped a few pictures. This is the head midwife and she watched me deliver my first baby. Good memories...

A mean prank

2008-08-13T09:20:00.000-07:00

How is the summer treating you? Are you bored? Tired of life? Do you want to go on a road trip, but can't afford the gas? Have you completed all of your 1,000 piece jigsaw puzzles, and don't know what to do next? Do you delight in the inconvenience of others? Are you just itching to play a vicious prank on a sort-of friend? If so, this is the blog entry for you! Follow these simple steps and watch your friend/acquaintance agonize for weeks and loathe your name.

Note: For the purpose of this entry, we will call the person on whom you are playing the prank, "The Victim."

Prank Day 0 (Planning stage): Go to a local store and buy several large bags of candy. Any kind will do, but preferably it would be small, individually wrapped and easy to distribute to large numbers of children. Also, make a time schedule of when the victim is usually away from home.

Prank Day 1: When the victim is gone (consult time schedule), go to the victim's neighborhood and conduct some activity to attract small children. This could be playing a game of soccer in an
area next to the victim's house. Once a large number of children are gathered, ask them if they would like some candy/sweets. Of course, the children will say, "Yes!" Next, GO TO THE DOOR OF THE VICTIM'S HOUSE (This is a very important step) and proceed to give out 1 or 2 pieces of candy to each child present while still standing outside the victim's door. When the children call their friends, give them candy too.

Prank Day 2: Repeat the process. The sports activity won't be necessary. The children will be ready to run to the door of the victim's house to receive their piece of candy bliss.

Prank Day 3: Go to the victim's door, but don't give out candy. Tell the children that you don't have candy EVERY day, so they have to keep coming back even if they don't get candy for a couple days.

Prank Day 4: Go to the victim's door and give out more candy.

Prank Day 5: Give out tons of candy at the victim's door! Get rid of what ever candy you may have left.

Prank Day 6 - infinity: Relish the misery you have inflicted on the victim as every child in the neighborhood hounds them with,"Give me sweets! Give me sweets!" as they go to and from his or her house.

The worst part of it, is that the victim will feel so bad having to say, "No, I am sorry, I don't have any sweets" to cute little children every day. You also have the perfect cover if you get caught giving out candy - just say that you really like being nice too kids.
________________________________________________
I am sure that you have already guessed from the bitter nature of this entry that someone did this very prank at the our apartment in Kampala. I don't think the individual was consciously trying to be vicious. However, the end result was the same. We also know who did it because Annie caught him red-handed as he was giving out the last of a huge bag of candy to small children outside our door. The individual was a friend of one of the Swedish medical students and for some he thought it would be a good idea of give out candy at the door of our house for 6 consecutive days.

For the first week after the candy was distributed, every time Annie and I came home we would be mobbed by at least 4 children yelling, "Mzungu (white person)! Give me sweets! Give me sweets!" We would respond by saying that we were sorry, but we didn't have any candy/sweets to give. They usually left and would try again the next day, but one time they actually laid on the ground and kicked the door of our apartment screaming, "Give me sweets! Give me sweets!" They have gradually thinned, but there are still 1-4 children who follow me to the door of our apartment asking for candy.

If you have read some of my earlier blog entries, you may be confused - I always talk about how much I love children and how cute they are. This is true, and I do love children, just not when they are stalking me for candy. Also, please don't be under the impression that these are starving children. They are actually the children of quite affluent families who live around us (we live in a fairly nice area of Kampala) and the children are fairly spoiled by Uganda's standards. But yes, in general, I do still love children.

"Give me sweets!" I took this picture today, almost 3 weeks since the last day of candy distribution at our door. There were two small children waiting outside my door today. They are still cute, even if they are getting on my nerves a little bit.

Pics from Kumi Hospital

2008-08-07T07:35:00.000-07:00

Here are some pictures from Kumi Hospital that I have been meaning to post.

This is some of the equipment in the orthopedic surgery ward.

Here is the surgery table.

This is Annie and me with Dr. Ekure. He is very talented and an excellent teacher.

