toolof dozes

New Year's Eve

2011-12-31T01:15:00.002-05:00

Another year gone! Can you believe it? I sure can't.

See you in 2012.

For the Greater Good

2011-10-27T23:32:00.006-04:00

Yesterday, Wei (the Chinese MD who works in our lab) and I "sacrificed" two mice for the purpose of extracting dendritic cells from their bone marrow. We accomplished this by sticking each mouse into a shoebox sized gas chamber (one at a time, to ensure maximum freshness) and once expired (after about one minute), dissecting away the skin and muscles of both legs. Once the soft tissue was out of the way, it was a relatively simple matter to remove all of the leg bones (femur + tibia). The whole thing sounds a lot cleaner than it actually was. The end result was 7-8 tiny bones floating around in a petri dish. We took these bones under the hood and watched the color of the bones change to pearly-white as we flushed the marrow out using a small syringe and 25 gauge needle, with a buffer solution.

Today, Wei and I anesthetized six mice for the purpose of inoculating their livers with malignant tumor cells. We accomplished this by injecting anesthetic directly into the peritoneal cavity and once unconscious, performing surgery on the mice. Wei made a horizontal incision in the upper epigastrium with a pair of scissors, both at the surface level and into the peritoneum. He would then pull a large chunk of the liver (possibly all of it) out through the incision and rest it on the mouse's abdomen while he injected it with tumor cells cultured in the lab. Once hemostasis was achieved, he placed the liver back into the abdominal cavity and then passed it to me. I closed each incision by running a suture through both layers and tying off with three knots at each end.

Sewing up these tiny incisions was the highlight of my week. My suturing skills were quite rusty, but luckily, Wei had every bit of confidence in me. As I finished stitching that first mouse we operated on, I asked Wei, "OK, I think I'm done... how's it look?" He's a man of few words: "Still alive?" We both stared at the mouse intently for about two seconds. I breathed a sigh of relief. "Still alive!" He nodded, and continued working on the next mouse.

To summarize, yesterday, we gassed two mice and ripped out all of their leg bones. Today, we gave six mice liver cancer. And eventually, in three to six weeks, we will be killing these same six mice to collect data on how much the tumor has grown, how the normal liver tissue has responded to the tumor, and how all sorts of miscellaneous parameters relate to the immune response mounted by the mouse. The autologous dendritic cells I mentioned in the first paragraph are actually being used as a novel technology to vaccinate these mice who now have cancer. The idea is that this kind of immunotherapy will strengthen the host's natural response to the tumor and the results have actually been somewhat promising so far, at least in this simple murine model. Trials of a similar nature are currently being conducted in humans, and one of our goals as a research group is to eventually develop our own clinical trial.

That's the big picture. We call the deaths of many mice "sacrifices" for good reason, and it is because they are dying to further research that may someday help discover new technologies and treatments for cancer. While a small part of me cringes at the thought of what kind of activities I've been complicit in for these last two days, my conscience is assuaged by the fact that mice aren't nearly aware enough to appreciate that they are, in fact, being subject to great difficulties. And so I will continue to sacrifice my mice and give them cancer.

For the greater good.

The Dark Side

2011-10-17T22:47:00.007-04:00

One of my responsibilities as a research fellow working in Dr. ______'s lab is to facilitate the transport of resected liver specimens from the OR to the surgical pathology lab in the adjacent building. There, I ask the pathologists to cut for me a few samples of tumor and normal liver tissue, which I proceed to take back to our basic science lab in another building up the street. Upon arrival at this final destination, these tissue samples (in addition to blood samples) are eventually processed for RNA, DNA, cccDNA, etc. analysis. Much of the funding for our research comes from this tumor banking protocol, and there are several avenues of research being explored with the data that is being amassed through this project. Tissue is harvested exclusively from patients with both HBV (hepatitis B virus) and HCC (hepatocellular carcinoma) and the overarching goal (at least on paper) is to explore the mechanism by which hepatitis B can cause cancer while bypassing the phases of liver fibrosis and cirrhosis. Hepatitis B is unique in this capacity because all other forms of hepatocellular carcinoma arise in the setting of progressive liver damage, manifested first in fibrosis and eventually cirrhosis (hepatitis C, alcoholic liver disease, etc.).

My day to day activities often center around this study of HBV/HCC. However, I have also been assigned to rewrite a paper looking at risk factors for peritoneal carcinomatosis (a type of metastasis) in gastric cancer patients. This was a project started by a medical student a few years ahead of me, and while he produced a final paper, it was never published. My job is to update this paper with the latest numbers (done) and to rewrite it in a manner that will be palatable to at least a few decent journals (in progress). I had been working on this study almost full time for the last couple of weeks, although this more-independent project of mine was interrupted last week when I was requested to help run some assays in the basic science lab. Although I had no experience whatsoever (being that I majored in anthropology), the Ph.D. in our lab took me under her wing and we ran an ELISA last week. It's a fairly straightforward process and not difficult to teach, and she benefited by having me do all the menial tasks (i.e. endless pipetting) for her. Tomorrow, we will be running a Western blot. While absolutely basic for most researchers in biology, this benchwork is completely new to me and I have been having fun learning these techniques.

It's been almost two months since I started this scholarly year and it certainly has picked up more than I ever thought it would back in August. But this entry wasn't meant to be about my research. The problem with all of this activity is that very little of it involves any real interaction with patients. And the problem with not interacting with patients is that it makes one prone to forget the reason any research is being conducted in the first place. I find myself going to the OR once or twice a week to collect my chunk of chopped liver, and the only thing on my mind is how quickly I can get all my samples back to the lab so I can leave and enjoy a nice, long lunch break. Only once in the last two months have I actually paused and even considered visiting one of the patients receiving surgery the next day, and this only because he seemed so terrified prior to starting the case. And in the end, I didn't check up on him anyway.

Up in the surgical pathology lab, you see all kinds of interesting specimens that have made their way up from the OR. Almost all are recognizable - they are usually simply diseased organs of some sort. Today, I noticed a smattering of tissue at one station that looked unlike anything I had ever seen before. The color was all wrong - it was gray-white, almost pale and translucent looking. Furthermore, it wasn't one confluent mass; it seemed somewhat feathery and looked like a scattered jumble of chicken or fish bones. I don't usually like to intrude on random attendings while they are teaching their residents, but this attending noticed me hovering near the table and so I had to ask what it was. She explained that it was a fetus that had been aborted at about 13 weeks because of some perceived anomaly. It was their job to try and determine what that anomaly might be by sifting through what are called the "products of conception." The problem, however, was that there was little left of the fetus to examine. The attending went through the scraps and highlighted the spine and tiny little ribcage that remained together as one piece, another little piece that turned out to be the right arm (complete with little fingers), and another piece that was the left leg. She picked up a tiny little scrap that had a vague circular indentation in it and said with half a smile, "this is the tongue."

The resident and I looked on with appropriate scientific curiosity and marveled at how small all the little pieces were. But inside, I felt a little sick. Just a little. The attending shook her head and said that there would be no way they'd be able to find any "anomaly" with what they had. She poked at a tiny piece that she was calling the heart and said they might try and examine the septum, but likely they would have to report no findings. I went back to my liver soon after that, collected my samples, dropped them off at the lab, and had lunch. I almost completely forgot about that fetus until now, and for fear that I might forget and never remember again, I decided to blog.

Three years ago, had I witnessed a similar discussion/dissection of an aborted fetus, I'm fairly certain I would have been profoundly disturbed. Maybe just reading my description of this morning might produce a similar effect in some readers. But I'm no longer that person. My empathy has largely been replaced by apathy. Over the weekend, I received news of the deaths of two people - immediate family members of two friends/acquaintances. Though I tried to express outward sympathy, I was not moved. Our church sent out a request for prayer for an elderly man who had been going back and forth to the hospital in the last few days. I dismissed this notion, thinking (and saying), "the ER is sending him home for a reason, it's probably no big deal." A similar cry went out for healing for a lady who had suffered a stroke a few weeks ago. In my head, a voice uttered: "not likely."

What's the problem here? Is it really the lack of interaction with patients that's caused me to stop caring about people? Is it simply the inevitable jadedness/cynicism that will befall every medical student who's finished third year? It's not the research. Research is an important and interesting process, and I'm glad I'm taking this year off to familiarize myself with its workings. It's me. I was never the most selfless person to begin with; however, I feel like what little has been left of my "good intentions" in coming to medical school has been spiraling downward for the last few years. While experiencing first-hand what hospital life is like for patients and their families when my dad was sick helped me to empathize with patients this past year, I am discovering that this empathy is remarkably short-lived. More often than not, I find myself presuming to know more than others because I have already been through such an experience, and I downplay their sufferings because I refuse to accept that anyone can suffer or has suffered more than I have.

Which is absolutely absurd. There is a reason for suffering in this world and it is sin. That is a central tenet of the faith I subscribe to... and yet sometimes I wonder if I really believe it. Why is it so hard for me to practice what I preach? Why is it so much easier to slip into the corners of anger, bitterness, self-pity, and self-righteousness? In community group about a month ago, we talked about how prayer can be a scary thing - particularly when you ask God for something you don't really understand. In my case, I remember at the end of college, I thought I had it all. I felt like my spiritual life was on track, my professional life was on track, and even my romantic life was on track, albeit with a few hurdles to cover. I had prayed the year before for the ability to fully trust God, and after feeling like that prayer had been answered, I started to pray for brokenness. I wasn't even sure what that meant, but I prayed that he would break me, teach me what it is to be fully dependent on him and nothing else.

I forgot about this prayer until we happened to discuss it at that particular community group. Three years later, I'm looking back at how I've been living since college, and examining how I feel at the moment. I feel broken. Broken and dependent not on God, but on worldly things that I know won't satisfy - career aspirations, material pleasures, emotional needs, and desires of the flesh.

And I don't know whether to praise God for his faithfulness or beg God for some way out of this pit. The answer, I suppose, is what it always is: both.

Hallelujah... and hosanna.

Not Quite 4th Year

2011-08-14T21:31:00.004-04:00

I struggled just the slightest bit in coming up with a title for this entry. My first thought was to call it "Life Goes On." But I hate ending sentences with prepositions... and here I went ahead and did it anyway. It also sounded needlessly melodramatic. I then thought about returning to an often used title back when I was on LiveJournal - "Logorrhea." But this is a different blog... and I've tried to stay away from using one-word titles for some time now. And so I decided on a statement of the obvious - not quite fourth year.

Tomorrow feels like the first day of school. It's been just about three months since last I wrote, and as I suggested in the previous entry, I will be taking a year off to do some research. While initially, I had anticipated this year would start on the 1st of August, it turns out that the official length of my scholarly year will be August 15th (tomorrow) - June 15th. The details of what I will be spending this year doing are still not perfectly clear. My mentor is a surgical oncologist who specializes in hepatocellular carcinoma (HCC) and particularly hepatitis B (HBV) associated types of liver cancer. I developed a good relationship with this man during my surgical rotation, and despite my extreme tardiness in deciding to pursue a scholarly year, he single-handedly made everything possible - including handling the administrative details, writing the proposal, and securing a stipend for the year.

I finished up my medicine rotation near the end of June uneventfully, overall feeling satisfied with my efforts and performance, though not quite enthused. By this point, Hannah had returned to California for the summer to help out with her sister's wedding and spend time with her family. July was spent taking the school-sanctioned USMLE Step 2 review course and then actually sitting for the exam on the 23rd of July. These three weeks were fairly relaxed, with the course running only in the mornings and four times a week. The intensity of studying for this test did not compare to last summer's prep for Step 1. While not entirely pleasant, going through the question bank this time around was far from miserable.

I spent all day on the 23rd going through the eight sections of Step 2 CK and then my mom and I flew out to California that same night. We spent just over a week in California doing some light sightseeing and meeting up with friends, the first few days in So-Cal and the remainder in the Bay Area. This one week vacation concluded with Jeanee's wedding on the 30th and on the 31st, my mom flew to Korea while I returned to the east coast. I spent another week trying to study for Step 2 CS (and largely failing) and took this exam (the practical portion of Step 2, involving seeing 12 fake patients in a simulated setting) in Philadelphia on the 5th of August, Friday. This exam is only offered in five cities throughout the whole country, and it is pass/fail. While inconvenient to travel to Philadelphia, there was less stress involved because of the way it is graded.

This past week, I spent most of my time sleeping in, spending time at Starbucks trying to read through my research proposal at least once (and largely failing), and attempting a road trip to Boston/Maine. I say attempting because I cut this trip short when I left Boston prematurely late Thursday night. Apparently the cool parts of Maine are at least an additional five hours of driving from Boston. This fact, combined with my quasi-anxiety about starting research this week and an overall lack of enthusiasm about the trip in general had me driving home to make it back to New York in just under three hours, my fastest time yet.

The weekend flew by as it always does, and I now find myself comfortably situated in my newly-renovated apartment, mentally preparing myself for my first day of work, which starts bright and not-early-at-all at 9AM. I had been trying to write something here for all of these last two weeks, but it wasn't until just now that I felt ready. Was I inspired by the research proposal that I finally was able to read through and, moreover, to actually understand? Was it the clever and deceptively subtle writing of Tom Rachman in The Imperfectionists, the first work of fiction I am reading in who-knows-how-long? Was it listening to the steady downpour of pitter-patters that's been falling unrelentingly all day? Was it this article that had me panicked and wanting to blog about the uncertainty of my future chosen profession? Was it frustration with the ever-growing tedium of Facebook and YouTube?

I'm not sure. All of the above. I will be engaged in this mode of leisurely (hopefully) purgatory/limbo (call it what you will) of "not quite 4th year" for the next ten months. Despite my describing this upcoming year in these terms, I actually hope to accomplish a lot before next July arrives. Figure out what to do with the rest of my life. Get married. You know, minor details.

It starts tomorrow. Wish me (us) luck!

End of an Era

2011-05-18T22:41:00.005-04:00

Well, maybe "end of an era" is a little dramatic. Yesterday, Hannah graduated from the Mailman School of Public Health at Columbia University. The last two years flew by - and here's hoping the next two will go the same way. Although I mentioned in a previous entry that I would be taking a year off and trying to get into this same public health program Hannah just finished... it's looking more and more like I will instead be taking a year off to do research.

Whatever the case, I had mixed feelings watching Hannah graduate yesterday afternoon. I was extremely proud and happy for her to be done with this phase in her life. And I was also jealous, recognizing the fact that I will be unable to do the same for another two years. That fact is particularly potent because of this moment I now find myself in - just five and a half weeks away from finishing third year. Fourth year is so close we can taste it, and we all know that fourth year is basically a drawn out yet pleasantly meandering preamble to Match Day and graduation.

Regardless, it's important to remind myself not to lose my head in dreaming about the end. I gave myself similar advice several weeks ago, in the context of thinking of residency as a new beginning, as opposed to the end-point of all training. This advice was helpful in wrapping my head around the idea of spending five or more years studying and working in a residency program. Right now, I need to focus on finishing this year well and making the most of next year. Graduation will come in time, and when it does, it will mean that I am one step closer to entering the real world. I should count myself lucky that I can push it off for another year.

My fiancée, on the other hand, is not so lucky. She will have the next few months off to recuperate in sunny California and help her sister prepare for marriage (another end of an era for the two of them). And then it will be back to New York. "New York, New York," which the speakers blared at the end of her graduation yesterday. We've developed a bit of a love/hate relationship with this city... and I'm grateful Hannah will stick it out here with me for at least another two years. She will be looking for a job starting August or so, and then it will be time to start planning for our own wedding and marriage. The real world awaits - and while I dread its approach, Hannah has always been far more courageous than I. She is the reason I'm not worried about the future.

Congratulations!

Turn It Around

2011-05-09T21:29:00.005-04:00

Last week, I met a patient with hemophilia A, HIV, and HCV cirrhosis ("triple H," as he called it) who presented to the hospital with altered mental status and spiked a fever soon after his admission. It turned out he was encephalopathic with possible spontaneous (or secondary) bacterial peritonitis. The first morning of his stay in the hospital, he appeared to have a normal enough mental status. As such, he was not being monitored closely. When I went to see him with one of my senior residents, we found him falling asleep in the shower - at risk of falling, injuring a body part, and possibly bleeding to death (probably not, though).

I was instructed to ensure his safe return to his bed. This involved hanging out with him in the bathroom as he attempted to dry himself off in his vaguely-awake state. He plopped down on the toilet and proceeded to relieve himself in front of me as I pretended like I was used to this sort of situation. Happens all the time. I helped him put on his underwear and some pants and eventually guided him to his bed. I patted myself on the back afterward, both for tolerating the somewhat awkward circumstances and for averting what could have been a disaster.

Hardly a day later, we ended up doing a diagnostic paracentesis of the fluid in his belly - we took a sample to determine what kind of infection was responsible for his fever. Much of the diagnosis hinged on a single numerical value: the number of polymorphonucleocytes (a type of white blood cell) to be found in the fluid. If highly elevated, the value would suggest secondary bacterial peritonitis. If mildly elevated, the value would suggest spontaneous bacterial peritonitis. They sound similar enough... except secondary bacterial peritonitis is associated with a significantly increased mortality rate when compared with the latter.

Just two or three hours following the procedure, the count came back: 12,800 WBCs, 70% poly. Mildly elevated implies >250 poly count. This value was well into the thousands. I excitedly reported this result to my senior resident, only to see his face fall. "That's... really bad." And he was silent for a little while. I found myself confused. The tap was a success - we have a conclusive value, we can assign a diagnosis... aha! Secondary bacterial peritonitis. Case closed. But that's precisely the problem. The case is far from closed.

At this stage in the game, that's precisely all it is... a game. Some would argue that treating work in a hospital like a game is the only way to survive. You can't empathize with every sick patient in the hospital, nor can you console every family member of every dying patient. Who has the time? Who has the energy? Yet there are others who would argue that you can't afford not to empathize with the sick people you are treating. I learned more from observing my resident's reaction to the bad news I delivered than I did from most of these last three years.

During rounds last week, he shared a story of a patient he saw while in medical school. This patient of his was a perfect example of everything that can go wrong in a hospital, resulting in completely preventable bilateral below-the-knee amputations. The only success he describes in his story is her eventual regaining of the ability to stand with prosthetic support. At the time, I thought to myself, "Big deal." The resident earnestly encouraged us to find similar stories of our own, to hold onto them, and to always remember why we ever decided we wanted to spend our lives helping people in the first place. I thought to myself, "Lame."

This entry is not about my finding a similar story for myself. It is about my realizing how easy it is to lose your humanity when working in a hospital. You can find yourself congratulating yourself for helping a patient in the most menial and basic of ways... and a day later find yourself completely ignoring the consequences and implications of condemning a man to death.

It's more than a game. It's about surrounding yourself with the sufferings of real people... and learning to embrace it. And so the questions I now face are numerous. Am I ready for this kind of commitment? Will I ever grow to love my job? How much more of this can I possibly endure? When will I finally start to feel like a doctor?

Today I left the hospital at close to 7PM. It was not a call day. And I had been at the hospital since 6AM. I spent most of my day on the phone, trying to expedite and facilitate the various processes that need to happen in order for a patient to receive proper care: labs to be drawn, imaging studies to be performed, reports to be uploaded, conversations to be had. There are precious few opportunities for any one individual who works in a hospital to be involved in direct interaction with the patient. It is one massive, orchestrated, yet often dysfunctional team process. But it works. Most of the time. And it needs workers to function.

All this time, I had been looking for something meaningful to do with my life, preferably unrelated to medicine. I found comfort in excuses and turned my nose up at what truly is a privilege: the opportunity to be in medical school, the opportunity to become a doctor. It's taken me a long and difficult three years to realize that I might actually need to work to achieve my goals... to pursue happiness and to find contentment.

I'm not there yet. But I will be someday.

Let's turn it around.

Live to Love

2011-05-02T21:46:00.006-04:00

Continuing to find inspiration in the form of a status message on Facebook, shared by a recently befriended friend:

"I mourn the loss of thousands of precious lives, but I will not rejoice in the death of one, not even an enemy. Returning hate for hate multiplies hate, adding deeper darkness to a night already devoid of stars. Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."

Martin Luther King, Jr.

One New York Times headline describes the situation as such: "A Mix of Emotion Stored for a Decade." I'm not sure how to react to the news of Osama bin Laden's death, which was broadcast across the world late last night. It's not quite the same response I had to Saddam Hussein's capture and public hanging many years ago, which I thought was in poor taste. As usual, there is an element of surreality that settles like a fog over my entire understanding of the significance of this momentous occasion. But for the most part, my gut reaction is one of indifference.

People will continue to be born, to live, and to die. There will be war and there will be peace. And at the end of the day... life goes on.

Business as usual.

Stumbling Along

2011-04-17T20:38:00.012-04:00

It is now two weeks into my medicine rotation. Prior to starting this last block, we were treated to "Intersession" in place of our spring break. Intersession consisted of multiple seminars, panel discussions, and workshops regarding fourth year, residency applications, and our future careers. While this week was relaxing because of all the free time we were given, it was also stressful in serving as an acute reminder of how close the end of medical school is... or rather, how close the start of our careers. By now, most of my classmates have decided what specialties they are interested in, and they are beginning to plan accordingly. Based on a poll of my class conducted at the end of the week, I am one of 4% of my class that still has no idea what to do in life. This indecision/lack of motivation has been a complicated issue for me for most of this past year, and I have yet to come up with a good solution.

In the meantime, I am planning on applying to one (and only one) school for an MPH (Master of Public Health) degree. While I've always been interested in doing an MPH, the idea of delaying my graduation for a year and taking out another year's worth of loans had served as a strong deterrent for the first half of this year, when applications for most schools were due. Now, there is only one school that is still taking applications, and to be perfectly honest, the biggest reason I am applying is to give myself a possible opportunity to stall. A chance to take a step back, decompress, soul-search, reflect, pray, and really figure out what I should be doing with the rest of my life. Whether or not I will actually get in and have this option is another issue altogether. Meanwhile, I am continuing to stumble along in this brutal marathon that is third year.

Medicine is a 12-week rotation (like surgery), but like surgery, it's more like an 8-week rotation (4 weeks of geriatrics, which is considered to be very light). I've been at Englewood Hospital in New Jersey for the last two weeks and I have two more to go. It's been a little strange working here, mainly because this is a hospital I was well-acquainted with growing up, serving a population that I've been a part of for most of my life. I've noticed by now that New Jersey hospitals (e.g. Morristown, Overlook, Englewood) are much slower-paced and seemingly less busy than hospitals in the city. As a result, Jersey rotations are considered to be more "chill" and relaxing. I think it's been a good setting to become oriented to the practice of inpatient medicine. I'll reserve judgment on the specialty for now, though I will say that I am already sick of all the note-writing that is required in medicine. I am not looking forward to these next two weeks, and definitely not looking forward to next month, which will likely be more of the same but substantially busier (i.e. much more of the same).

And then it will be fourth year. Whether or not I end up taking a year off next year, my summer will be fully booked. Immediately following medicine, I am starting an elective review course at my school for the first three weeks of July. The review course is for Step II CK (clinical knowledge), which I will be taking July 23rd. That last week of July following this exam will be spent in California, partly for vacation and partly for Jeanee's wedding on the 30th. August will be my psychiatry rotation (deferred from this year), and I will actually be taking Step II CS (clinical skills) at some point in the middle of this month. Then it will be September. Summer will be over, and I will either be starting my emergency medicine rotation or taking classes for my MPH. Third year will be over in the blink of an eye...

and I can't wait.

