Monday, March 19, 2018

I love you so

'Oh no, please don't go. I'll eat you up I love you so'
-Maurice Sendak

Precious few things have given me as much joy as writing for you over the past four years. The one thing that has, is when my humble slice of the internet allows someone else to share something important, something meaningful, something wonderful. And with that it is my great privilege to play host to the wise words of Melanie Koppula. I'll eat you up, I love you so.

It hit me on the Sunday after Match, that med school was almost over. A day after hanging out with part of our Rural PRIME cohort. These were the OGs, the ones I met before med school started. Our same doctoring group since 1st year. And now it was coming to a close. A time for one last hang out before the final goodbyes.

I have always been a fan of Irish goodbyes. Slipping out the door unnoticed. It’s less drama and I'll see you tomorrow for coffee anyway. But I'm moving. I'm moving to New York. What the hell was I thinking. Many of you will still be in proximity to each other or even be co-interns, but you may feel the same sentiments as me in regards to medical school.

I started med school when I was just 22. And it has been one of the most significant times of my life. Perhaps I may say the same of residency when it comes to a close. But I grew up. We all grew. Even if you started med school at 50, you have grown. It was a journey. For me probably filled with many more firsts than most. Med school was the first time I felt like I found "my people," the first time I got drunk, the first time I felt heartache, the first time I knew I could be a doctor, the first time I believed I was a failure. Med school is unlike any other. Tested and pushed and expected to be, to do, to act in every which way. My friend Daniel, jokingly said, "It's like going through trauma, it bonds us." Morbid and true.

 These 4 years were certainly not all daisies, third year and parts of fourth year rolled around and made me hate med school. And I hated it a lot. But the beauty of sentiment is the view through heavily tinted rose colored glasses. You see, I'm surprised to find myself fond of my worst memories. I recall them now realizing how far I've come and who I've become because of these moments. I think back to when I cried in my car the first time I interviewed a standardized patient in front of my doctoring group. I thought I wasn't good enough. I didn't know what I was doing. But each of you has been there along with me. Helping me, helping each other. Its the small moments that stick with me the most. Dylan making me laugh about our crazy surgery chief resident, Angel tossing a football with me when I felt like crap after a Step 1 practice test, Kristiana quizzing me on histo slides, Fiona proofreading my emails and way too many Rural PRIME vent sessions. I'm realizing that it's not just med school that has shaped me but each one of you.

Living in Sacramento has been fun, but I don't think I actually love Sacramento. I think I love how I can walk down a street and name off certain memories. I could count on seeing Gagan at Tupelo, Eman used to live at Alhambra Starbucks, deep conversations with Omar would always happen at Temple, in third year Erik and I basically went to every bar and Tower Café was for post quiz brunches when Daniel and I felt especially accomplished. Now, I know these random things, like the quickest way to R street from any location and the ability to list off every Starbucks, even the new ones and the ones that serve alcohol.

I'm sad and excited to leave. But this phrase keeps coming in my head. "no one else will know." When I leave, no one else will know--know about the ping pong tournaments, or spamming the online sign ups with memes.  No one else will know about hating coming to med ed and just panoptoing instead. No one else will know how frustrating parking was during construction. Or still getting ticketed when you secretly parked at the gym. No one else will know about avoiding the mic during Olson’s pathology TBLs. Or calculating your grade every week  on the spreadsheet. Or BeyoncĂ© playing at the white coat ceremony. McCurdy and his unicycle. Aronowitz being a legend. Our picture collection of people sleeping. The halloween parties that always got out of hand. Being nervous when Dr. Gross came to your cadaver. Dr. Henderson who oddly always remembered your name. 

No one else will know. Only us.

So, I think I owe medical school, and you, more than just an Irish goodbye. 

To each of you in the Class of 2018. Thank you. For your heart, your humor and your passions. For the memories I would never change.

Love,
Melanie Koppula

Friday, March 2, 2018

How to open your match letter: by specialty


Radiology: Just hold the envelope up to a light box. Clinical correlation recommended.