Here we are with the surgery staff. They were all so nice.

pics - kids are cute

2008-08-06T09:12:00.002-07:00

At home my little sister Monica (5 yrs old) likes to put a ball under her shirt and pretend that she is pregnant. Yesterday I met the cutest little Ugandan girl who likes to tie a bundle of blankets on her back and pretend that she is carrying around a baby. I guess it is the Ugandan equivalent of pretending you are pregnant. I thought it was so cute that I asked the mom if I could take some pictures.

Here she is showing off her bundle/pretend baby. I love kids. I forgot to mention that I am wearing my Ugandan dress that I had made in Kumi. It is a little bright, but I got a lot of compliments on it from Ugandan women who enjoy seeing a crazy white person dressed in their style.

She was a little shy so I had trouble getting her to look at the camera. Although she was shy, she did shake my hand and wave goodbye to me when I left.

I am still not sure what I want to do for residency, but I think it will probably come down to a choice between pediatrics and family medicine. We will see what the future holds.

pics of the hosptial!

2008-08-06T09:12:00.001-07:00

Here I am sporting my Ugandan dress outside the med school.

The outside of the hospital.

A visit to Mabira forest and a renewed faith in humanity

2008-08-03T09:55:00.000-07:00

Last week I was slightly discouraged about the state of the medical system in Uganda as well as the attitudes that seem prevalent in some aspects of Ugandan society (women not being valued as highly as men, etc). Also, Annie and I seem to continually be faced with people who want to rip us off/cheat us out of money or anything else just because we are white. We decided that we just needed to get out of Kampala for the weekend. Annie and I both like nature/hiking so we decided to visit the Mabira Rainforest. It is one of the biggest rainforests in Uganda (about 300 sq. kilometers) and the guidebook rated it highly. We made our way to the old taxi park and found a mini bus that was heading toward Jinja (Mabira forest is between Jinja and Kampala). A nice Ugandan man in the minibus knew the road between Jinja and Kampala very well and he told us that he would tell us where to get out. It was so refreshing to have someone volunteer to help us without asking for anything. We got out of the minibus and were surrounded by a delightful little market and lush forest. About 30 second after leaving the transport it started pour down rain. It made sense - it probably RAINS a lot in a rainforest. We ducked into a little restaurant and ordered some tea. It was run by a older woman and her entire family (children and grandchildren) lived in the adjacent room separated from the restaurant by a little curtain. She seemed delighted to have us as customers and was particularly thrilled when we ordered some matoke (cooked green bananas) and beef stew. She was so nice and welcoming and charged us a very fair price even though we had to sit there for over an hour while it rained. We explored housing options and found the most affordable option was to stay at the housing provided by the park itself. We were shown to a delightful banda/house that was surrounded by lush forest. Although there wasn't running water, a woman very kindly brought us warm water to bathe with. The park director found out that we had been working/studying in Uganda for over 2 months and gave us a small discount off of the normal tourist fee for staying in the banda and hiking in the forest - a very refreshing change from the norm.

After a refreshing shower and watching the monkeys swing from the trees around our banda Annie and I walked to the road-side market. We were able to purchase grilled bananas and chicken that we ate with a plate of delicious beans. All for a price much cheaper than Kampala. We finished off with some fresh pineapple for dessert.

The next day we hired a guide and had a delightful hike through the forest. We saw lots of birds and fascinating botanical specimens as well as hundreds of butterflies. Our guide stopped us towards the end of the walk - a cobra had been lying across the pathway. Fortunately, it slithered away and didn't bother us.

Here are some pictures from our awesome weekend:

Here is the view (away from the forest) on the top of a nearby hill.

Here are some children that were carrying firewood to their homes. They were really cute.

Annie and I in front of the a field of sugar cane. The pictures from inside the forest are a larger file sizes so I didn't try to upload them.