Bad Days

2011-03-16T21:21:00.015-04:00

Today was one of those days when nothing seems to go your way. I woke up at the ungodly hour of 3:27AM, rolled around in bed for another hour or so, and forced myself to get up and work on a presentation I was giving at noon. Naturally, I had neglected it to the best of my ability this past weekend and past few days. I scrambled to put together a PowerPoint on a poorly-selected, ridiculously broad topic (infectious disease in pregnancy) and managed to cover about 30% of the material I wanted to cover. Utterly dissatisfied with the bare-bones presentation that was my final product, I trudged my way to work, not at all looking forward to the slew of patients we would see in clinic throughout the day.

This is my first week in the clinic, and I've been struggling more than I have in any other rotation this whole year. Working in any clinic always involves a bit of a learning curve and is usually somewhat awkward the first day. However, by the second day, most people get a feel for what is expected/required by the preceptor and become more comfortable with the patients they see. I felt like this was the case by the end of yesterday, after a morning of pre-natal visits (which are uncomplicated routine check-ups) and a hectic afternoon/evening at the local Planned Parenthood clinic.

I started the morning somewhat anxious about my presentation, but relatively certain I would fare comfortably with my patient encounters and teachings with my preceptor. I was in for a rude awakening. Perhaps yesterday was a busier day with less time for focused teaching (hence less questions asked), perhaps the patients were easier to discuss yesterday, or perhaps I was just off my game/out of my element today. The answer, as always, probably involves a little bit of all three of these possibilities.

I saw patient after patient this morning, and yet I repeatedly failed to look up certain pieces of information, failed to ask certain questions, failed to perform certain physical exam maneuvers, or failed to answer my preceptor's questions appropriately. Unfortunately, this preceptor isn't the type of teacher who holds your hand as he walks you through the learning process. He expects you to know what you're doing and will criticize you mercilessly and emotionlessly if you miss even the slightest detail. On the positive side, he appears to be fairly objective and his comments are difficult to take personally. Still, by the end of the morning, I felt like he transitioned from being frustrated with my shortcomings to no longer interested in me as a student. I felt like he had given up on me - and to be perfectly honest, I couldn't blame him.

The noon presentation went better than I expected, all things considered, although it was certainly shorter than I was originally planning. Again, I got the impression that my preceptor was completely disengaged, especially given the fact that he did not comment on the presentation at all - not one word. Ordinarily, I wouldn't find this surprising, given his personality. However, he has been in the habit of at least saying a few sentences following other students' presentations and usually offering a somewhat sincere "good job."

In the afternoon, I worked with him for another hour or so and continued to demonstrate my ineptitude in various ways. My Spanish would not flow, I would botch the order of different parts of the exam, and at one point, even when I was seeing a patient by myself, I found myself completely blanking on what questions to ask for the most basic of medical student tasks: taking a history. My confidence was shot. At this point, another attending doctor (who had most likely been witnessing my failures throughout the day) took me under his wing and saw several patients with me, asking less questions, cracking more jokes, and teaching with minimal criticism. I slowly began to relax a little at this point.

Of all the times during third year I had expected to freeze up and fall apart under pressure, OB/GYN was not at the top of the list, although in hindsight, I guess it isn't too surprising. Today was like a self-perpetuating downward spiral that I could not control. I thought, having done surgery already, I was perfectly capable of maintaining my cool during stressful situations; if there's one thing I learned after today, it is that I was sorely mistaken. Granted, there were a lot of predisposing factors in the environment that probably exacerbated the situation. 1. The preceptor himself. 2. The general awkwardness of breast/pelvic exams. 3. My sleep-deprived and already-anxious state (due to presentation).

There are several lessons to be learned from a day like today. First and foremost, it is important to understand the value of holding on to your confidence and maintaining your composure when faced with a difficult situation. This preceptor may have been the first doctor to challenge me in this way, but I'm sure he will not be the last, given the many years of training I have yet to complete. Second, it is equally important to realize that you will always have bad days. But in the end, that is all it is: one bad day. The only way to move on is to look at the bigger picture, pick yourself up off the ground, and try harder next time.

I went to Barnes after work for a few hours in an attempt to decompress and relax. I pulled out a crossword (New York Times) I had started yesterday and found, to my surprise, that I was able to fill in most of the boxes. Ordinarily, a Tuesday crossword is well within my ability to complete. Yesterday, to my frustration, I found myself stuck after only a few clues. It only took one day and a fresh new setting for me to come up with the answers to other clues, which eventually led me to solve most of the puzzle. Yesterday was a bad day...

...and tomorrow is a new day.

Deliver Me

2011-03-02T19:50:00.021-05:00

1. It is March, I have relocated to New Jersey (for the time being), and I am currently on OB/GYN (obstetrics and gynecology).

2. OB/GYN is actually a lot more interesting than I imagined it would be - female anatomy is certainly unique/special and there is nothing quite like seeing a baby being born.

3. When I speak of female anatomy, I am mostly talking about the uterus. Despite the fact that the menstrual cycle is kind of disgusting, the uterus is kind of amazing. For some reason, I find the shape of this important organ aesthetically pleasing. Also, the uterus expands like crazy during pregnancy (in order to facilitate the growth of the fetus). At one point during the course of a Cesarean section, the uterus (by now, a gigantic pink blob) will actually be pulled out of the body and placed on the woman's belly while her insides are cleaned out. Bizarre.

4. When the baby first emerges from the womb, whether via Cesarean section or vaginal delivery, it does not appear human. The baby is blue/purple, its eyes are tightly shut, its head is oddly shaped (depending upon the method of delivery), and there is a sizable gelatinous cord emerging from its belly button. The baby does not actually make any noise or start moving at all until it is completely out of the mother's body. As such, there is a period of 1-2 seconds immediately following delivery when you can look at the once-fetus/now-newborn and truly appreciate how alien the creature appears. And then the baby starts crying/flailing its extremities, the parents start crying, and the whole situation becomes surprisingly emotional for everyone involved.

5. It is nearly impossible for the woman to maintain any shred of dignity or composure in the setting of a hospital labor and delivery floor. Having a baby is messy business. Similarly, any type of gynecological exam or procedure will place the woman in just as compromising of a position. It takes a special kind of doctor to develop a relationship with women when they are most vulnerable and helpless (whether or not childbirth is involved).

6. That said, I don't think I can be that kind of doctor. Sometimes, I find myself wondering if I can be any kind of doctor at all. But this is a quandary I've been having that goes beyond the scope of my OB/GYN rotation. And I don't think there is any imminent delivery (or perhaps deliverance would be more appropriate) waiting for me in the wings.

7. Time is running out, and I am nowhere nearer to deciding what to do with my life than I was first year. More to come on this later... maybe.

31 Pictures

2011-01-05T14:55:00.008-05:00

[All photos should be enlarge-able. They are unprocessed, and courtesy of Hannah Chung.]

How Hannah and I spent our New Year's Eve...

This was my first time back in Berkeley after several years. My thinking at this moment: "This is it. Today's the day!"

The weather couldn't have been better. We arrived relatively early in the morning, after the shortest flight in the world out of Long Beach.

After a brief wait, we were seated for brunch at La Note. I ordered something with a French name I don't remember. It involved eggs and ratatouille.

Hannah ordered a latte that came in a cup the size of a soup bowl. It didn't have a handle. In fact, it probably was a soup bowl.

The best breakfast I've had in years. (And for half the price we would have paid in New York)

We didn't pay anything for this meal but tip. And we got free croissants. Our waitress felt extremely bad that we had to wait a little longer than usual for our food... we hardly noticed the delay.

I was planning on renting a somewhat sporty car for the weekend. They were all out, and upgraded us to a silver Mustang convertible instead.

No complaints here.

This was the first and only time that weekend we had the top down. (It was cold, and often rainy)

At this point, I was starting to feel a little nervous. It might have had to do with the light drizzling we encountered on the way over to the beach. Or it might have had to do with the fact that I was planning on proposing to Hannah in less than an hour.

And then a rainbow appeared in the sky.

I told Hannah: "Behold! This is a sign of God's promise for our lives. For our... future. Together." She smiled (or laughed, rather). I don't think I actually used the word "behold."

And so, the sun began to set.

We talked about what a long year 2010 had been, and how it had been so difficult in many ways.

I apologized for the many times I had failed her... and thanked her for standing by me through every circumstance.

And then it was time.

Her first reaction. (No, she's not crying)

She actually thought I was joking at first. Until I pulled out the black box. And then my simple question was lost amidst a chorus of "OMG"s and "KI WON KIM!"s. I asked her to marry me. Twice.

She said yes. BAM!

Shock.

Victory.

We raced home to change and spruce up for the boat that would take us all around the bay for the next four hours. There were some great views of the city and surrounding islands/bridges.

There was... an open bar.

There was dancing (with live music).

And there was prime rib.

Complete with dessert platter, for the lady with the sweet tooth (and recently treated root canal, may I add).

Though it was cold and slightly rainy, we headed out to the deck right before midnight.

And just like that - it was 2011.

It was a perfect day. As cheesy as it sounds (ahem), it felt like the world was celebrating with us as we watched those fireworks go off at midnight. When we got home later that night, nothing felt different. But everything was different. We were engaged.

Thank you for all your congratulations and warm wishes.

Happy New Year!

Cantique de Noël

2010-12-25T21:31:00.008-05:00

This year, among many Facebook statuses, the one that stood out was the following:

Surely he taught us to love one another; his law is love and his gospel is peace.

Merry Christmas.

Pumpkin Patch

2010-10-31T21:17:00.003-04:00

Yesterday, Hannah and I went to a farm about twenty-thirty minutes from my house. Who knew there were so many farms in Bergen County? We took a hayride out to the pumpkin patch, picked out three that we liked, and made sure to stop by the petting zoo before we left. The last time I carved a pumpkin, I was probably less than ten years old - the first and only time that I ever carved a pumpkin. Until last night. We didn't start working on this guy until past 10PM, but we finished right around midnight... just in time!

Happy Halloween.

(He's a pirate, in case you couldn't tell.)

Not Exactly Brain Surgery

2010-10-26T21:10:00.005-04:00

It's been about a day and a half into my surgery rotation, and I'm currently doing a two-week selective in neurosurgery. It's been interesting in the sense that I am seeing a lot of cases that we always seem to learn about, but never really expect to see in person (because they are relatively rare).

For example, the only three surgeries I've observed so far have been for resection of: a pituitary adenoma, an acoustic neuroma, and a neurofibroma. Lots of -omas. All benign tumors, but tumors that create problems by virtue of taking up valuable space in the brain. It's been hard to get a grasp of the whole scope of each disease, simply because we haven't really been spending any time with patients outside of the OR. Still, it is somewhat surreal to connect everything we've been learning about to the little mound/gob of tumor/tissue/bloody goop that presents itself as abnormal within the confines of the tiny holes neurosurgeons drill into skulls to access these masses.

Except for the neurofibroma we cut out of a little 4-year-old girl's skull today. This was a massive chunk of mush that invaded the entire right temple region and almost enveloped her eyeball, causing her skull and eye to be misshapen and protruded out of place. It took all day to clear the majority of this tumor away, and even then, there was no way the surgeons would be able to get everything (the residual will hopefully be treated with radiation at a later time). Large portions of skull bone were sawed off, and the second half of the surgery was spent fitting a prosthetic in place and making sure everything was reconstructed nicely.

She was a cute girl to begin with, even with the deformity, and she looked amazing after the surgery. We stayed as anesthesia pulled out all of their many tubes and wires - seeing her come back to life after many hours of being essentially comatose on the OR table, crying hard but wonderfully healthy, was truly something special.

I can't remember the last time I actually felt somewhat excited to be working in this often-miserable hospital setting. But that isn't to say I am optimistic for what these next two months will have in store for me. These two weeks don't contribute to our grade, and so there is naturally less pressure to perform. Which makes the whole experience completely different. Following neurosurgery, our hours are only going to get worse, although we are already reporting to the hospital by 5:30AM and getting home no earlier than 6PM. And there will be plenty of write-ups, presentations, weekend shifts, and exams to worry about before this clerkship comes to an end.

What I really want is for it to be winter break already. But I'm just whining. I guess it's not too bad. Even though it's only been two days. It's not exactly brain surgery, is it?

But... it is brain surgery.

-_-;

Septembers Remembered

2010-10-16T16:25:00.011-04:00

With only two weeks of October left and November right around the corner, I wanted to make note of September, which flew by so fast it feels like it almost didn't happen. There are lots of photos to share from this past summer and even these last few weeks, but now is not the time to upload them. In the meantime, I thought I might share some pictures from many Septembers past...

9/2007: At this point in our relationship, Hannah and I were often at odds with each other. We enjoyed making fun of each other in public, though in private, she was actually very kind to me. She sent me some photos upon my request, but proceeded to place the yellow visage you see below over her face in each and every one - she was shy.

9/2008: One year later, Hannah and I had revealed our feelings for each other and knew we were going to be much more than "just friends." But she had decided to go to Africa for a year and I was starting my first year of medical school. It was a bittersweet goodbye as she stopped by New York for one day before leaving the continent.

9/2009: After what seemed like an eternity apart, Hannah finally made it to New York to begin her graduate studies at Columbia University. The first few weeks of our official relationship were quite surreal and only slightly awkward. At this point, we had no idea what the next twelve months would have in store for us, but we were excited.

9/2010: This past year has been a tremendous period of discovery, growth, and endurance. We have learned much and are now beginning to think about the life that will follow once we finish our respective studies. What the future will hold is still unclear. But we are ready to face whatever may come - and we are still very much excited.

Or at least, I am.

My Brain and My Mind

2010-09-22T19:36:00.003-04:00

I was hoping to find time to update more regularly this year, but lo and behold, time has again come and gone. Today was the last day of neurology. Tomorrow, we have a review in the morning for several hours (oh, the joy of not having to get up before 6:30AM) and then the rest of the day off to study for our shelf exam, which will take place Friday morning.

It's a rite of passage of sorts, your first month or two as a third year - getting acquainted with life on the wards for the first time and finally beginning to apply learning from the first two years of school, in order to learn something about how to actually care for patients. How has it been for me? What's changed in the <4 weeks I've been on neurology at Elmhurst Hospital?

Not too much. I can now go into my next rotation (Ambulatory Care, in New Jersey at Overlook Hospital) with a little less trepidation and anxiety, but hardly any more knowledge or experience than I had going into neurology. Well, I guess that's not true. I have become fairly comfortable with the neurological exam, and I have learned a decent amount about strokes and seizures, which are probably the most important and prevalent neurological complaints most people will come in with. We'll see how useful all this proves next month and throughout the rest of the year.

But I guess that's the whole point of third year. To pick up these little skill sets here and there, one at a time. And hopefully by the time we approach graduation, we'll have developed enough competency to "do no harm" as we go into our residencies as freshly minted doctors. Getting up early to do a full day's work (sort of) and coming home each evening with the obligation to study even more has been, needless to say, a bit soul-killing. Dare I say, sad-making? Ha. It makes me realize how much I've been taking weekends and days off for granted, this past summer break and even the last two years, considering I never went to class.

At the same time, this exam on Friday is supposed to be quite tough, and I have yet to begin studying. I'm in the exact same mode of procrastination/denial that's gotten me into trouble so many times in the past. Hopefully I'll pass... and then it'll be the weekend... and then it'll be back to work next week, business as usual.

While nothing about this past month has been particularly inspiring, and many things have been, in fact, quite the opposite, I do have higher hopes for ambulatory care. I should be able to spend more time with patients, and not insignificantly, patients who aren't comatose or demented. It'll be nice getting away from the brain for a while and brushing up on all the other parts of the physical exam and history I've been forced to neglect since last spring.

But one thing at a time. There's a reason I'm updating at this moment, a reason I've been on Facebook for the last two hours, a reason I napped for several hours before that. There is something else I need to be doing. And that is studying. Using my brain.

It's too bad my mind is elsewhere.

At Last

2010-08-29T23:19:00.005-04:00

After two months' delay, I will finally be starting third year tomorrow.

Officially, the start was the beginning of orientation week at the end of June, which I attended. However, instead of heading to the wards immediately afterward in July, I left on a vacation to Turkey. Upon my return, I immersed myself in moderate-intensity studying for about four weeks and severe-intensity studying for one final week before taking Step 1 on August 16th. The next day, I flew to Korea.

I returned from Korea yesterday. And tomorrow, I begin my neurology rotation.

It's been an eventful summer, and I'm sure my return to reality will be an uncomfortable transition for at least a few weeks. Hopefully, there will be many more updates to come.

In the meantime, check out B.o.B's full album (B.o.B Presents - The Adventures of Bobby Ray) there's a lot of good stuff on there besides "Nothin' On You" and "Airplanes." The following is from the first track, "Don't Let Me Fall" :

It was just a dream, just a moment ago
I was up so high, looking down at the sky
Don't let me fall

I was shooting for stars, on a Saturday night
They say what goes up, must come down
But don't let me fall

Don't let me fall

Billionaires

2010-08-04T15:53:00.006-04:00

At a time when songs like the following are topping the charts...

... it's good to know that those who have succeeded are making the most of what they've earned (and/or inherited):

40 billionaires pledge to donate half their wealth

Less than two weeks to go before Step 1, followed immediately by Korea. See you in September?

Homeward Bound

2010-05-27T00:03:00.008-04:00

An excerpt from a private entry I wrote on 3/5/2010:

"I've been thinking more and more about the possibility of his passing these days, almost to the point of guilt for thinking about it so much. I had been concerned that my parents weren't appreciating the severity of the situation, but after talking with my mom just now, I learned that this concern wasn't necessary. It seems like they have both accepted that his death is likely and are just dealing with the situation as best they know how - with positive attitudes and with unflagging faith and trust in God. My mom and I talked about how much of our sadness and emotional reactions comes from feeling sorry for ourselves, rather than sympathizing with my father. And then I listened as my mom shared how in spite of everything, she is so thankful for every other aspect of this situation: how she has a stable job that not only pays well and provides incredible insurance, but is also completely understanding of her situation and allows her so much time off to care for my dad; how her two kids are grown and able to take care of themselves; how we have the support of an entire church community. You hear all those sad stories of families stripped down to nothing because of medical bills, patients who are unable to get the care that they need... and we really can't help but be incredibly grateful that we have this kind of provision.

Which isn't to say that it isn't hard. My mom still shed some tears as she talked about how there is still so much more that my dad wants to do with his life, but if God is calling him home, who is he to say no? As she spoke about what she might do after he's gone, it sounded like she was trying to steel herself and convince herself that she would be okay, that she would be able to survive. Even then, she put a positive spin on things - how she is grateful for the love that she and my dad have shared throughout their lives, how there are people whose marriages end in bitterness and divorce, how there are women whose lives completely fall apart after the sudden death of a spouse (again, an issue of provision).

One of the best parts about growing older and becoming an adult has been experiencing a greater depth of relationship with my parents. In the last few years, I've heard my parents open up about all kinds of things, share all kinds of stories, facts, and tidbits about their past, and I've begun to see them in an entirely different light. I am understanding more and more that my parents were people before they ever became my parents, and that they are completely human. While sobering, it was refreshing to have this kind of conversation with my mother. I don't know if I'll ever be able to have a similar conversation with my dad, who, while open and loving in every way possible, is not likely to share his vulnerabilities or reflect any of his suffering onto anyone else. From speaking with my mom, however, it does appear that he is able to share almost everything with her, and for that I am grateful. She marveled at his strength and fortitude, and it is his example that she follows during these times.

I have to constantly remind myself how much God has blessed me with the family that I have. Both my parents are such amazing people. Whether it's within the year or many years down the line... I will miss my dad so much when he's gone."

Hay Fever

2010-04-13T22:06:00.004-04:00

Most of my friends and family are aware of the fact that I hate going to the doctor or taking any type of medication (the irony is not lost on me). So it says something about allergy season this year when my desk looks like this:

Zyrtec - My drug of choice from last year; this year? FAIL.
Claritin-D - Tried in various combinations with Zyrtec and Tylenol at several points in time; sometimes worked (the "D" represents pseudoephedrine, a powerful sympathetic mimetic that is quite effective at relieving nasal congestion, also a precursor molecule to methamphetamine), though not the most consistent. MINIMAL-FAIL.
Tylenol - This pill includes a mixture of phenylephrine and chlorpheniramine along with the classic acetaminophen to try and address some allergy symptoms; no noticeable effect. EPIC-FAIL.
CVS Saline Nasal Spray - A clean, non-medicated nasal spray was recommended by a fellow sufferer; it made my nasal passages feel slightly more refreshed, but had close to no effect on relieving my actual congestion. PSEUDO-FAIL.
Zyrtec-D - In theory, this should have a similar effect as the Claritin-D. However, I purchased a smaller dosage designed to act over 12 hours, as opposed to the Claritin-D I had (ran out), which has an extended release over 24 hours; overall, I still have a lot of trouble breathing starting around the middle of the night and into the early afternoon, but things start to clear up around then and I am functional for the rest of the evening/night - which isn't ideal, but a workable situation. MINIMAL-FAIL.
Omnaris Nasal Spray - I recently acquired this steroid (ciclesonide) spray through a friend who happens to have an allergist for a mother. I am told that it works wonders; that remains to be seen - this one is for emergencies only.

Basically, I can't wait until spring is over.

FLASH!

2010-03-30T23:26:00.007-04:00

Sometimes, I wish my life was a lot more like what I see on television. Specifically, I'm talking about Chuck, a geek-turned-spy comedy/action hour-long TV show on NBC. It's currently in its third season, and while I've been aware of/intrigued-by-the-concept-of the show for quite some time now, I didn't start watching until several months ago, in response to the persistent encouragement (i.e. nudging) of my roommates. Chuck is a Stanford drop-out who works at the local "Buy More" (a la Best Buy) as head of the "Nerd Herd" (a la Geek Squad), currently lacking any kind of motivation or direction in his life. One day, he receives a strange e-mail from his ex-roommate (who happened to be a spy) - long story short, he unwittingly ends up with a super-computer's worth of government (CIA/NSA) secrets planted in his head. He is soon contacted by the nation's finest intelligence agents (one gorgeous blonde and one military bear of a man) and in no time at all, finds himself leading a double life: computer nerd by day, espionage analyst by night (figuratively speaking, as many of his missions take place during the daytime).

Chuck's contribution to his team of spies has very little to do with his innate abilities, although we discover throughout the course of a season that his innate abilities are, in fact, what distinguish him and give him the potential for greatness. It is the computer in his brain that is of greatest value to the government. On any given day, Chuck can see or hear something that will trigger him to "flash." For example, he may cross paths with a shady-looking character in a restaurant, and if that character's identity has ever been recorded or stored in the vast CIA/NSA bank of secrets, Chuck will flash and instantly recall every salient fact about who the character is, why he/she is dangerous, and what he/she is doing at the restaurant - basically, everything short of an entire life history. He can flash in a similar manner to a surprisingly large variety of triggers, be it someone's voice, an image in the news, a graphic on an advertisement, or even an everyday object, if the circumstances are right. The computer in his brain, referred to as the "Intersect," receives several upgrades as the show progresses, and Chuck's abilities reach their impressive peak in this latest season - I'll leave it at that.

After a long ten days of finals, spring break has finally arrived. At this time last year, I was in Mozambique, coming off of a few days spent in a rural community in South Africa. This year, the only things I have to look forward to are a possible trip to Boston/Newport and studying for "Step 1" - the first of three USMLE board certification exams. Of the three, Step 1 is notoriously the most difficult and almost certainly the most important exam. Like the MCATs for medical school, our Step 1 scores will play a large role in determining where we will end up for residency. The comparison ends there, however. I have mentioned in the past that these last two years of schooling haven't been too bad when considering the pure difficulty of the course material. The struggle mainly involved trying to manage the tremendous volume of material that we have been expected to master. And "master" is not simply a synonym or superlative I am liberally utilizing for literary effect. Step 1 will test not only whether or not we have memorized all of the many concepts, facts, and figures we have been presented with for two years, but how well we can apply this knowledge and make use of it in an environment of clinical problem-solving.

