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.

Ups, Downs

It was a day of ups and downs.

On the one hand, my beloved yellow netbook Sunbeam is almost certainly irretrievably dead. On the upside, I should be able to salvage all my data, and my sister has a pink version of Sunbeam that she's going to let me use, so all is not lost. Still, I liked my little yellow netbook. It won't be the same.

Went to Macy's with my mom to shop the clearance and "one day sale," ostensibly to find some professional clothes for my medicine rotation, which begins in about a month. Here's what I discovered: the clothes at Macy's are almost all ugly. I'm better off buying random things off of the clearance racks at New York and Company and Express and Ann Taylor. I did, however, buy myself a little sweater dress for $4.99. Oh how I love cheap things. Sadly, the clearance shoes were neither cheap enough to buy nor comfortable or professional enough for clinics.

Spending the weekend at home for the first time in a while gives me plenty of time to watch I Love Lucy with the parents and eat too much Indian food. I realized last night that if/when I get married, I will most certainly put I Love Lucy on DVD on my bridal registry. It might sound weird, but I know that show will be a central part of my future family's traditions, so it's of paramount importance that I get a copy when I strike out on my own--or with a husband, as the case may be.

Lastly, listening to John Mayer's Battle Studies while reading Pestana's surgery review makes studying that much better.

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.

Now You're in New York

Just because I haven't blogged about my India trip as promised (so much for putting pressure on myself; who was I kidding? Seriously, though, I will blog about it. Someday.) doesn't mean I can't write about the trip I'm currently on: visiting a friend from high school (and middle school) in New York City for a week! I was really excited when I first scheduled the trip, and I'm still definitely happy to be here, but upon consideration, I've decided that my trip here is too long: it spreads out the excitement a bit too thinly. Additionally, going to a tourist mecca like New York and staying with someone for whom this is just home dissipates a bit of the excitement of being in said tourist mecca. Still, I'm enjoying myself here, and have seen some wonderful things. For which reason I'm writing this post. So here we go:

The first night I was here (Monday), my friend and I had dumplings in Chinatown for dinner, which was pretty delicious. We then had our obligatory bubble tea and then sat around her apartment for a while before getting dolled up for a [Monday] night on the town! It was the birthday of two of my friend's friends, so we went to an Asian-themed bar called Forbidden City, where I imbibed a little. One of my drinks, called the Red Lotus, is pictured below. It had a lychee at the bottom!

The next day was cold and rainy, so we spent it inside at the Metropolitan Museum of Art!

This place is GORGEOUS, top to bottom. Beautiful architecture, amazing detailing in the ceilings and walls and everywhere, and the art is to die for. I really enjoyed this day, but by the time we got back to Katherine's apartment cold and a little wet, all I wanted to do was curl up with a movie and take-out, so we did just that: Thai food and The Time Traveler's Wife, which was a nice chick flick.

Katherine was busy the next day, so I ventured out into the city by myself. I was a bit nervous, but with the expert advice of hopstop.com, which gives public transit directions for many cities, I got to and from the New York Public Library, which took my breath away repeatedly with its sheer beauty, safely. The library is celebrating its centennial next year, so the front of it was covered in drapes while it was being cleaned, as a result of which I couldn't get a great shot of it. Notice in the picture below, though, the lion (one of two) in front of the steps leading up to the library. Mayor LaGuardia (whose namesake is one of the two airports here in NYC) named them Patience and Fortitude, because he thought those were the qualities New Yorkers would need to survive the Great Depression. I spent the majority of my afternoon in the library, part of it on a free public tour, and part of it just walking around and marveling. Trust me: there was much at which to marvel. Beautiful!

Thursday afternoon (we've been skipping breakfast altogether and starting our days around lunchtime), Katherine and I went to SoHo, a district known for shopping and food (sounds like a lot of other districts...). We ate fusion dosas (Indian rice crepes, often stuffed with curried potatoes) at Hampton Chutney Co. I wasn't terribly impressed with the food, but it was an interesting experience nevertheless. We then browsed the stores in SoHo. I bought a slightly unnecessary shirt at H&M, but not much else.
We swung by NYU, Katherine's alma mater, and Washington Square Park on our way back to her apartment. The park is really beautiful, with the gorgeous arch depicted below being the standout feature. Similar to our tradition with the Sallyport at Rice, students at NYU aren't supposed to walk under the arch in Washington Square Park at all until they've graduated. Katherine and I walked under it together, officially marking her graduation from NYU!