IM: Before opening your letter, consider all possibilities, bring a copy of the original stable marriage algorithm paper with you, call several other people to ask what they think the letter says. Round for 9 hours.

Ortho: Open envelope with a hacksaw. Bring staple gun to put shredded pieces of letter back together.

Surgery: Make 1cm openings in envelope. Insert trocars without damaging the letter. Make 3rd year med student steer the camera. Yell at them to hold it steady so you can read the letter. Close with a vertical mattress.

OB: Your letter will be given to you suspended in pink and squishy gelatin. Pull envelope out. Get pink squishy goo all over you and everyone sitting within a 6 foot radius of you. Insert IUD in place of envelope. 

Derm: Cover envelope in moisturizer with SPF. Take punch biopsies, see if path can tell what your letter says.

EM: Get super excited when you get your letter. Page everyone you can think of. Rip letter accidentally as you open envelope. Call surgery to fix it.

Family: Open everyone’s letter. Pass out all of the letters. Ask about preventative health screenings, refill everyone’s prescriptions and go around giving flu shots. Stay 6 hours after Match Day is over documenting all of it.

Anesthesia: Play on your phone for several hours after getting your letter. Look over table cloth to see what other people are doing. Open your letter while trying to eat breakfast, talk to two people, fix your hair, take a selfie and pour champagne. Make it look effortless.

Psychiatry: Ask your letter how it would like to be opened. Ask everyone at your table how they feel about you opening your letter. Consider the possibility that the envelope has really been through a lot, starting out as a tree, getting cut down, going through the trauma of a paper mill and is facing being recycled. Nod a lot.


Peds: Decorate envelope with stickers, crayons, glitter glue and dry macaroni to hang on fridge as a keepsake. Announce where you have matched in the voice of your favorite cartoon character. Celebrate with milk and cookies.

Saturday, February 17, 2018

Good Bones



I am a proud Auntie to no less than 3 beautiful babies. And friend to their exhausted, caffeine deprived parents.

Buying presents for them is the first and foremost duty of a good aunt. I delight in finding cute little outfits with the tiniest matching shoes, kids toys of all kinds (I threaten the noisiest of toys for their parents enjoyment) and story books with beautiful illustrations.

My newest niece is just learning how to reach for things and to smile, which never ceases to delight. Plus her wardrobe is far better than mine, so there’s also that.

I was talking to a classmate in the student lounge the other day and she asked me if I wanted children someday. I launched into a rant about the problems in our troubled world; nuclear war with North Korea, climate change, the latest of school shootings. And on top of that there are the mundane terrible things in life, like traffic jams, acne and Monday mornings. How could I ever explain these things to a child. I shake my head. I just don’t know.

But as I hold this beautiful new baby in my lap, none of that really seems to matter. I am consumed by her tiny little hands, and her soft skin and the only thing that matters is this brand new person, just discovering the joy of smiling. She also fell asleep on my chest and I have never sat so still in all my life for fear of disturbing her precious dreams (she only drooled on me a little).

I want to show my nieces and nephew things. The important stuff, like how freshly cut grass feels beneath your feet when you run through the sprinkler, like hot chocolate on rainy days and how to cannon ball into a swimming pool. I want to share with them my love of reading and chocolate and lazy Sunday mornings in bed.

Our human experience runs the gamut. Happiness, hope and joy come with disappointment and sorrow and fear. Our world has seen the greatest of loves, the most amazing and awe inspiring acts of compassion and the worst evil, the most malevolent of hatred.

Maggie Smith said it best in her Poem entitled Good Bones….

“The world is at least fifty percent terrible, and that’s a conservative estimate at best….Any decent realtor, walking you through a real shithole, chirps on about good bones…

And indeed as my niece is sleeping in my arms, she smiles—interrupted by the occasional hiccup. I find myself whispering to her all of the good things that she has yet to know, and telling her about all of the amazing things she will accomplish, all of the people she will help.


