The Ethics of Staying Home While Sick

I get sick frequently. This has been true about me since childhood, when it seemed like I had a runny nose or hacking cough at least once a month. Having been sick so frequently as a kid, I've learned to go to school even while ill. Because when you're sick several times a semester, and you're trying not to rack up a huge list of absences, ain't nobody got time to stay home when you have a little runny nose.
I've carried this general attitude of work-through-the-illness into adulthood. This presents a unique conundrum, when my "work" is interacting with hospitalized patients on a daily basis, some of whom are immunocompromised (ie, their immune systems are less capable of fending off illness than the immune systems of typical people). I've also learned that the more rest I allow myself during illnesses, the better. After all, when I have muscle aches and a fuzzy head and a fever, I'm not a very useful member of a patient care team.
So this Monday, when I began to feel a little fuzzy-headed and muscle-achey, I decided to go to my assigned night shift, since a part of me wasn't sure if my symptoms were due to sleep deprivation or a true illness--though a couple of sneezes from earlier that morning should have told me it was clearly the latter. Of course, I got to work and scrubbed into a surgery, only to find myself getting uncomfortably light-headed and feeling my bowels go into disarray. I ended up scrubbed out, on a stool in a corner of the OR, with my head between my knees and a juice cup in my hand. Since this week's rotation involves delivering babies, my resident and my attending decided I should stay away from newborns with whatever virus was afflicting me, and I was sent home early, with assurances that no one would fault me for doing so, and that I should take the next night off too, if I was still feeling bad.
I was really grateful for my team's incredibly healthy attitude toward illness. As one of my residents said, as a medical student, I should take advantage of being able to take time off when I'm sick, because most residents have precious little opportunity to do that. Since Monday night, I've also ended up staying home from work on Tuesday and Wednesday night, because my symptoms have steadily worsened into a garden-variety upper respiratory illness (URI)--one that rendered me unsafe to practice any kind of medicine, especially medicine involving newborns who would literally be entering the world into my germ-ridden hands.
The frustrating thing is that, in the time since I was sent home by my team on Monday night, I've gotten steadily more and more signs that people seem to think I'm stretching my sick leave a little longer than I should be. My residents have asked whether I've told the clerkship director about my absences. My dad keeps talking about how I should be sure not to miss too many "credits," and is expressing concern that I'll never learn how to deliver a baby (a skill that, while important for any physician to know, likely won't be of great use to me as a pediatric geneticist).
And this brings me to the point I'm trying to make with this post: When is it okay to prioritize my health above other factors? Granted, I'm not suffering from Yellow Fever or something, and this URI certainly isn't going to kill me. But it will make me uncomfortable and inefficient at work, and it will make me a hazard to the patients I encounter. Isn't it right to take off as much time as I need to get over this illness, or at the very least to get over the phase of the illness during which I feel like I'm actively shedding germs from every pore of my body? Or is it more important to fulfill my duties as a student? If I still don't feel 100% tomorrow, should I go to work anyway, lest I exceed the allowed number of days off from my rotation, and end up having to do makeup days?
Perhaps a more pressing line of questioning is, How will all of this play out when I'm a resident, and later an attending physician? When my contribution to the medical care team is no longer negligible, when my notes in the medical record carry actual legal weight, when my patients won't have a doctor if I don't come to work? I'm not sure what the right answer is. I suppose it's something I'll have to wrestle with in the future. For now, I will content myself with being grateful that, as a student, I can still take time off when my body needs me to.

Wifehood, Motherhood, Doctorhood, Womanhood

Tonight I met two bright, female high school teachers who love science. They were closer to my mother's age than to mine. Both told me that when they were in college, they wanted to be doctors. But both of them decided to forego that career path and chose teaching instead. Both said they made that decision because, as one of them put it, "I realized I couldn't be the wife and mother and doctor I wanted to be" all at the same time. They don't regret their decision one bit, both of them said. They don't make a lot of money, but they're happy and love what they do. Now, normally my English major mentality would leap forth at a moment like that and scream "Methinks she doth protest too much!" But I really don't think those women meant anything negative by what they said. I really do think they're happy, and they love what they do, and they don't regret their decisions at all. 

I reassured the AP biology teacher that as a medical geneticist, I won't be making a fortune either, not compared to people in business and certainly not compared to physicians in many other subspecialties of medicine. And then I stopped to think.

For most of my early childhood, my mother was a stay-at-home mom. Though she started working outside the home after my sister and I got a bit older, and continues to work outside the home, she and my father demonstrate very traditional gender roles. My mom does all the cooking. My dad cleans up after dinner. He pays the bills and drives the family around and is the family's primary breadwinner. She tries to teach my sister and me to cook, say Hindu prayers, and generally gain other skills that will make us suitable wives someday. It surprises me a little that I didn't give motherhood even a moment's thought when I decided to become a physician. Believe me when I say I wasn't one of those kids who dreamed of being a doctor all her life. I resisted the idea of going to medical school for quite some time, but by the time I was in college, I knew it was a field in which I would excel, and a career that would give me deep satisfaction. And that's where my thought process more or less stopped. Sure, I wondered if I'd ever have time for anything outside of medicine, but my focus was more on a vague sense of a personal life, and not caring for a family the way my mother always did. 

I suspect that more than a little of the hesitation of the women I mentioned earlier, and my lack thereof, has to do with the fact that those women likely had boyfriends or husbands with whom they were planning a future while they were considering medical school, and I simply didn't have that pull then, and don't really have it now. Because I don't have one person to mentally Photoshop into my imagined scenes of domestic bliss, I'm not very attached to that vision of the future. Here's what I know: I'm going to make a good physician, and my career will make me happy. Maybe someday I'll find myself in a domestic situation that causes me to change my tune and become a stay-at-home mother and wife. Maybe I just won't like the idea of someone other than me being at home with my children. Maybe none of those things will happen. Whatever the situation, I'm glad I decided to go to medical school, gender roles be damned. I think I can find a way to make doctorhood live in harmony with motherhood, wifehood, and womanhood, or whatever -hood life throws at me.

Lessons from a n00b - The end of the beginning

12 months of clinical rotations has swept by in the blink of an eye, and here I am, approximately 8 weeks away from taking the biggest exam of my life so far (my first licensing exam). It's a somewhat nostalgic time, and thus a good time for reflection. A few more lessons I've picked up along the way:

Lesson 1:
A lot of times, attendings say words that I try to avoid. For instance: the word titrate. Do most people understand what titrate means? I mean, even I have only dull memories of the word from my chemistry classes in high school. I've heard attendings and residents often tell a patient that we'll start them on a low dosage of a particular medication, then titrate the dose as we see how the patient responds. I suppose this isn't such a bad usage, since it's the physician side that does the titration. But sometimes they'll tell patients to "titrate" the dosage of over the counter medications, based on their response, and I always have to wonder if patients understand what they're telling them to do. It's interesting what words we do and don't use in various situations, and sobering to think how important words are in a field like this.