This picture exemplifies one of the highlights of our trip. There was this little craft shop run by the women of Najembe (the road town of Mabira Forest). I poked my head in the little shack and found this woman making a basket. It was a heart warming sight to see someone actually making the crafts that they were selling. Apparently, there is a lot of the plant that they make baskets out of growing around the forest. Annie and I noticed that her baskets weren't as Fancy as the ones available in Kampala, but I told Annie that I had a very good feeling about this woman and wanted to by something from her. We picked some of the baskets she had made and asked how much. She gave us a very fair price and we bought several. She was so happy that we bought the baskets that when we stopped by later she gave a taste a a sweet potato paste she was making. She indicated she sold it by the road and we were confused if we were supposed to give her money or not (she didn't speak any English). We decided to give her a couple hundred shillings and she came after us with a huge banana leaf filled with sweet potato mush indicating that this is what we paid for. It was so refreshing that she didn't try to cheat us. Anyway, now I have a huge simple basket that I bought from this woman. It is very special because the woman who made it was so nice!

Global pulse, photo essay

2008-07-25T23:29:00.000-07:00

Just in case you are interested, some of the pictures I took during my last trip to East Africa were recently published in "Global Pulse," the American Medical Student Association International Health Journal.

The web address is: http://www.globalpulsejournal.com/

Scroll down to an article entitled: An African Essay.

shock, anger, blah

2008-07-25T23:25:00.001-07:00

Yesterday I was filled with the most shock and anger I have experienced during this trip to Uganda.

Soon after arriving at the delivery ward, the third year medical student asked me to assist her for a delivery. I helped prep and got a clean sheet ready for the baby. The third year student did an expert job of delivering the baby. This was the young mother's second baby and she didn't tear at all. I helped hold the baby on the mother's stomach while the third year student tied off the umbilical cord. The baby was very healthy and beautiful baby girl and she let out several strong cries immediately after delivery. After the cord was cut, we showed the sex of the baby to the mother. One of my favorite parts of delivery is when you show the baby (including the sex) to the mother and she gets a huge grin across her face. However, when we showed the baby to this mother she glanced at the baby and looked away in absolute disgust. Confused, I tried to show her the baby again and said, "Congratulations mama! you have a beautiful baby girl!" The mother continued to look away with contempt and refused to look at me or her child. Still confused I took the baby, weighed her, cleaned off her face, examined her toes and back, etc. She was looked perfect - she had all her toes and fingers, she was actively moving and breathing/crying very well. I wrapped the baby up in several sheets and went back to the third year student to ask what was going on. The third year student told me that the mother doesn't want the baby because it was a girl. The young woman's first child was a girl and she wanted a boy because their family needs a male child. The third year medical student then spent about an hour telling me of how common a problem this is. Many women, if you do not show them the sex the the child and get a witness will later accuse the staff of replacing a "less valuable" female child with the male child they claim to have delivered. Apparently, boys are seen as a way to wealth and security, but girls are seen more as a liability in some aspects of Ugandan culture. It was so sad. This beautiful baby wasn't wanted because she was a girl.

I asked the third year student what we were going to do. She said that there really isn't anything you can do besides give the baby to the mother and hope she will care for it. The third year student said that she would hope that mother would have some counseling and someone would make sure she wasn't suffering from post-pardum depression, but the facilities/resources just weren't available there. After the woman was cleaned up we placed the baby next to her. I watched in horror as she apathetically stared at the ceiling while the baby screamed next to her and she made no attempt to console or breastfeed it. What is wrong with the world? Something seems so inherently wrong in a mother not wanting her newborn baby. I calmly tried to maintained my self control despite the feeling that if I could shoot lasers from my eyes everyone in the room would be a singed skeleton, and talked to Annie over lunch. It is great that we have each other to talk to!

Unreasonable fear

2008-07-25T23:23:00.000-07:00

This week was awesome. I asked to be placed in the delivery ward of the hospital for uncomplicated cases (there is another ward where complicated cases, such as breach presentation, hypertension, twins, etc are referred) with the hope that I might be able to assist in some deliveries and perhaps deliver a baby (supervised, of course) at the end of the week. The week was by all accounts a success, but it was definitely stressing at times. I got to watch so many births. There weren't any doctors in this delivery ward, but there were about 5 or 6 midwives and a third year medical student. About a couple hours after I arrived in the ward, the third year medical student let me watch while she delivered a baby. She was really good about explaining every step and helping me understand why they did things certain ways. Apparently, one of the most important things to do during the delivery process is to give a shot of oxytocin within 1 minute of the delivery. The third year medical student also taught me how to deliver the placenta with continuous cord traction. She also taught me the basics of delivery and how to minimize tearing and what position to hold the baby. Did I mention it was amazing?

