Medical School Learning

Sometimes more than a year goes by in which you don't write in your blog. And the best thing to do is to forgive yourself, to write a new post about the present, and to move on. Ha ha! That is my approach.

Medical school has been so fantastic. I love it--I love how challenging it is (well, most days I love how challenging it is), I love how interesting it is, and I love the privilege that it affords me to get to work in the lives of others. Just today, we took a four-hour final for our cardiology, pulmonology, and hematology course. It consisted of 12 four-part questions that required short essay answers, and it was somewhat exhausting. Though this last course and this exam required truly massive amounts of work, we learned so much over the past couple of months. And I am happy to report that, though I loved cardiology and hematology (but wasn't so hot about pulmonology), my interest in maternal-fetal medicine is actually stronger than ever. I often found the most compelling part of each of these units to be their application to the fetus (for example the various differences in fetal circulation and fetal hemoglobin compared with those of children and adults, or the development of the fetal lung, and so forth). I am seeing a clearer picture for myself as an obstetrician in the future, though of course this is still very open to change once I do my rotations in the hospital next year and get exposed to more medical specialties. But I am loving just about everything that I'm learning and feel so happy about and confident in my choice to be here in medical school, much more content and clearer than I ever thought I would feel with it. I'm happy as a clam out here in Boston.

I wanted to share a few clinical anecdotes that I've had over the past month. 
 
On Wednesday, February 4, I spent the morning having my second clinical immersion experience in pediatrics after my first one in neonatology two weeks prior. I was assigned to follow a pediatric anesthesiologist around Boston Children's Hospital and to practice taking a medical history and performing a physical exam on the patients that he had gathered for another student and me to meet. The first patient that we saw was an eleven year-old boy admitted to the hospital in a pain crisis due to sickle cell anemia. He was one of the sharpest, best patients that I have ever interviewed, completely remarkable given his young age. He knew every medication he was taking, knew the genetic status of everyone else in his family regarding the sickle cell anemia allele, and was generally self-aware and confident in his interaction with us. He knocked my socks off. When I asked him what he wanted to be when he grows up, he said "An auto mechanic, like my dad. In the future, cars are going to be more complex, and we'll need to find ways to have them cut back on pollution." Wow! This kid has a better idea of what he wants out of life and what type of labor and skills our world needs than most people in their twenties.

The other patients we saw were all neonates and young infants.Two of them were in rather critical condition due to a respiratory virus they caught that for most infants just becomes a common cold but for them became debilitating disease and made breathing for them almost impossible. One of them was on extracorporeal membrane oxygenation, meaning blood was being taken out of the jugular vein in his neck, kept from clotting while getting oxygenated and filtered in complex machines outside of his body, and then returned back in the carotid artery of his neck. The poor guy was two months old and had to be kept almost entirely sedated so that he wouldn't be in pain or tear the tubes out of his neck. His mother was by his side the whole time, but she was in remarkably good spirits given how sick her baby was and how long he'd been in the hospital (an entire month). Another mom who only spoke Vietnamese was there with her baby, a plump little boy who was born with a genetic disorder that meant his cells couldn't metabolize certain compounds normally. This led to a toxic build-up of ammonia in his bloodstream. The geneticist in the room attempting to explain this to the interpreter and the mother was not doing a effective job, both by using overly technical language (more complicated than even we medical students could completely understand) and by asking questions of the mother in such a way as to make her feel scared and guilty. It was a good example of how not to approach patients, especially when linguistic barriers are present that exacerbate the pre-existing power differentials between doctors and patients. It was a somewhat awkward and sad interaction to observe, though it gave the pediatric anesthesiologist that we were shadowing a chance to talk to us about what the geneticist could have done better in interacting with his patient. There is much to learn both in seeing what we do want to imitate and that which we do not.

That afternoon, we examined six patients who all have pulmonary diseases since we are studying pulmonology and cardiology currently. It was such a neat opportunity to get to apply our book learning to real patients by asking them questions about the course of their illness, auscultating their lungs for abnormal breath sounds with our stethoscopes, and looking at their imaging (x-rays, CT scans, and so forth) and other tests (like pulmonary function tests) to attempt to understand their entire clinical picture. It was so gratifying to hear crackles for the first time today on an elderly, lovely gentleman who worked spraying asbestos for many years and who now had fibrotic lungs because of that. It was also wonderful to realize that all of this knowledge that we've been amassing about the physiology, pathology, radiology, and pharmacology of these diseases is actually helping. I definitely feel like I have learned so much and come a very long way from where I was before I started medical school. It's neat to recognize that we are becoming conversant in the language of medicine.

This past week, my clinical immersion experience was to follow a resident in internal medicine for his morning rounds. Of the multiple patients that we saw, the majority were in the hospital for an illness related to their heart, lungs, or blood, so all that we have learned in my cardiology, pulmonology, and hematology classes was directly applicable, which was fantastic. We saw a patient with community-acquired pneumonia and longstanding chronic obstructive pulmonary disease, for example, and others with abnormal red blood cell and white blood cell counts. We also visited an elderly man in the dialysis ward as he was having his blood filtered, a female-to-male trans man with horrible gastroenteritis, and multiple other patients. That is one of my favorite things about the hospital--the pace is riveting. You are always thinking about the disease processes and management of your patients, seeing the complex ways that social and cultural problems impact the lives of real people, going around from room to room to visit patients, communicating with other healthcare workers, and truly never having a dull moment. The time flies by, and it's incredible. Being a medical student and a doctor have got to be some of the most exhilarating jobs, and you really feel what a privilege it is to have a job that requires so much of you in an exciting way rather than a job that saps your energy.

