Dinner with Andrea

Once again, I force a boring update about my life upon you. However, I thought it would be good to report every once in a while that I occasionally do things other than study and feel overwhelmed.

On Wednesday I had the pleasure of meeting one of my long time friends, Andrea, for dinner. Andrea and I did the neurobiology program together during undergrad. We were lab partners during the first year of the neurobiology program and then we continued to work together throughout the program. We became good friends, in part because of our similar interest in working internationally and in public health. During our senior year I decided to get my Master's in Public Health in International Health and Development from Tulane, while Andrea decided to go straight into medical school at the UW, but still focus her carrier on international health.

Andrea is now a third year medical student at the UW and a wellspring of medical school knowledge and wisdom. She did the IHOP (International Health Opportunities Program) between her first and second year of medical school. She went to southern India and assisted in a hospital program working on the prevention of mother to child transmission of HIV. She is also doing the School of Medicine Global Health Pathway (discussed in a previous blog post). Andrea has also been fighting tooth and nail to get a combined MD/MPH program at the UW School of Medicine. She, and some other students, have made progress towards this goal, but not enough to make it as practical as most other MD/MPH programs. The big name schools that have both a medical school and a school of public health have a combined MD/MPH program (Havard, Tulane, Johns Hopkins, etc.) that is only one additional year over the normal 4 years of medical school. However, the UW School of Public Health insists that medical students must take an additional 2 years to get their MPH. Also, the UW School of Public Health is ULTRA snobby and only takes a few students each year who they believe are worthy to study public health. Therefore, most UW med students who want to get an MPH usually take a leave of absence and just go to Harvard for year to get their MPH (an MPH from Harvard probably looks better on your resume anyway). Anyway, I am glad that I already have my MPH from Tulane so I don't have to deal with the UW school of public health nightmare.

It was really fun to meet with Andrea. It is great that we are finally at the same school again. I am hoping to do the IHOP program (this summer) as well, but I haven't heard back about my application yet.


This is a picture of me and Andrea after dinner. Andrea is on the right.

Sweet! Only 1,233 days until I'm a doctor!

I found this fun countdown thing so I decided to approximate when I will graduate with my MD degree. This year the medical school graduate ceremony is going to be on the first Saturday of June. If they hold it on the same day in 2011 (the year I am scheduled to graduate) then it is only 1,233 days from today until I graduate. Sweet! It still feels like a long time from now. (particularly on days like today when we had 8 hours of class)! Also, if something happens and I have to expand it will be a year later when I graduate. Of course, there is always the possibility of flunking out too. We will see.

“Psst! Turn your Stethoscope Around!”

The “Clue-O-Meter” has many different readings. Just a few of the possibilities are: “Stills needs some guidance, but has the big picture” “Generally out to lunch, but occasionally has moments of understanding,” “Pretty clueless,” “Definition of clueless,” and “So completely clueless, that the Clue-O-Meter can’t even get a reading on how clueless this person is.” Unfortunately, at our stage in our medical educations, many of us are at the last of those Clue-O-Meter readings. In fact, it is my new found conviction that if our future patients could see us right now in our education, they would never come to us for medical advice and they would definitely never let us treat them.

Allow me to demonstrate from my own experiences (and those of one of my friends) to refute the widespread belief that being in medical school equals intelligence and medical knowledge. Allow me to start with the basic tool of all of medicine and a physician’s best friend - the stethoscope. The earpieces of a stethoscope actually tilt in a certain direction. Please see the picture below. They are supposed to be worn so the earpieces point towards your nose. (So in the picture below, if I was wearing the stethoscope, my nose should be pointing towards my hand).