Lesson 2:
Neurology is kind of boring to me. Maybe that's because I don't understand the basics well enough, or maybe that's because it really is boring to me. Whatever the cause, I know for sure that it's not the field for me.

Lesson 3:
On a related note, I often felt, on neurology, that if we didn't know the exact reason a patient presented with particular symptoms, we'd chalk it up to a psychogenic etiology--which means that their brain, for some reason, believed that they were weak, or felt tingly and numb, or couldn't walk, or whatever, and so they experienced those symptoms--but there was no physical abnormality causing them. I had SO many patients who we concluded had psychogenic causes for their neurological symptoms, that now I'll always wonder if a person's neurological problems are psychogenic.

Lesson 4:
Contrary to what I believed at the beginning of this year, shelf exams really do get easier to perform on and study for as you take more and more. This is great news. The key, at least for me, was to repeatedly do practice questions until I got them all right...then rinse and repeat.

Lesson 5:
It's amazing how often you'll hear interesting stories from your patients, especially when you're treating outpatients. Almost every day when I was on family medicine, I'd meet a patient or two who had had interesting life experiences, had cool goals for the future, or were interesting in various other ways.

Lesson 6:
A year's worth of clinical rotations definitely teaches you a thing or two. It's amazing how much my confidence has grown, along with my knowledge base. This is a good thing.

Lesson 7:
Shingles comes in many shapes and sizes. So does mono.

Lesson 8:
I still have a lot to learn in terms of handling patients, especially those I would call "difficult." I was impressed by my family medicine attending's ability to entertain even the wackiest of patient requests without missing a beat. And she did it all while maintaining the patients' respect and trust. Hopefully this is a skill I'll gain with time and experience.

Lesson 9:
It's surprising how many people are vehemently opposed to the flu shot. It's also surprising how many people think that the flu shot "injects the flu into you" (not quite), a belief that implies they don't realize that most other vaccines also inject the disease-causing entity into you. For the record: the flu vaccine, and the majority of other vaccines, inject a dead virus, or an inert part of a bacterium, into you. The point is to teach your body to react against the disease-causing entity, without giving you the disease itself. However, since your body is supposed to launch a counter attack (which is what you're experiencing when you feel "sick:" fever kills bugs and helps the body fight infection better; runny noses are meant to flush out bugs living inside your nose, and so on), you often do end up feeling a bit sick after getting a vaccine, any vaccine. It sounds like more people get sick after getting the flu vaccine than after getting other vaccines, but that's probably because more people get the flu vaccine, more often, than any other vaccine. Basically, my point is that if I had to choose between getting sick after getting the flu shot, but never truly getting the flu, and actually getting the flu--I'd choose the shot every time. You should too. Just saying.

Lesson 10:
Time flies. I've said it before, and I'll say it again. Forgive me for the repetition. But these 12 months flashed by in an instant, and I'm sure the next 18 will do the same. At that point, I'll just be Dr. n00b.

Kangaroo Kitty Cat

I met a new patient yesterday, a 30-something year-old dad. He was coming in with an upper respiratory illness that involved a mild sore throat and a pretty nasty dry cough. While taking the social history, I asked him if he had any animals at home. The patient chuckled then, and his laugh suggested there was a story there, but all he told me was that he had one cat, though he's allergic to cats, and two dogs.
Later, when I re-entered with my preceptor, I noticed that the patient's cough sounded mildly wheezy, not unlike the cough I get when I'm around cats (I, too, am allergic). Our patient had been sick for a little over a week, and I wondered if maybe the cat wasn't responsible for his symptoms. "How new is this cat?" I asked. "Two months," he told us. "I guess getting the cat was your wife's idea?" we asked. Well, it's a handicapped cat, he told us. Its back legs are normal, but the front legs are stunted, so that the cat walks on its hind legs or scoots around on its bottom. The very idea was both comical and precious. "So your wife rescued this cat, I guess?" my preceptor ventured. Well, not quite. Our patient had seen the cat on a ranch while he was away for business. He took a picture of the funny little creature and sent it to his wife, saying "It's too bad they'll have to kill this cat." Of course, he received an immediate, vehement response: "You bring that cat home immediately!"
So now our patient lives at home with his wife, daughter, two dogs, and a malformed, adorable kitty, to which he's allergic. He showed us pictures of the thing. It looked like a feline velociraptor. "Look at how the silly thing sleeps!" he told us, showing more pictures. We told him to use an inhaler as needed, pop antihistamines regularly, and learn to live with the cat. His fate was sealed.
Funny the people you'll meet and the stories you'll hear.

Past Medical History

This morning I did an initial History and Physical on a patient who was new to my preceptor's practice. Before I went in to meet him, I learned his chief complaint (rash), and his name: Wilbur. Funny, I remarked to my preceptor. That's a pretty old-fashioned name.

When I walked into the room, I was greeted by a sandy-haired balding gentleman in a crisp white shirt, khakis, and boots. He was wearing too much cologne, which portended sleaziness, but his manner was respectful, professional. We talked about his rash for some time. It had been around for about 5 days, he was developing new spots every day, and they were slightly painful. I think it might be shingles, he said, Or Ramsay-Hunt Syndrome. Usually, patients with shingles complain of terrible pain, I told him. Have you been taking any medication for the pain? No, he said. I've dealt with a lot of really bad pain before, took extra strength Vicodin (Vikodayn, with his Texan accent) for a long time, and now I'm off all that stuff. My eyebrows raised at this hint of a significant medical history. Yeah, he said, I was taking morphine IV and everything, because of a plane crash I was in, but I'm getting off topic. Yes, I told him. We'll get to all that later.

A few questions later, we arrived at the Past Medical History, that fateful part of the initial H&P. Finally, he could tell me what had happened. It was a plane crash, he said, in the mid '90s. Right femur broken. Right arm nearly amputated. Right ulna lost proximally, right radius lost distally. Both shoulders dislocated, sticking out "right here," he told me, indicating his mid-clavicular region bilaterally. He was in the hospital for months, out of work for over a year, underwent 27 surgeries in that time and many more for the reflex sympathetic pain syndrome he developed as a result. He underwent intensive psychiatric therapy and rehabilitation to wean himself off of the megadoses of narcotics required to manage his neuropathic pain. Nearly twenty years later, he was fully functional, working and traveling without any hitches.

The most remarkable thing in all of this was that I never would have guessed at this incredibly traumatic history until he rolled back his shirtsleeves. The scars on his right hand were barely visible, and the hand was stupendously functional, considering the trauma it had undergone. The man sitting before me was shockingly unscathed, at least outwardly.

The interview over, I examined his rash, listened to his heart and lungs, and felt his distal pulses (To my surprise, the right radial pulse was intact). Then I smiled at him and said I'd be back soon with my preceptor.

In the hallway, I gave her a quick rundown of his rash and his storied medical history. A plane crash? she asked. Wow.

When we re-entered the room, after some cursory questions about the rash, she asked what I hadn't: So tell us about this crash. You've gotta tell us the whole story.