The delivery process itself is surprising fluid-involved. By "fluid-involved" I mean that every fluid that could possibly come out of your body comes out during the delivery of a baby. [Warning: Don't read if you are eating lunch]. First the expectant mother must urinate and empty her bowels to allow maximum room for the baby to descend. The delivery process may or may not be accompanied with vomiting from the mother. Then the delivery itself is accompanied by large amounts of blood and amniotic fluid. Profuse sweating also takes place by the mother while she is pushing. The baby usually defecates as well sometime during the process, making the circle of bodily fluids complete. However, despite these many possibly offensive odors, I found the delivery ward a surprising pleasant place to spend time in and birth a miraculous processes.

Anyway, sorry about my rambling. You might be wondering why I have entitled this entry, "Unreasonable fear." I have entitled the entry thus, because of an experience I had on my third day in the delivery ward. Early on in the morning, a midwife assigned me to monitor a woman who was HIV positive and on HAART (Highly Active Anti-Retroviral Therapy). I looked forward to monitoring this woman and possibly being present while she delivered. I was not concerned about her HIV status as many women in the ward are infected with HIV, and just noted to myself to be extra careful to wear double gloves anytime I had to contact bodily fluids.

A couple hours later, the woman in the bed next to my patient started pushing and a midwife told me to quickly draw a syringe of oxytocin. The oxytocin are in little glass vials that each contain 1 dose of the medication. The women bring their own gloves, cotton, syringes, plastic sheets to deliver on and clothes for the baby. I quickly got a dose of oxytocin from the supply cupboard, put on a pair of clean gloves and used a piece of cotton to break open the vial of oxytocin. Then I opened a package with a sterile syringe and needle. However, while I was trying to un-cap the needle I accidentally stuck myself with the tip of the needle. I instantly froze and my pulse went up to about 250 beats per minute as I started to feel a small trickle of blood go down my finger inside my glove. I was so scared. I had just stuck myself with a needle! It didn't matter that it was a clean, sterile needle and my hand was clean and covered with a clean glove. All the secret fear of a needle stick came to me in a flood. What if I had just finished giving the injection to my HIV positive patient when I accidentally stuck myself? For the first time since Annie's blood-splash scare, I was glad that the UW made us bring HIV prophylaxis with us. I took a couple deep breaths, and then dropped the contaminated needle/syringe in the sharps container. With slightly trembling hands I successfully filled a new syringe with oxytocin and handed it to the midwife. I then excused myself and washed my hands about 5 times and called Annie (who was rotating in endocrinology) and asked if she wanted to have lunch.

During lunch Annie was really nice about listening to me and was very reassuring when she told me that a needle stick with sterile needle into a clean gloved finger is actually safer than cutting yourself in the kitchen with a knife. I am now fine and completely calm. It was just rattling to realize how easy it would be to stick yourself with an infected needle.

The week's tally...

2008-07-25T22:42:00.000-07:00

Whew! I just finished one of the busiest weeks so far during my visit to Uganda. I spent this week in the obstetrics ward for uncomplicated deliveries at the large hospital in Kampala. It was tiring, but so much fun. I have a lot of good memories from this ward that I will share shortly. I just wanted to give you a summary of my week to start off the entries:

Deliveries observed/assisted on: 13

Guided deliveries (a midwife put her hands on top of mine): 1

Unguided deliveries: 2

Placentas delivered: 4

Newborn babies named after me: 1

Scary experiences: several

Adrenaline rushes: countless

A Green Mamba Story

2008-07-20T11:11:00.000-07:00

As Annie and I were leaving Kumi we saw one of the most poisonous snakes in East Africa - the Green Mamba. It is a thrilling tale, but unfortunately I don't have any pictures to accompany my story so I have taken one from the Whozoo website in addition to some interesting facts.