The School of Medicine alumni association generously gave us each a stethoscope at the beginning of fall quarter (previous pictures posted). However, many classmates and I haven’t really used them before in a practical setting. This quarter several of my friends and I are taking our very first preceptorship. We get to follow around a real doctor and get a taste for what we might be doing several years from now. It is so much fun (I am planning on posting more about my preceptorship in the future). At the end of my first morning with my preceptor she told me to bring my stethoscope next time. I was pretty excited, what was I going to be doing? The night before my next preceptorship I realized that I wasn’t exactly sure how to wear my stethoscope. I looked up the directions and discovered that the earpieces were supposed to point forward and I successfully listened to my own heart beat.

The first patient that morning was in for a health check and a referral. I was watching the visit with interest and suddenly my preceptor turns to me and says, “Great. Well Christine, why don’t you listen to this patient’s heart and lungs while I get this referral form?” Slightly startled, I said “OK” and approached the patient as my preceptor left the room.

(This is what I felt like as I approached the patient, although I tried to hide it in an appearance of calm)

He was an elderly gentleman and the lifted up the back of his shirt so I could listen to his lungs. He gave me a look of complete confidence and trust. I quickly put on my stethoscope (ensuring the earpieces were facing forward) and looked at the patient’s back with trepidation. I had never actually listened to someone’s lungs before. I thought back to anatomy and placed my stethoscope in the general vicinity of where I thought the left lung should be. It sounded sort-of like wind blowing through a tunnel. I figured I’d better move the stethoscope around a bit (like I had seen my preceptor do on an earlier patient). While I was doing this I thought to myself, “I am so totally faking this right now and this guy doesn’t have a clue that I have no idea what I am doing!” I also successfully listened to the patient’s heart and was finishing just as my preceptor stepped back into the office.

She looked over at me and asked, “So everything sounds good?” I said something like, “Well, um, it is my first time listening to the heart and lungs of a patient so I don’t really know what to listen for. But I think it might have maybe possibly sounded like what I would imagine good heart and lungs to sound like.” She said, “Well, if you aren’t sure, I guess I’d better listen then.” My internal reaction to this statement was “WHAT?” Apparently, if I had said that I was completely sure this patient’s lungs and heart were fine, she wouldn’t have even listened to them. I think she had much more confidence in my skills than I did. She listened to the patient’s heart and lungs and determined that they were in great condition, so I guess it would have turned out fine anyway.

One of my friends who also just started his preceptorship had a similar experience, except he didn’t practice with his stethoscope the night before. Therefore when his preceptor told him to listen to the patient’s lungs, he put on his stethoscope on backwards (earpieces pointing towards the back of his head). He later described his extreme mortification when his preceptor whispered behind the patient’s back, “Psst! Turn your stethoscope around the other way.”

Now, you may be thinking, ‘Oh, that isn’t so bad.’ Unfortunately, my embarrassment does not end there. I must further display my lack of knowledge of medical instruments, by admitting my difficulties in trying to find the on/off switch on my Oto/Opthalmoscope. For Christmas, my grandpa, grandma, aunt, uncle and dad all generously pooled together some money to buy me an otoscope/throat (and eye) illuminator which is required for spring quarter when we start learning the physical exam. Last week I decided that I was going to get it out and experiment with it. I briefly considered reading the directions and then scoffed at the idea. I am a medical student after all, how hard could it be? When I first took it out of the case I tried to find the “on” switch, without much luck. Then I realized in a stroke of genius that it probably had to be charged before it could be turned on. I successfully managed to take it apart and place the base in the charger overnight.


(Ahhhh... Genius. You have to charge it before it will produce light)

The next evening I decided to try again to conquer my now charged otoscope and learn how to turn it on. It sounded so simple, and yet, the on/off switch still remained a mystery.

(My bewilderment as I tried to figure out how to turn on my otoscope).

Finally, after at least five minutes of additional experimentation, I found the elusive on/off switch. It was at the top of the handle. You had to push a green button and rotate a black ring about a quarter of a turn until the green button popped back into place. Intuitive? Not for me!

The on/off switch circled.