It's a long story, he started. (And long it was; we probably ended up listening to him for 30 or so minutes; at one point, his wife called the receptionist and asked why his appointment was taking so long.) Little by little, the details came out. A private plane, a complete engine failure right after take-off. 78 seconds from take-off to hitting the ground again in a terrifying crash. The other passenger 76 years old, hurt, but not as badly as our patient. Our patient lost a lot of blood. His blood pressure was 40 over nothing, a first responder said. Our patient, declared dead on the scene. Our patient viewing the entire scene from above, in an out of body experience.

And there were three people there, he went on. I remember them so vividly, but I couldn't possibly tell you if they were male or female. I just know they were there. One placed my head in their lap, another held up my feet, and a third held my left hand and fed me some cool water. Later, I saw those three people move the other crash victim's gurney into the life flight helicopter.

Once he arrived at the hospital, my patient remembers being wheeled down a cavernous hallway, with a white sheet covering him. He saw fluorescent lights and ceiling tiles flash past as his gurney progressed, until finally he passed through a set of double doors large enough for all of humanity to enter at the same time. On the other side, he saw his wife in her wedding dress, his kids in their Easter clothes, and his father in his coveralls lined up along the right wall. As he began sitting up to speak to his family, my patient felt a hand on his left shoulder, pushing him back down. A voice said, "Lie back down. There will be time to talk to them later."

Next thing my patient knows, he sits straight up in his hospital bed, lines and tubes coming out of many natural and artificial orifices. "Holy shit, God's hand was just on me," he says. From her chair to his left, his mother turned to him and said, "There you are, son. I was wondering when you'd come back."

In bits and pieces, my patient learns that he's been unconscious for days. The doctors and his family had no idea if he would regain consciousness, no idea if he would be the same man he was before. But he has and he is. Over the next year, our patient is "put back together" by a brilliant surgeon who gave him back full function of his right arm, hand, and leg. He suffers from reflex pain syndrome, taking megadoses of Vicodin and other opioids, just trying to stave off the pain. Eventually, he undergoes intensive inpatient rehab and gets off the narcotics for good. Years pass, and now he sits before us, mildly distressed by shingles.

By this time, over half an hour has passed, and my preceptor and I have exchanged many a quick glance communicating anxiety over the increasing length of this patient encounter. There are other patients out there waiting for us. But our patient says, "I'll just tell you one more thing, and then I'll finish the story, even though there's much more to it," and we say all right. He needs to tell this to us.

A couple years ago, our patient entered a local grocery store in search of a squeegee for his shower. "I know, you're wondering where I'm going with this," he assured us as our eyebrows raised skeptically. "But don't worry." After searching the store himself with no luck, our patient asked a little old man working at the store if he could help him find the squeegees. Why sure, the little old man said. But, he said, glancing at our patient's scarred right arm, what happened to that arm there? A plane crash, our patient said stoically. I bet that's a good story, the little old man said gamely. Why don't you tell me about it while we walk? And so our patient related the whole tale to this perfect stranger. By the time they reached the squeegee aisle, the tale was nearing its end. The little old man cleared some space on a low shelf, and they sat together while our patient told the part that bugs him the most. "Whenever people hear this story, they look at me (and here, he squinted his eyes in a way that said goshdarnit I'm sure of it) and say, God saved you for a reason. You have a purpose in this life. But that's the whole problem. I don't know what my purpose is. Here I am over 10 years later and I still don't know what I'm supposed to be doing. God never told me what He wanted me to do," our patient bemoaned. The little old man put his hand on the patient's shoulder, said "Yes I did, son," and walked off.

Here our patient choked up for the first time, and my preceptor and I exchanged a look altogether different from the ones before. This was a special moment, a moment neither of us was likely to forget. Moments like these remind me how lucky I am to be in the medical field. Being a physician means being let in on the most intimate details of strangers' lives. People trust you immediately, and tell you things they don't tell others, even those they love and know well. It's a position of immense power, and one that keeps me in touch with my own humanity. For this I am grateful.

Shooting Stars and Flowers Coming My Way

At the beginning of September, I moved out of my apartment and home to live with my parents because there was mold growing on a bunch of my clothing in my apartment, and that mold made my lips swell and gave me hives and sent me to an emergency room.
About six weeks later, someone decided it would be fun to vandalize [albeit mildly] my car, and I spent a considerable amount of time and energy and a small (though not negligible) chunk of change buying a new mirror for my car and getting it fixed.
Then last week, I see that I've gotten at least one, and maybe two, incredibly harsh evaluations from people I worked with on my Pediatrics rotation, the rotation in which I worked harder than ever before, yet got a few evaluation scores lower than I'd ever received before.
And today, I hear that it's a very real possibility that someone got ahold of my social security number, somehow, and is actively using it to commit, you know, tax fraud.
The world is doing a GREAT job of sending shooting stars and flowers in my direction. If President Obama does not win the election tomorrow, I may be forced to give up on everything. I cannot catch a break.

The n00b Files - Week 3 of Pediatrics

I'm on my third week of Pediatrics, which means I've completed 2 weeks of Pediatric ER, and am on my first week of outpatient pediatrics. I've also fully completed 8 weeks of Psychiatry, during which time I neglected to write down any n00b lessons. But never fear! More lessons await, below:

1. Turns out it's not that hard to look into a lot of infants' and children's ears as I had previously feared. More kids than you'd expect are pretty calm about the whole thing, which makes life a lot easier.
2. On a related note, you know how you're taught to pull a patient's ear back and up in order to straighten out the canal and take a good look at the eardrum? Yeah, with infants and young children, it's a LOT easier to see the eardrum when you pull straight back. Now that was a revelation.
3. The great thing about psychiatry is that you get to spend a LOT of time with patients, just talking to them. I like talking to patients, so I liked that aspect of it. 
4. After seeing a patient who suffered from debilitating generalized anxiety disorder, I'm starting to believe that having severe anxiety may well be much, much worse than having severe depression. I actually felt like crying while talking to said patient, whereas I don't think I ever got emotional while talking to depressed patients.
5. Um, apparently you're not supposed to feed your baby any plain water until he or she is at least 6 months old. Babies are not good at regulating their water balance until then, so if you give babies water, their electrolytes can go all out of wack and then they can have seizures. So, don't feed your infant water!
6. ^Then again, very shortly after I wrote this, I heard my preceptor tell a mother of a 4-month-old that she can give her baby water if they're outside for a long time....so I guess the other lesson here is that the advice that doctors give can vary from doctor to doctor.
7. Subsequently, it's amazing/borderline scary to think how much of my behavior as a full-fledged physician will be directly influenced by the training I receive. For instance, I've learned at school that it's best to hold an otoscope with the handle down when examining ears. My preceptor last summer said that holding it upside down was the "weenie" way, and I had been taught well. Then last week, another pediatrician demonstrated a really adept way of examining an infant's ears...holding the otoscope upside-down. It was just crazy to realize that, more than likely, the way I ultimately do things (including the advice I give parents on some topics, the way I do physical exams, and probably more) may well be determined simply by the last way I was taught to do said things.
8. You can learn a LOT by watching the way your superiors interact with difficult patients and other medical teams. I was super impressed by the way one of my psychiatry attendings handled small and large annoyances. That dude had an amazingly cool head.
9. Psychiatry can really be a very amusing rotation. When I was on inpatient psychiatry, my team and I had many a laugh-filled morning of rounds while discussing some of the unusual things our patients said. For instance, this exchange:

                    Did you sleep well tonight?