While the MCATs also emphasized application of knowledge and analytical problem solving, Step 1 will quite literally be a step-up from this former bane of my existence. For the MCATs, all we were required to master was basic science: that of biology, chemistry, and physics. The body of medical knowledge we will be tested on for the boards is far more expansive and far more frustratingly loaded with minutiae and subtleties. It is this last point that causes me to think of Chuck and wish for this alternate reality. To a small extent, a lot of learning medicine relies on triggers and buzz words. Every medical student knows to think of lupus as soon as the phrase "butterfly rash" is uttered. We hear "bowed legs" and we think of rickets, "blue sclera" and it has to be osteogenesis imperfecta. But these triggers can only carry me so far. It's a far cry from the technology that allows Chuck to have access to boatloads of information within seconds. What I need is to be able to flash like Chuck does; what I need is an Intersect in my head.

Unfortunately, life is a little more complicated than that. There are few shortcuts and even fewer gimmicks to rely on when studying for this exam and trying to survive medical school. There are still two more courses of pathophysiology to complete before second year officially ends (renal and pulmonary), and ASM is definitely going to go out with a bang with the nerve-wracking "COMPASS" final exams in mid-April. There's a community health fair around the same time that I'll be working on logistics for (Magic Johnson will be coming!) and possibly one last retreat for our network of fellowships shortly afterward. As much as I can daydream about Chuck and whine about how much there is to do in preparation for these next few months, at the end of the day, there's only one way to go about this whole process: one step at a time (forgive the pun).

Reforming Health Care

2010-03-23T14:14:00.007-04:00

Some highlights (for full article, click here):

With the strokes of 20 pens, President Obama signed his health care overhaul — the most sweeping social legislation enacted in decades — into law on Tuesday during a festive, at times raucous, White House ceremony.
...............

The landmark bill, passed by the House on Sunday night by a vote of 219-212, will provide coverage to an estimated 30 million people who currently lack it. Its passage assures Mr. Obama a place in history as the American president who succeeded at revamping the nation’s health care system where others, notably Bill Clinton, tried mightily and failed.
...............

The measure will require most Americans to have health insurance coverage; would add 16 million people to the Medicaid rolls; and would subsidize private coverage for low- and middle-income people. It will cost the government about $938 billion over 10 years, according to the non-partisan Congressional Budget Office, which has also estimated that the bill would reduce the federal deficit by $138 billion over a decade.

Whether good or bad... definitely history in the making!

Photo credit: The New York Times

A Special Day

2010-03-19T23:51:00.006-04:00

My first attempt at baking a cake completely from scratch, and I had to enlist the services of the girl for whom the cake was being baked. Still, I have to take complete credit (blame) for the bloody-looking script and outstanding presentation...

Happy Birthday.

Medical Idol

2010-03-17T15:54:00.005-04:00

It is now mid-March, and second year will be over in less than two months. We are approaching that important transition from our pre-clinical years to life on the wards - the series of rotations that will make up our third and fourth years of medical school. No longer will we introduce ourselves as just "medical students," but as "student doctors" (that's the rumor, anyway)... and it won't be long before we introduce ourselves as real doctors.

I've written about our ASM (Art and Science of Medicine) course in the past - basically, it is the only source for anything clinically related and for most of us, the only taste of the reality of medicine we will get in these first two years of medical school. As third year draws nearer and nearer, ASM has started to become more and more rigorous. The number of evaluations, simulations, and observations has dramatically increased, and we've been investing more and more time learning all of the standard fare of working in the hospital (writing up cases, presenting, working with differential diagnoses, and thinking about treatment plans).

Today was one such simulation/observation, and the thought occurred to me that medical school is a lot like American Idol. The system that forms the foundation of our clinical education is based on feedback and evaluation, and students often find they are receiving mixed criticism. Learning the day-to-day practice of medicine (the "art" of medicine) is something that is surprisingly difficult to standardize in the context of today's medical schools. Our teachers and preceptors are all doctors who work at Mount Sinai, but the majority of them have not been trained at Sinai, and there is no extensive training or qualification required for them to serve as ASM faculty. Basically, every doctor is different and every doctor likes to do certain things his or her own way.

Aside from the actual content of the feedback we receive, the actual fact of sitting there and having to listen while people who know better critique you is... a unique experience. It's not like I haven't been placed in this situation countless times already in the last two years, but today in particular struck me as a situation remarkably analogous to what all the contestants go through on American Idol every year. Hardly coincidental, however, considering how much American Idol I've been watching the last month or two. I've never followed the show in its nine year history, but this year I've been watching almost religiously. My infatuation began because Andrew Garcia, one of the amateur artists I stalk regularly on YouTube, auditioned and started off quite successfully on the show. Since then, he has been overwhelmingly underwhelming and he is not likely to stick around for much longer (see here for Andrew's best performance on the show).

Instead of going to Englewood Hospital like I have been for the last three weeks, I spent an hour this afternoon at the Morchand Center, which is our school's simulation center for standardized patient interactions (i.e. a fake clinic with fake patients where medical students can practice their skills). After I finished taking my full history and physical exam, the fourth-year student evaluating me asked me how I thought I did. I think it was this question that triggered me to think of American Idol.

Usually, I can just listen quietly and nod enthusiastically as my preceptors or evaluators give me helpful tips. This time, I was forced to re-think my performance, with the implication that I had done several things wrong. I found myself overly defensive when faced with legitimate criticism, and imagined how it felt like for the many (many, this season) contestants who bombed these last few weeks; I also found it quite awkward to sit through the compliments, and imagined what it must feel like for the contestants who light up the stage.

Ultimately, though, most of what our evaluators and preceptors have to say won't matter. Very few of us will fail ASM and go on to become horrible doctors. The feedback I receive will help me to hone my craft, to come up with my own individual style, and perhaps motivate me to work harder when it comes to the standard of care. But it is America (and by America, I mean the population of future patients I will see) who will decide what kind of doctor I will be - whether I can be considered a good doctor, whether I will be successful, whether I will even have a future in medicine. All of these things have been weighing on my mind lately, and I can relate to this season's American Idol contestants in more ways than one.

At least they only have another month or two of this to endure. For the rest of us in my second year class, the judging has only just begun... and the voting is right around the corner.

At Long Last

2010-03-12T19:27:00.002-05:00

Coming out of retirement, just so I can share the following...

Where can I go to learn some kung-fu around here?

Not Quite Writer's Block

2010-01-22T11:31:00.004-05:00

When I was young, I was taught: "if you have nothing nice to say, say nothing at all." I would modify this statement a bit, to reach the following conclusion: "if you have nothing nice to blog about, blog about nothing at all."

It's been one of those weeks. Things I used to update about (including outings, movies, news, YouTube clips) all seem trivial, and anything of consequence I might be able to write about, I find I'm unable to follow through with - partly due to lack of time and mostly due to unwillingness to share the depressing/weighty nature of what would be produced. Even addressing long-overdue subjects such as my trip to Haiti seems inappropriate, in light of recent events.

For these reasons and more, I haven't been writing. These days, I find I am continually having to remind myself: every day is a new day, every Sunday signals the start of a new week, no matter what happens, God has a wonderful plan for my life.

Perseverance must finish its work so that you may be mature and complete, not lacking anything. - James 1:4

More Bad News

2010-01-13T16:29:00.004-05:00

Today hasn't been a particularly good day. CNN has reported estimates of close to a hundred thousand deaths in Haiti. All the major news stations on TV seem unable to cover anything else right now. Whereas yesterday, I had assumed that the fallout wouldn't be too bad, now I find myself fearing for the lives of the many friends (most of whom reside in Port-au-Prince) we made several weeks ago. Please keep this nation in prayer as the people struggle to recover and rebuild for the next few months.

Photo credit: The New York Times

Thoughts on Haiti

2010-01-12T18:45:00.008-05:00

Articles have been reporting the collapse of a hospital in Port-au-Prince, which is quite tragic - and a bit ironic. Life has been more than a bit chaotic since coming back last Sunday, and it's been difficult finding the time to write to all the wonderful Haitians I've met, to blog, to share reflections on this past trip, and to update with pictures. But reading about what's just now happened in Haiti, I am reminded of the two principal realizations I was able to come to while abroad for winter break. These are obvious conclusions, to be sure, but it's one thing reading and hearing other people talk about something, as opposed to living and experiencing it for yourself.

1. The world is a big place - and we are extremely fortunate to be living in America. With all of our modern comforts, pleasures, and amenities, it is so easy to forget that the great majority of the human population does not live like we do. Over the course of my life, I've traveled to about twenty or so different countries (six of them in the past year), and it's taken long enough for this realization to hit home. More than witnessing the degree to which poverty exists in another country, I think it just sunk in that far more people on planet Earth spend their lives in these poorer living conditions than do not.

2. The long-term impact (clinically speaking) of medical missions (at least, the kind of mission we were on in Haiti) is close to insignificant. This is a belief that is commonly held in public health classes and sectors - how relief efforts are temporary, a quick fix, a Band-Aid at best. I witnessed this first-hand as we attempted to serve the local populations of Port Salut. We served over 1,200 people: provided them with all sorts of medications, donations, glasses, optometric care, and dental care. But at the end of the day, their medications will run out within a month, their diseases and infections will return, and their access to health care will continue to be virtually nonexistent.

Combined, these two observations/conclusions help me to think again about what I want to be doing with the rest of my life. On the one hand, it's become clear to me that trying to change the world through medical missions won't be the most effective way to go about it (from a health standpoint). I guess I never thought about the situation the way a medical missionary would think about it, which is to say this: medical missions works because medicine is a vehicle to share the Gospel. Nothing less, nothing more. Of course the physical needs of the people are of concern to those who serve out in the missions field, but at the same time, I think there is an acceptance of the fact that it is not medical care which will revolutionize and change people's lives - only Jesus can do that.

On the other hand, I feel like I would like to make some kind of difference from the purely physical/health standpoint - and if that is my desire/calling, it will have to be through some sort of public health/policy modality. How to incorporate the Gospel into this type of vision is another question that I haven't begun to think about, but I'm sure these two hands are far from mutually exclusive. This renewed interest in public health may fade just as quickly as it came about (as it did towards the end of my summer in India), but for the time being, I'm happy with where I am. It takes a bit of pressure off of the need to perform well on the boards in five (!) months, and it's helping me to stay (slightly) motivated as I continue my (ever-arduous) studies this semester.

So that's that - I wasn't planning on it at the beginning of this entry, but I think I've completely addressed all of the biggest thoughts I've had since Haiti. Which leaves only pictures - I'll post some more of my own later on, but in the meantime, check out the following links:

http://picasaweb.google.com/ben.lok/Haiti2009BestOfPhotos?feat=directlink

http://picasaweb.google.com/ben.lok/Haiti2009Keepers?feat=directlink

http://www.flickr.com/photos/esoosse/collections/72157623148854968/

In the News

2010-01-12T17:55:00.005-05:00

Today's highlights range from inane...

To mundane (but still of interest)...

To grave:

Shylock's Assumption

2010-01-06T17:05:00.005-05:00

"If you prick us, do we not bleed?"

Yesterday, in our first hematology lab of the year, everyone got the chance to practice their venipuncture skills on each other. After getting stuck about five times by my classmate, we gave up and switched. I drew blood on him without too much difficulty, but he is a fine specimen of athletic ability and physical fitness, and his veins were easily visible and palpable. I, on the other hand, have been known to have small, thin, veins - somewhat visible, but barely palpable and virtually unreachable. Only well-experienced nurses have ever drawn blood from me without any trouble, and so I was expecting this sort of trouble going into yesterday's lab. I felt bad and wanted to offer more veins (perhaps in the hand, or in the leg) for my friend to try, but though I may not bleed when pricked, I do feel.

Ouch.

A Fresh Manifesto

2010-01-06T16:09:00.004-05:00

I'm not quite sure where to begin. Last year ended with a hectic frenzy of finals, mostly inadequate Christmas shopping, last-minute hang-outs, car repairs, and botched snowboarding trips. It culminated in my leaving for Haiti early morning on the 26th, and I didn't even get a chance to update regarding my intended absence and what I would be doing while abroad. I do plan to write something more formal and comprehensive for everyone who supported me (along with photos), but for the time being, I'm going to put that particular update on the back burner.

I arrived back in New York this past Sunday night with moderate difficulty, which was all I could hope for, considering the relative ease with which we (our large team of 30) landed in Port-au-Prince and traveled around the country. There was no time for rest or dilly-dallying, as classes picked up at 9AM the next day and went straight 'till 4PM. This appears to be the typical schedule for this semester, and for a change, I plan on attending all of my classes.

Going to Haiti was enlightening in several ways, and though I wasn't expecting too much, I find myself armed with more motivation to study than I have had since starting medical school. Not only have I developed a bit more interest in clinical affairs, I have also come to a greater appreciation for free time and proper time management, after experiencing a highly efficient usage of time during our one week running clinics, both during the work day and afterward. At the same time, we can all already sense that this semester is going to be different.

Though the feeling of productivity that accompanies sitting through a full day's worth of classes is somewhat sublime... the physical/mental exhaustion that follows is difficult to manage. There are plenty of hours in the day, and specifically, in the evening to accomplish the necessary hours of studying and reinforcement for the class material, and yet I find myself unable to strike that balance. But overall, this is a problem I don't mind having. For once, it's nice struggling with finding the energy to study as opposed to finding the drive to study.

As several professors seem to have stated already in the last few days, the stakes are definitely higher from here on out. It's no coincidence that our schedules are packed more than ever before, that ASM (our clinical skills course) is picking up like crazy (after all, we'll be on the wards in July!), and that everyone is looking to remain as focused and determined as possible. There is still a good amount of material to learn before Step 1 in June, and on top of all of this new learning, it's time to start reviewing everything we are supposed to have learned in the last year and a half. Ideally, I would like to stay on top of everything I am learning in class on the weekdays and focus on the boards during the weekends.

But in the end, I'm coming to the realization (one that I am reminded of time and time again) that it's OK if not everything goes my way. The G-string on my guitar snapped this morning, barely two months after I had replaced the set (I broke another guitar string on someone else's guitar in Haiti). My Vaio PC is out of commission because it contracted some sort of uber-powerful web-browser-debilitating virus before break. I can't seem to keep myself awake during the first lecture following lunch. The heating radiator in my room blows cold air instead of hot. I consistently forget to address the million responsibilities for extra-curriculars and such that I've been neglecting for months. And the list can go on and on...

At the InterMed retreat last spring, I attended a seminar on prayer and was given the following advice: instead of constantly asking God what His vision for my life is, constantly seeking that knowledge, I should simply ask God for the ability to obey, whatever that plan turns out to be. A difference of "Lord, what do you want me to do with my life?" versus "Lord, I trust you completely and want to obey you in all that I do." The concept is one part abstraction and one part avoidance, but I feel like it applies to what I want this next semester, and really, the rest of my school years, to look like. I need to lose that mindset of scoring as high on the boards as possible, padding my resume with the most impressive activities, matching into the most prestigious residency... and focus on living a lifestyle that is balanced, fulfilling, and most importantly, pleasing to God. And everything will follow from there.

At least, that's what I hope for; that's what I pray for; that's what I believe.

Happy Christmas

2009-12-25T09:13:00.004-05:00

It's been a busy week, and there are lots of things to write about... but now is not the time.

Joy to the world - the Lord is come.

And...

Avatar

2009-12-19T15:59:00.004-05:00

I laughed, I cried, I sighed. I am definitely not a fan of these sci-fi, alien-type movies... but this is one film you really need to see (preferably in Digital 3-D/IMAX).

Pharmacological Gripes

2009-12-15T14:59:00.007-05:00

There are only two more exams before winter break. At 11:59PM this coming Sunday (at the latest), I will be finished with 1.5 years of medical school. First up is the pharmacology exam, which I will have to take by Thursday night at the latest, and last is our Brain and Behavior exam, which closes on Sunday at the aforementioned time. Overall, this semester has been similar to last year in several ways, mainly relating to my ineffectual study habits, horrible work ethic, and inability to engage with or grasp the material being taught to us (which I reiterate for the 14th time, John!). It's a shame, because it's only when exams roll around that I start to appreciate how interesting (sort of) and important (sometimes) our classes are.

Take pharmacology, for example. All of medicine revolves around this course, and any medical research of consequence involves the eventual application and utilization of this important field. But one thing I am finally starting to learn for myself is how imperfect of a science medicine is (as opposed to reading about this same concern in books written by Atul Gawande). This upcoming exam will test us on the various mechanisms, properties, and adverse effects of over 150 different drugs. I don't think I'm even halfway through them yet, but I can already see a pattern. For many drugs that have proven effective in treating a disease, the biggest problems lie in the host of adverse side effects the patient will have to endure. You can prescribe clozapine to treat schizophrenia, but along with that you'll have to prescribe a variety of other medications to deal with the resulting metabolic syndrome and other symptoms caused by the blockade of various receptors by clozapine (muscarinic, histamine, alpha-1, etc.).

In the end, it seems like pharmacology, and to expand upon that, medical treatment as a whole, is often just a giant crapshoot. Doctors do their best to be scientific, "evidence-based," and logical with the whole process, but the underlying principle is basically trial and error. See what works, the best combination of drugs and procedures, and do your best to mimic that in a real-life setting. Half the time, the exact reason a medication works is unknown, and it is then characterized with the fluffy label, "disease-modifying." But I guess it's difficult to expect any more of medicine than this. There have clearly been centuries of teaching and research that have gone into establishing this institution which, for the most part, works miracles every day.

Problems arise because most people, physicians included, fail to acknowledge these important limitations of medicine. Science can only take you so far - and doctors who invest their entire beings in a broken system will eventually end up disappointed. When I was writing my various personal statements for both undergrad and medical school, I often described medicine as "my calling." But my mindset has changed since then. I want medicine to describe what I do... not who I am. Which leaves that last, ages-old, fundamental question:

Who am I?

Discipline

2009-12-10T00:27:00.007-05:00

Something I require in great quantities; something I require in many areas of my life; something I will have to fight to attain; something I will be unable to achieve on my own.

Then the LORD answered Job out of the storm. He said:

"Who is this that darkens my counsel
with words without knowledge?

Brace yourself like a man;
I will question you,
and you shall answer me."

- Job 38:1-3

Falling Apart

2009-12-06T21:19:00.004-05:00

It seems unlikely that my brain will be able to get me out of this hole that I've dug for myself.

A Fresh Season

2009-12-02T00:48:00.006-05:00

Tim Keller and Redeemer Presbyterian Church were featured in New York Magazine this past weekend:

http://nymag.com/news/features/62374/

It's a good read, providing an overview of the church's history, theology, and future directions. Almost as interesting as the article itself, if not more so, are the comments that have been raging back and forth since the article was first posted. When I first checked it, there were about 30 comments. At the time of this writing, there are 108. This article is in the top five on New York Magazine's "Most Popular Stories" board: Most Commented (#4), Most Viewed (#3), and Most E-mailed (#1). Clearly, there is some polarizing content to be found in there.

In other news, "Scrubs" Season 9 quietly snuck up on me and premiered this evening on ABC. I hadn't been keeping up with any of the announcements since the show supposedly concluded last spring, except that it had indeed been renewed for a ninth season. And so I was caught completely by surprise when I turned on the TV at 9:15PM and found myself watching a "Scrubs" drastically different from what we've come to know and love in the last eight years. Not that there's nothing to love in this new approach to this classic show. Basically, we've shifted gears and are introduced to many of the principal cast (JD, Turk, Cox, Kelso) working in a new capacity: medical school professors. The focus of the series now shifts to three (or four?) first-year medical students and their relationships with said professors, both in and out of the classroom, in and out of the hospital. The show has moved to an entirely new lot with brand-new sets (as opposed to the old hospital they had been using up until this season), and it shows.

It's exciting to see all of these changes that have taken place (there are more, which I haven't revealed for those who have not yet watched last season's finale, ahem ahem) and I'm hoping that the show will be able to maintain its momentum once the novelty of these changes wears off. Zach Braff is only signed on to do six episodes, Sarah Chalke (Elliot!) will probably guest-star in a similar number of episodes, and the only official regulars from the original show are Turk and Cox. I'm not sure how I feel about that. Also, we (a roommate and I) did notice several inconsistencies in the experiences of these "first-year" medical students and our own experiences from last year. To be fair, we were fairly disoriented and reeling from all of the changes for much of the time, considering we missed the first ten-fifteen minutes which were probably spent explaining what's happened since we left off at the end of last season. All the same, I laughed loudly and laughed often - which bodes well for the future.

I always get over-excited about "Scrubs" and end up devoting an inordinate amount of text to the subject. Sorry if I lost you somewhere in the middle there. School is bustling on as it always does, though I feel like I am never trundling along with it. This probably has a lot to do with the fact that I am never in class. These days, I am in need of discipline.

Can you tell?

Bits and Pieces

2009-11-28T23:42:00.006-05:00

In the last week, I watched four movies: An Education, Fantastic Mr. Fox, Michael Jackson's This Is It, and The Twilight Saga: New Moon. Three out of four of these movies received great reviews; one was labeled a stinker (can you guess which?). Unfortunately, the only movie I enjoyed was Fantastic Mr. Fox. An Education was well-made with great acting and the like, but ultimately fell flat with its too-neat ending, leaving the viewer wholly unsatisfied. I'm not sure what I was expecting from the MJ movie, but I wouldn't call it a movie. It's basically an overlong compilation of behind-the-scenes footage combined with repetitive clips of various people singing his praises. And New Moon was exactly how the reviewers on Rotten Tomatoes described it. Fox, on the other hand, was short, sweet, clever, funny, artistic, and unique. I'm a sucker for feel-good movies.

We spent our Tuesday evening at a jazz club (Dizzy's Club Coca-Cola) on the top floor of the Time Warner Center: a place with somewhat-fine dining, a terrific stylish atmosphere, and a spectacular view of Columbus Circle and the East Side skyline. Performing were a quintet of various musicians, including Bucky Pizzarelli (pictured above), Ken Peplowski, and Derek Smith. Watching Bucky and Derek play, who are both in their 80's and late 70's, respectively, was sweet assurance that even as I get older and older, lose more and more of my various capacities and abilities... I will always have music.

Thanksgiving weekend up until now has been filled with a lot of playing and chilling. There was a large luncheon with various families at my parents' place on Thursday, and the rest of the last few days were spent mostly with friends, either watching movies, having coffee, walking along the Edgewater boardwalk, shopping, or karaoke-ing. Yesterday, I finally changed my phone after two and a half years. I'm surprised my old phone held up as well as it did for all this time (considering how roughly I treat my phones). My newest toy: the Nokia Twist. I chose it almost entirely for its novelty - it's funny having a square phone, and tricky getting used to the way it "twists" open. But it's also awesome.

Now I am back in New York. All of this time off from studying has been like a dream - it feels like it's been a long time, but it was all much too short. There's less than a month of school left, but I find myself already looking forward to January. Sort of. I am eager to move on from this painfully-mediocre semester... but I am terrified of next semester and having to face the reality of medical school (though long overdue).

I can hardly believe November is already over.