“On”

“Off”

At last, complete success – stethoscope correctly positioned and otoscope turned on. Whew. I have a bad feeling this is just the beginning of feeling cluelessness as I embark on many years of medical training. Will my future patients ever find know just how clueless I was during medical school? I hope not. (Although the fact that I am publishing this on a website available to any internet user does not bode well for hiding my ignorance. Hmm... Perhaps this blog entry will mysteriously disappear after a few months).

Christmas Pictures/ Birding Rant

I had a really good time visiting friends and family over Christmas break. Here are just a few pictures from my travels. Not that you really want to see pictures from my various family gatherings, but for those foolish enough to continue to visit my lame blog site now that my life has become boring, I will force them upon you.

I visited two sets of grandparents over Christmas break as well as spending some time with my family in Camano Island.

We had Christmas morning at my Grandpa Stan and Grandma Lorie's house (aka Gramps and Grams) in northern California. Their house can be summed up in one word: Birds. Everything is about birds in that house. Pictures of birds, sculptures of birds, paintings of birds, books about birds, birding handbooks, windows to see birds out of, 10s of bird feeders so that birds will come to the yard, a basement to store bird seed in, spotting scopes and binoculars to see birds with, a coat rack to hold birding coats and hats, a driveway that holds a car so that they can go birding, etc. What is the reason for this bird mania? Gramps (aka 'doc') was a professor of ornithology at Humboldt State University for over three decades and he is pretty much as bird crazy as they get (but we love him for it)! After reading this, you may not be surprised to know that their Christmas tree is decorated primarily with bird Christmas ornaments. Gramps counted them one year. I think there were 120 bird ornaments then and there are probably more now. I have included a picture of the tree just to illustrate my point.

The bird ornament tree. Unfortunately, the top of the tree got cut off in the picture. What was topping the tree? Was it a star? Was it an angel? Nope. It was a bird, big surprise there. :)

This is Gramps after we all opened our presents on Christmas morning. He requested socks for Christmas and was satisfied. In his lap was his biggest present: Handbook of the Birds of the World volume whatever (or something like that). I love the fact that it is called a "Handbook" when the whole idea of a handbook is something that can fit in your hand, i.e. is small and concise so you can take it in the field with you. I don't think he will be taking that huge book out in the field with him.

Speaking of books, Gramps has actually written a book himself. I know, impressive isn't it? I know your mind is going wild right now with interest. Am I descended from a line of great writers? Is my grandfather's book perched at the top of the New York Times Best Seller list? You might even be wondering what the book is about. Is it a thriller novel? Perhaps a mystery? Memoirs from his travels to nearly all the continents in the world? I think that if you dig deep into the depths of your mind you can probably guess what the book is about.

Think....



Think harder....



You're getting there....


Yup! You guessed it! His book is about birds. It is called, "Northwestern California Birds" and it actually has some nice pictures and useful information (if you are an avid birder, that is). It has been a good retirement project for him. Every few years or so he starts revising it again between coordinating Christmas bird counts and the like. I think he recently finished the 3rd edition.

Don't get me wrong. I am poking this fun at birders, but I actually like birding myself. It can be fun, particularly if it is nice weather and the birds are big and easy to see. It is also a good way to get a little exercise, enjoy nature and socialize with friends. I have just never been completely off the deep end about birds. I have tried, believe me. I even took a birding class at the UW during my undergrad years. (When they asked, "Why are you taking this class?" My response was, "Because I want to be accepted by my family." It turns out that the professor of UW class was friends with my grandpa and wrote him a letter at the end of course to tell him that I had done well in the class, but that I missed a robin on the second field identification exam). However, the birding madness has never quite infected me like it has with the rest of the family. Oh well, I guess they still love me even if I am the mutant non bird crazy granddaughter.


After Christmas I went back up to Washington. Here is a picture of my mom back in Washington making one night's dinner for 14 people. Yup, we really did eat it all.