                    I was 14 once.

          Or this one:

                    Can you tell me a little bit about your childhood?

                    Absolutely not. 

          ...Okay, so maybe you had to be there.

The n00b Files- Week 3 of Infectious Disease Consult/Week 11 of Internal Medicine

I'm now approximately one week away from finishing MS2 and becoming a wise 3rd year. In preparation for moving onto the second half of my medical school career, I am frantically gathering yet more knowledge as I wrap up my last month of the Internal Medicine rotation. Here's the low-down:

Lesson 1:
Being on a consult service is frustrating in that you make recommendations and write notes and put in orders, but ultimately the primary team makes all the decisions, and sometimes even decisions in your field of expertise. For instance, the primary team stopped an antibiotic on one of our patients without consulting our team first. They stopped it for a good reason, but stopping it without letting us know beforehand was kind of a crazy thing to me. But I get the feeling this sort of thing is not uncommon when you're consulting on a patient.

Lesson 2:
One thing that makes me really, really happy is talking to people in their 60s or so who've already made it through all the hurdles I face now as a 20-something. Most of them have found their life partners, borne and raised children, and had their careers. In a time when I feel like very few things about my future are certain, it gives me hope to look at others who have come before me and made it through and are still smiling. This is probably why I like working with the Alumni Association at my school so much.

Lesson 3:
This is not a lesson by any means, but I took a picture with one of my patients this week, by her request. It made me feel really happy (she was a sweet, short elderly lady who reminded me of all kinds of grandmas), and it also made me realize that doctors take pictures with their patients all the time--and this was hopefully the first in a long line of photographs to come.

Lesson 4:
I may never get over the mental/emotional trauma of seeing patients in the ICU. I know it's a bit rich to say that when I'm, oh, less than 6 months into many, many years of working in and around hospitals. But seriously, how does anyone look at a patient, legs sprawled about awkwardly, mouth open with an intubation tube and orogastric tube hanging out, and catheters and lines coming out of necks, arms, and you-know-wheres, and not shudder, even if for a millisecond?

Lesson 5:
One of the toughest things about being a student is having patients with complex medical problems, whose prognosis you can't predict. Heck, who even knows if the attendings can predict some patients' prognoses? But what I'm getting at is, it sucks to walk into a room in the morning and examine an unresponsive patient while said patient's spouse sits in the corner in expectant silence, hoping you'll tell them something about the patient's progress. Unfortunately, being as inexperienced as I am, I have no useful information for families in a situation like that. It's rough to walk out without exchanging a word with others in the room, but doing that is better than trying to exchange pleasantries, or worse, telling them things about their loved one's medical problems that simply are incorrect.

Lesson 6:
There are 14 specific "systems" that Medicare and Medicaid look for on a Review of Systems; you have to hit 10 to get full credit. They are: Constitutional, Eyes, ENT, Cardio, Respiratory, GI, GU, Musculoskeletal, Neurological, Derm, Endocrine, Allergy and Immunology, Heme/Onc, and Psych. Isn't that wild?

Lesson 7:
I'm really grateful that I don't have inflammatory bowel disease. That stuff sucks.

Lesson 8:
Learning where all the free food is in any given hospital is a worthwhile endeavor. It feels good to walk around with ice cream and smile mysteriously when others ask you where you got it.

The n00b Files - Week 3 of Internal Medicine Wards

I've made it all the way through my Surgery rotation (a 3-month slog!) and I'm 4 weeks into my Medicine rotation (another 3-month slog...what was I thinking?). I'm still learning something every day, but I haven't been very good with recording my discoveries. So here's a braindump of lessons from the wards:

Lesson 1:

Your first shelf exam will crush your soul. Twice. First, you will leave the exam hall wondering if shelf exams are supposed to feel the way you feel at that moment. Then, you'll get your grade and wonder if you've been learning anything at all and/or whether you're cut out to be a physician or if you should just quit now with fond memories of pre-clinical success to look back on. Unfortunately, there's no way to go back and change your performance on your initial shelf, and as Abraham Lincoln (or someone) said, If at first you don't succeed, try, try again. Learning during clinicals is a whole different ball game from learning during pre-clinicals. All of a sudden, you have to not only work all or most of the day (and often 6 days a week), but also go home and study. It's kind of a cruel joke, really. But I figure if thousands of doctors have done it before me, I can do it too.

Lesson 2:

It's really difficult to deal with emotional patients. I like to think of myself as a compassionate person, but I find it hard to comfort a patient when he or she is crying, or talking about how rough life has been lately. It just feels very strange.

Lesson 3:

On wards, you'll probably work with pretty darn awesome scientists/clinicians without even realizing it. In the past week, I've worked with one doctor who was instrumental in discovering the connection between H. pylori and ulcers, who is now working on curing C. diffcolitis, and another who may have found a cure to Hepatitis C. No big deal. [For those of you not in medicine, those are both really big deals.]

Lesson 4:

I've said it before and I'll say it again--having a good team makes all the difference, for real. I have some pretty darn sweet interns, a friendly upper-level, and a couple of great fellow students on my team right now, and if I have to spend the day in the hospital, it's fun to talk to them while I do it.

Lesson 5:

A lot of the time, when it rains, it pours.

Lesson 6:

You're more likely to hear an Internal Medicine resident complain about a pointless admit (for instance, a patient with a history of cancer who's had a 12-hour history of nausea and vomiting and shows absolutely no signs of dehydration) than a very complicated patient. I found that pretty interesting: residents prefer not to have a really "easy" patient who doesn't really need to be hospitalized. They'd rather take care of patients who really need tertiary care, like a hospital provides.

Lesson 7:

When you're a medical student, you can't do a whole lot to help your patients. You can suggest lab tests or imaging studies to your residents, or perhaps pick up on the fact that a patient isn't receiving an important drug to prevent blood clots. But not really much else. What you can do is simple things for your patients, like getting them a toothbrush when they ask, or helping them take their hair out of a ponytail (which was placed when the patient was intubated). Patients tend to be pretty grateful for these sorts of actions, and if something so simple can brighten a hospitalized person's day, it's worth doing, especially when, as a student, you have many fewer constraints on your time compared to your residents.

Lesson 8:

That being said, there will always be patients who seem to need to complain about at least one thing every day. And sometimes you can't do anything to address their complaints, and you don't really want to stand around and listen to them. But like most people who are venting their frustrations, many patients benefit simply from having someone commiserate, if only for a little while every day.