Life Lessons

2009-11-23T09:38:00.004-05:00

This past Friday, Sam Murray won a million dollars in the "Who Wants to Be a Millionaire?" Tournament of Ten. How the tournament works is pretty straightforward: the top ten competitors in the last few months of this season are each given one shot to win a million dollars by answering one question, with a few minutes extra time, but no life-lines. Each competitor is allowed to walk away with the money he/she has already won (ranging between $50-250,000), or they can guess and have their winnings reduced to $25,000. And if they answer the question correctly, of course, they win the million. Of the ten, Sam Murray is the only one who dared to make an educated guess and go for it, risking a good chunk of his winnings for the chance to earn significantly more. Here's the kicker: although the other nine contestants chose not to answer the question and walk away with the money they had already won, each (or ~8/9) when prompted to offer their best guess, "just for fun," guessed correctly. Sometimes, in life, you have to trust your first instinct and be willing to take a risk - it will almost always be worth it.

Last Tuesday or Wednesday (I cannot recall which), I was jamming away on the gui-tar with one of my classmates when I broke a string. The last time this happened was in college. The thing is, a guitar should have its strings changed regularly if it is played often enough and is to be properly maintained. My brother is always talking about the need to change strings once every month or two, at the minimum. I always found this excessive, as the cost for new strings would quickly add up, and breaking a string happens so rarely that otherwise, one would not need to replace his strings for years on end (as was my case). I replaced all six strings (this is standard procedure when you break one string) and have since been enjoying the fresh, crisp sound of shiny new strings on my well-broken-in guitar. The first week or two following a guitar's restringing, there is a need to constantly tune the guitar, as the strings are always going out of tune with the process of stretching and adjustment. And I do realize that in another couple of weeks, the clean and clear sound of these new strings will fade, as the strings begin to oxidize (?) and gather the usual coat of crud and grime. But if I am to hold onto this new sound, one that I much prefer to the usual sound I have been settling with (pre-changing of strings), it will require all of this work and maintenance: changing strings regularly and constantly tuning. Sometimes, in life, changes are important and necessary - constantly challenging yourself with unfamiliar situations and monitoring the way you react and adapt will maintain a brighter and more productive lifestyle. Otherwise, you'll get stuck in a rut of complacency and snap like a broken string on the gui-tar.

If you couldn't tell by the lack of updates in the last week, or the most recent entry following that brief pause (see below), it's been a slow week. I finished my last pre-holiday exam on Thursday afternoon, but I spent barely any time at all studying for it, so it wasn't much of a burden to bear. Since then, there has been a lot of eating, playing, watching movies/shows, reading Harry Potter, and fooling around. If it weren't for the pharmacology problem set due tomorrow, and a few other important matters to take care of before I head home for Thanksgiving (probably for just a day or two), I feel like things would spiral out of control and I would lose all sense of academic responsibility. Or is it too late for that already? I am still waiting for myself to magically transform into "a serious medical student." And I am quickly running out of time. Sometimes, in life, you can't expect change to happen overnight - you have to surround yourself with constant reminders and make a practice of self-control, discipline, and diligence. Key word there being practice.

Uh, yeah. Nothing big planned for Thanksgiving weekend. There will be an Intermed retreat the following weekend. Finals the couple of weeks following that, and then Christmas. I will be spending a good chunk of winter break in Haiti on a medical mission trip (more to come on that later, hopefully). And then it will be 2010. It's way too early to be thinking about the end of the year. Or is it?

Elf Yourself

2009-11-22T22:56:00.002-05:00

Send your own ElfYourself eCards

Not quite in season yet, but I couldn't resist. Enjoy! (And try it yourselves - the disco version is pretty hilarious as well, provided you can find the right pictures.)

Weekly Update

2009-11-15T11:23:00.005-05:00

It's been a rough week, in many ways. Monday through the early hours of Thursday morning were completely overcast by the shadow of our pharmacology exam. Friday was mostly a recovery day, capped off with a spectacular concert (David Crowder) in the evening and chicken and rice (the chicken and rice) late at night. Saturday was a busy day, with volunteering at the "Father's Heart" homeless shelter in the morning and praise practice in the late afternoon. We tried to study in the evening but ended up eating a lot of food and playing games (Settlers, for the first time in close to a year!) instead.

Today, we will be checking out Times Square Church in a few hours - and then we'll study. Or watch Fantastic Mr. Fox.

Today is Sunday. And I'm ready for a...

Purpose

2009-11-09T10:13:00.003-05:00

I am often losing sight of what I'm doing here.

For (significantly) better quality audio, click here.

23 Pictures

2009-11-04T14:13:00.008-05:00

[All photos should be enlarge-able. They are unprocessed, and courtesy of Hannah Chung. Photos by Frank He will be available at a later date.]

Last weekend, we visited...

Walden Pond.

We went mainly to check out the fall foliage.

(Clearly not a priority for some people.)

Photographer #1...

...and the boys.

An underwater park bench!

Photographer #2.

The entire trail was matted with leaves... look at all the colors!

There was a lot of light in this clearing.

"Signature shot."

Gum.

Awkward.

Content.

One of the few group shots we managed to take.

"Beneath these Stones lies the Chimney Foundation of Thoreau's Cabin 1845~1847 - 'Go thou my incense upward from this hearth'"

South Boston harbor.

A great candid, taken by a great photographer.

I got into some trouble shortly after this was taken.

Three-headed monster #1.

Three-headed monster #2.

We are in North End, waiting in line to get into...

Giacomo's!

We drove over to Brookline for dessert at Finale with two special people afterward (not photographed here).

OK! I'm ready for winter now.

Eventful Tuesday

2009-11-03T21:53:00.010-05:00

I started the day much like any other day. I woke up early to finish a pharmacology problem set, endured two hours of discussion of said problem set, and sat through the first hour of a lecture on schizophrenia given by the president of our hospital. Afterwards, I went downtown to Union Square to meet up with Hannah, from where we would continue on towards Momofuku noodle bar. While we were killing time waiting for my classmates to head downtown, taking photographs and such, we noticed a large number of elves congregating in the park area of Union Square (we witnessed mainly the last 30 seconds of the following clip):

Following this amusing display, we walked over to 1st Ave., in between 10th and 11th streets. Four of my classmates joined us and we were seated for our "chicken dinner" lunch - a reservation that usually has to be made months in advance (but one we happened upon because of a fortunate circumstance), for a $100 fixed menu of fried chicken, mushu pancakes, and various greens/sauces to go with it all. The chicken was great, the place was packed, we didn't receive our second helpings of pancake, but we received ice cream on the house instead. The picture to the left is pulled from Google - I will probably upload the pictures from our particular lunch, once the opportunity presents itself.

After lunch, we stopped by Momofuku's milk bar a few blocks away for a cookie/piece of pie and eventually ended up in Central Park. The plan was to take a leisurely stroll over to the Mall area from 59th Street, and maybe wrap up the day with a few hours of studying at the Lincoln Center Barnes & Noble. Instead, we went as far north as Belvedere Castle, realized we overshot it by quite a bit, and doubled back to finally check out the Fountain, Mall, and Literary Walk area. Despite its fame, I had never been there before. It looked very different from all of the pictures and videos (Where The Hell is Matt?, Enchanted, etc.), mainly because it was dark by the time we got there. It was pretty deserted, a little bit eerie, and everything I imagined it to be.

Finally, we were rather tired by the time we made it back to Columbus Circle, so we decided to have some coffee and relax at the Borders in Time Warner Center. As soon as we stepped inside the building, we noticed it was much more populated than usual. There was a huge crowd right outside of Borders, and flashes going off every second. The whole scene was very reminiscent of the time my college roommate and I went to the local used bookstore in Berkeley and happened upon Jane Fonda giving a talk and promoting her new book. To my half-surprise and pseudo-delight, the entire cast of Glee was seated at a long table signing copies of the new Season 1 soundtrack, just released today and pictured to the left. I say half-surprise only because one of my classmates at lunch had mentioned seeing two of the cast members in SoHo earlier, and I say pseudo-delight because though I have been enjoying the show, I am not familiar enough with any of the cast members to know any of their real names (except maybe Mercedes Jones, a name that's pretty easy to remember).

It's days like today I appreciate living in New York City.

EDIT: See Hannah's blog ("bananas in space") under my "currently reading..." links at the right for more pictures from Momofuku!

50 is the New 30

2009-11-02T17:53:00.005-05:00

Happy Birthday, Mom.

October 31st

2009-10-31T01:23:00.006-04:00

The last few days have been great - much needed rest and recovery from the preceding week of exams and other academic responsibilities. We're rounding out the week by spending the next day and a half here in Boston, visiting old friends and doing the tourist thing. I've been meaning to post a few pictures from the various trips and excursions these last couple of months, but I'll probably wait until next week to do so. In the meantime...

Happy Halloween!

An Aside

2009-10-26T15:56:00.003-04:00

I am finally starting to get a little excited about health care reform:

http://www.msnbc.msn.com/id/33479225/ns/politics-health_care_reform

A Brief Respite

2009-10-26T13:55:00.003-04:00

How do you pronounce "respite?" Is it "RES-pit" or "re-SPITE?" (Or is it both? The answer is always both.) This past week has been a maddening interchange of debilitating procrastination and frenzied productivity. This was the first weekend I found myself faced with two exams at once, in addition to various labs, problem sets, extra-curricular responsibilities, and a research poster to boot. I am about halfway through the struggle - hence, this is my respite.

I waited until the eleventh hour (almost literally) to take the musculoskeletal final last night, but luckily it turned out okay. We received an e-mail just a little while ago, saying everyone had passed. Which wasn't too surprising, considering how straightforward (read: easy) most of the test was. But I had no time to take a break, because our posters for the research fair (which will be held at the end of next week?) were due today, if we wanted free printing. Also luckily, I was able to recycle many elements of a friend's undergraduate research poster, which saved me a lot of time in terms of design and busy work. The final result is a pretty poster, though one severely lacking of content. Which also isn't too surprising, considering the nature of my research.

Still to come are the problem set for our pharmacology session tomorrow morning and our second brain and behavior exam which I will have to take by Wednesday afternoon at the latest. Then, and only then, will I be able to thoroughly relax for the first time in what feels like forever. Even so, it will only be a week or two until the next exam. The grind continues.

I realized just a little while ago that I have to take the brief moments of freedom and rest as they come. Throughout the school week, I make time to watch the latest episodes of all my favorite shows, but I justify it by noting how short they are (I had a 20-minute-show policy until Glee came along). I won't, however, allow myself to watch a movie or read a book (leisure) in good conscience, simply because I know that I should be using the time to study. I end up wasting a lot of time anyhow, but the decisive act of choosing to use a few hours for an activity that isn't academically oriented... is difficult.

And then I thought about it, and it turns out I am actually reading for fun occasionally. I started a book (The Good Thief, by Hannah Tinti) before the school year began, and I'm a little more than halfway through it. In the beginning, I did devote an hour or two to sit down and read it, but once classes picked up, it was left to gather dust on a shelf. Except for when I went to the bathroom. To handle my business. Traditionally, I used to go to the bathroom (for a bowel movement, not to urinate) just once every few days (sorry if that's TMI). I grew up most of my life not realizing that that is actually kind of unhealthy. I have phases when I am more regular, but they don't come along too often. These days, I am going fairly regularly, and as a result, I have been able to make progress through my book.

I am only reading a few pages at a time, and I won't take the time to fully indulge myself (though if I did, I could probably finish the book within a few hours). The pace that I am going at, the little snippets of story that I am receiving, the small moments of leisure (while I'm on the toilet) - all of these are enough. And it's the same with everyday life. A few minutes on YouTube. A few songs on the guitar. An episode of something or other on TV while eating. A blog entry while taking a breather between assignments/exams. It may seem like I'm wasting time, but in the end, I know I am making some kind of progress.

In work, in music, and in life, rests are often just as necessary as the activity being undertaken, or the notes being played. Otherwise, everything will fall to pieces. And so I will enjoy my brief respite... and then go back to work.

Chinese Christian Rappers...

2009-10-20T13:49:00.004-04:00

... for the win. First is a new single released by MC Jin (AKA Jin the MC from BET's 106th and Park, back in the day):

And this one is by Jaeson Ma, a well-known preacher/rapper from California (check out his blog at http://jaesonma.com):

Ask the Audience

2009-10-19T17:54:00.003-04:00

My roommates and I are fond of watching certain game shows. During lunchtime, at 12:30PM, we watch a fair amount of "Who Wants to Be a Millionaire?" on ABC.

I had no idea it was still running, but apparently it's been going strong. There have been a few changes since it first debuted many years ago. Regis Philbin has been replaced by Meredith Vieira (for some time now). They got rid of the "fastest finger" thing, and now contestants are just brought out one by one to answer questions. The first five questions or so are ridiculously easy, and so most contestants are guaranteed around $5,000. Following those, however, the questions get pretty tough pretty fast. And so it seems like there is a higher turnover of contestants than there was in the past. But I might be making that up.

They've added a life-line (after you get past a certain point), called "Ask the Expert." They've modified a few of the existing ones, such as "double-dip" (as opposed to 50:50), and allowing for multiple friends on the "phone a friend" life-line. The one life-line that's remained untouched is "ask the audience." This has always been a fairly reliable one for questions that are earlier on in the game. I have yet to see an incident when the audience has been wrong.

Today, in a class on valvular defects, we were presented with a few questions on aortic stenosis in the middle of the lecture. They gave out electronic remotes, and all of us were expected to ring in with what we thought would be the correct answer. It was pretty cool, actually. The lecturer gave us a minute or so to configure the remote, ring in our answer, and afterwards, he was able to display the results on the next slide. I could practically hear the "dee-doo-dee-doo-dee-doo" music of the "Millionaire" show playing as the bars popped up, presenting the distribution of answers. I actually clapped my hands in excitement when this happened, and my classmate sitting next to me picked up on this, exclaiming sarcastically, "ooh, technology!"

In both cases, the majority of the class (over 50%) voted for option B, which represented "syncope" as the answer for the first question, and a specific graph comparing aortic and left ventricular pressures as the answer for the second question. Both times, the correct answer was C. Both times, the majority was wrong. Both times, the audience failed.

There's a lesson to be learned here. The majority of a general audience will always be correct when polled about any variety of subjects, ranging from the mundane to the extraordinary. And... uh, never trust an audience of future doctors .

Dee-doo-dee-doo-dee-doo-dee-doo-dee.

Higher Than Mine

2009-10-15T15:26:00.009-04:00

There's nothing sweeter than the taste of freedom. A canceled obligation is like a breath of fresh air, and lately I am being hit by gust after gust of blessed refreshment. There are two situations in which these feelings manifest themselves - A. The fulfillment of an obligation (e.g. endorphin rush after a long run, feeling of liberation following a long tutoring/TA-ing session); B. The cancellation of an obligation (e.g. deciding not to have HIV testing in clinic this Saturday, showing up for prosections only to be sent back home ten minutes later). There is a time and a place for each situation, and while I should be gravitating towards type A situations, I find I am often seeking out type B situations. This is my principal problem.

I have always known it, but I often gloss over or plainly deny just how lazy I am. What's worse is that I am not the kind of lazy person who is satisfied staying where he is, doing whatever he's doing. I have ambition and goals (almost entirely selfish ones) that extend far beyond my reach; and I am never willing to put in the necessary hard work. I am a lazy fool with delusions of grandeur. I often reflect on my shortcomings, but rarely do I take any action to remedy them.

Sinai has a unique program called the Humanities and Medicine Program. The philosophy involves accepting a more diverse, well-rounded cadre of students into medical school who may not have chosen the medical field were they not presented with this opportunity. Only humanities or social sciences majors are eligible to apply in their sophomore year of undergraduate studies. Applicants are required to demonstrate a passion for what they are studying/pursuing, and in doing so, justify their acceptance into what is essentially, a back door into medical school. What do I mean by that? The biggest draw of the HuMed (as it's referred to here) program is the early acceptance. Though accepted applicants are obligated to attend Sinai once they graduate several years down the road, here are the perks: MCATs are not required, organic chemistry is not required, physics is not required. The typical pre-medical requirements are halved, essentially. And there is no need to go through the grueling application process, not to mention tackle the beast that is the MCATs. Being free of these various obligations will allow the accepted applicant to pursue his passions to the fullest, undistracted and unconstrained. Such a course of study in undergrad will hopefully lead to more compassionate and humanistic doctors. That's the theory, anyhow.

The program doesn't have the best reputation among the general student population here, due to a fairly consistent string of coincidental acceptances (i.e. many accepted applicants tend to have connections to Sinai faculty). Many students also feel cheated (and jealous, I would imagine), having worked so hard to get where they are... only to meet a group of students who reached the same destination by a completely different, often seemingly more appetizing, route. I am not one of them. Why? I was a HuMed reject.

At the time when I applied, I told myself I would not apply to medical school again if I wasn't accepted into this program. I would take it as a sign that I was not meant to be a doctor. I worked harder on that application than I had ever worked for my college applications, and my numbers (SAT score and GPA) were far above the average for those accepted into the program. In hindsight, it's easy to see why I wasn't accepted. I did end up pursuing anthropology quite thoroughly by the end of college (a significant factor contributing to the interviews/acceptances I did receive later on), but when I was applying back in sophomore year, I hadn't done much of anything. I was simply looking for that quick, fast, easy shortcut into medicine.

I have asked myself many times in the last year and a half why I ended up here, regardless. It seemed like I would have a decent chance at many other schools I would have preferred; I was relatively happy with my interview trail and experiences; surely, HuMed didn't work out so that I would get into an even better school later on? But that wasn't it. Maybe God wanted to humble me. He is well aware of my delusions of grandeur and my excessive pride - sending me to a top five school may not have been the best thing for me. At least, that's what I told myself last year.

Now that I think about it again, the answer is even more plain. Perhaps God always intended for me to go to Sinai - and he just wanted me to work for it. There are no shortcuts in life, I have always been told. With my track record of seeking out what is easy and fast, maybe my whole application experience will serve as a lifelong reminder of how you can't expect to get anywhere by taking back doors and coasting on along. There is a set path, long, tortuous, and winding... and the way home is the simplest and most intuitive there is: step by step.

The weather has shifted dramatically this past week. As one of my roommates describes it, we seem to have skipped fall and moved straight into winter. Temperature is in the 40s, though it feels even colder. Today, it has begun to rain. And I don't mind one bit.

⁸ "For my thoughts are not your thoughts,
neither are your ways my ways,"
declares the LORD.

⁹ "As the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts.

¹⁰ As the rain and the snow
come down from heaven,
and do not return to it
without watering the earth
and making it bud and flourish,
so that it yields seed for the sower and bread for the eater,

¹¹ so is my word that goes out from my mouth:
It will not return to me empty,
but will accomplish what I desire
and achieve the purpose for which I sent it.

Isaiah 55:8-11

Disclaimer: Nothing against the HuMed program - my point is that it wasn't right for ME, because I am lazy and need to be constantly reminded of the fact.

All or Nothing

2009-10-13T00:44:00.006-04:00

I guess I've mentioned OCD once in the past few entries, in the context of fictional character Dr. Kevin Casey. The guidance counselor from Glee (I don't usually do hour-long shows... but this one is worth checking out for the biting humor and fantastic music (not the melodrama)), Emma Pillsbury, is another such character pretty clearly afflicted with this condition.

We haven't learned much about psychiatric diseases since coming to medical school. There was that course in "Behavioral Science" at the end of last year, but I didn't attend a single class - probably barely passed. The psychiatry unit of our neuroscience course this year is coming up. In any case, what I know about OCD is that everyone has obsessive-compulsive tendencies. When it reaches a severity that can cause great suffering and/or debilitation, I would assume it is then that a diagnosis and medication would be helpful.

So what are some of my own OCD-like symptoms? I would argue that most of these aren't too strange at all, though some have argued differently...

If I own something sleek/pretty (e.g. my black MacBook), I'll develop a pseudo-obsession with keeping it spotless. I carry around a cloth with my laptop and make sure to use it when pulling the laptop out of its case. I wipe down all of the surfaces at least a few times every few minutes, and with particular vigor if I happen to notice a smudge anywhere on the casing. A little bit of dust on the screen doesn't bother me too much, however.
I develop the same mentality with my car - if I notice leaves or other debris on the windshield or body, I have to remove it instantly. Whenever I spot a bird poop stain, I pull out a wipe from my trunk and clear it off right away. It bothers me when people open and close the door by grabbing/pushing the glass of the window, as opposed to the door handle or door frame (my car's frame doesn't extend all the way around the window, which is why most people end up touching the glass so often). The kicker is that my car is quite old, not particularly well-preserved, and has plenty of scratches alongside its body.
If I am ordering at a restaurant or fast food joint, I will go out of my way not to order the same dish or item ordered by any member of the party I am with. It used to bother me when two or more of us got the same thing, but I am getting better with this one. It's alright if we get similar things, especially at Wendy's, for example, as long as the combination of items is varied. With Chinese take-out, if two of us happen to order the same main dish, I'll get mine with brown rice (as opposed to fried or white).
Whenever I take a drink from a public water fountain, I've developed the habit of counting off the gulps/seconds I drink for - usually it'll have to be seven or ten.
Every night I set my alarm clock for an arbitrary time in the morning - however, this time will always have to end in an odd-numbered digit that is not five or nine. So basically, the time I set it for has to end with one, three, or seven (e.g. 7:31AM, 6:47AM).
This was more severe in college than it is now, but whenever I come across a person (e.g. a television or movie star) or subject that I am not familiar with, I have to spend an adequate amount of time on imdb.com (Internet Movie Database) or Wikipedia researching the necessary background and accompanying information. I was particularly thorough with this several years ago, and used to waste hours reading up on all the various plot summaries for a TV show's entire run, just because I happened to come across an episode while channel-surfing.
Whenever I walk past any reflective surface (e.g. mirror, car window, storefront), I can't help but check myself out to make sure everything is in order - no matter whether I've seen my reflection just the second before, or whether I'm running late for a meeting. This one is probably just me being vain. I also developed a habit of looking in every car window I pass to see whether the car is automatic or manual.

I'm sure there are more, but these are the immediate ones that come to mind. For me, the biggest problem with having a slightly obsessive personality is what happens when things don't go the way you want them to (which, naturally, they won't). I seem to have developed an unfortunate attachment to an "all or nothing" mentality - which clearly presents problems in my daily life. It probably started during the end of high school, when I started losing weight by watching what I eat/exercising.

As anyone who has ever tried dieting can attest, the second you cheat, you feel like quitting the whole thing entirely. Carrying over into freshman year of college, I had a phase where I ate a lot of healthy food (lots of vegetables, believe it or not). But every time I ate something that didn't match the parameters of my ideal diet, I would end up bingeing on junk food for a couple days, telling myself, "eh, might as well." It was the same with exercise. If I ever broke with routine, missed a workout at the gym, or didn't get up to run one morning, what would follow would be a week or so of inactivity - half dejectedness at being unable to maintain the discipline I desired and half relief for having found an excuse to be lazy.

Since starting medical school, I realized that I've adopted this attitude with my studies as well. During college and all the years before that, I never saw my classes this way - they were just something that had to be dealt with, no matter what, and if you fell behind, you had to work your hardest to catch up, as soon as possible. Nowadays, if I miss a few lectures, begin to find that I'm having trouble with the material, or am unable to maintain an ideal study schedule, I retreat into the cave of my room and drown myself in the world of YouTube (for example). At least, that was last year.

This year is a little different. I still have all of the bad habits that developed over the course of last year, but I'm being forced to do something about them. Living with roommates who are constantly studying has been a largely positive influence. Dating a girl who is immersed (ha!) in graduate studies has been a far more productive use of time than whiling the hours away on the Internet, even if we are only half-studying every time we get together to study. The enormity of board exams in less than a year and the fear of life on the wards next year are beginning to weigh heavy on all of our minds and souls. It's about the right time to start being a "serious medical student," as I've joked I've become since purchasing my piano. I haven't, not by a long shot. But I'm feeling fairly confident that I'll get there. Everything is still just as hectic as it was a month ago, and I guess things won't really settle down. It's just a matter of learning how to handle everything at once, and seeing things in the proper perspective.