Green mambas are very poisonous but are less aggressive than their relatives, the black mambas. (Black mambas will hunt you down if you make them mad and they will probably be successful in their attempts to kill you as they can travel as fast as a human can run, climb trees and swim). Anyway, green mambas don't get upset as easily but they are still very dangerous. There was a joke in Tanzania that the "medicine" for a green mamba bite is this: you see that you have been bitten by a green mamba and then you get out a piece of paper and and a pencil and write a quick note, "Mom and Dad, I love you." You then have just enough time to put the piece of paper back in your pocket before you die.

Back to the story: Annie and I had just packed our bags and were taking two motorcycle taxis to catch the bus when Annie's motorcycle, which was riding in front, swerved drastically on the dirt road. Annie asked what was going on, and the driver said something about not to worry because it was "a green one" and the motorcycle didn't hit it. My motorcycle also swerved to miss a 5-6 foot long snake that was bright green. The motorcycle driver told me it was a green mamba and that they are, "Very common" in the area. He said it that he was very good that we didn't run over it or make it mad. Anyway, that was my second close-proximity story to a poisonous snake in East Africa.

Shoe project...

2008-07-18T07:55:00.000-07:00

I posted earlier about the projects that Annie and I are trying to do in Kumi. They are going well and I thought I would give you some update pictures:

First some of the posters we made:

One of Annie's posters in English.

Translated into Ateso. For some reason some of the letters went funky when I tried to convert it into a JPG and upload it. The Ateso posters aren't the final drafts either, but you get the idea.
My poster in English. Essentially just trying to get people to wear shoes and advertise the reduced prices I was able to get for diabetic patients.
Then also translated into Ateso. Once again, not the final draft, but you can get the idea.

This is another poster and Annie made (I helped a little, but she was the mastermind).

Now some pictures of the tire shoe guy making shoes. We made 48 pairs of shoes in 2 weeks! Whew! Hopefully, he will continue to make shoes.

The guy is cutting the tire. He has dismember the tire before he can make shoes out of it.

The diabetes focal person. She was very very nice and extremely helpful.

The shoe guy is fitting a patient for a pair of shoes with the leather straps for a diabetic patient.

A pair of happy feet. One of the women we made shoes for had never worn shoes before and she had to practice several times before she could put her foot through all of the leather loops at once.

Our shoes! They have leather straps instead of rubber to make them more comfortable. The tire shoe guy is making them for us for slightly less than $2 US a pair. A pretty good deal. They also look nice which makes the patients very happy.

Kumi pics

2008-07-14T06:14:00.000-07:00

Some pictures from Kumi, Uganda. I wish I could put up even more, but maybe this will give a taste for what our lives were sort-of like.

This is Dr. Ekure, the super super cool orthopedic surgeon that we spent a lot of time with in Kumi. He was very nice and taught us a lot while we observed in the wards and watched surgeries. He does a lot with the limited resources. This is the office he runs the Friday orthopedic surgery clinics in. Next door was the room that they ran the club foot clinics on Wednesday.

Annie and I got to visit the local school while we were there. There were 135 grade 1 students in this room. The government school was also doing a lot with limited resources. The school asked if a school in the United States would be interested in starting a pen-pal program with their school (which they hope may eventually result in some fund raising after a few years). If pen pal program is something you are interested, please email me.

The school had a whole program for us including a demonstration of their sports programs and signing by the children. They also have us some beautiful flowers that grow around Kumi. Annie and I gave them some soccer balls, crayons, and a Frisbee that I brought from the States. Thank you to those who donated money or supplies before I left! I think the kids at the school will appreciated it.

Here are some children we me while going for a day trip to see the Kumi Rock Paintings. It wasn't the most exciting thing ever, but still it was fun.

More kids.

Here is a woman we met in Kumi. She is over 100 years old. She is such a beautiful and friendly person.