The n00b Files - Weeks 1 and 2 of Emergency Medicine

Working in the EC of my school's county hospital was a welcome break, to a medicine-minded (as opposed to surgery-minded) girl like me, from being in the OR a lot. It was also an opportunity to learn yet more things, some of which I shall record here:

Lesson 1:

Sometimes patients flirt with you. This can lead to very conflicting emotions. On the one hand, these patients are often people with debilitating, chronic illnesses, and you can see that this is an exciting interaction for them--and they don't get very many of those. On the other hand, you kind of want to clock them super hard for hitting on you in your workplace.

Lesson 2:

Apparently, as women progress into the later stages of pregnancy, their bellies get so heavy that if they sleep on their right side, their inferior vena cava (IVC) is compressed by the uterus, and they can't breathe well at night as a result. So a lot of women who are pregnant end up preferring to sleep on their left sides or backs instead. I found this news a little upsetting, since I LOVE to sleep on my right side. Does this mean that if/when I am pregnant I'll have to switch sleeping sides? And if I do switch sleeping sides, will I find myself continuing to sleep on my left side after delivering, or will I switch back to my old habit? There's so much uncertainty in my future!!

Lesson 3:

It's amazing how quickly two days off from work can make a person feel lazy to the bone and utterly useless. It's also amazing how one 12-hour shift in a county hospital's ER can make a person feel like they've worked for days on end, even when they've just come off of 3 days of vacation.

Lesson 4:

Turns out I'm pretty interested in women's health issues. I saw a lot of interesting OB/gyn cases while working in the ER, and I found myself really wanting to follow up with those patients and find out what happened to them. Kinda cool.

Lesson 5:

Altered mental status sure can sneak up on you. I had a patient who just seemed to be in a lot of pain and probably had strep throat with complications. A couple hours later this patient started acting strange and forgetting simple things. BAM, the patient is transferred to an isolation room and I'm sitting around worrying that I have meningitis droplets all over myself and my white coat. Thankfully, the patient probably didn't have bacterial meningitis. Something weird was definitely going on though, and I totally didn't realize it at first.

Lesson 6:

A lot of people show up in ERs for completely non-emergent reasons. Some people just call ambulances when they feel lonely or are suffering from slightly-more-than-normal pain from their arthritis. While it can sometimes be gratifying to help these patients by giving them some human interaction (which I'm pretty sure is all they're really looking for), it can also be frustrating to see them taking up beds in the ER when patients with actual medically urgent ailments are still in the waiting room.

Lesson 7:

I put in an IV while I was in the ER! I know this isn't a lesson, but I was kind of proud of the accomplishment, so I decided to count it as one. Here's the lesson: with a good teacher (a really nice nurse showed me how), even a daunting task can be accomplished successfully. Of course, it didn't hurt that my patient had really nice veins, too.

Lesson 8:

If a patient complains of generalized throat pain that gets much worse when you push posteriorly on their hyoid bone, they might have epiglottitis, which is a pretty scary thing to have, indeed. Most young people can't get it, since it's caused by a bacterium that people have been immunized against for decades now, but patients 50+ are still at risk.

Lesson 9:

Learning the dosage of narcotic pain medications is worth one's while. I'm sure most people have it completely memorized by the time they finish med school, or at least intern year, but here it is:

for morphine, give 0.1 mg/kg

1 of Dilaudid is worth 8 of morphine

for Fentanyl, give 1 microgram/kg.

Keep in mind that Fentanyl is really short-acting, despite being very strong.

These lessons may have been a little boring...

The n00b Files - Week 1 of Transplant Surgery

More things I've learned, some more pleasant than others:

Lesson 1:

One of the best things about being a surgeon is that you get to make people listen to your favorite music when you operate, if you're so inclined.

Lesson 2:

One of the worst things about being on your surgery rotation is that you have to listen to your attendings' favorite music while they operate, if they're so inclined. Sometimes you like their music, and you jam out to Chumbawumba and Third Eye Blind and Hootie and the Blowfish behind your mask. Other times it's lots of Nickelback and Lifehouse and really bad Top 40 and you feel like your ears are bleeding.

On a related note, it's funny when middle-aged white surgeons have club music on their playlists.

Lesson 3:

LUNGS ARE HUGE. I'm talking, each lung is like twice the size of my face. On the real. They're all puffy and somehow remind me of two large-ish Teddy bears. I saw live lungs for the first time last night. Crazy thing.

Lesson 4:

Organ transplantation, when successful, is a wonderful thing, giving recipients a new lease on life. What one often doesn't think about is organ donation, which almost always happens when a patient dies. I came face to face with that part of the equation last night during an organ harvest. It was surprisingly disconcerting to see the patient wheeled into the OR, and then to see the patient's vital organs being removed and the patient's life blood being flushed out. All a part of the circle of life, to be sure, and organ donation is a way to make a senseless death worth something more to others. But all these things being true, it's still a difficult thing to stomach, at least at first.

Lesson 5:

I apparently have a tendency to experience dysphagia (ie, difficulty swallowing) and subsequent throwing-up on mornings after I've had very little sleep the previous night. I've had two such nights in my 5 weeks of the surgery rotation so far, and I've thrown up on both of the following mornings. This has happened to me in the past before, too. This can't be good, as I'm sure residency will put me in this very situation many, many times. Must learn to pace oneself in the morning instead of trying to nom after a long night.

Lesson 6:

If you don't watch sports, it might be smart to start doing so in order to interact with a large number of patients during semi-awkward situations. One of my teammates last month could always talk to patients about sports while changing their bandages in order to distract them from the pain. I usually stood mute, especially when the patient was a man and I was pretty sure we had nothing in common. The talking-about-sports route was much better.

Lesson 7:

When asking questions to attendings, be careful not to ask too many questions that reveal your lack of knowledge. Otherwise you might find yourself being told to research your own question and report back to the attending the next morning. Which is what happened to me today when I asked one too many questions about the steps of a kidney transplant. Drat!

Lesson 8:

Sometimes people are just kind of crabby and prone to snapping at you. That's pretty crummy.

Lesson 9:

You know how on Grey's Anatomy, whenever they're doing a transplant they anxiously wait for the organ to "pink up" while thoughtful music wells up in the background? Yeah, that happens in real life, too. I got a bit of a kick out of that.

Lesson 10:

You'd be amazed how quickly a pink bowel turns white when it's not getting blood flow anymore. Conversely, if you look away for a second after a kidney transplant has been attached to the recipient's blood supply, you'll miss the magic moment when it goes from being white to being a rich purplish-pink. Blood flow is cool.

The n00b Files - Week 4 of General Surgery

More things I'm learning:

Lesson 1:

An NG tube is used to suction/drain fluid that is building up in the stomach. I used to be under the misguided notion that NG tubes were used to feed people. Wrong.

Lesson 2:

When examining a patient with a diabetic foot, make sure to feel for their distal pulses if you don't want to feel totally silly when your upper-level comes in to check up on the patient.