Before going to see Gramps and Gramps I was visiting Granny and Spiro in the Bay Area in California. Here is a picture of Granny and Spiro together. Aren't they cute?
Spiro and me.
Granny and me.
I thought this was pretty funny. My older brother, Aaron, is actually staying with Granny and Spiro while he starts a new job in San Jose so we were both there visiting Granny and Spiro together. Granny is ULTRA organized and she had a towel rack for Aaron and a towel rack for me both clearly labeled with post-it notes. Granny is a retired message therapist/counselor.



Here is Spiro. It was so much fun to spend time with him. He told me (and Aaron) about the Great Depression, about how he meet Granny and other fun stories. It was a blast.

:-( Tribal Violence in Kenya due to the Elections

You all might be interested in the following New York Times Article: "Mob Burns Church in Kenya Killing Dozens"
http://www.nytimes.com/2008/01/02/world/africa/02kenya.html?_r=1&th&emc=th&oref=slogin

While I was in Kenya, I spent a lot of time talking with Betty, the Kenyan cook at the house I stayed at in Nairobi. A lot of the time I would go out shopping with Betty for meat and produce and other times I would practice my Swahili skills with her. I also asked Betty to help me understand Kenya politics. Betty is from the Luo tribe which is the second largest tribe in Kenya. The Luo's primary rival tribe is the Kikuyu tribe which is the largest tribe in Kenya and the most powerful politically and economically. Apparently the root of the Kikuyu tribe's power goes back to colonial days when the colonizing British forces discovered that the Kikuyu tribe would do their will, even betray their fellow Africans, if they were paid well enough. Therefore the members of the Kikuyu tribe were placed in positions of leadership and were given the most fertile lands and the best jobs in exchanged for their allegiance to the British forces and their help controlling the other tribes. After Kenya gained independence from England, the Kikuyu still maintained a status of power and economic superiority over the other tribes. The current president, Kibaki, is from the Kikuyu tribe. According to Betty, he has used his place of power (being president) to give further opportunity and resources to the Kikuyu areas of Kenya while depriving the parts of Kenya inhabited by other tribes, particularly the Luo. This was even evident as we drove around Kenya as a part of our Tulane University class. We would be driving along a horrible bumpy road with huge potholes and all of the sudden reach a wonderfully smooth paved road with no potholes. Along the the road were some of the nicest schools I had seen in Kenya. I asked what part of Kenya we were going through and the driver told me it was the Kikuyu section of Kenya. Elsewhere in Kenya roads have not been worked on for decades and schools are in a shameless wreck.

This favoritism towards his own tribe in President Kibaki is viewed with loathing as corrupt behavior by a large portion of the Kenyan population. Many of the Kenyans I spoke to over the summer said that they were so excited for the next election when they could vote Kibaki out of office. However, many people said that he was so corrupt they expected him to try to cheat a win in the next election.

Now, there has been an election in Kenya and Kibaki won by a thread. Many people believe he cheated and President Kibaki is refusing to let an independent party come in and investigate the validity of the election results. I never advocate violence as the solution to a problem, but I definitely understand why people are rioting in the streets. They believe democracy has failed them and they are turning to violence as way of being heard by the world.

Mwhahahaha - Blackmail material

In large families, it common knowledge that one of the primary functions of older siblings is to collect blackmail material on all of their younger siblings. This blackmail material can be used for mere entertainment value or to intimidate your younger siblings when they threaten to upstage you in life. Younger siblings must be reminded of their place after all! My older brother pulls out the occasional embarrassing story from my childhood and uses them on me at appropriate moments. For example, if I said, "Wow, I just got accepted to two medical schools and wait listed at a third." Then a few minutes later it would be appropriate for my brother to remind me and the other people in the room of the time I ate fish food when I was 3 years old. Although I may be in med school he has reminded me that he still has the goods on me and he is not afraid to use them if he needs to put be back in my place as his little sis.