Tonight, I'm more optimistic than usual. Tomorrow, I may decide I don't want anything to do with medicine upon graduating (a situation I've thrown around (half-jokingly) many times in the last few months).

Currently listening to: Relient K - Savannah (from their newest album, Forget and Not Slow Down, check it out, it's great.)

On Cupcakes

2009-10-08T22:00:00.003-04:00

They say cupcakes are in fashion these days. I feel like they have been for a while now - who doesn't love cupcakes? I used to eat a lot of cupcakes when I was in elementary school. Back then, it was customary for kids to bring in cupcakes for the entire class on their birthdays. I was never able to do so, being a summer baby and all. Between the sixth grade and college, there was a long period in which I did not eat cupcakes. Not for any particular reason... I was just into other things. Like Spam. And Chinese food. After I quit being a fatty towards the end of senior year in high school, my body's metabolism flipped out on me for the next year or so and made me start craving sweets like never before. I developed my sweet tooth during the second half of freshman year, and I've enjoyed many a cupcake since then.

But really, it's since coming to New York that I've been eating many, many cupcakes. They're all over the place: the classic red velvet cupcake, the banana cupcake, the pumpkin cupcake, the PB&J (oh, yes) cupcake, the green tea cupcake, the vegan (blah) cupcake. Some of the more popular places I've tried:

- Magnolia - I just realized, I haven't actually had a cupcake from here. I had a slice of the red velvet cake. Which was pretty good, but nothing special.
- Crumbs - A large selection with a very unique variety of cupcake (this is the place with the PB&J cupcake, among others)... but they are huge. Each cupcake is muffin-sized and very difficult to eat on your own.
- Babycakes - This is the vegan bakery. Probably enough said (maybe I'm unfairly biased).
- Two Little Red Hens - One of my roommates brought home a box of cupcakes from this local joint a few hours ago. We destroyed them, piece by piece, each of us sampling all five flavors (vanilla, chocolate, carrot, pumpkin, and red velvet). Hence the inspiration for my most recent G-chat status: "For a bunch of guys, we sure love cupcakes."
- Kyotofu - I don't think this is much of a bakery. It's more of a restaurant/tofu place (as the name might suggest)? But their desserts are pretty bomb (yes, I just used "bomb"). I had a green tea cupcake here that was delicious, though heavily over-priced.
- ChikaLicious - The cupcakes from this place (pictured above) on St. Mark's are the simplest - and the best (in my opinion). Something about the combination of cake and frosting here just... works. Be sure to try the banana cupcake sometime.

- Honorable Mention - Another one of my roommates is very fond of baking. He is quite talented, and his passion is baking cupcakes. They turn out very well, and don't last long whenever he whips up a batch (incidentally, I just saw Whip It last night... it was mediocre). And by "don't last long," I'm implying that they get eaten very quickly by the rest of us (in case that wasn't clear). Check out his blog under my "currently reading..." links - "my baking experiments."

I guess I've been paying more attention to the cupcake culture since moving here, despite having had many good cupcakes in California as well. I know there were at least a few places in So-Cal that were halfway decent (ha), but for the life of me, I can't remember their names. I'm finding that I can't recall a lot of the names of great restaurants/places I've been to while in college. Which is a little sad. But life goes on, right? It moves at a brisk pace. OK. Maybe I'll write about burgers next time. Or not. (-_-)

Impulse Buy

2009-10-03T22:38:00.004-04:00

The timing is terrible, my funds are quite low, and it is the eve of our first Brain & Behavior exam. But it was an impulse that would not be denied. After weeks of intense monitoring on both Craigslist and eBay, one purchase and subsequent refund of a brand new product, a spontaneous road trip to Philadelphia, and close to five hours' worth of driving - success.

Moving On

2009-10-01T00:47:00.003-04:00

The following is a clip from one of my favorite Scrubs episodes of all time - "My Catalyst," Season 3, Episode 12. I love this episode for a variety of reasons, most of them having to do with the special guest star, Michael J. Fox (I've always been a big fan). He plays a visiting attending who is doubly specialized in medicine and surgery (which doesn't really happen in real life). He is personable, incredibly smart, and talented to boot. As a result, Dr. Cox, Turk, and JD all get riled up by the end of the episode because he makes them (Cox and Turk) look like fools (just because he's that good) and mocks (unintentionally) JD's neediness in desiring a mentor figure. The twist to the story is that Fox's character (Dr. Kevin Casey) suffers from a severe form of OCD (obsessive-compulsive disorder) - a situation reminiscent of Fox and his struggle with Parkinson's in reality. Anyhow, as I listened to JD summarize the lesson he's learned at the end of the episode, I figured this would be a good follow-up to my previous entry.

"I think owning your burdens is half the battle... Still, it's not that daunting if you look around and see what other people have to deal with."

Ramblings

2009-09-29T21:41:00.006-04:00

DISCLAIMER: I try not to do this so often, but I've produced another long, boring, and quite incoherent rant of sorts. I wasn't going to make it public, but now I figure, might as well. Sorry!

September's nearly over and I don't have too much to show for it. I took my Genetics final this morning, and thus concluded the first course of my second year - and it was a rather fruitless/trivial one. For about one week, we will only have Brain and Behavior (our neuroscience course) and Musculoskeletal (the first module of our pathophysiology course) to deal with, in addition to ASM (our clinical skills course, always ever-present). After that, I think our Cardiovascular unit starts up, followed by Pharmacology a week later. I might have the two of those mixed up.

Now that we're more than a few weeks into the school year, I can say that things have settled a bit. The hustle and bustle of managing all my extra-curricular activities has died down, though we will have to deal with training a much larger group (for our free clinic's HIV testing/counseling program) than we originally anticipated. Being an anatomy TA keeps me busy, but is definitely a reasonable commitment. As far as classes go, the workload/difficulty of material hasn't been too different from first year courses. I still feel like I'll be fine, as soon as I get my act together (that was my line all of last year as well). Of course, things are expected to pick up as we continue along the year, and I might be singing a completely different tune another month from now.

Every now and then, I go through phases when I really start contemplating what I should be doing in the future, whether I should take a year off after third year, and even what other things I can do with my life outside of medicine. This happens relatively often, and was another common theme of last year, though I don't know how apparent that was in my various writings. I had hoped to resolve a lot of these issues over the summer, but that didn't happen either. I ended up sitting on most of them/tabling them for later. The last few days was another such phase - I hit a new low yesterday as I bemoaned my general situation as a medical student plus the recently acquired burden of going home on the weekends again (for another tutoring gig, though only Saturdays and just for a month or so). It's always difficult for me to adjust back to going home again when I've been away for a little while - and I'm not quite sure why. My parents spoil me consistently, leaving me with guilty feelings. And lately, my dad has taken to expressing his views about certain things he would like me to be doing (mostly related to his church) in a manner that also leaves me feeling guilty and a bit frustrated, though there is never any tension or anything like that.

But I digress. It was mostly my specific situation this week: having to deal with exams, activities, and just overall life as a student. After a phone conversation consisting mostly of my whining about these basic responsibilities (read: my being a baby), I realized that I've been pretty silly for the last year and few weeks. Despite all my joking about just sticking out medical school to earn the degree, and then doing something else, I'm fairly certain that I'm meant to be a doctor - that I'll be a decent physician (or surgeon) and that I'll enjoy my job. I think being exposed to all of the many opportunities in this field (medicine), being overly ambitious too early on in my career (or is it too early?), and just plain being lazy has done an effective job of clouding the real reason I am in medical school at the present time. And that's fairly obvious - I'm here first and foremost to learn how to be a doctor. I'm going to be practicing in less than three years, with patients and colleagues alike calling me Doctor, expecting me to know what I am talking about and what I am doing.

At some subconscious level, I don't think I've fully accepted this fact. If I really believed that I will be a doctor after I graduate, responsible for people's lives, why aren't I trying my hardest to learn, to make the most of my opportunities and experiences here in New York as a medical student? I think I need to take a few steps back and take a more practical approach to my education. The first step would involve me getting my head out of the clouds, filled with grand delusions of changing the world, and scoping out realistic specialties based on what I can see myself doing in ten years, and what I can see myself doing for the rest of my life. No matter what I choose, I need to have the best record possible these next few years, which would involve my applying myself, studying hard and learning the material properly - so I can perform well on Step 1, and more importantly, during third year rotations. And as far as a year off? There seem to be a vast number of different options, something suited for everyone. So I'll figure it out.

There are certain things I've learned about myself this past year, despite my confusion and ambivalence about what I like in medicine and what I should be doing. I've found that many of my decisions and impressions from last year have been very telling. For example, my choice to get involved in EHHOP, specifically with the HIV testing program. My desire to see HIV patients as part of one of our ASM modules. My respect for and envy of the many students and doctors who are able to speak Spanish fluently. My decision to go abroad for the summer to do research, when I could easily have stayed here. While in India, my aversion to spending any time in the hospital going to rounds or observing surgeries, choosing to focus my energies on befriending the locals and learning the language instead. I feel like there's a reason this past year has turned out the way it has, and that my activities and pursuits have done a good job of reflecting what my true interests and values are - though that sounds obvious now.

And yet, if there's one thing I actually managed to learn over the summer, it's that these interests and values are constantly changing. As I approach third year and think about spending more time on the floors and actually practicing medicine, the prospect of doing research in a lab, working with attendings, assisting in surgery - all of this is beginning to sound more appetizing. Last year, I just needed to get away, as often as possible, and I needed to be doing something different. This year, even as I nurture my interest in academic medicine, I'll continue to remain invested in global health, under-served populations, and the like.

But I've already strayed from my initial point: I'm a student. More specifically, a doctor-in-training. Therefore, I should be valuing my education more than I have been thus far. And I should be concentrating on learning, instead of dreaming dreams and making plans for the future. So that's the epiphany I came to at some point last night.

All of this was a bit of a ramble - and I definitely could have organized my thoughts better. But it's here for future reference, even if I don't make this public. Hopefully I'll be able to come up with something more interesting to post before October hits.

The Road Less Traveled

2009-09-23T00:50:00.003-04:00

The Road Less Traveled is a book written by M. Scott Peck, MD - a psychiatrist. It was written close to 30 years ago and has been a bestseller ever since. My dad is a big fan, and he has been recommending it to me and my brother for several years now. I only started it this past summer while in India, and I got about halfway through before the school year started. Now it is sitting on my bookshelf, woefully neglected for the last month or so.

Dr. Peck isn't the most engaging writer, but his material is well-organized and he presents his points very clearly and meaningfully. I can see how many of the ideas and thoughts he espouses in this book were novel for the time they were published, and though I've heard it all before, it's still slightly inspirational/motivating to read it in a more original context. The tales of Peck's relationships and encounters with his patients definitely help move the text along, and they were effective enough to make me consider a career in psychiatry. Unfortunately (or fortunately?), psychiatry as it is practiced today is probably unrecognizably different from the psychiatry Peck practiced in the seventies.

He divides the book into two principal treatises on the practices of discipline and love, followed by a discussion of religion and grace. I still have a lot to cover if I am ever to finish the book, but in the meantime, there are two points he makes that I've been thinking about lately - they've been particularly relevant to my learning experience as a medical student.

1. Delaying Gratification - This is how Peck describes this subject: "a process of scheduling the pain and pleasure of life in such a way as to enhance the pleasure by meeting and experiencing the pain first and getting it over with. It is the only decent way to live." When I was a child, my parents used to marvel at the fact that I would cut away all the white in a fried egg, eat it first, and save the yolk-y parts for last. To me, it made (and still makes) perfect sense. Clearly, I should eat the best-tasting bits last. I can employ this mindset without a problem when it comes to food, but I've always had a problem adopting a similar approach when it comes to schoolwork and academics. At some point in high school, I developed the many bad habits associated with procrastination and I've never really grown out of them since. Even now, here I am updating my blog and doing various things online when I should be preparing for my small groups and discussion sections tomorrow. I'll work on them first thing in the morning.

2. The Work of Attention - Peck writes about this subject in the context of love, and how love is truly expressed through commitment, often the commitment of time. Talking about how difficult it is to truly listen to someone, he describes the experience of attending a particular lecture: "I therefore listened to him with all the intentness of which I was capable. Throughout the hour and a half he talked sweat was literally dripping down my face in the air-conditioned auditorium." This year, I've been doing a good job of attending my classes (for the most part). There isn't much point to it, though, the way I "attend class." I don't know when it happened (sometime in college), but I've somehow lost the ability to focus and really concentrate on what the speaker is saying, to concentrate only on the material that is being presented. I guess it comes down to a matter of the will - at this point, I am never willing to listen "with all the intentness of which I [am] capable." And that is a problem.

How do I go about effecting change in my daily lifestyle? I'm not really sure. I have a hard time disposing of old habits (though it would seem some of these poor study habits are not that old). But I was (relatively) diligent in college, and I ended up satisfied with my record and the way things turned out (for the most part). I can only hope I can say the same when it comes time to make some of the important decisions that will define my education and my future - i.e. the end of this year. More on that later. Probably.

A Healthy Dose of Fear

2009-09-17T21:40:00.005-04:00

Classes: It's been one week and a couple of days since second year officially started. It feels like it has been much longer. Second year is noticeably busier than first year. The days are longer, starting at 8AM, often plowing through the morning with four hours of lectures, and an additional two-four hours of lecture, lab, or both in the afternoon. Every so often, there will be a day (usually Monday or Friday) with the afternoon off. Tomorrow is such a day, and I will be using it to (surprise) study my butt off. We had our first test/quiz of the year in genetics this past weekend, and I performed pretty horrifically. Luckily, there will be plenty of chance to redeem myself, and apparently, "no one fails genetics." Yesterday, I submitted a pedigree to my course instructors for extra-credit. This pedigree was based off of song lyrics written by a folk musician on YouTube (search "I'm My Own Grandpa," pretty amusing, actually) - only the finest quality education for Mount Sinai students.

Activities: Part of the reason school has been so much busier is because of the various activities and responsibilities I've taken on this year. Because it has been the first week of school, all of us have been busy running around from meeting to meeting, planning fresh activities and getting things in order for the new year. At the worst, I had four different meetings in one day, in addition to all of my classes. This year, I am one of many TAs for our first year anatomy course, and this has turned out to be a bigger commitment than I had anticipated. Still, I am enjoying the experience, meeting the first-years and offering them my knowledge (of which I have plenty, clearly). I think I did a good job this week of convincing them I know what I am talking about. I'm sure it will be difficult to maintain this illusion as the semester progresses. Talking with the first-years has been almost unsettling in some way. It's still strange to think that I am no longer a first-year, and seeing them in my position from last year evokes mixed feelings. It makes me wonder what I have taken away from this past year, and how much I've really grown, if at all.

Everything else: This year will be different in several other ways. I am now living with close friends, as opposed to upperclassmen strangers who stayed in their rooms all the time. Hannah is now a mere 70 blocks away, as opposed to an ocean and a continent away. I am no longer going home every weekend, which means that I am no longer attending my father's church. I mentioned going to Redeemer that first Sunday of September; this past Sunday, we attended the Brooklyn Tabernacle for the first time. The worship there was amazing, and I left feeling more refreshed after church than I have been in a long time (the last was probably in South Africa). The church has an amazing testimony and they seem to be doing a powerful ministry in the local community. I will almost certainly go back at some point - I guess we'll see what happens.

I am (very) slowly learning to manage my time, and I am doing my best not to be intimidated by the busy-ness of my schedule, the weight of what I am learning, and the commitment required of my various activities/relationships. But to be perfectly honest?

I'm a little scared.

Research Recap

2009-09-14T14:02:00.001-04:00

In case anyone was interested...

PREVALENCE OF HIV INFECTION IN PREGNANT WOMEN IN RURAL VILLAGES OF JAMKHED PROJECT, INDIA

Ki Won Kim, Shobha Arole, Ramaswamy Premkumar, Natasha A. Anandaraja, Global Health Center, Mount Sinai School of Medicine, New York, NY 10029.

Introduction: HIV prevalence in the general population of India has shown signs of stability in this new millennium. Despite this, a significant burden still remains and can only increase if efforts at prevention are not scaled up. In published recommendations for treating pregnant women with HIV (2006), the WHO recognized that a “disproportionate burden has been placed on women and children, who in many settings continue to experience high rates of new HIV infections and of HIV-related illness and death.” This research project sought to obtain current rates of HIV prevalence and identify potential risk factors in the pregnant population served by the Comprehensive Rural Health Project (CRHP), a community health organization based in Jamkhed, India. A prevalence study in the same population in 2000 revealed an HIV rate of 0.7% among pregnant women.

Methods: The project covered 11 randomly selected villages that receive CRHP services. Data were collected over one month, beginning with identification of all pregnant women in these villages. This was accomplished by working with the various community health workers and their respective health records. After counseling and consent, 138 participants had peripheral blood samples collected and tested at CRHP via the TRI-DOT Rapid HIV test. A questionnaire was also administered to collect demographic information and determine presence of risk factors.

Results: The prevalence rate of HIV among the population tested was found to be 0%, despite the substantial presence of risk factors such as nomadic lifestyle (12.3%).

Conclusion: The apparent lack of HIV infection in pregnant women in Jamkhed villages can be attributed in part to the work CRHP has done in the area over the past two decades. Through increasing knowledge of disease and encouraging constructive health practices, CRHP has maintained a pregnant population virtually free of HIV burden.

49 Pictures

2009-09-10T18:04:00.016-04:00

Without further ado...

This is the campus we stayed at for a little less than two months. On the right, the two-storied building you see is the old hospital.

And this is the new hospital: beautiful.

This is our class of 15 - for one month (a little less for some), we studied community health and the "Jamkhed Model" together.

This is the mural we worked on (painted on one of the walls of the new pediatrics ward) tirelessly that last weekend before the course ended. This is an "in-progress" shot, taken the first day of painting.

This is the final product (almost) - picture taken just a few days later at our graduation. There has since been a red dot added to the map to mark where Jamkhed is.

These are just a few of the faces of the many VHWs CRHP has trained.

There were lots of cows/cattle in India - this picture was taken at the local cattle market. They really love their bright colors there in India.

The native word for "India," Bharat, apparently means "spice" in Turkish. There were lots of spices: in the markets, in the food, in the tea, etc. etc.

There were also lots of tractors.

And cute kids.

And more cute kids - this picture looks like a Mac advertisement, no?

Ajanta (See earlier entry...)

And Kailash, in the pouring rain (didn't come out too well in the photo).

At Sautara, the local waterfall - more of a trickle, and you can barely see it here. I'm also in this picture, though it'll be nearly impossible to find me at this resolution.

Me chilling with the guys underneath the waterfall.

The entire valley/cliff landscape: it was pretty amazing.

Me with Hakim and one of the "dancing girls" (during Panchami).

Me and my research team, from right to left: Chandu, Prasad, and Rajasree.

The day after leaving Jamkhed - at the Church of the Immaculate Conception in Goa.

At one of Goa's many popular beaches.

This is a Chinese fishing net in Kerala. I don't know why it's called Chinese.

We were on that boat to the right, gliding through these Keralan backwaters for a day.

We had our lunch served to us on a giant leaf.

There was some classical Keralan theater in the evening.

And then we flew to Mumbai - I'm also in this picture, a little easier to spot?

Outside the "Oval Maidan" area in Mumbai, watching a cricket game. The Mumbai high court and University of Mumbai buildings in the background are just a small sample of the ubiquitous European architecture that characterized Mumbai.

At one of the beaches Bollywood stars like to go to in Mumbai, apparently, with our ex-pat host on the right and her daughter - we received absolutely royal treatment in this city.

This is Udaipur - the "White City" in Rajasthan, a state characterized by desert and mountains.

We took a boat to one of the palaces out on the lake. This is us, staging an argument.

We hung out in this type of cushy area for hours, enjoying the breeze, the fantastic view of the lake, and the mountainous scenery. One of the Bond movies, Octopussy, was filmed in this city, at various locations including that white island palace you see in the middle of the lake.

On our last day in Udaipur, we hiked up to the Monsoon Palace to watch the sunset.

This was the busiest intersection in Udaipur, clearly. Very typical of Indian traffic.

We're now in Jaipur, the "Pink City." Again, Indian traffic.

I didn't really enjoy Jaipur that first day, but the second day we went out to this place, Amber Fort - which was something else altogether.

This is Agra Fort - the first place we visited when we arrived in Agra. Agra was not a pleasant city, and it is famous only because it is where the Taj Mahal was built. The reason we were at the fort, and not at the Taj Mahal, is that we unknowingly scheduled our one day in Agra on a Friday - the one day of the week the Taj is closed. Heartbroken, we were forced to settle for lesser monuments like this - though the fort was pretty cool.

This tomb was nick-named the "Baby Taj." I repeat: lesser monument.

And then we found our way to the Taj's backyard. There is actually a river separating these gardens from the back of the Taj. The gardens themselves were kind of dumpy. But we were as close to the Taj as we were going to get. And so we had a hard time deciding whether it would be worth coming back from Delhi just to go inside the actual walls and see the full thing...

In the meantime, we decided to take pictures with all those silly poses we'd be too embarrassed to actually do in public (the gardens were pretty deserted).

Yeah.

We left Agra and moved on to Varanasi. These are some Buddhist ruins at a small town outside of Varanasi (Sarnath). Notice the large stupa (we had fun with this word) in the background.

It almost looks like we took this shot with a blue-screen. The colors were really pretty at sunset. We're at the ghats by the Ganges river in Varanasi - definitely one of the cooler places to visit in India.

This river is extremely holy to Hindus, who come from all over to bathe in the river, die by the river, and die in the river. We saw examples of all three of these.

Taking the obligatory sunrise boat ride. Too early.

This is the Manikarnika ghat, the most popular place for locals to come and be cremated. Note the smoke and various fires.

Eventually, we decided in Delhi that we should take the four-hour trip back to Agra to see the Taj properly. It was worth it.

They took a lot of these "Bollywood dance" pictures. A lot.

This was the best I could manage.

We left Jamkhed on August 8th. Five overnight trains, one day train, two domestic flights, a few private taxis, and an endless number of rickshaw rides later, I was very tired of traveling through India. We met some great people, both at Jamkhed and during our travels. We saw lots of pretty buildings, magnificent forts, and majestic landscapes. But we also met plenty of unyielding beggars, greedy merchants, and shady characters. We saw all kinds of slums, many different diseases, and the oppressive effects of vast, vast overcrowding.

When I came back from my summer in the Middle East a few years ago, I was sure I'd be back someday. I still am. India? I've been telling people that I'd be OK not going back for a long time, maybe ever again. My feelings probably won't change anytime soon.

At least, until the next time I watch Slumdog Millionaire.

How Am I?

2009-09-07T00:43:00.020-04:00

In the last week or so, I...