Lesson 3:

It feels pretty darn cool when your team's patients run into you outside of their rooms and address you as "doc." It also feels a little scary; I'm always quick to correct them by saying, "Well, I'm almost a doctor.."

Lesson 4:

Working with a good group of teammates makes all the difference. The other medical students on my team are nice and funny and very accommodating when I need them to cover for me. I'm glad I started out my time in clinics with them. My sister told me that one of her favorite things about clinicals was getting to know many of her classmates much better than before. I'm really grateful for this, too, and I'm off to a good start!

Lesson 5:

Taking time to engage in your interests really improves your quality of life. I've started writing these n00b lessons, and I've also redoubled my efforts to publish my latest essay. Both of these pursuits give me great joy.

Lesson 6:

Finding beauty everywhere makes you pretty happy. I think bowel is beautiful. Weird? Yes. Good for my mental health? Arguably, yes.

The n00b Files- Week 2 of General Surgery

More words of wisdom from a certified n00b:

Lesson 1:

The nicest people during the day become terse and impassive when you're on overnight call with them. It's hard not to take that personally, especially when you're fresh out of pre-clinicals and normally only saw authority figures in the bright light of day (or in the dim light of the lecture hall, as the case may be). However, one should try to keep in mind the simple fact that people are cranky when they're sleep-deprived and/or hungry. Even doctor-people.

Lesson 2:

Planning ahead helps make your life a lot easier/happier when you're on clinicals. For instance, when you're going to take overnight call and know you'll have to sit through boring meetings/lectures the following morning instead of going home before rounds like you wish you could, make some coffee at home and bring it to the hospital with you. That way you don't have to spend an arm and a leg getting coffee to keep your sad little eyelids open. Also, throw an extra granola bar into your lunchbag so you can use it for breakfast the following morning.

Lesson 3:

I can now recognize the smell of dried blood. I'm not sure how I feel about that.

Lesson 4:

Chest tubes, while very important clinically (they're designed to suck out air, fluid, blood, etc out of the cavity around the lung, so that a collapsed lung can reinflate and get back to normal), are really freaking gruesome to put in. They're also pretty unpleasant to remove, but not quite as bad as the insertion process. Shudder.

Lesson 5:

I'm pretty scared of trauma cases, and tend to tense/freeze up when I'm in the shock rooms when a trauma comes in. However, I'm glad to report that I haven't felt nauseous or faint in trauma situations so far, and that's an improvement over some of my previous experiences. Hopefully writing about said improvement won't jinx me.

Lesson 6:

When asked if you're interested in a field in which you have absolutely no interest, a very diplomatic answer would be, "I think it's a great learning experience, but I don't think it's the field for me." Not that I've had the presence of mind to utilize that phrasing so far. Still, it's a good thing to keep tucked away in my brain.

Lesson 7:

Take care of any chronic and/or annoying health issues you may have ASAP. I've had this annoying cough for the last three weeks and it's really cramping my style. I'm pretty sure it's an asthma flare-up, but who knows. Anywho, I have an appointment to get it worked out tomorrow, and I'm very excited about that. Ailments begone!

Lesson 8:

Use an alcohol wipe to clean your trauma shears or stethoscope between patients, especially for the trauma shears. You never know when the dressing you're undoing covers a wound infected with MRSA, and it's best not to spread that from one patient to the next...for obvious reasons.

The n00b Files - Week 1 of General Surgery

I'm now one week into my general surgery rotation, and I've learned a great deal in a short amount of time. Some of the knowledge is clinical, some is more in the life lesson category, and some is simply important knowledge about my own self. In the effort to record what I've learned and perhaps share it with those who might benefit, I've decided to start writing The n00b Files, filled with the edification I gain on clinical rotations. Here's to a great new start.

Lesson 1:

Everyone on the surgery rotation is nicer than the general reputation of surgeons would have you believe. I expected my interns, upper-level residents, and attendings to be much more brusque or impatient with me and my many mistakes, but nearly everyone has been nothing but kind and patient. It's a really nice thing.

Lesson 2:

You're going to mess up at first. It's inevitable. But the nice thing about a month-long rotation is that it gives you ample opportunity to learn from your missteps and do better next time. I think I'm finally starting to be useful to my team, and that feels good.

Lesson 3:

When you're scrubbing into a surgery, you might be asked if you want to double glove. If asked, say yes. Wear a blue pair of gloves as your "under glove," and a white/cream pair over those. The under glove is typically a half-size larger than the over glove, which was somewhat surprising to me, but now makes sense.

Lesson 4:

Being a surgeon basically consists of two main things: actual surgeries and wound care. Nobody becomes a surgeon because they enjoy wound care. Wound care is gross. So basically, if you're not super excited by surgeries, then you probably wouldn't be happy as a surgeon. I'm glad to report that having discovered this, I have confirmed that though surgery is a rotation that's enjoyable and informative, and though I respect surgeons a great deal, I do not want to be a surgeon. It's nice to know that my initial stance was correct.

Lesson 5:

I really, really, really enjoy the clinic setting. Today, during our first day of surgery clinic, I enjoyed myself more than I have throughout the last week. Which isn't to say the entire rotation has been a drag so far. It hasn't. Clinic has just been the highlight. Compare this to my interns' advice to avoid clinic at all costs, and you have further evidence that I am not made to be a surgeon.

Lesson 6:

Shockingly enough, waking up at 4:20 AM isn't all that horrible. It helps that the first few hours after I get to the hospital keep me very busy, so I don't have a chance to get sleepy. It also helps that I go to bed around 9 PM every night now.

Lesson 7:

While free food was the best thing ever during pre-clinicals, free coffee is the best thing ever during clinicals. I probably drink too much coffee now. I should start putting in less sugary creamer so that I don't get fat off of coffee alone...

Lesson 8:

The laparoscopic camera is pretty confusing to drive, and the medical student often has the privilege of driving it during surgeries. You can get some explanation of the camera prior to surgery, but try to ask someone to give you a quick run-down on how it works when you're scrubbed in. The scrub tech is a good resource for this (at least, that was the case in my experience), and knowing how it works will not only make you more useful during the surgery, but also make you feel like your upper-level resident doesn't think you're a total n00b.

Lesson 9:

It is truly a privilege to care for patients. It doesn't always seem that way, and I've found it difficult to interact with some of my sicker patients because I simply don't know what to say or how to act when they seem to be in such pain or so badly damaged. But when I finally did start talking to some of them (while changing their wound dressings, for instance), I felt like I was making my own small contribution towards their healing process. It's a nice thing.

Lesson 10:

Life is good when you're doing what you want to do. Weekends are wonderful for seeing friends you're not rotating with. There are always challenges to overcome and more mistakes to be made, but there's little to complain about.

What If

A lot of subjunctives have been on my mind lately, though I hadn't really put my finger on "what if" as the theme of my current or recent thoughts until today.