Beyond the classroom, I have been really involved in preparing the Fabric 2016 show. Fabric is a Harvard Medical School tradition in which the first year medical students put on a show for the admitted, incoming students to highlight the diversity of our class and how much we celebrate it. I am participating in the salsa dance, three of the South Asian dances, and will also be one of the two co-emcees for the evening. Even though it has been quite a bit of work with dance practice rehearsals and writing the emcee scripts on top of our heavy curricular load, I think it will all be worth it when we get to present both to the incoming students and, more importantly, to Mom, Dad, and Josh when they are out here! I can't wait to see those three and have some fun around Boston with them. I'm truly counting down the days!

Socially, things have been incredible lately. Even since being single in January, I have had a lot more time and energy to give to my friendships, and it has been fun to see some of them blossom. I have been playing basketball with a few friends here at school named Jonathan, Sagar, and Andy. We have a blast playing knockout, two-on-two, or Around the World. I'm not a great shot by any means, but it's so much fun to go shoot hoops with these guys on Friday afternoons when the stress is off. We three plus some others have also used the enormous projector in our medical education building to watch Netflix movies on some Friday nights, which has been a blast (albeit an illicit one, perhaps. Haha.) I've also had the chance to grow a lot closer to Andy lately. He and I have become workout partners, which has given us more time together and helped our relationship grow into other realms, as well. I met his mom when she was in town from Pennsylvania a few weeks ago, and we all ate a fun Vietnamese meal together. I've gotten to know his girlfriend better, Charlene, who is completely wonderful and a first-year medical student at Mayo Medical School in Minnesota who comes to visit when she can. And just last week, I got to meet Andy's best friend from his undergraduate days, Brian. We three had dinner on Friday night and then went and hung out around Cambridge on Saturday morning. We ended up checking out the Harvard Museum of Natural History. Andy loves bird-watching and knows a ton of ornithology, so we spent quite a bit of time with the stuffed birds as Andy explained everything from the habitat of the tufted titmouse to Darwin's incredible discovery of the mechanisms of evolution by analyzing the finches on different isolated islands of the Galapagos archipelago. I'm including a picture of the owls here, a photo that I sent to Dr. Henderson, who has a collection of owl statues and other owl paraphernalia in her apartment. There seems to be some correlation between amazing (Andy and Dr. Henderson) and loving birds!

Andy and Simone invited me to watch their final intramural volleyball team game. Their team name was the "beta blockers" a pun on the volleyball move of blocking and a common type of cardiac medication for people with coronary artery disease. I extended the pun by using a couple of names of specific beta-blocking drugs. We are all massive dorks!

My break-up has also given me a new surge of strength to evaluate my life and make changes to the parts that are not as I want them to be. It has been beyond empowering to make some of these changes. None of them has been huge, but they have added up to make me feel so much more in control of my life, which has really boosted my sense of self-efficacy. For example, there were a couple of small organizational projects in my room that I needed to do, and I finally addressed my barriers to doing them and did them. I also now make my bed every day and keep my room clean daily instead of letting it deteriorate all week and then binge cleaning on weekends. I go to bed every night around 10 PM and wake-up at 6 AM to send e-mails and texts for about an hour before class, which has dramatically helped to clean up my inbox and help me feel more professional and on top of things. I plan all of my meals out well on the weekend and thereby save money by not eating out. Doing this also helps me to know that I am getting enough fiber, protein, fruits, and vegetables each day. I feel myself maturing and becoming more professional in these ways, and it feels great. It's wonderful to know that we ultimately are in control of our habits and our actions and that it might be harder but it feels so much better to have habits that align with what you want for yourself and your life. And it's never too late to change. I know it sounds completely corny and cliche, but I wake up most days and say to myself somewhere in my mind, "you are wonderful. Give the best that you've got to the world today. If you work hard and love yourself, you can do anything you put your mind to!" This positive attitude has helped me feel better in the past couple of months than I've felt in a really long time. Yeehaw!

All is very well. I have not been taking pictures of my life or my friends really, but now that I'm blogging more, I will begin to so that I can share on here. Expect more this time in less than a year!
Below are a few photos I found on my phone that might be of interest. 

Me with some of my close friends at our White Coat Ceremony this summer. From left to right: Cameron, Leo, Claire, Kirsten, Ali, me, and Danika.

Me with some friends for Halloween. From left to right: Leo as a witch, Clara as Cruella DeVille with her dog Beanix, me as a "Freudian slip" (a dress with psychoanalysis terms and a picture of Freud on it), Danika as a tick (we've learned a lot about babesiosis and Lyme disease, both transmitted by deer ticks), Cam as a Cam-positive bacterium (a pun on gram positive bacterium, which is another medical joke), and Ben as...I'm not sure!

Above: my lovely friends threw me a potluck dinner birthday party! From left to right: Kirsten, Leo, Elizabeth's boyfriend, Danika, Elizabeth, Emily, Micah, Cameron, Dana, Rahul, Samantha (in front of Rahul), and Andy

Below: my wonderful friends read me a Shakespearean sonnet and then toasted me with prune juice (a joke among those of us who are a little bit older) at school on my actual birthday.