Caught up on most of the movies I've wanted to watch: District 9, Inglourious Basterds, (500) Days of Summer. I actually never wanted to see (or had heard of) District 9, and I fell asleep at the end, but it was decent enough. 500 Days was a little different than what I expected, but definitely well-made and a lot of fun to watch. Basterds was my favorite - classic Tarantino at his best. It's probably telling that I fell asleep during District 9, which was about 2.5 hours, felt like 500 Days dragged, which was about 1.5 hours, and didn't want Basterds to end, which was also about 2.5 hours.
Took a brief road trip to the greater Boston/New England area. We spent our nights bumming around in Cambridge and took a day trip to Martha's Vineyard - the playground of the rich and white. I think I read an article in Time a while back that described the island as "a picture of racial harmony," while simultaneously quoting the statistic that "of its 65,000 summer residents, only about 3,000 are black." But because Henry Louis Gates Jr. says that Martha's Vineyard is "the most integrated community [he has] ever experienced," it must be true. The article was a bit fluffy, but the island itself was gorgeous: lots of picturesque beaches (despite the surprising number of (old) nude sunbathers), quaint houses/towns, lighthouses, and scenic drives. It's a bit of a hassle to actually get on the island and get around once you're on the island (with a hefty $130 price tag for bringing your own car there, we ended up renting one for the day) - but all in all, definitely worth the trip. I'll probably go back someday... when I'm richer and whiter.

In the last twelve hours or so, I...

Attended Redeemer Presbyterian Church for the first time. We went to the evening "jazz" service, though it seemed just like a classical service, with a few extra instruments thrown in the mix. The message was pretty good, though Tim Keller was nowhere to be found. Bummer. I bought his book The Reason for God yesterday. Turning to the Introduction to see what his writing is like, I discovered that he opens with a quote by Darth Vader. I'm already hooked.
Had a "Shack Stack" at Shake Shack for the first time. The catch - we didn't go to the Shake Shack at Madison Square Park. There's a new sit-in Shake Shack that opened up at 77th and Columbus. It's quite nice, and was very busy (though nowhere near as busy as its downtown counterpart). The "Shack Stack" combines a juicy cheeseburger with a huge cheese-stuffed, breaded/fried Portobello mushroom. If I had to describe it in one word: win.
Killed a fly by swatting it while it was crawling around on my desk. While I have been known to swat the occasional fly out of the air with my bare hand, I've never been able to do the same with a fly crawling around on a surface (desk, wall, arm, etc.). It was cool - one second it was moving, the next it was lying on its back with its legs up, blasted several inches from where my hand had made contact. It was a lot like what I imagine performing an Avada Kedavra spell on an insect would be like. Not that I think about these kinds of things on a regular basis.

It's Labor Day and I...

Am kind of freaking out about school starting on Tuesday. Things have already started rolling for several of my extra-curricular activities, and there are plenty of things backed up for my India wrap-up (i.e. reports, reflections, abstracts, etc.). As much as I had been looking forward to a steady schedule and attending classes again, I'm filled with a bit of dread at the thought of renewed duties, fresh obligations, and intensive studying.
Need to overhaul my various profile pictures and possibly the design of this blog. Unfortunately, my only resources are pictures from Africa or India, both of which I am trying to get away from at the moment. At the same time, I was browsing through my pictures from India and I realized (to my surprise) that I am looking forward to sharing several of these photographs! There are too many to choose from, and so I just need to set aside a time, pick out an adequate representative sample, and upload, upload, upload.
Will be busy cleaning my room, enjoying my last day of unfettered freedom with a special friend, and thinking about the million things I have to get in order for these next upcoming weeks. In that order.

Life is good.

Currently listening to:
- Keri Hilson - Knock You Down (ft. Kanye West & Ne-Yo)
- Black Eyed Peas - I Gotta Feeling
- Jackson 5 - ABC

Back to Reality

2009-08-31T08:24:00.004-04:00

I've been back from India since early Thursday morning. It's been a year since this blog was started! August has slipped through the cracks twice now. There wouldn't have been too much to write about, though. I spent most of this past month sight-seeing, and pictures will definitely speak louder than words. Unfortunately, I don't have the patience to upload any pictures right now (despite my promises from earlier entries). It's been a bit rough adjusting to being back in the States, mainly because of jet lag, reduced appetite, that kind of thing. There's a lot to update about, but I haven't been spending much time on the computer these days. And so I'll probably ease back into updating slowly. It'll come out in bits and pieces, as it always does (or does it?).

School starts in a week, and remarkably, I'm kind of looking forward to it. In the meantime, one of the few group shots we were able to have taken during our travels (yes, it's a little crooked):

And... We're Off!

2009-08-08T00:10:00.003-04:00

As always, I have run out of time and am desperately scrambling to get ready to leave - in twenty minutes. My Internet access will probably be a great deal more limited in the next few weeks. So this might be it! For the next 2.5 weeks, my itinerary:

Goa
Kerala
Mumbai
Udaipur
Jaipur
Agra
Varanasi
Delhi

Nothing more to say - see you later?

Happy Raksha Bandhan

2009-08-06T05:56:00.003-04:00

From Wikipedia:

Raksha Bandhan (the bond of protection in Hindi, Punjabi, Oriya, Assamese and most other Indian languages) is a Hindu festival, which celebrates the relationship between brothers and sisters. It is celebrated on the full moon of the month of Shraavana (Shravan Poornima).^[1]^[2]^[3]^[4]

The festival is marked by the tying of a rakhi, or holy thread by the sister on the wrist of her brother. The brother in return offers a gift to his sister and vows to look after her while presents sweets to her brother. The brother and sister traditionally feed each other sweets. It is not necessary that the rakhi can be given only to a brother by birth; any male can be "adopted" as a brother by tying a rakhi on the person, that is "blood brothers and sisters", whether they are cousins or a good friend.

Yesterday, I received three rakhis - one from a member of the mobile health team here, Ratna, who also happens to be Dr. Arole's younger sister. She's been a grandmotherly figure to all of us since we started our research and has a fantastic personality/sense of humor. The other two I received from my classmates and travel buddies for the next couple weeks. It's such a simple gesture and sentiment, but I was nevertheless touched each time one of these women came over with a rakhi and tied it on my wrist. Nearly every male I ran into that day (whether Indian or not) had received a rakhi or two, and many had the accompanying bindis brightly adorned on their foreheads. The whole "feeding each other sweets" aspect of the holiday did not seem to be practiced as widely. All in all, I found I much preferred this brief festival to the slightly-ordered chaos that was Panchami.

Anticipating Goodbyes

2009-08-02T03:38:00.001-04:00

This morning was our last Sunday service here. We stood next to Shobha (who is an ordained minister, on top of her being CRHP's medical director) and greeted each member of the congregation as they headed out. They wished us "happy journeys" and offered exclamations of "praise the Lord!" or "salaam." One of the women who came by is an AIDS patient who works on the CRHP farm. She has quite an amazing/sad life story, and I had connected well with her the few times I had been to the farm. Since the course ended, my only interactions with her have been at church on Sundays, but these were always limited by the significant language barrier. Today, we shook hands and smiled at each other. There was a bit of a pause, as we tried to think of something to say (considering this would be my last Sunday), but I felt as if my awkward Marathi would only ruin whatever sentiment I wanted to express. And so she continued to smile, said "salaam," and that was that. It was the first of many goodbyes that are still to come.

The whole time I've been in India, I've found myself frustrated or dissatisfied on several occasions, due to a lack of ability to communicate properly. When these occasions occur at inopportune times (such as the last time you will ever see someone), the sense of dissatisfaction is heightened. But at the same time, I'm realizing that, corny as it sounds, life goes on. The community here has seen countless numbers of foreigners come and go, and they easily accept the fact that they will never see most of us ever again. When all of us from America here for the course were splitting up several weeks ago, the goodbyes were often over-the-top and drawn-out. That is, several grand speeches were given, lots of hugs were exchanged, and promises to visit each other were made. In reality, some of us are just as likely to see each other again as we are to come back to CRHP at some point in the future - which is to say, not very likely. So I can appreciate the simple albeit slightly awkward goodbyes that will characterize this next week. In the end, that's all you can do for someone - shake hands, smile, and wish them all the best. Salaam.

Special Events

2009-07-28T14:08:00.004-04:00

Sunday: We drove out to see the local waterfall and the steep/misty valley it occupies. There was a bit of hiking and clambering-over-rocks involved, and so I had a great time. The highlight was jumping onto a boulder to join a bunch of the local guys who were chilling out, enjoying the water falling directly on top of them. They had stripped down to their underwear and were shrieking like schoolgirls. I made sure we got a good photo together (which I'll have to share another time).

Monday: For the last week or so, there's been a good deal of hype about the "Panchami" (pronounced similar to "punch-me") festival in town. The bulk of the celebratory activities have been in the last couple of days - these involve stages all over town filled with dancing girls and drunken men waving money/hollering at them from the ground. I had an interesting night out on the town with some of the sketchier friends I've made since coming here. It wasn't particularly unpleasant, but I am looking forward to a return to normalcy (without the obligation to go out and experience as much of the local culture as possible).

Tuesday: As part of the festivities, tree swings have become fashionable and popular diversions for the children. This swing is called a "zopala," which literally means "cradle." I tried one out in the village (Patoda) this morning, and it required a surprising amount of upper-body strength to propel myself to the necessary height (i.e. achieving a 90 degree angle). On a slightly larger scale, a fair (jatra) has come to Jamkhed. I hadn't ridden any type of carnival ride (i.e. ghetto, run-down, and barely functioning theme park style) since high school, and it was fun risking our lives on these rust-monsters for 10-15 rupees apiece. The machinery and engines running each of the attractions were clearly visible just feet from where people lined up to get on, with belts screeching, smoke puffing, and all kinds of creative repairs (e.g. plastic water bottles) attached on various parts. The fair itself was highly congested, and walking around was ridiculously messy, as town (and this part of town in particular) gets extremely muddy with even the slightest bit of rain.

In other news, my research has been going swimmingly. Despite all the unique experiences that happen every day as I go from village to village, my mornings have become mostly routine. We are a little bit past the halfway point, with six villages completed and five more to go. There have been close to 90 women tested and they are all negative. If all goes according to plan (and even if it doesn't), I should be finished by the end of next week. My classmates and I have officially decided to leave early, and we've booked all of our train/plane tickets (two train, one plane). We will be leaving CRHP on Saturday, August 8th.

That means that we will be traveling all over India for a good 2.5-3 weeks. And on the 26th or 27th, we'll be heading back to America. School starts on September 8th.

Hm.

Money, Money

2009-07-25T05:08:00.007-04:00

Disclaimer: The following is mostly a rant. It's quite boring and very long. Read at your own risk - you have been warned.

The first full work week is over and it's been pretty exhausting. I've been having trouble getting up in the morning, taking long naps in the afternoon, and going to bed late as a result. It's a self-perpetuating cycle that contributes to my general lack of energy and enthusiasm when I'm out in the villages. I was fine at the beginning of the week, but today, I could barely focus and force myself to engage others in conversation. I definitely could not stay awake during the long car ride to Mandawa. This last village we finished today was strange in the number of pregnant women it contained. There's been an average of 10-15 women per village up until Mandawa, and so we went yesterday prepared for no more than 20 women. We ran out of supplies and had to go back today to test the remaining 5-6 women.

It's become a practice of just going through the motions, and I'm fully aware that all the "data" I'm collecting regarding demographics and risk factors are highly biased and incomplete. At the end of the project, I'll be able to give a prevalence rate (probably 0%) and say something about the kinds of work (mostly agrarian) pregnant women and their husbands are doing in the villages, though this information will be mostly irrelevant. At the same time, progress has been almost three times as fast as we had originally anticipated. Dr. Premkumar and I had planned for six villages when we first started, and we quickly realized that we would be able to do more than that, so he added an additional five. If we continue at the pace we've been going, I'll be finished testing women and collecting my field data by the end of next week - two weeks before I leave Jamkhed.

So where does that leave me? We are considering an extended weekend trip to Goa a week from now, which would take us into Wednesday morning without breaking a sweat. If there is some carry-over from this upcoming week (which is probably likely), I can probably spend the rest of that week finishing up the remaining villages and tying up loose ends. And that leaves me with one week of nothing to do. I suppose I can start trying to analyze my data and putting together some sort of abstract/report, things I was going to deal with when I return to the States. The last and most far-fetched possibility for my dead time after I finish with the villages is to strike out on my own, leave Jamkhed early, and go traveling in the south for a week or so.

There are several incentives and disincentives to each and every single one of these scenarios. Not surprisingly, they are all financially related. To go in chronological order, my financial woes started a few weeks ago when I noticed that my subletter's remaining rent balance was late. This was frustrating because I need the balance to pay CRHP and go traveling - I had little to nothing left in my bank accounts. Luckily, the payment finally registered yesterday. It was three weeks late. Next time, I'll probably insist on having my subletter pay the full amount in advance (as was suggested to me from the start by an upper-classman).

About a week ago, I received my financial aid package from school and discovered I'll be receiving $10,000 less money in grants this year - the bulk of it will have to come from unsubsidized loans (which I barely used at all last year). Last year was too good to be true, and I feel like I'll be experiencing the medical student lifestyle (at least financially) for the first time this year. The fact that I won't be going home on the weekends and earning money from tutoring only worsens the situation. This is slightly frustrating because neither my nor my parents' tax information has changed drastically in the period of one year, but it was enough to lose that substantial amount of financial aid. I guess I need to come to terms with my inevitably gargantuan debt at some point.

Finally, the last financial stress factor has been from the entirety of my stay here. When we budgeted for this summer, we were told that living expenses would fall in the area of $1300. About a week before we left the States, we were sent an e-mail informing us that our two-month stay would essentially cost closer to $1800-$1900. I talked to the administrative director here as soon as we arrived, and he told us not to worry too much about it, that he would talk to our research advisor (Anu, from Sinai) and work something out. I was slightly reassured, but not much. Since starting my research, I've been incurring other unexpected costs as well.

Before the course ended, the medical director asked me whether I would be paying for all of the testing kits myself; I didn't know what to say - she said she would talk to Anu. As I actually started going into the villages every day, I realized the gas costs and personnel costs (for my team of four-five) would probably add up. I had been assuming CRHP would cover everything, but I'm realizing more each day that that is not a fair assumption. Yesterday, I was told I'm supposed to be paying each of the VHWs (village health workers) we consult in the villages 100 rupees/day for their services (the other students here have been doing so for their research). This is not a lot of money at all, but I was surprised because the VHWs I had been working with for the past week were completely helpful and cooperative without any talk of money. And now today, one of the VHWs at Mandawa tried to convince me that I had to pay them for two days' worth of work when they had in fact been paid for yesterday's already.

And that is the frustrating part of this whole situation. All of us who are here doing research have been getting the vibe (or maybe it's just me) that we are making life difficult for the staff here and that they are accommodating us in a great way by working with us in our research practices. This morning, one of the mobile health team members (probably half-joking) flat out said, "you are causing a lot of trouble for us!" What is unfair about this attitude is that these projects were assigned to us by the higher-ups here at CRHP - there (often) seems to be a fundamental disconnect between the staff working on the ground and the directors. Furthermore, my project specifically is supposed to be something CRHP does on a regular basis - testing all the pregnant women for HIV/AIDS (and I doubt they pay the VHWs in the same fashion that they are currently requesting from us). Maybe we are going about it differently (and much faster) than the way the process is normally carried out, but I feel like the burden of resources and funding shouldn't be placed on Sinai (or really, me, because we're certain Anu will tell the directors here we are on our own) just because we happen to be partnering up for research purposes this summer.

So I need to back up and put everything in perspective. At the best case, we'll be charged $1300-$1500 for living expenses and my research expenses will be footed by CRHP (with the exception of paying the VHWs, which will amount to ~$20 from me). I'll spend a couple hundred on travels for the last couple weeks in India, and I'll still start second-year with a decent surplus from last year (which pales in comparison to the new debt I'll be racking up from this year on out). Worst case scenario, I get charged much more than I had expected and I'll end up losing at least half of my surplus from last year (which will pale even more so in comparison to next year's new debt). I guess the moral of the story is this: I'm going to be broke no matter what happens... so I should stop sweating the small stuff.

The end.

Famous Firsts

2009-07-21T09:37:00.005-04:00

- Today, I drove a motorcycle for the first time. The last time I tried (several weeks ago), I could barely get it started (kick-start) and I didn't move around at all. This morning, I got it into gear (quite counter-intuitive: pressing the clutch with your hand and shifting with your feet) and spun around the compound plaza for a few minutes. It was great.

- Today, my friend sutured for the first time. She spent a good chunk of the day observing procedures and surgeries in the operating theatre. This afternoon, she scrubbed in for a C-section and was taught how to sew one knot. It sounded great.

- I am in the process of beginning to soul-search. Whatever that means. During this past school year, I recall having a conversation with another friend at a different school. He said, "it seems like everyone else is a lot more interested in medicine than I am." I agreed with him at the time, and I think I would still agree with him now.

- So when will I start caring as much as everyone else seems to care? Third year? Intern year? Residency? Will it be too late by then? Why am I more excited by the prospect of driving a motorcycle around than working on a patient in the operating room?

- These are important questions to consider as I prepare to transition into what will probably be the most unpleasant year of medical school. I've been saying that I enjoy my lazy afternoons and ample amounts of free time, and I truly do. But maybe I should make a larger effort to be productive and ready myself for the future. "Next week," I keep telling myself.

- After all, Matt 6:34 does say: "Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own."

- Right?

He Said, She Said

2009-07-20T05:39:00.006-04:00

Now that there are only five-six of us left, we've all been spending a good amount of time together in the evenings. We play games, we watch movies, and sometimes, we'll just sit around and talk for several hours. Saturday night, we stayed up till 3-4 AM simply chatting away, eating sweets and drinking coffee/soda. We watched In Bruges (second time for me, but enjoyed it just as much this time around) before that. As you might imagine, considering how late we stayed up talking, we discussed a great variety of topics. One area of interest was the dynamic between men and women in this country - this has been a running theme and a hot topic throughout the entire course as well.

We talked about how boys and girls (once they're past toddler age) do not interact at all, and how there is such a sharp division between men's activities and women's activities. More specifically, many of my female companions have expressed frustration at the fact that the male population (e.g. dining hall staff) here is so exclusive - not a single male member of the CRHP staff will feel free to be himself or just "hang out" with us until the females are out of sight and gone for the night. We've gotten to know much of the CRHP staff pretty well, to the point where we can joke around with them, and to the point where some can even feel comfortable drinking (which is quite taboo) around us. But by "us," I mean the guys here, absolutely not the girls.

Yesterday, after church, I went fishing with three of the locals (Hakim and Jabar, who I mentioned in an earlier entry, and Rais, a night watchman here) and one of the guys (a young doctor from Holland). This doctor (Wout) has been here for almost a year now, is quite fluent in Marathi, and has gotten to know everyone (i.e. staff) quite well. I was basically tagging along on their somewhat spontaneous Sunday afternoon outing. It was a lot of fun driving around the Indian countryside on a motorcycle, having a sumptous picnic of chapati and kima on the lake/reservoir-bank, and actually catching a few fish with the simple contraption of a stick, line, floater, and hook. We sat around, fished, drank beer, and snacked on the mildly spicy Indian trail mix that is popular here (depending on the variety, sometimes called persan or bhel).

One of the men was sharing stories of his female conquests, and overall, the whole situation was very typical of male hangouts in the States. The atmosphere reminded me of the time in college when a few of us went to a shooting range (which we considered to be very manly) and a Chinese buffet afterward. I was surprised, because I hadn't expected behavior of this sort from any of the guys here. All three of the Indians we went fishing with are married and have children, and I guess that contributed to my skewed pre-conceptions.

I realized that afternoon that certain things in life are universal, and I added male bonding behavior to that list. It was a little ironic that I had this experience after discussing how closed off men are (to women, at least) the night before, but even that I feel is universal. Men will always do things and say things in the presence of other men that they will never do or say in front of women. The level and degree of this comfort/openness may vary from culture to culture, but the principle is the same.

And "you've got to stick to your principles." Or at least, that's what In Bruges encourages.

Wrap-up and Kick-off

2009-07-17T04:46:00.005-04:00

- We finished the mural on schedule and cleaned up to the best of our ability. We made a complete mess of the floor, walls, sink, beds, and mattresses. We spent a few hours cleaning up and got most of the paint off the floor, walls, and sink, but the beds and mattresses are pretty much ruined - the mattresses especially. We felt terrible and offered to pay for new ones, but were told not to worry about it. The final product looks great, though after spending so much time working on it and looking at it, I have to admit that I have grown a little weary of it. I have finally started to compile some pictures, but they are too large and I can't upload them at the moment. Hopefully I'll figure something out.

- The class concluded with long presentations of our action plans and a nice little ceremony. All of the faculty wished us well in our future endeavors and presented us with shawls/stoles, leis of fragrant flowers, and laminated certificates. That was on Wednesday. Since then, people have been taking off in groups of 2-4 and the last two remaining students (not including the five of us staying on for research) left this morning. The goodbyes were sad, but not too emotional, and there was an overall sense that we would be seeing each other again someday - how likely that actually is, I can't say. Campus and mealtimes especially feel noticeably emptier.

- Monsoon season has come upon us (we think) and there is at least a little bit of rain every day. Stepping/walking in mud has become a part of everyday life. The days are slowly getting shorter (a sign that summer is progressing surely and steadily). And the bugs are as crawling as ever. Especially now that I am spending my mornings in the villages, I find myself constantly surrounded by flies, ants, and mosquitoes. I've been getting bit continuously for the last week or so (at a rate of 3-5 bites a day), but the fact that I haven't been taking my malaria medicine doesn't really worry me - this area is supposed to be malaria-free.

- We spent Wednesday evening getting things ready for our research and I kicked off my field visits first thing Thursday morning. It's been an interesting experience, to be sure. From spending extended amounts of time with one of my research advisors (Dr. Premkumar) out in the villages, I have been learning a lot about how to maintain consistency and thoroughness in collecting data. At the same time, maybe because he is old-fashioned, maybe because he is simply old, or maybe because it is his personality - he is often rigid and inflexible with his practices to the point of counter-productivity. More than this methodological stance, however, it is his lack of tact and sometimes downright rudeness that irks me. He has no problem criticizing members of our team if they are not doing something the way he envisions it, and he will insist on having everything done the way he wants it. Still, he smiles a lot and is generally very friendly - just stringent about his research (and that's the other thing: it's supposed to be our research, but a few of us have been feeling like lackeys working on his projects).

- But it's really just a matter of getting used to him. Today was much better than yesterday and I'm sure it'll be even better tomorrow. Moreover, he is leaving on Tuesday, so I will be going into the villages without him for most of the month. Our team consists of myself, Dr. Premkumar, Chandu (the percussionist for services/lab technician to draw blood), Prasad (a member of the mobile health team who helps with interviewing and having the subject fill out my questionnaire), and a woman (to increase the comfort level of the subject - this is usually the village health worker who will accompany us, and we try to get any female CRHP staff who is available to try and come with us each day).

- We leave campus at about 9AM and stay out in the village (we finished up Padali this morning) until 1PM. The first thing we do is talk to the village health worker, the Anganwadi workers (sort of like pre-K nurses), and the ANM (Auxiliary Nurse Midwife, a government nurse figure) to try and get the names of all the pregnant women in town. Whoever is in the immediate area or available to test is called and Chandu draws the blood. We have them fill out the questionnaire independently with the help of Prasad asking the questions. At Padali yesterday, we tested six women consecutively. We spent this morning driving out to the outskirts of the village and various neighborhoods that are associated with Padali but located farther out in the farmlands. Here, we asked around again to see if there are any pregnant women. Finally, we strolled around town for a little bit to get one last consensus of whether we missed any of the pregnant women.

- It's nice to go into the villages with an actual purpose and to be carrying out an activity (whereas our previous village visits were mostly observational/sitting in on meetings/walking around aimlessly). The pace is pretty relaxed, the team is very chill, and the weather is great (not too hot, no rain in the mornings). This morning, we spent more time walking on trails to get to the farther-out neighborhoods and Chandu was feeding me various types of greenery all morning. He gave me a small stick of sugarcane, some leaves from a tamarind tree, and Babytai (the village health worker for Kusadgaon) placed several immature (I think) tamarind pods in my hand to eat. It tastes much like mild sour candy.