A few days ago, there was a suicide bombing in the International Arrivals terminal of the main airport in Moscow. At approximately this same time last year (February 7, to be exact), I was in that very same terminal. What if the attack had happened a little over a year ago?

I suppose we're all here for some reason, and that we're all only a minute, or a decision, or a chance away from our lives taking a wholly different path than we had originally expected. Makes you think though--what if you had taken a wrong turn somewhere, and weren't here anymore? I believe we'll only take that wrong turn when we're fated to do so. What do you think?

Fun fact of the day: warfarin, an anti-clotting drug, gets its name from Wisconsin Alumni Resource (or some other R- word) Fund, because it was developed at the University of Wisconsin. So every time a patient gets prescribed warfarin, the University of Wisconsin cashes in a little [or maybe a lot? I'm not sure]. What if warfarin had been developed at Baylor College of Medicine? It would be called barfarin. hahahaha.

Selection Bias

I've been playing my iTunes on shuffle for the past three days, and I've been continually impressed with just how good the playlist has been. Owl City and Ingrid Michaelson and Imogen Heap and Kate Nash and Hellogoodbye and some great Tamil songs thrown in, along with some of the new Maroon 5 album. It made me really happy that such great songs were coming up on shuffle.

...

And then I realized that I'm loving all the songs that are coming up because they're, well, my library. Selection bias works its magic: I chose all the songs that went into my iTunes library, so of course a random playlist of them would be filled with all my favorites. It ruins the magic a tiny bit, but it also makes me smile. How circular our lives can be.

Another example of selection bias: patients on peritoneal dialysis are more likely to survive than those on hemodialysis, even though peritoneal dialysis is less effective at renal clearance than hemodialysis. Why, you ask? Well, because of many factors, including better retention of renal function in those on peritoneal dialysis, the lack of biocompatibility issues for peritoneal dialysis [unlike the ones rampant in hemodialysis], more cardiovascular complications on hemodialysis, and better clearance of middle molecules [which may be toxic to dialysis patients in the long run] in peritoneal dialysis. But most importantly, patients on PD might have a selection bias phenomenon: those who choose to do the more independent and demanding form of dialysis are likely to be better-educated (and thus take better care of their renal health overall), less sick, and have better family support.

^I wrote that entire paragraph to review something I studied today. Exams start in 6 days, and it's time for lockdown. Not long till I see the light!

Ostrich

Every once in a while I get to acting like an ostrich with its head in the sand. I get ensconced in my routine, used to the way I run my life, and fail to reach out and grab the chances offered to me. Meetings of interesting organizations go unattended, simple surveys unfilled, because I'm just used to the way I've settled into things, because Grey's Anatomy is on and I don't want to miss it. It's a ridiculous and infuriating tendency in me, this love of sitting back and relaxing. Life would be better if I were always on my toes, at the edge of my seat. When I was finishing college, I realized that though it might seem on paper that my hand was always in something or other (metaphorically, not literally), I really didn't do nearly as much as I could have or should have or might have.

Because of that realization, and because I don't want to have regrets when I graduate from medical school, I'm trying to live with the concept of doing more than you think you can. Like Imogen Heap sings in Tidal, I want to "do it for all the times we wished we had." And that means stretch myself academically, extra-curricularly, socially, and with new experiences. I've been doing all right so far, and it was especially easy to stretch myself out of some comfort zones while medical school was still new and fresh and I hadn't yet settled into a routine, but I'm finding myself edging towards that dangerous complacency now, and I want to avoid it.

Also like an ostrich with its head in the sand, I can be completely clueless sometimes. Case in point: this evening around 9:30 I realized that I had failed to attend the FIRST SESSION of an elective this afternoon. I was really excited about this elective, too: Art of the Human Body at the Museum of Fine Arts. But instead of going to it like a responsible student, I completely. Forgot. Instead, I took a two-hour nap this afternoon (glorious, but not exactly productive), studied some, cooked a tiny bit, and watched two premieres of two shows. I'm not saying it wasn't a good day overall. I'm just saying I need to get my head out of the sand (or my ass, or my routine) and take a look around every once in a while, because I miss important things when I get this way.

The Good, the Bad, the Ugly

The Best: I met Amy Tan tonight! I love her books, though I haven't touched one in ages, and I didn't even get to hear her read because I had to leave early, but meeting her was such an honor, and I got her to sign my yellowed paperback copy of The Joy Luck Club and take a picture with my sister and me. All in all a pretty great Monday night.

The Great:

1. I went to a reading last Tuesday evening by my wonderful former creative writing professor, Emily Fox Gordon (www.emilyfoxgordon.com). She is one of the most intelligent authors I've ever read--in my adult life, other than when reading, say Moby-Dick or Midnight's Children, never have I had to look up words so many times while reading a book. Emily's cadences are nearly always spot-on, and I am so proud to have been taught by her. She struggled with trying to write fiction for many many years before realizing that personal essay was the genre for her (and, I think, the genre for me--this is the class I took with her), but she had to write two memoirs and one novel (the last a triumph for her, because she never thought she could write fiction) before FINALLY getting to publish a collection of her personal essays entitled Book of Days. I bought this book at her reading and had her sign it, and she signed it "To Chaya, one of my very favorites," which made me feel really special. I'm hoping to have lunch or coffee with her some time in the near future. That reading came at the perfect time: between my first medical school exams. It reminded me that there's a whole other amazing and happy side to me and my life that isn't sciencesciencescience, and I had nearly forgotten about that aspect. So it was just. Great.

2. I've realized that I can count on my best friends to see through my facades and know exactly, exactly when I need them and to be there when I need them, and that is comforting in a way I cannot even express. I don't know what I'd do without the wonderful people I have in my life.

The Good:

1. I've made soup twice since moving into my apartment, and both times, the soup has come out great. Really, great. This is absolutely wonderful, partly because I love soup, but also because I've always, always wanted to be a wonderful recipe-less cook like my mother, and I'm finally starting to edge towards the possibility of that. I've eaten tons of sub-standard Indian food (prepared by myself) for the past few years as I've tried to find my cooking rhythm, and I'm finally starting to get that magical intuition that all Indian mothers seem to have. And my newfound cooking savvy seems to extend to pastas and soups as well! This is wonderful news.

2. I'm one block into medical school, and I've not only made it so far, but enjoyed it. I'm a little loath to begin studying again now that a new block has begun, but I'm hoping that my enthusiasm will grow slowly but surely.

3. The new Sara Bareilles album is filling me with great joy. How wonderful when an artist one loves proves her worth with a second album that is quite possibly better than the last.

The Bad:

1. It's 9:10 PM and I've only reviewed one of the four lectures I had today. And I wanted to go to bed early tonight as getting up early (after four days of vacation) was particularly difficult this morning.

2. Crazy as it sounds, medical school is the simplest, most manageable thing in my life right now. On the one hand, this makes medical school not so bad. On the other hand, it shows how much of a struggle many other things are being right now.