Special note: outside of Washington Square Park is one of my favorite things, so far, in this city: A DOSA CART! Two men stand there and whip up masala dosas (as I mentioned before, that is an Indian rice crepe stuffed with curried potatoes). I haven't tried out the cart yet, but I plan to before I head back home.

Next on our trip back to her apartment was the Strand, a bookstore the logo of which is very recognizable (red oval, white lettering, says "The New York City Strand: 18 Miles of Books"). This place had TONS of books, and as I was browsing the fiction stacks, I realized that they probably carried one of my favorite books that was stolen along with the rest of the contents of my friend's gym bag when I let her borrow it. So I asked the friendly people who worked there if they carried The Tale of Murasaki and they sure did! This was probably my favorite purchase so far of the trip. = )

Thursday night I had the best burger ever at the Shake Shack, located in Madison Square Park. This thing didn't have a veggie patty; instead, it contained a portobello mushroom coated in cheese...and deep fried. Sounds horrible for your health, and probably is, but it's also incredibly tasty. The Shake Shack also has great custard desserts called Concretes, because they're theoretically thick as concrete. They start with a normal flavor of custard, and you get to choose your "mix-ins." Amazing! Go here when you come to NYC.
Katherine was also busy on Friday, so I spent the afternoon (which started out so hot I really thought I would melt) in Times Square and Rockefeller Center. Here are the obligatory shots of the billboards and digital displays of Times Square:

I explored the flagship Toys'R'Us, which has an actual ferris wheel contained within the store. Kind of amazing. My favorite part of the store, though, was the public restroom on the top floor. I was beginning to get desperate when this one came into view. Yay for Toys'R'Us. I also explored the M&Ms store (three floors of merchandise dedicated to M&Ms! Amazing), which put the nearby Hershey's store (one floor and tiny) to shame. The other stores I visited (Gap, American Eagle) were not quite as impressive. I caught a glimpse of the inside of the under-construction flagship Forever 21, and it was CAVERNOUS. I actually thought I was confused for a second and was looking into an under-construction hotel lobby. That's how huge it was. I wish it had been open while I was in Times Square...

It took me a while to find Rockefeller Center, but with the help of the handy dandy map I procured at the visitor's center in Times Square (go there when you're here, too; it's useful for good maps), I eventually got there. Back in 2006 when I visited NYC with my family, my Dad and I woke up at 5 AM or so on two consecutive mornings in order to be part of the crowd that cheers during the Today Show. This show was a big part of my life growing up. I would wake up to the opening strains of the theme song every morning during middle school, and I almost always watched it in the mornings before going to school. I'm not as into it anymore (Katie Couric is gone, and she was my childhood idol!), but it still holds a special place in my heart, as does Rockefeller Center. So it was fun being there and just looking around. Also enjoyable is the NBC experience store, which contains memorabilia for tons of NBC shows, from The Office to Saved by the Bell to Friends to The Today Show. Check out the clearance section! Here's a shot of me in front of Rockefeller Plaza. I look a little dumb, but I guess that's okay. It was still very sunny and pretty hot at the time:

And that has been my trip so far. Think of this as my halfway-done report. I still will have to blog about today (Saturday), Sunday, and Monday. Sneak preview: today we saw the financial district in downtown Manhattan, and tomorrow we're seeing an off-Broadway play: Avenue Q! Exciting!

Note: Post title lifted from, of course, "Empire State of Mind."

We Should Be Happy, That's What I Said from the Start

This morning I took a partially eaten box of Club crackers to lab. Starting two summers ago, one of my labmates, James, has consistently kept dark chocolate chips at his bench, and I spent many a quiet lab afternoon munching on those dark chocolate chips and chatting with him and the rest of my labmates. Unfortunately, I don't have much of a sweet tooth, and dark chocolate chips don't exactly fill me up. So forever, I've been telling myself that I need to bring savory snacks into the lab for everyone to snack on. Finally doing what I've told myself I would do for so long really felt good. Even better was that I finally got to snack on crackers in lab! And the best was that my labmates enjoyed [and are still enjoying] the crackers as well. I didn't realize until some time in my college career that I'm turning into my mother in the sense that I love it when people eat food I offer. So to see the cracker box slowly emptying brought me more joy than something like that normally should. Ha.