- We only missed one pregnant women in Padali this morning because she had gone to town (Jamkhed). We spoke to her family, who served us tea and told us very casually that she was going to a hospital to check the sex of the baby. Revealing the sex of a fetus is actually illegal in India, because many (many) families will find out the sex and abort the baby if it is a female. This is precisely what this pregnant girl had gone to Jamkhed to do. The CRHP hospital does not condone this practice at all, and so she went to one of the many private hospitals in town who do offer the service for a good price. This pregnancy is her third child, and she has two girls already. People value having a male child to an almost ridiculous degree (to outsiders, at least) and as a result, India's male-to-female ratio is highly skewed. We had learned about this mentality during our course, but today was the first time I had witnessed it for myself; it was, to say the least, slightly disheartening.

- All in all, though, it's a great feeling being out in the countryside, surrounded by Indians (both CRHP staff and villagers alike), and losing that feeling of tourism/being gawked at that was always there when all 13-15 of us would go into a village as part of our course. We had planned on covering six villages throughout the next month, but we decided today we can try for closer to ten. Despite our relatively slow pace, four hours everyday is a long time to find out who all the pregnant women are and test them, so we can probably cover each village in 1.5-2 days.

- We make it back to campus by lunchtime, have lunch, and then I go over to hospital to run the rapid Tri-dot tests in the new hospital's lab (Chandu taught me yesterday). It's a simple process of adding buffer and conjugate to the blood serum, and it's very quick. Everyone is negative so far, and this will probably be the case for the entire study. I go to the library for a little bit in the afternoon to check my e-mail/affairs and do some data entry on my Excel spreadsheet. And then my day is pretty much over. There's going to be a lot of down time for the next month, and I am looking forward to it a great deal. In a week or so, I will probably be bored out of my mind.

- I'll try for a more dynamic and colorful entry another time. Holler.

Half-Time

2009-07-14T00:09:00.003-04:00

It's been exactly a month since we left the States, and we are just about halfway through our stay here at Jamkhed. By we, I mean those of us here from Sinai. Our course will be ending tomorrow and by the end of the week, it will be just the three of us and two other survivors remaining. The two others (from Emory and Duke) will be doing their own research project, and will be leaving after the first week of August. We will be taking off August 14th or 15th, leaving about four solid weeks for our respective projects. Until August 26th, we will be traveling throughout Rajasthan and the Delhi area, with an excursion to Varanasi thrown in there somewhere.

I've reached the point where I am starting to miss certain things about life back in America. Namely, food. This past week, the great majority of us have begun avoiding the plain rice and daal that we always have for meals and turning to PB&J (usually just peanut butter for me) chapati sandwiches as our sustenance. The food in India can be really amazing, but here in the compound, we literally have the same food two out of three meals a day, every day. With minor variations. Which is totally fine. But while we've usually had the chance to eat other foods on our weekend trips, this past weekend, we stayed here and missed out on the chance for a culinary escape. Hakim did have us over for breakfast Sunday morning, however - it was delicious.

The final assignment for the course is an "action plan," applying everything that we've learned this past month to come up with a project for any under-served area in the world (e.g. a North Dakota Indian reservation, Kashmir, urban Washington D.C.). A lot of people have been working hard on this last project, but a couple of us have been entirely occupied with the mural instead.

I've been getting up at 6AM for the last few days, and painting in shifts of 2-3 hours an average of three times a day. It's been very fun, peaceful, and exhilirating at times - the painting has turned out better than I ever imagined, and we are actually finishing it on time (roughly). Unfortunately, we made a huge mess while working on it, splattering paint all over the floor, neighboring walls, beds, mattresses, stools, and stands. Today we will attempt to wipe everything down and get all the paint off, but I am not optimistic. As with all things, the hardest part always comes at the end, and both weariness and drudgery are making it difficult to put the finishing touches on the mural and work up the enthusiasm to clean properly. I'll try and post some pictures in a few days.

Research starts on Thursday, and I will be going into the villages with a small team, probably consisting of a lab technician and one of my research advisors. My guess is that the busy pace of the last few days (week, even) will slow down considerably, and I am looking forward to that. But we'll see what happens when the time comes. Sorry for the boring update, but I've been living and breathing paint since my last entry - there ain't much else to share.

Early Morning Exercise

2009-07-09T09:37:00.003-04:00

Since coming to India, I've been exercising far more than I have been all year. Several of us go running in the mornings (7AM) every other day or so, and we've been fairly consistent for the last few weeks. There's a small dirt road that passes through the tiny neighboring village (hardly a village, at that) into the farmlands. There is always some kind of obstacle that prevents us from covering any kind of meaningful distance, however. Sometimes it is our fault, such as when we lose track of the trail/road, get lost, and end up having to turn back early. Sometimes there is a pack of angry dogs barking/howling at us from across the field. More often than not, parts of the trail/road get unbearably muddy, to the point where we end up with pounds of mud caked around each sneaker. This scenario has become more and more frequent in the last week, as monsoon season has slowly but surely snuck up on us.

Running through the neighborhood at so early an hour, we often feel as if we are intruding on the locals' private affairs. The animals are barely rousing, but the townspeople are busily about their morning activities: brushing teeth, bathing toddlers, washing clothes, and other types of household chores. There have been more than a few incidences of accidentally happening upon a local woman squatting out in the fields (the implications are debatable).

This morning, I was invited out for a walk with two of the guys who work at CRHP, Hakim and Jabar. Hakim has been the driver for our last two weekend excursions, and also the guy who drove us from Pune to Jamkhed when we first arrived. Jabar seems like a utility man who does a bit of everything around here, from bathroom repairs to construction. We've bonded over a mutual love for cricket. Well, it's not really mutual, considering I am barely learning the game and do not hold it in any particular esteem. But that is our connection, all the same. Apparently, they go for a walk every weekday at 5:30AM, and finish up by 6:30AM. Both guys are in their 30s and have wives and kids. They report to work at 8AM, and though they live fairly close by (I think), they seem to enjoy exercising at that early (ungodly) hour.

I joined them this morning with little difficulty, despite only sleeping five hours (late night of Mafia). We took off down the main road, which I discovered is far smaller than it seems from inside of a vehicle. Many of the roads (particularly in rural areas) in India look as if there is only room for one-way traffic. And yet, when the need arises, trucks, buses, rickshaws, motorcycles, bullock carts, herds of goats/sheep/cattle, and pedestrians all make room and find a way to coexist. It really is quite remarkable. At 5:30AM, this road was completely deserted.

The sky was a dull gray and the sun had not yet risen. There was enough light to make out my immediate surroundings and the features of my companions' faces, but not much else. We walked briskly for about twenty minutes and stopped near a small local road to stretch, do push-ups, etc. By this time, the sun had risen, though you couldn't tell, what with all the clouds occupying the expansive sky. I found this weather more peaceful than ominous, and it is always a pleasure to enjoy a bit of chilliness in India - even if it's slightly humid chilliness. Does that even make sense? There were just a few other Indians out on the road by the time we started back, wrapping up some form of exercise or meditation. And there was one old man who had just finished defecating on the side of the road (no debate here). There was one barking dog, which was wholly manageable and hardly a nuisance for Hakim and Jabar, though he seemed threatening enough to me.

We parted ways at the gate, as the men headed off to get ready for work. I hitched a ride back to my room hanging off the rear of my next-door neighbor's bike (that would be Vinod, the gardener). I went right back to bed, missed morning prayer for the first time since I've been here, and headed to breakfast.

About half an hour ago, I finished preparing my presentation on spiritual practices at CRHP, which I will give tomorrow morning. Tomorrow evening we will attempt to sketch the entire mural up on the wall of the children's ward, and over the weekend, we will attempt to start (and finish) painting it. There's one last project to work on for the first half of next week and then our course is over (Wednesday). Research will start immediately afterwards, on Thursday (hopefully). Time is slowly flying by. That was an awkward sentence.

That is all.

Ajanta and Ellora

2009-07-06T08:11:00.005-04:00

We spent our 4th of July weekend visiting some "caves" nearby the city of Aurangabad, which is located about four hours from Jamkhed. It didn't feel like Independence Day at all, and I found myself surprised every time I checked my watch to discover it was the 4th of July. We did have a spectacular fireworks display (put together by CRHP staff) last Wednesday night, which I now suppose served dual purposes - a parting gift to our friend Jayendra (from Bhutan), and an early celebration for this important American holiday (warranted because the majority of us visited the Ajanta caves on Saturday, followed by the Ellora caves on Sunday).

I've been able to update a lot more than I had imagined, but it is disappointing for me not to be able to post any photos or other similar visual aids. The camera that I brought here (borrowed from my parents) has been non-functional from the moment that I arrived (bummer), and though nearly everyone else here has been taking lots of pictures, we will probably not share any of them until the course is over - next week. The image of Kailash temple above (Ellora) is pulled from Google, but it does not by any means do justice to the real thing.

The whole time we were touring these caves (many of us were expecting American-style caverns), I kept thinking back to my visit to Petra in Jordan. The idea was the same - exquisitely carved monolithic structures. At Petra, the highlights were the details of the facades themselves. The interior rooms were often very small, plain, and if I remember correctly, surmised to be ancient tombs (built by the Nabateans). The striking contrast between these Indian caves and the ancient city of Petra is that at Ajanta and Ellora, the interior (carved straight into basalt rock cliffs) is every bit as elaborate and ornate as the exterior. Moreover, the interiors were designed to be functional, providing housing, worship halls, and even dining halls for the monks who lived there

The earliest caves at Ajanta date from 200 BC, similar to the time period Petra was constructed. Petra was made known to the Western world for the first time by a Swiss explorer in 1812. The Ajanta caves had fallen out of use many centuries ago and were covered by a great amount of debris and foliage until 1819, when they were re-discovered by a British officer who was hunting a tiger in the region. There are 20-30 some odd caves, and they are all Buddhist temples and structures. The rich paintings (murals, not frescoes) found in the temples are what bought great fame to these caves, but the sculptures and facades are every bit as impressive. The whole place was very clean, well-preserved, and well-staffed (informative guides, in particular).

The Ellora caves are actually more famous (mainly because of the pictured temple above), but most of us found that we preferred the Ajanta caves. Many of the sculptures at Ellora (which is known for the sculptures as opposed to the paintings, of which there are very few) were in various states of disrepair, and the whole place as a whole was smellier (more people urinating in various corners) and less regulated than Ajanta (less guard-rails, rope barriers, etc.). Ellora has 30-some odd caves, and these are mostly Buddhist and Hindu, with a few Jain temples towards the end. The Buddhist temples were not as impressive as those at Ajanta, but it was definitely a treat to see the Hindu and Jain temples (Hindu temples in particular were built with a completely different style).

Kailash, cave no. 16, is the most famous Hindu temple at the Ellora caves. The weekend trip would probably have been worth it just to see this structure alone. Unlike most of the other caves, which are carved directly into the side of a rock face, many of the Hindu temples are "cut-out" structures - which means they (ancient stonecutters) started at the top of a rock cliff, and basically carved a temple straight down. These efforts resulted in a gigantic man-made canyon/basin, with a beautiful temple complex as its centerpiece. The temple was reminiscent of many of the small Hindu temples I've been seeing around the countryside, but much bigger and far more elaborate. And of course, rather than being built from the ground up like a conventional building, this temple was carved entirely out of one gigantic piece of rock - monuments, roofs, towers, ceilings, floors, walls, bridges, stairs, walkways and all. Absolutely incredible. I'm sure I'm not doing a good job of explaining how impressive it was, but I was pretty blown away - more so than I was at Petra.

I would imagine that I'll continue to see lots of impressive structures and monuments when we embark on our travels after our research finishes, but this past weekend was a good taste of India's remarkable history and heritage. All of our mostly low expectations were exceeded and we returned home for dinner at a local restaurant (Sahara) highly satisfied, though not hungry at all (the quantity of food I consumed this past weekend was the most I've had in a long time).

Otherwise, the rest of this week will be occupied with several of the things I mentioned in my last entry, and there probably won't be much traveling until our research finishes (mid-August). As I try to put together what I've learned in the last few weeks, as well as come to some kind of decision about what I want to do with the rest of my life, I find that I'm as stuck as I was back in New York. But I think it's still premature to be thinking these thoughts. My time here is less than half over, and I should really consider my experience as a whole before I move on with my life. More on that later. Maybe.

I Like to Paint

2009-07-02T23:35:00.004-04:00

This week, we got the chance to watch several operations take place. The CRHP hospital is the only one available for most of the population in the immediate area, and the bigger district hospital is located in Ahmednagar, a few hours away. Even better care is available an additional few hours away in Pune. This hospital has been transitioning into a secondary care center, as most of the primary care needs of the villages are taken care of by the village health workers (local women who have been trained by CRHP to work in the communities). Whereas decades ago, the hospital would see lots of infectious disease and health problems related to poor sanitation/nutrition, these days the hospital is seeing more chronic conditions like diabetes and high blood pressure (as a result of development and better health practices in the villages).

We were given a tour of the upstairs floor of the hospital, which is devoted to administration, during our first week here. It wasn't until just a few days ago that I was able to see the medical/surgical facilities themselves. Because of all the good things we've been hearing about improved health and progress and such, I guess I was expecting a hospital that would meet with American standards of modernity (technologically), cleanliness, orderliness, and the like. Instead, what I found was strikingly akin to the hospital that I visited in Mozambique several months ago (Gondola). Not terribly dirty, but not terribly clean, either. There seemed to be an air of disorganization, and I'm sure the fact that most of the walls and floors were painted earthy brown/dark colors biased my impression (as opposed to the pristine (sort of) white of American institutions). The OT (operating theatre, as they call it) in particular exemplified this atmosphere to a tee.

This is the first hospital that has been in use since the organization first started (I think). What's exciting is that a new building has recently been constructed and they will be moving within the next few months. Though CRHP held a formal ceremony celebrating the new hospital's completion back in April, they have run into a few setbacks and won't actually be operational for at least another few weeks. We were given a tour of the new facility a day or two after seeing the surgeries. Simply put, it is amazing. The new building will have room for many new beds, including separate neatly labeled and constructed wings for maternity, pediatrics, out-patient care, intensive care, ophthalmology (a recent addition to the hospital's medical repertoire), and surgery (three beautifully built/clean OTs). There are all the appropriate spaces for registration, pharmacy, and administration, as well. To top it all off, there's a terrace on the second floor with a fantastic view of the surrounding landscape - we are trying to convince the director to turn it into an outdoor cafe.

It's exciting to imagine this new hospital up and fully running, and the glitz and glamour of its fresh construction might make it easy for me to forget that the core mission of CRHP involves community transformation, as opposed to providing an advanced medical center for curative medicine. Still, the course we are taking has been doing a more than effective job in hammering home these important concepts (to the point of repetition). And so it was refreshing to catch a glimpse of the future and see how modern medicine/technology can contribute to the organization's noble cause. Much of the important transformation in the local communities (breakdown of the caste system, proper sanitation, health education, etc.) has already occurred, and it's an appropriate time of transition for everyone involved.

Finally, while we were seeing the children's ward, we immediately noticed that this room possessed some minor decorations. A team from Japan had visited at some point in the last few months and painted colorful pictures of animals and other figures along the side wall. There was still plenty of space on the back wall, and so I asked if we can claim that area for our own mural. Today, a couple of us went back and measured all the dimensions. We got trapped in the hospital for another half hour or so due to heavy rain, and used the time to come up with some elaborate designs.

As we approach the end of our course, we are being required to put together presentations and "action plans" to demonstrate our intellectual competence and absorption of the material. Needless to say, I'm much more excited about this mural project. The prospect of leaving my mark (selfish, I know) on this place is what appeals to me, and I am glad that I can contribute to producing something tangible and lasting (at least for a little while) for the organization. This is also the same reason I am more interested in surgery than anything else at the moment - the prospect of having an immediate impact, producing visible results, and receiving personal satisfication/gratification.

Again - selfish, I know.

Language Barrier

2009-07-01T05:13:00.002-04:00

This morning we went out to one of the local villages (Khur Daitan?) with the mobile health team. Several of us had been to this village in our first week, but this time the entire group was kept together. While our village visits are normally well-structured, with planned meetings or family visits, this time, we were basically told to tag onto any one of the mobile health team members as he/she went about his/her business.

The whole morning was very informal, with a few brief gatherings of the women's group, younger men in the farmer's club, and adolescent girls to have their hemoglobin levels measured. We visited some people who had had leprosy in the past, and that was it. For the remaining hour or so, many of us were just milling around watching the team members work with their respective groups, or trying to strike up conversation with the locals. I chose to engage in the latter activity.

We have been taking a Marathi (the local dialect of Maharashtra state) class as part of our course, but it has been very casual and based off of a simple 3-4 page handout. I've learned the Marathi words for such things as "cattleshed" or "vegetables" or "would you like tea?" (an important one). We've learned basic greetings, enough to get us to the "I'm fine, how are you?" stage, but nowhere past that.

Some of the younger men, all around eighteen years of age, had been congregating together and watching us with curious eyes for much of the morning. They would follow us around here and there (Indian children especially have no issues with stalking foreigners), and eventually one of them worked up the courage to ask me where we are from, and what my name is. For the next hour, we had a good time sharing simple things like our names and ages, and exchanging vocabulary in English and Marathi. Added to my simple lexicon are words for "rain," "monsoon," "summer," and "tall."

One of the first questions they asked was whether I am married, and by seeing that dialogue through to the end, I learned less formal terminology for "husband" and "wife." Naturally, they asked if I have a girlfriend. In trying to learn the Marathi word for "girlfriend," however, we ran into a snag. I couldn't quite pronounce the word that they gave me, and after a few tries, they told me a simpler word: "saman." They were all giggling/laughing as they told me this, and as I repeated this word, I was convinced that they had actually told me some dirty word that would be highly embarrassing for me to use in a public setting.

It turns out "saman" means "luggage," or "property." Which says something about the attitude many men have towards women in this country (or in rural settings). Then again, they were obviously joking around. And I am known to have a sexist streak myself. So we got along famously. I was slightly bummed when it was time to go, but I'm sure that won't be the last time I visit that village. It wasn't quite goodbye (accha!), but more see you later - "bareyeto."

In other news, I just met with one of our research advisors here, Dr. Premkumar. We discussed the important logistical considerations for my project and it seems like it is time to get things rolling. I am moderately excited. More on that later.

Village vs. City

2009-06-28T23:50:00.002-04:00

We just returned from a trip to Pune (the 8th most populated city in India?) this past weekend. While we drove through both Mumbai and Pune to get to Jamkhed, this was the first time many of us had spent an extended amount of time in a bustling Indian city. Some observations:

- In the villages, 99% of females riding as passengers on motorcycles (which are highly prevalent here) will be riding side-saddle, as opposed to straddling the bike. In the city, you will see many women not only straddling a bike or moped, but actually driving them, often complete with headscarves, ninja-style.

- In the villages, you will notice men urinating while standing in the middle of a field when driving by on local roads. In the city, you will notice men urinating while standing off to the side of a highly congested sidewalk on a bridge overlooking the train tracks.

- In the villages, your main obstacles on the road are bullock carts, tractors, and the occasional motorcycle. In the city, your main obstacles on the road are motorcycles, rickshaws, buses, cars, people, bicycles, dogs - basically anything that moves .

- In the villages, a local rickshaw driver will have no problem loading up nine foreigners in his tiny vehicle and will be extremely grateful for a 100 rupee fare. In the city, you will have to work hard to convince a rickshaw driver to take more than two passengers (three, if female) and have drivers who actually turn you down if you try to haggle with them.

- In the villages, women spend their time hovering around the houses and tending the children while the men congregate near trees and the road, chatting or playing cards. There is a sharp divide and little to no physical contact (in public) between sexes. In the city, you will catch a couple holding hands or linking arms every now and then.

- In the villages, local families will invite you in, offer you their floors/seats, and make you some tea. In the city, the first place we ate at for lunch was McDonald's (where the Chicken Maharaja Mac was a popular choice).

There's more, for sure. But that is all for now.

Watershed Development

2009-06-25T05:04:00.004-04:00

Today we learned about the watershed development program CRHP has introduced into several of the villages in the area. I had heard the term "watershed" several times since coming here, but up until this morning session, I hadn't the foggiest idea what it actually meant. It turns out that watersheds are used here as a form of simple and highly effective agricultural technology.

Much of Maharashtra state is drought-prone, and the area we are staying in receives about 15 inches of rain a year. Lack of water has been a problem we have been hearing about from many of the different villages we've been visiting, and so any means of conserving water is highly valuable in this environment. While some villages are situated near rivers that are able to be dammed up, leading to irrigation possibilities for the crops, other villages are solely dependent on rain for water.

Watershed development makes use of the natural hilly landscape to create new stores of water that are able to percolate through the ground and be utilized through the creation of new wells. As rainwater trickles down the hilltops, it commonly removes the layer of topsoil with it, resulting in erosion and an overall waste of water. The process of creating a watershed basically involves changing the topography of the hill (they call it a "hillock" here) to create "contour bands," so that the topsoil won't be completely lost as the water flows down. Moreover, towards the bottom of the hill, an area is excavated and bounded in to create a storage space for the accumulation of rainwater. Through this simple technique of modifying the hill's natural landscape, the village we visited this morning has been able to expand the number of wells it possesses from two to a hundred. During drought years, this village was able to turn down government aid in the form of water tankers - lack of water is no longer a problem.

This one example highlights many of the values and principles CRHP has based its organization upon. Simple solutions, efficiency, and real results. While I found myself marveling at the way watershed development was able to bring about such a dramatic change for a community, the question of how to apply similar ideas to the many problems in the States naturally arises. I suppose its easier to come up with powerful and effective (yet simple) solutions for relatively simple problems. But are problems in the West that much more complicated? Or do they only seem that way?

One Week In (dia)

2009-06-22T03:37:00.002-04:00

It's been over a week since we left the States, but not quite a week since we've been here. The time difference is 9.5 hours and I can't be bothered to calculate exactly how long it's been at the moment.
Jamkhed is less rural than I would have imagined, and the facilities are much better than I anticipated. The food is great, the rooms are clean, and the classes are educational.
Indian people are beautiful and friendly. One of my goals before I leave here is to perfect the head-bobble/wag that is so customary here - a stereotype that is remarkably true.
My camera has mysteriously stopped functioning at some point along the journey here, so I haven't been able to take any of my own pictures (though I probably wouldn't be able to upload them with this connection, anyhow). Hopefully I'll be able to dump some highlights at the end of the course (which ends in mid-July).
The weather is hot and humid, with random spurts of rain as we approach monsoon season.
I've been spending a lot of time playing ping pong and sleeping, but learning a lot from interacting with the staff here at CRHP and going into town/the villages occasionally.
Internet is freely available, but there is high demand and limited supply of computers, so updating frequently may not be possible.
That is all for now. Namaste.

Leaving Again

2009-06-14T15:43:00.002-04:00

I wanted to write an entry with slightly more content before I leave, but there is no time!

My flight leaves at 8:20PM from Newark, non-stop to Mumbai on a Continental Airlines flight.

I'll try to update when I get a chance and blog regularly if at all possible. Otherwise...

Have a good summer?

The Beginning of the End

2009-06-10T23:13:00.003-04:00

Between reality and realization, there was a pause. It was over. There was a beat - time for hearts to skip. There was a gap - time for hearts and minds to connect. There was a moment for joy to find its home. It was over. And Epiphany had won.