These memories must be carefully filed away so that you can remember where they are for future use. For example, in my brain there is a clearly labeled folder called, "Embarrassing Stories and Memories of Little Siblings" that is much larger and has much better recall than my "Organic Chemistry" folder. Some of the contents of this embarrassing stories folder are:

-When Paul was 3 years old and would ride his tricycle around with bottle sticking out the belt of his pants. He clearly thought he was pretty hot stuff with his bottle ready for fast drinking action just in case his tricycling action made him thirsty.

- When Sarah was about 4 years old she pretended she was a dog for 3 weeks straight. She would even try to eat dog food and lock herself in the dog kennel. (Yes, we do have pictures of this). Mom was particularly embarrassed when our family went up for communion at church and Sarah insisted on coming back crawling on all fours and acting like a dog.

- When Gene was when he was 5 or 6 years old (this period went on for a really long time so getting the exact age is a little tricky) he had just learned English after being adopted from Russia and he didn't understand what made a joke funny. He heard the joke, "Why did the boy throw butter out the window? He wanted to see butterfly!" So he would try to make up his own versions of the joke substituting the word 'butter' for various other household objects, "Why did the boy throw a carrot/teapot/spoon/knife/cake/pencil out the window? He want to see the carrot/teapot/spoon/knife/cake/pencil fly!"

Monica is currently going through a stage that is quite similar to Gene's "Why did the boy throw the ____ out the window" stage. Monica's stage is currently revolving around the inability to remember the punch line to several knock, knock jokes. The knock, knock joke is supposed to go something like this:

Person 1: "Knock, knock"
Person 2: "Who is there?"
Person 1: "Boo"
Person 2: "Boo who?"
Person 1: "It's only a joke! Why are you crying?"

Monica's version? Well, it is Monica's version. Mwhahaha, Aaron and I might be able to blackmail her with this video when she gets older." Who knows? Maybe she will end up being a stand-up comedian and this video clip with be in a documentary about the development of her amazing comedy skills. But us older siblings will know how to use it when she outshines us.


(Video recorded by older brother Aaron)

Great! Now I have guilt!

During fall quarter I had an experience that made me think of Rex's line in the Toy Story Movie: "Great! Now I have guilt!"

(Picture of Rex downloaded from a Google image search to jog your memory about the famous line).

During fall quarter I went home quite a bit to help mom out after her hip replacement surgery. However, towards the end of the quarter I saw the impact it was having on my studies and decided to stay in Seattle and just focus on class for the rest of the term. Unfortunately, this meant that I could not come home for Monica's birthday at the beginning of December (right before finals week). Monica was very upset by this and tried diligently to convince me over the phone to come home for her 5th birthday party. I examined my schedule and determined it was completely impossible to come home for her birthday and had to give her a firm, "No" over the phone. She too hard but at the end of the conversation she said in her little cute voice, ""Its ok that you can't come. Christy, I love you and I miss you and I love you. OK?" I hung up the phone and felt absolutely terrible. Was this to be the first of many situations through out my life where medicine would prevent me from being with friends and family when they wanted me? I bought Monica a birthday present (a little pan flute from Peru) which I gave to her after finals were over. I felt really guilty when I gave it to her. It was almost as if I was trying to buy her off or something - as if the present was saying, "I am sorry I couldn't be here when it was important to you. Here, have something that costs money instead." Is that what busy physicians and medical students do? Hmmmmm. I just hope I don't have to proclaim my guilt about this too much in the future.

Me after fall quarter = a juiced orange

Fall quarter is finally over! Yeah! I just took my last final and it is really good to be done! How do I feel right now? I guess the best way to describe it is that I feel like a juiced orange. (But a very happy juiced orange!) I started medical school as a whole freshly picked Florida orange and right now I feel like a the peel with a little bit of pulp left over inside. I am not saying that this is a bad feeling, I am still very overjoyed to be in medical school, I just have new respect for what medical school takes out of you.