You know how people talk about the straw that broke the camel's back? I feel like eating three Club crackers on my way out to the parking lot after my day in lab was that for me, except in a positive way. It was the one incident in the day that made me realize that, once again, I'm happy today. There are just so many reasons to be joyous. The weather was beautiful today, and I ate lunch outside with two of my closest friends. I started a new mapping project in lab, and if things go well, I'll leave the lab [forever, which makes me sad] two weeks from now having mapped two mutations in about 10 weeks. Actually accomplishing things in my labwork makes me feel so good. I got to leave early today, and beat traffic coming home, but also managed to do real work in lab--yet another thing to be happy about. Last but not least, it didn't hurt that I wore a bright red shirt today that made me feel pretty. Course, I ruined the whole look (tunic and skinny jeans) by wearing chunky flip-flops, but said flip-flops are very comfortable, so I'm okay with that.

I very recently reconnected with two friends I haven't really kept in touch with throughout college (one via facebook message, the other via phone), an act definitely galvanized by the funeral I went to last weekend. That it was so simple to get back in touch with those two, especially one of them, that all it took was one facebook message, one phone call, made me feel...hopeful. It's great to make new friends, but the Girl Scouts weren't kidding when they said, "Make new friends, but keep the old, one is silver and the other's gold": there's nothing like the comfort of knowing that someone who knew and loved you back in your middle school dork days is still at least mildly interested in your life and your future.

And a lot of other things are going well in my life right now: my family, my future, my love life. There's just a lot going right, right now. It feels a little precarious, but hopefully life will stay this way. = )

"Hopelessly, the hope is we've got so much to feel good about." (Good Life-OneRepublic)

Note: Entry title is lifted from a line from "Happy" by Nevershoutnever, some of the lyrics of which confuse me, most of which make me, well, happy.

And There'll Be Sun Sun Sun...

I feel almost guilty [almost, but not quite] that I'm enjoying temperate, sunny weather in Chennai, India while my friends back home shiver in 40-degree weather. Then I remember that I'm covered in mosquito bites (and getting more by the minute) and I don't feel so guilty anymore. This, my friends, has been the [happy] refrain (happy refrain, that's from some song I think...anyone know which? "And we will sing this happy refrain..." something like that) of nearly all the postcards I've written so far--and I've only written ten out of the 28 or so I'm to write from India. Funny story: the postcards, which feature scenes only from South India (in fact, I think, only from Tamil Nadu--which makes me happy because yay South India!) cost 6 rupees each. Postage for each one to America costs 15 rupees each. To be expected, but it's still pretty funny.

Other news:

1. My cousin who picked me up at the airport is a pretty darn good driver, which is saying something because driving in India is insane.
2. I made enchiladas for my two cousins here in Chennai for tiffin yesterday. (I love the word tiffin. Tiffin tiffin tiffin.) They rather enjoyed them, but now I have lots of refried beans and tortillas and enchilada sauce left in the refrigerator. I'll have to get my aunt and uncle to eat an enchilada or two later today.
3. Yesterday I showed my cousins (Abhi and Akhil, so I can stop writing "my cousins" all the time) the video for "Down" by Jay Sean on my iPod Touch (yay iPod which has proven so useful on this journey so far!). It was rather an interesting moment, just because there I was, Indian by birth but thoroughly American, showing my Indian-Indian cousins an r&b song by a British-Indian guy. They didn't really say whether they liked the song.
4. I bought myself Indian shampoo on the first day I got here. I'm really fascinated by the concept of beauty products and cosmetics made solely for Indian women. Foundation that's actually brown? Yes, please! (Okay fine, you can get brown foundation in the States, too, but it's different here. It just is. Plus, cosmetics are a bit cheaper here.
5. I won't be leaving India for another five weeks, but when I do, I'm going to go crazy buying Indian packaged food. We've been to the grocery store twice already to buy enchilada supplies, and I've begun to scope out all the types of noodles and sauce mixes and soups I can buy to fill up my soon-to-be-emptied suitcases. Yay empty suitcases! Speaking of which, when I was unpacking the things my parents had bought for our extended family here in Chennai, I found that it brought me great joy to begin clearing out my suitcases. It generally bring me joy to throw things out or get rid of things: papers, old ticket stubs, and so on. This is not really a very good thing, I'm afraid, because it's nice to hold onto objects that carry sentimental value. But I've never been very good at that.
6. There's a store near my uncle's flat that sells fresh chips. Kind of like a donut or bagel shop, except with chips. There are chips made of all sorts of vegetables and tubers: plantains and potatoes and lots of other Indian vegetables that I don't know the English names for (or the Tamil names, come to think of it...). I need to hit that place up soon because chips in India (even regular potato chips) are FTW.
7. I'm planning to get my nose pierced this Saturday. I'm pretty nervous about it, not so much for the impending pain, but because I really don't know how I'll look with my nose pierced. Truth: it could turn out really terribly. Also truth: I don't really care that much. I've wanted to have my nose pierced ever since I was a little girl. My mother has her nose pierced, like my grandmothers and most of my aunts. It's just something Indian women do. So hopefully the next time I blog I'll be able to tell you what it's like to get one's nose pierced in India. Let's cross our fingers for a no-harrowing experience!