- The View from Saturday, E.L. Konigsburg

Well, it's not really over yet. I haven't been updating much this month, and it's not because I've been particularly busy doing one thing or another. It's because I've been busy doing a whole lot of nothing. Our two week Bench-to-Bedside course turned out to be as much of a joke as I had anticipated, and it will conclude officially tomorrow with an afternoon jaunt to the Bronx Zoo.

It's not as if nothing's been happening, however (sorry for the double negative). My dad had surgery early on last week, it's been a struggle trying to slowly disengage from my home church, and there's been a whole lot of playing this past weekend and last few days especially.

In the meantime, the anticipation (and a bit of anxiety) has been slowly building for India, probably for several reasons:

The last two weeks of class (ha!) for those of us in this global health module have been devoted entirely to presenting our projects, discussing our expectations, and going over the dangers of spending extended periods of time abroad. I'm ready to quit talking about India and just go already.
It feels like there are still a million different things I need to do and take care of before I leave - this coming Sunday. These are always the end results of prolonged procrastination - lack of time and lack of motivation.
Anytime I am about to take off for a new summer program or embark on a journey to an unfamiliar destination, I get mixed emotions: a kind of laziness, with an "I don't really want to go through all the hassle" attitude, and a bit of weariness, with an "I hope this goes by really fast" attitude.

Whatever the case, I think it's safe to say that the end of the year has finally arrived. I've been putting off talking about it and I'll probably just end up reflecting about the whole experience of first year in random entries throughout the summer or next year (or not at all). We received the grades for our last two courses (after a long delay) yesterday - and despite all of my biggest fears, I passed. I can move on to year two without any issues, a full year (sure didn't feel like a year) of medical school and a summer in India under my belt.

Assuming I make it back alive. Over-dramatic? After learning about all of the many, many bacteria, viruses, bugs, and parasites that are out there in this big world of ours (most in developing nations not unlike India), as well as the risks of getting hit by a car, robbed, ripped off, and God-knows-what-else, in developing nations not unlike India, I am not nearly as optimistic as I used to be.

The last time I spent a summer abroad, I left the states totally oblivious and unaware of the many things that can happen when traveling... and I found myself in the middle of a Middle Eastern war (so to speak). This time, I'm going in armed to the teeth with the painful knowledge of every little thing that can go wrong... and so I expect it'll be a relatively tame summer.

"Between reality and realization, there was a pause." This is that pause. I think I'll be here for a little while. If you'd like to know a little more about what I'll be doing this summer (if you're interested in the specifics of my research, feel free to contact me (though, to be quite honest, it's not very interesting)!) and how you can contribute to a great cause, please check out:

Comprehensive Rural Health Project: Jamkhed

Job's Syndrome

2009-06-05T16:33:00.005-04:00

A while back, I wrote an entry about "Ondine's curse," a medical condition named for a water nymph from German mythology. While studying for some of my finals a few weeks ago, I discovered another disorder that peaked my interest: Hyperimmunoglobulin E syndrome, AKA Hyper IgE Syndrome (HIES), AKA "Job's syndrome."

According to Wikipedia, the condition is "characterized by recurrent staphylococcal infections, unusual eczema-like skin rashes, severe lung infections that result in pneumatoceles (balloon-like lesions that may be filled with air or pus or scar tissue) and very high concentrations of the serum antibody IgE." The disease was named for a character from the Bible, Job, who suffered many boils and similar skin lesions as part of an experiment between God and Satan. Job is one of my favorite stories from the Bible, and though the clinical presentation of HIES doesn't match up 100% with what Job seems to suffer from, I was tickled to find this reference in the medical literature.

People have said that the book of Job is actually a fictional story written by Moses (though for the most part, origins are hotly debated), as opposed to most of the books of the Old Testament, which are supposed to be historical in nature. It has been called (again, Wikipedia) "the most profound and literary work of the entire Old Testament." A lot happens throughout the entire book, and there are many, many things that can be drawn from the speeches/poems that take up the bulk of the text. Most of the narrative, however, takes place in the first two chapters, establishing the background story and context for the poetry that follows.

Job is a righteous man with whom God is pleased. Not only is he devoted and pious, he is extremely prosperous, with many children, livestock, and servants. When the angels present themselves before the Lord, God asks one of them (Satan) for his opinion about Job, "a man who fears God and shuns evil." Satan is not impressed, and basically describes Job's devotion as a natural result of being blessed with many possessions: "But stretch out your hand and strike everything [Job] has, and he will surely curse you to your face." God accepts the challenge and allows Satan to terrorize Job, with the condition of "on the man himself do not lay a finger."

Soon afterward, foreigners attack, fire falls from the sky, and a mighty wind sweeps through the land. Job's livestock, servants, and children have all perished or been plundered. Job's response:

²⁰ At this, Job got up and tore his robe and shaved his head. Then he fell to the ground in worship ²¹ and said:
"Naked I came from my mother's womb,
and naked I will depart.
The LORD gave and the LORD has taken away;
may the name of the LORD be praised."

²² In all this, Job did not sin by charging God with wrongdoing.

On some other day, Satan comes before the Lord again, and God asks again about Job, "a man who fears God and shuns evil. And he still maintains his integrity, though you incited me against him to ruin him without any reason." Satan is still not impressed, implying that God wasn't hard enough on Job: "A man will give all he has for his own life. But stretch out your hand and strike [Job's] flesh and bones, and he will surely curse you to your face." God allows Satan to do his worst, with the important provision of "but you must spare [Job's] life." Job is then afflicted with many painful sores "from the soles of his feet to the top of his head."

⁹ His wife said to him, "Are you still holding on to your integrity? Curse God and die!"

¹⁰ He replied, "You are talking like a foolish woman. Shall we accept good from God, and not trouble?"
In all this, Job did not sin in what he said.

What follows afterward are forty some-odd chapters of Job and his friends discussing (arguing about) why this has happened to him. Eventually, God himself speaks directly to Job... and there's a happy ending. The story is simple, but powerful in the way that it addresses the presence of evil in the world and responds to the age-old question, "Why do bad things happen to good people?"

I've drifted a long way from Hyperimmunoglobulin E Syndrome, I know. But IMHO, the Bible is much more interesting.

Summer Again

2009-06-01T22:09:00.005-04:00

I'm tired. I haven't been getting much sleep the last few nights, though for the most part, this hasn't been a bad thing. Key points:

School. is. over. Technically, we end June 12th - but my coursework concluded when I took my last final Sunday night. For the next two weeks, I'll be coasting through a global health elective (classmates are scattered throughout various clinical selectives) which will include movies, a few seminars, and field trips (including one to the Bronx Zoo). Yeah.
I'm leaving for India in less than two weeks. Last minute preparations are quickly becoming overwhelming. It's all so exciting, and slightly scary. Freaking micro course - does a highly effective job of convincing you that you're going to contract every single infectious disease there is the second you step foot in a developing nation. It doesn't help that I won't be insured for the last month and a half I'm there. Shhh!
I almost forgot to register for the NYC Marathon lottery. The deadline is tonight, at midnight. I signed up just now - they'll pick the entrants in a few weeks, I believe. I have mixed feelings. I would love to run it, but I'm not too sure my body will survive it this time around. This year has been a year of relatively poor health.

There's more, naturally. There always is. But like I said, I'm tired. And I don't want to get too swept up with "this is the end" euphoria, prematurely reflecting on this past year and looking toward the future. There is a good chance (50%, I'll say) I failed my microbiology final, leading to an even higher chance I failed the whole course, leading to the definite fact of my not going to India and spending the summer making up coursework. Remedially. That would suck. Let's hope that doesn't happen. I don't think my spirit will be at peace and truly free until I get that last test result. Or actually, until I'm on the plane to India. Flying away. Yet again.

To another escape.

/drama

Big News

2009-05-27T00:58:00.005-04:00

International: If ever there were to be a World War III, North Korea would probably be the country to start it. Nuclear tests, military threats, socialist regime, isolationist hostility, paranoia, propaganda, international alarm and condemnation. This whole situation sounds like it should be in a bad Bond movie. Oh, wait. It is in a bad Bond movie. In other news, the growing trend of celebrity suicides in South Korea takes another victim this past weekend with the death of former president Roh Moo Hyun.

National: President Obama nominates the first Hispanic justice to the Supreme Court - Sonia Sotomayor. She would be only the third female justice in history. As one article put it, she complements our black president and white vice-president nicely in forming "a picture of diversity." Aside from her ethnicity, she is highly qualified, popular with both parties (in theory), and hailing from the Bronx. It should be an exciting couple months leading up to her likely confirmation.

State: California's Supreme Court upholds Proposition 8, a hotly-contested ballot measure from this past November's election, banning same-sex marriage. The proposition came about in response to a decision in the spring of 2008 by this same court, legalizing same-sex marriage. Once Prop 8 passed in November, the many concerns that rose among the gay community included the question of whether gay marriages officiated during the few months they were legal will be honored - and they will be (i.e. the measure will not be retroactive).

Local: A small bomb exploded on a bench outside of a nearby Starbucks (UES) early Monday morning (3:30-4:30AM). No one was injured, though the bench was destroyed, the Starbucks' windows were shattered, and the apartments above the Starbucks were briefly evacuated. Bizarre. As one of my classmates put it, "There goes [another] study spot."

First-Time Insomniac

2009-05-23T04:05:00.005-04:00

I never have trouble sleeping. Let me rephrase that: I never had trouble sleeping. My sleep schedule has become increasingly, for lack of a better word, wack this past week. I've been going to bed at a relatively constant hour, usually sometime in between 11PM-1AM. But I've also been getting up later and later, to the point that it's become difficult to get up before noon these last few days. Count that - I've been averaging 12 hours of sleep. And still taking little mini-naps during the afternoons or early evenings.

Tonight, I think it's all finally caught up with me. It's past 4AM and I can't fall asleep. I tried, starting at 1AM. My evening nap was longer than usual, over an hour.

I think a big part of the reason I haven't been sleeping well this week is my difficulty breathing - a consequence of my hay fever. My allergies were really bad most of my life and during high school, but they died down quite a bit when I moved to California for college. Now that I'm back, everything seems so much worse than it was in high school - namely, allergies, and winter. Did we just happen to have a harsh winter this year? And are we experiencing a particularly bad year for pollen and other allergenic substances? Are all of these things really contributing to my insomnia?

Or is it just me?

Good Teachers

2009-05-20T20:04:00.003-04:00

I just got out of a mandatory lecture on Research Design and Data Collection, as part of a course of seminars for students going abroad to do summer research projects. It doesn't sound like the most exciting subject matter in the world... but it was probably the best talk I've heard all year.

The guest lecturer was a Ph.D. from the Mailman School of Public Health at Columbia University - and she was fabulous. I don't know what it was that gave her such star quality: her obvious enthusiasm for the material, her genuine interest in facilitating our absorption of what she was presenting, or her quirky mannerisms that made her thoroughly entertaining to watch. With all of these qualities combined, she managed to engage every person in that room and hammer home all of the important points she was making in an effective and efficient manner.

Sadly, this kind of teaching has been the exception rather than the rule here at Sinai. Most everyone who is called upon to talk possesses adequate speaking and presentation skills. The problems haven't been in that area. I've found that lectures this past year have fallen into two broad categories:

Presentations that are fun, dynamic, and engaging, given by prestigious doctors in their respective fields. Problem: these doctors are invited to speak mainly because of their prestige, as a courtesy and an opportunity for them to show-and-tell. The lectures often end up being discordant with the rest of the course material and usually don't contain many teaching points, if any. Classic example: gross anatomy lectures.
Lectures that are comprehensive, informative, and thorough, given by dedicated researchers who are on the cutting edge of modern medicine. Problem: these speakers are often uncomfortable or not as experienced working outside of their element (research). As a result, they are often unable to organize/present the material in a way that is conducive to learning; many times, they are simply unable to hold the audience's attention.

To be fair, I haven't attended half of the lectures given this year. So I'm making some sweeping generalizations based on my limited experience. But according to my classmates' feedback, I haven't been missing much. People often talk about how their best teachers in life were in high school, even elementary school. And I guess it's understandable - professors in college are there mainly to explore their own research interests (at least at my school), and professors here are either busy practicing clinical medicine or, like undergrad, exploring their own research interests. Basically, our faculty is composed of people who work for the medical institution that is Mount Sinai, and happen to have time to teach on the side. It doesn't feel like a school.

That's the sentiment that's been forming in my mind over this past year. And so it's refreshing to hear from teachers who can actually teach. Teachers like Mrs. Greenberg, in sixth grade, who taught us to memorize "kingdom, phylum, class, order, family, genus, species - hey!" by jumping out of our chairs and singing/dancing it with her. Teachers like Ms. Latham, in eleventh grade, who succeeded in presenting calculus as interesting and surprisingly easy. Teachers like Professor Lightfoot, my freshman year of college, who taught us the basic principles of anthropology and archaeology, while entertaining us with his many stories from the field. Teachers like Dr. Linda F. Cushman, who took the subjects of research design and data collection and made us understand why they are important and how they can be fun.

There's only been one teacher here at Sinai who's had a similar impact, despite the few lectures that he gave (Bob Krauss, Ph.D.). Here's hoping for more next year. And if not, whatever. Starting third year, we will be out of the classrooms... forever? I can't wait. While teachers like the ones I mentioned above remind me how much fun learning can be... they are too few and far between for me to risk pursuing more education (e.g. MPH, MSc). Right?

Piano Meets Cello

2009-05-19T22:25:00.003-04:00

Yes, I know I've been updating a lot lately. I couldn't help myself. In my long and illustrious history of YouTube watching, there have only been a few videos that have blown me away. And none in the same way that the following video has. I'm passable at a variety of typical band instruments, and I've accepted that I will never be good at any of them. This year in particular, I've been developing a stronger-than-usual interest in two instruments: piano and cello. Aside from this fact, the video I'm posting below speaks to me in so many ways: the song selection, the middle-aged-ness of the two musicians, and just the arrangement as a whole... amazing. If you're not familiar with (or don't particularly like) either of the songs being covered, my excitement will probably come off as a bit over-the-top. Enjoy!

Oh, Brother

2009-05-18T14:16:00.005-04:00

Continuing in the vein of family pictures... it was my brother's birthday yesterday. He is now 26 years old. Happy belated birthday!

Somewhere in Fort Lee during the summer of 2004.

On a speedboat in Chicago during the summer of 2007.

On campus after my college graduation, May of 2008.

Thoughts on Tea

2009-05-17T00:41:00.005-04:00

This is the bungalow where we spent one night in Zimbabwe, back in early April. What I want to highlight about this photo is the vast field of crops you can probably make out in the background. These are tea leaves. Actually, I don't really know what they are - but we were told that these plants are used to produce tea. I'm just assuming tea plants have leaves. After all, it is Coffee Bean and Tea Leaf, right?

I've been drinking more tea than coffee the last few weeks. Partly for a change of pace, partly because I worry about coffee staining my teeth, and partly because I like swishing the bags around in the water. Though a typical cup of tea is supposed to have significantly less caffeine than a cup of coffee, I've been finding that the diuretic effect of either drink has been comparable. Tea leaves themselves actually have more caffeine than coffee beans - I guess coffee just ends up being a more concentrated drink.

Tea tastes like green things (e.g. leaves, grass), while coffee tastes a lot like smoke (I like my coffee black and heavily roasted). Neither taste is particularly pleasant. I remember the first time I tried my mom's coffee (with plenty of cream and sugar) when I was a kid, I found myself spitting and gargling for a good five-ten minutes afterwards - I was disgusted. A big part of growing up has been learning to appreciate other tastes beyond simply sweet or salty. With time, even blandness and bitterness can become prized qualities in caffeinated beverages. The drinks don't stop being bland or bitter at any point... they are loved and enjoyed regardless, nay, because of the fact.

Mamma Mia

2009-05-14T21:35:00.009-04:00

In looking back over this past week's entries, I realized I didn't bother to post anything for Mother's Day. I've been complaining to myself how I have nothing to blog about, and it's probably because I'm always so self-centered. Everything on this blog is about me, me, me, and because of this fact, it's no surprise that things might start to sound repetitive... that I might run out of fresh things to say. So even though I'm four days late, and even though I did celebrate Mother's Day properly with my family this past weekend, I'll dedicate this entry to my parents, and specifically, my mom - the least self-centered and most selfless person I know!

My mom is the little girl dressed in 한복 on the left.

My parents at their wedding.

I think this was taken at a photo studio. Nerds.

The Hospital is a Stage

2009-05-11T23:01:00.005-04:00

For the next two days, there is no school. Well, that's not entirely true. There are no classes.

I've talked specifically about many of my science classes throughout this past year, but I feel like I've only vaguely referred to our clinical skills course - and always just like that, a "clinical skills course." It's actually called "Art and Science of Medicine," or ASM for short. ASM lectures, workshops, and sessions are almost exclusively limited to Wednesday afternoons.

Since early September, maybe even August, we've been learning how to take a full history (first semester) and perform parts of a full physical (second semester). Specifically, we've learned to do the heart, lung, and abdomen exams. Some Wednesdays are spent just listening to instructional lectures, some are spent in small groups practicing on each other (or hired patient actors), and many Wednesdays are (were) spent out in various Sinai-affiliated hospitals, all across several boroughs of the city and New Jersey.

ASM is technically the only year-long course that we've taken, and the reason we don't have any classes for the next two days is that we will be taking our finals. It will be the culmination of everything we have learned this year, complete with patient actors, simulated hospital setting, and video-recording for the purposes of feedback (and embarrassment next year when we watch them). For our midterm, we watched a few videos on a website and typed in our history online. This final will be a significant step up from that experience.

We've been seeing patients and doing histories and physicals (in theory) for months now, so this final shouldn't be a big deal at all. Still, just the idea of being watched, recorded, and evaluated is slightly nerve-wracking. I guess we need to be getting used to this feeling, though - the majority of our grades third and fourth year come from performance evaluations.

The other thing is, even though we've learned all the motions of how to do a heart, lung, or abdominal exam, we are rarely able to learn anything of value from performing them. As first years who have no idea how to percuss properly, no idea what we're hearing when we place our stethoscopes on a patient's chest, no idea how to palpate someone's liver or spleen... we often find ourselves telling each other, "just fake it!"

The idea is that we need to become comfortable with going through the routine, carrying out the ritual, and putting on the act. It really is a performance of sorts. One of my clinical preceptors in the ER once told us that he stopped listening to people's hearts at one point because he felt like he couldn't learn anything useful from doing so - an echocardiogram would tell him everything he needs to know. He has since returned to going through the motions because the patients would question him, "aren't you supposed to be listening to my heart?"

So I'm not too nervous about my exam on Wednesday morning, at 8:35AM. The patient is an actor, and I'll be acting, too.

I just have to make sure I know my lines.

"My Finale"

2009-05-07T23:07:00.006-04:00

[Cross-reference Scrubs: Season 8, Episode 18]

At the moment, I'm working on immunology, the course that has been the most difficult for me this semester. In microbiology and pathology, I've been able to glean important tidbits from our various sections and labs, and I've been able to put at least a few pieces together in my understanding of infectious disease and disease processes. With immunology, however, I'm pretty lost. My strategy has involved staying quiet during small groups and looking no further than the answer for understanding when taking our open book quizzes.

At first, I didn't quite understand why we're taking microbiology, immunology, and pathology all at once, and at this point in our education. Especially when most of my friends at other schools are being occupied with some form of neurobiology and behavioral science (though we'll be taking a brief course in behavioral science to round out the year in just another week or so).

Given the fact that I haven't really been looking at any of the material since we started, it's understandable that I should feel this way. Exam season began last weekend with our microbiology midterm. This weekend is our immunology final, next weekend is our pathology final, and our microbiology final will round out the end of the month. Basically, it's that time again - for me to cram and actually learn something (at least in the short term). As I am slowly starting to absorb the seemingly disparate subject areas of these three courses, I'm beginning to see the bigger picture. And it's pretty cool.

In other news, the Scrubs season (and probably series) finale aired last night on ABC. It was kind of corny, didn't really have any plot, and slightly emotional. More than anything, it's hard to believe that the show is actually over - that there are no more stories to tell, that there won't be anything new to learn about the characters, that essentially, their lives are over.

Scrubs is the first show that I've religiously watched through every episode, and the first show that I've followed all the way to the very end. It sounds ridiculous, but I don't know if I would be in medical school right now, if it weren't for this show. I quoted episode 20 of season 4 in the personal statement for my applications, even. Needless to say, all things must come to an end. It could've been better, it could've been worse, but it was probably just right.

Optimism and Children's Literature

2009-05-04T21:56:00.005-04:00

I just had a conversation with one of my apartment mates, a fourth year who will be graduating in less than two weeks. I asked him a simple question: "Which was better, college or medical school?"

Lately, I've been feeling somewhat nostalgic. It's probably a combination of the fact that pictures from various end-of-year celebrations during college are being posted left and right on Facebook... and the fact that I've barely begun the marathon of exams that will mark the official end of this school year. It's still early to be reflecting on how this year has affected me, what I've learned, and what I'll take away for the future. But it's what's on my mind at the moment, so I might as well.

This past year hasn't been bad in any way, shape, or form. There have been lots of great, happy, and memorable moments. But the year wasn't particularly exceptional, either. My former college roommate and I used to always have a similar discussion at the end of a semester during our freshman and sophomore years. Despite the fact that we spent most of our time watching movies/studying unnecessarily hard at the library (freshman year), or bumming around in the apartment/never going to class (sophomore year), at the end of each semester, we would encourage and congratulate each other with hearty choruses of "it's been a great semester, man!" And really, they were great semesters. But we were to experience even better ones in the years to come. We just didn't know it. This is what I'm feeling at the moment. It's been an "OK" year.

I feel like life is that way - a simple rotation of "OK" years and "exceptional" years - and you can't have one without the other. Otherwise, how would you know what is "OK" and what is "exceptional?" It's an obvious conclusion, I guess. But the overarching trend that I've been noticing is most definitely upwards. I remember being so satisfied with my 6th grade year by the end of elementary school. I would think to myself, "it won't get any better than this." Yeah, in 6th grade. And then middle school kind of sucked, but the last two years of high school were pretty amazing. And the last two years of college were even more amazing. So I convinced myself that medical school would be the same way.

I've shared this philosophy with quite a few people in real life, but I think this is the first time I'm putting it down in writing. Everyone talks about how it only gets worse after college - how tough medical school is going to be, how brutal residency is going to be, etc. (though I guess everyone agrees life will be pretty good once you're making some real money). But I would like to believe that it only gets better - life in general. Without fail, every single doctor, resident, and now, graduating medical student I've asked has said that they preferred medical school to college. That's gotta count for something, right? I think somewhere along the course of this past year, my commitment to this belief has been forgotten.

And so tonight was a good reminder of the fact that I have no idea what's in store for me - the things God has planned for my life. I guess I am really an optimist at heart. I could throw in the first quote that comes to mind, from that famous song by The Beatles - "I've got to admit it's getting better..." But instead, the following is from one of my all-time favorite children's books, The View from Saturday, by E.L. Konigsburg (I was up till 3:30AM this past weekend re-reading it... and I will probably be quoting it a few more times before this year is out):

They did not know that Humpty Dumpty was not in Wonderland because they never journeyed through the looking glass to find him. How can you know what is missing if you've never met it? You must know of something's existence before you can notice its absence... Can you know excellence if you've never seen it? Can you know good if you have seen only bad?
...
As tired as she was, Mrs. Olinski took her copy of Alice's Adventures in Wonderland down from the shelf. She found the Cheshire Cat but no Humpty Dumpty. As Mr. Singh had said, if you've not seen something, it's hard to know what is missing. She took down Through the Looking Glass and found Humpty Dumpty sitting on a wall.