There were a bunch of people hanging out on Sunday afternoon and playing the local board game. I forgot the name of it in Uganda, but in Malawi the children called it, "Bao." People can get really into the game and soon there will be a group of men all watching the match. The guy in the white shirt kept winning the matches. I think he gets a lot of practice.

A sort-of sunset. The sunsets here are very beautiful. I have been trying to capture a good one, but it never looks the same. Here was one of my attempts.

A field of millet, one of the local staple foods. It is so pretty against the sky. they make "millet loaf" out of it which is millet flour mixed with cassava flour. They also make some drinks with millet.

Pictures!

2008-07-07T02:28:00.000-07:00

I got some pictures from Theresa's camera that I decided to share with you.

Grace, Theresa and I at the Uganda soccer match.

Campfire picture during our Sipi Falls weekend.

Here is a picture of me abseiling down next to a 100m waterfall at Sipi Falls. I look more athletic in this picture than I actually felt being very scared on my way down, but don't tell anyone.

Tips for bargaining - "the Christy method"

2008-07-06T06:37:00.000-07:00

When I am old and retired maybe I will spend my days of idleness writing a book called, "Christy's tips for travelling in East Africa." Or maybe not... Actually, when I am old and retired then everything I have experienced in my 20s will be completely out of date and the world will have exhausted its supply of fossil fuels so airline travel with be much more limited and cross-continental travel will be much slower. Sad. Anyway, if I ever do write a book on traveling tips it will definitely have a chapter on methods for successful bargaining.

Allow me to illustrate with an example from the art fair in Kampala. This is a true story:
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How foreigners usually shop in East Africa:

A group of 5 or 6 white people are meandering along being loud and talking rapidly amongst themselves as they walk between Ugandans selling handmade art, carvings and souvenirs. White people are saying to each other: "Yes, I know I couldn't believe that she has two cars! My car is such an old clunker... (more rapid conversation) .... the food here is so fattening, I mean do they NOT fry anything?"

The group of white people spot a Ugandan woman selling a medium sized drum. They walk up to her and someone says loudly, "How much is this?" while pointing at the drum. She gives the white people an appraising look and says, "50,000 shillings." They decide it is too expensive and walk away.

The white people continue browsing and eventually buy a couple over-priced items.
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Try #2, my personal attempt to get the exact same drum for a cheaper price:

I leave the group of white people and approach the woman who is selling the drum. I pause briefly smile and say in the local language of Luganda, "Oli otya, Nyabo?" (This means, "How are you, respected older woman?") She responds with a phrase that contains the word "bulungi" ("good") and asks me how I am doing. I respond in a similar manner. She realizes that I actually don't know much Lugandan and grins at my attempt at her language.

Then she asks in English how I am and I respond that I am well. I ask in English I ask, "How is your business today?" She responds that business is good but slow. I tell her that she is selling many beautiful things. She then asks if I am interested in any of the things she is selling. I respond with, "Yes, but I am a student and I didn't bring much money with me today, so I don't know if I will be able to buy anything." She says, "Tell me what interests you and we will see if we can work out a good price." I point at the exact same drum as before and say, "Mama, how much is this nice drum?" She responds, "25,000 shillings" (note: this is half of the price from the above situation). I then say that I can tell she is giving a fair price, but that I am about to leave and I only have a 20,000 bill left in my bag (a true statement) besides some change I need to catch a minibus back to the house. I ask if she will take "20,000" instead. She smiles ad says "yes." After making the transaction I stand and chat with the woman for a few more minutes. We are both pleased with the exchange.
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Now, this is just one method to bargaining. I am by no means an expert. I am sure that many people could have gotten the drum for less. However, note a few key concepts from the above scenario:

1) Bargain individually. You will get a much better price if you are able to get the vendor alone without a group of white people hanging around and talk to them for a while.
2) Be respectful/nice. White people generally have more money than Ugandans if you flash it around or talk in such away that emphasizes your difference in situation the person is going to be more likely to what to get more money from you.
3) Respect local cultural customs. In many parts of East Africa it is considered polite to spend some time greeting before you move on to business. It is sort-of like saying, "I am interested in you as a person and not just for the business transaction."
4) Don't take too much money with you and emphasize that you are student (if you are indeed a student). This will reduce your chance of getting a highly inflated price.
5) Learn a couple simple greetings in the local language. It doesn't take long to do and it shoes that you have been around for a while and know what is up.
6) Be patient. Sometimes it can take a while to talk someone down from a high price.