All in all: I haven't had coconut water or roasted corn or mangoes or palm fruit (my mom says it's probably out of season, which breaks my heart a little) yet, nor have I gone to any temples, but I'm having rather a good time here so far. It's nice to be here A) in February, when the weather doesn't have me sweating constantly; and B) alone. I'm not being dragged around by the whims of my parents (my dad is usually fun when we're in India, but my mom goes insane, talking incessantly about how there's not enough time to do all the things she needs to do). Being here alone makes me feel grown-up, in a good way, and truly participatory in my experience here. I get to suggest what I'd like to do or where I'd like to go. Accordingly, Abhi and Akhil are supposed to take me to a coffee shop today, which should be a trip.

Being here is nice. I just hate that I'm missing such a big chunk of my life back home (seven weeks is a long time!) while I'm away.

Note: Entry title comes from "5 Years Time" by Noah and the Whale, which is a fantastic and fun song.

A New Beginning

I've officially defected from Xanga and come over here. I've been thinking about doing this for quite some time, (a bit idly, I'll admit) but I was hesitating because I always develop attachments to the things I use often--cameras, computers, glasses, cars, and also blogging sites, apparently. I felt a bit like I would be betraying my little ol' Xanga were I to start a new blog here. But since I haven't posted regularly in my little ol' Xanga for ages, I don't feel so guilty anymore. Besides, the Xanga had too much of my teenybopper past attached to it; perhaps that's why I haven't blogged much recently: it was slightly buried in the remnants of the past. Anyway, though, here I am!

Having graduated a semester early, I'm spending this spring semester working in my lovely plant genetics lab on campus (You're sure to hear more about it as time wears on. Lots of fun stuff happens in lab.) and going to India (to visit family) and Singapore (to visit a friend) for seven weeks! Which is a long time. Which brings me to the reason I felt like posting in the first place. I know the trip could be really good, if I went at it with the right attitude. I'm sure there will be many memories to be made, lots of fun to be had, much soul-searching to be accomplished [check it out--countable and uncountable nouns in that list, woot!] in both India and Singapore. Yet I kind of don't want to leave home. I feel like being gone for such a huge chunk of the semester will lose me the opportunity to watch my friends do a lot of interesting things--not to mention to do a lot of interesting things (i.e. go to Chicago over spring break, do random stuff in lab that both annoys and entertains the postdocs, linger obnoxiously long over lunch in South Servery, do movie nights and celebrate 21st birthdays and on and on) with my friends here at home. And I know I'll get homesick in India; I always do. Plus I've never actually gone there by myself before, so I'm slightly nervous about lugging around my bags and making my way through the airport and actually knowing what I'm doing.

All that being said, though, if this trip isn't going to suck, I need to get myself excited for it. So to that end, here is a list of things I am looking forward to doing during my trip to Asia:

1. Drinking fresh coconut water (eleneer; how the heck do you transliterate that?)
2. Eating palm fruit (or so I think it is; all I know is it's called nungu--again, how do you transliterate that?--in Tamil)
3. Eating roasted corn (suttu solam!)
4. Seeing Singapore for the first time!
5. Visiting the temples I love
6. Writing lots of postcards to friends back home
7. Getting to know my cousins better
8. Going to Pizza Hut in India; yay for paneer on pizza!
9. Making enchiladas for my cousin in Chennai
10. Buying clothes and shoes and earrings and other nonsense in Pondy Bazaar and elsewhere
11. Seeing parts of Chennai I've never seen before (hopefully this will happen)
12. Writing in my little green journal and maybe even conceptualizing a new piece!
13. Reading lots of books in my spare time

Right, that's a pretty good start, I'm thinking. But if I want to actually get on the plane, I need to pack, which means I need to get off the computer and get my day started, which I am loath to do, but I guess I should just suck it up. Hopefully I'll be able to update this once or twice while I'm in Asia so that I can show you guys what I'm doing over there. Here's to happy blogging!