The Ugly:

1. I'm trying to write a piece for my medical school's literary magazine, and I'm running into problems from the outset. I haven't written anything worth anyone else's revisions in an incredibly long time, and I really want to make this piece great, because I know there's substance there. I just feel like the lolcat in that lolcatz picture, the one that's sprawled across a keyboard with the caption "Writer's block. I haz it."

2. I just want so badly to be substantive, real. I feel that I'm not really either.

Like a Duck to Water

Crazy as it may sound, that's the way I feel that I've taken to medical school. To be perfectly honest, I wondered for a long time whether medical school was the right path for me, even as I was interviewing and deciding where to go to school. Once I got here, though. I quickly [very quickly] learned that it was exactly where I wanted to be, where I was supposed to be. Perhaps it's just the excited flush of new experiences and new friends, or the joy of learning, or the even greater joy of finally starting on the path toward my chosen career, but medical school, though challenging no doubt, is proving to be much, much better than I had anticipated.

I've been taking classes for five weeks now (our orientation was six weeks ago), and it feels like forever. I barely have a memory of the summer that was before school began. We've covered in five weeks what a college course would have covered in at least 2/3 of a semester, encompassing two tests or more. And we still have one more week of classes before we finally have an exam over our first "block" of material.

When I was still in college [now that's a weird clause; I graduated from college almost a year ago. Imagine that!], I heard from a lot of friends in med school that trying to study all the information thrown at you is "like trying to take a sip of water from a fire hose." It's hard to actualize that kind of workload until you're experiencing it for yourself, but I'll have to say that the simile is quite apropos. I would like to add one of my own, though: each week, I feel as if I'm stuffing more and more compressible cotton balls (information) into a container with a snap-shut lid (my brain). As the weeks go by, the volume of the container gets more and more filled, and each week I'm having to push the cotton balls down, compress them as much as possible, then pull my pressing hand away as rapidly as possible as I rush to snap the lid shut on those overflowing cotton balls. It's a set of expectations the sort to which I've never had to rise before, and it's not easy.

But.

I'm finding that I actually like learning about feedback regulation in glycolysis, the muscle that makes my knee jerk in that famous reflex, the tendons visible beneath the skin of my hands. I like my classmates. Their intelligence, while a bit intimidating, is inspirational. Medical genetics and embryology, basically classes about every way a human being's development can go wrong, make me grateful that my genes contain no deleterious mutations, that the oddly-named Sonic Hedgehog signaling protein was present in all the right places and in all the right amounts so that my neural tube developed properly less than three weeks after my conception. There is so. much. to learn about our bodies, but how amazing to know how our muscles contract, that there are tiny little fibers that "walk" across each other every time our motor neurons fire and excite a skeletal muscle? Every time I get to thinking that this is just too much, that no one person can do this, I try to remind myself that so many others have gone before me, so it's possible. More importantly, one day I could be taking care of someone's motherfathersisterbrotherfriendhusbandwifechild, and I want to know everything I can so that I can take the best possible care of that person.

And it doesn't hurt that I still have time and energy to go out with friends on the weekends, talk to my roommate about our respective days daily, see friends from college, visit my family back home, and, yes, waste time every once in a while. More often than I probably should, in fact.

I've been watching Saved by the Bell in the mornings while I'm eating breakfast before school, and I can't help thinking that the theme for "The College Years" episodes is rather relevant to my current situation: "I'm standing at the edge of tomorrow...the future looks bright to me." I am so excited to be starting this next stage of my life, and I can't wait to be a real MD, with all the knowledge--and responsibility--that entails. Not to mention, it'll be nice to finally be getting paid.

"We're young enough to say, 'Oh, this is gonna be the good life.'" Good Life-OneRepublic

New Toy!

I'm writing this on my new netbook, a yellow Samsung N150. See below for a visual aid:

(photo cred: http://tinyurl.com/y7uo6zp)

I've wanted a netbook pretty much ever since they first came out, so I'm really excited about this one. It has a 10.1" screen and is, well, super cute. I got this netbook in preparation for medical school. I've had my old laptop (an IBM thinkpad that's solid, but a bit of a clunker) for about five years now, and it's definitely time to upgrade, especially since the harddrive on my IBM is woefully small. My lovely father has decided to get me both a netbook and a laptop for medical school. I know the expense may seem a bit over the top, but I won my first laptop (the IBM) in a scholarship contest, so I figure the amount of money I would have spent on that first one for college can be spread over to my new netbook and laptop.

Anyway, while I'm super excited to have an adorbes new netbook, I have to say there are a few things I'm not so jazzed about. To run through my reaction:

Things I Love

• It's so small!
• Hello, it's freaking yellow! (the inside is white)
• It has a sweet mousepad (wait, what do you call the mice on laptops? Touch...mouses?), that pretty much does all the cool things that Apple products do with their touchscreens: scrolling with two fingers, zooming in and zooming out when you make the corresponding motions with your fingers, and even rotating photos when you make, again, the prescribed motion with your fingers.
• Its speakers are pretty sweet, especially compared to the ones on my previous laptop, which were, like the harddrive, a bit woeful.
• It has a built-in webcam! I totally did NOT have that on my previous laptop, so I'm pretty excited about being able to, you know, video chat and take mirror image photos of myself and whatever.

Things I Don't Love

• Because this netbook, like all netbooks, runs on an Intel Atom processor, I can only run Windows 7 Starter on it, and not the full version of Windows 7. When my dad and I were looking at netbooks online, I thought Windows 7 Starter was just some sort of trial version, that you could upgrade your OS later on once you had bought the netbook. Yeah, I was wrong. Windows 7 Starter is apparently designed for low-process (or something) computers, and it has some limited functionality. For example:
• I CANNOT CHANGE MY DESKTOP WALLPAPER. You have no idea how much this bothers me. This was the first thing I was excited to do once I began playing with my netbook (I should name it...), to make it my own and personalize it in some way. But yeah. You're not allowed to change the desktop background if you're running the Windows 7 Starter OS. Why they limited that function, I have no idea. I don't imagine it takes so much out of your processor to just display a photo other than the standard issue one as your wallpaper. But yeah. Since this was the first thing I wanted to do, and it was also the first disappointment I had with my netbook, I find it incredibly irksome. This initial disappointment led me to see other things I'm not terribly fond of on this netbook. Which kind of sucks. [seeing the disappointments, not the netbook itself]
• I feel like even though its screen is the standard size for netbooks, 10.1", mine doesn't seem quite as small as the ones I've seen before. Maybe I'm just being silly. In fact, hopefully I am.
• The battery on this guy is definitely a little bulky. The other netbooks I've seen, mostly Acer and Asus and HP ones, seem to be sleek overall, pretty planar with no bumps or anything, but the battery on mine sticks out a bit, which I imagine would make fitting it neatly into a sleeve a bit difficult.

All in all, though, despite my few disappointments, I'm still quite excited about my brand new netbook. I'll get over the unchanging desktop eventually, and on the bright side, I can still have a slideshow of photos as my screensaver. I'm sure this is the start of a beautiful relationship.