7) When possible, buy items from women. They are generally nicer and countless studies have shown that when women earn income in a developing country it is more likely to go to the health and well-being of the household than when men earn money. Thus you are more likely to improve the health of a family by giving business to women.

Here is a woman I bought a basket from at the art fair. She was pregnant and really nice and I decided that I wanted to give her my business over other vendors.

Our Project - shoes and footcare education for diabetic and leprosy patients

2008-07-06T04:47:00.000-07:00

For the IHOP program Annie and I both have to do a preventative public health project. We were quite stressed over the last couple weeks trying to figure out what we were going to end up doing. At first we wanted to do something with HIV/AIDS or malaria, but these turned out to be much bigger diseases/problems than we could have managed in the period of a few weeks. However, now we have selected our project and are working towards our goal so we feel much better.

While working in Kumi hospital we have met a lot of patients who have had to get their leg or foot amputated because of (type II) diabetes or leprosy.

Some of you have asked how diabetes or leprosy leads to foot problems. Here is a basic explanation of what happens (I am sure I have mad a few mistakes, but it is the general idea anyway):

Diabetes (mostly type II, adult onset, in this area):
1) Trouble with, or insensitivity of, the insulin receptors makes it difficult for glucose (sugar molecules) to get inside fat and muscle cells in the body (some of the main tissues that use glucose). Type I diabetes is a little different because the body doesn't make insulin.
2) This results in higher than normal levels of blood glucose because it can't get into fat/muscle.
3) The high levels of blood glucose cause some of the initial symptoms: excessive thirst (body is trying to dilute the extra sugar), excessive urination, weight loss (the fat cells can't get glucose), and fatigue (muscle isn't working probably).
4) Prolonged uncontrolled diabetes leads to constant high blood sugar. These damages many parts of the body, but primarily the nerves and blood vessels.
5) Damage to the nerves and blood vessels predisposes people to get sores on their feet. This is because they can step on something sharp and injure their foot without knowing it. Then the sore can get infected and there is poor circulation to help repair the injury.
6) If the infection gets out of control the person has to get their foot amputated.

Therefore people with diabetes should control their blood sugar, wear good shoes, and clean/examine their feet everyday to look for injuries, etc.

Leprosy leads to foot problems because the leprosy mycobateria damage the nerves in the cooler parts of the body such as the ears and extremities and patients can't feel injury to their feet.

It turns out that many patients with diabetes and some with leprosy in Kumi don't have shoes and therefore it leads to the very bad foot problems. (see following pictures).

My part of the project is to try to make good shoes affordable for patients with diabetes and leprosy. Annie is going to do educational foot care posters and information about diabetes.

People with diabetes and leprosy should wash their feet and examine for injury every day. This can be hard in rural areas of Uganda where water can be hard to come by.

Here is a pair of shoes that can be purchased for 1,500 shilling (a little less than $1 US). They are made from old tires and last for about 20 years. I am trying to get the shoes modified so they will have a leather strap which should be more comfortable.

A craftsman making the tire shoes.

Splitting the rubber tires.

A view of the tire shoe guy and his work area. Guess what? There are lots of tires in his work area. Go figure.

Below are some pictures of wounds from the hospital. I got every patient's permission before taking each picture.

A patient with leprosy and a wound on her foot. She has already had all of her toes amputated.

A person with diabetes who had dead tissue removed through surgery after allowing the foot to get infected.

A person with leprosy who needs an amputation.

Anyway, you get the idea. A had a picture of some one with diabetes who had their foot amputated, but it showed his face, so I couldn't put it up on the website.