(written a couple weeks later) Everyone has been asking me how fall quarter went. I guess it went well. At least they haven't kicked me out of school yet! Fall quarter was very stressful. Towards the end of the quarter I could see what the stress of medical school was doing to my body. I was having trouble falling asleep at night while I worried about classes and life and general. Also, my stomach started to hurt, particularly before exams. These symptoms started going away immediately after the quarter ended and now are completely gone. I just hope they won't reappear during winter quarter stress.

Sometimes during fall quarter I really started to envy people who can come home after working all day and can just relax and spent time with their family and friends without the stress of feeling like you need to study all the time. I am sure it will all be worth it in the end.


These oranges are what I felt like before medical school started. (Photo from google image search)


This is what fall quarter felt like, particularly Anatomy. (Photo from google image search).

Some disappointing news for those taking final exams

An article with some disappointing news for those taking final exams: "It is only Tuesday"

http://www.theonion.com/content/news/it_only_tuesday

YIKES! (again) My Winter Class Schedule

Once again I was traumatized by looking at next quarter's medical school class schedule. (perhaps by spring I will be used to it? We will see.) The only good thing about winter quarter is that it doesn't begin for another 3 weeks. First (this upcoming week) we get to take cumulative final exams in our remaining fall quarter classes: Biochemistry, Histology and Social Aspects of Health and Behavior. Two of these classes, Biochem and SHB, are continued in winter quarter. One thing that I am actually looking forward to in winter quarter is my family medicine preceptorship. I will get to tag along one morning a week with a family practice doctor as she sees patients. Sometimes I might even get to help/participate (we will see). The preceptor I have been matched with is the Harborview Family Practice Clinic.

Here is my schedule of classes:
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HUBIO 512: Mechanisms in Cell Physiology (5 Credits)
Physiology of the cell membrane, including ionic and electrical potential gradients; active transport, excitability, and action potentials; biophysics of sensory receptors; neuromuscular transmission; muscle energetics and contractility; spinal reflexes and central synaptic transmission; autonomic nervous system; energy metabolism and temperature regulation; epithelial transport; gastrointestinal motility and secretions.

HUBIO 520: Molecular and Cellular Basis of Disease (6 Credits)
Patterns of cell and tissue response to injury. Mechanisms of cell injury, the inflammatory process, immunology, immunopathology, thrombosis, normal and abnormal growth, neoplasia, clinicopathological correlation.

HUBIO 522: Introduction to Clinical Medicine (4 Credits)
Medical history is introduced and instruction in data collection is begun. Experience in conducting medical interviews with patients to obtain the medical history and patient profile. Special problems related to interviewing are addressed.

HUBIO 523: Introduction to Immunology (2 Credits)
Basic concepts such as antigens; antibodies; complement; B- and T-lymphocyte function, including interactions with each other and with accessory cells; immunological tolerance; major histocompatibility complex; and role of these basic concepts in immunopathology (immunodeficiencies, hypersensitivities, autoimmunity, blood transfusion, and transplantation).

HUBIO 524: Biochemistry (4 Credits)
Classical molecular and cellular biochemistry, cellular physiology and molecular genetics. Metabolic interrelationships as they occur in the individual stressed and related to disturbances in disease states.

HUBIO 526: Systems of Human Behavior (2 Credits)
Effects of behavioral factors in major management problems faced in medical practice relating to cultural background, social role, sexual identity, and belief systems. Acquisition of skills in analyzing behavior, defining objectives, and designing precise treatment strategies.

HUBIO 590: Introduction to Critical Reading and Evaluation of the Medical Literature (1 Credit)
An introduction to methods for identifying and retrieving Web-based high quality, relevant evidence, and to methods for describing and applying rigorous criteria when reading primary research studies or reviews of primary studies that report on the effectiveness of therapeutic or preventive interventions.

FAMED 501: Introduction to Family Medicine: Preceptorship (2.5 Credits)
Students spend one morning per week for one or more quarters working with a practicing community family physician.

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If my calculations are correct, I am registered for 26.5 credits for winter quarter - fewer credits than we took in fall quarter, but apparently winter quarter is much shorter so the work load is worse than fall. Good times.