 This place could be beautiful, right? You could make this place beautiful.”


https://www.youtube.com/watch?v=zdHFEkNZM9k

Thursday, January 11, 2018

Lifer


I am a learner with a student problem. I have been a student at UC Davis my entire adult life. A week before my 18th birthday I packed all of my worldly possessions into plastic tubs stacked neatly in the back of my mom’s minivan and drove to my dorm room here at UC Davis. I got out of the car, made my bed with extra long twin sheets and my whole life changed forever.

15 years later, I am about to become a five-time graduate of this institution. Being an Aggie has been one of my greatest and proudest achievements. To be able to learn and grow in a place where I feel loved and challenged is why I have never been able to part from Davis. The teachers and mentors I have met along the way—those who encouraged me and helped me, are the reasons I have been successful here.

Throughout my tenure I have completed over 1000 quarter units and the running total of my tuition bill could buy a rather large house in the Midwest. I love learning and I take my commitment to education seriously.

I ring in the New Year not in January with champagne and a count down to midnight, but every fall with fresh notebooks, pens and the crispy crackle of new book bindings.

I believe fervently that education is the great equalizer. I believe in the hope and the promise an education can bring.  And I have seen it. I have seen education change the lives of my friends and classmates. But we must remember that education only works in so much as we let it. A 2002 study from the US Department of Education found that disadvantaged children are often placed in low-resource schools, magnifying initial inequalities between them and their more advantaged peers before they have completed the first grade. If we are to be champions of life long learning, then we must make a commitment to prioritize and advocate for equitable and quality education from the start.

I’d like to tell you that being a professional student has always been wonderful and easy and joyful. But the truth is—like anything worth having in this life, its been hard and scary and I have known great failures and disasters along with my triumphs. Being a life long learner is not using a free afternoon to finish off a book you’ve been neglecting. But rather a commitment to forever trying things you are bad at, failing and a willingness to be humbled.

My recent venture in humility was during my anesthesia clerkship. The resident asked me to hand her the IV bag, and I was so excited that this was a task I felt that I could reasonably accomplish that I ripped the tubing off the bag and was promptly doused from head to toe in a liter of very cold saline. One of the many lessons I learned that day was that scrubs turn see through when they get wet.

To borrow from the adage in the Pixar film Ratatouille—‘anyone can cook,’—anyone can learn. Our brains are amazing, and adaptable and capable of way more than we think. By tolerating and dare I say, even searching for the edge of our comfort zone—where we learn and forget and learn again, get it wrong the first, and the second and if you’re a med student—the third time, until we finally get it right—that’s where the good stuff is.


And the best part is—it doesn’t matter what it is you’re learning about. With the internet and iphones, the world really is at our finger tips. So wherever you are in life, I hope you’ll join me in being a student. Let’s rev up out search engines, make mistakes and break in those book bindings. Pull up a chair. I’ll put the coffee on.

Saturday, December 16, 2017

The Lovely Bones


The foot bone’s connected to the shin bone. The shin bone’s connected to the knee bone. The knee bone’s connected to the thigh bone. The thigh bone’s connected to the hip bone.” –Dem Bones, JW Johnson, 1928.

For the last two weeks, I have been on an orthopedics rotation.

It wasn’t exactly my first choice to be honest. I usually enjoy being on the other side of the blue drape, but this elective fit my schedule so perfectly, I couldn’t pass it up.

Before I started, I sealed myself mind, body and spirit. You see, I had heard stories. Namely, my cousin who had aspirations of being an orthopod himself recounted getting shoved and having surgical instruments thrown at him whilst on his ortho rotation—ultimately choosing to go into internal medicine instead. Additionally there had been rumblings that ortho residents could be just a tad inappropriate, with reviews regarding their treatment of medical students decidedly negative. So when Monday came, I was ready. Ready that is to have a completely miserable time.

Ortho is one of the most male dominated specialties, both here at Davis and across the nation. According to the current listings on the Davis website, there is just one female ortho resident here. And if you give me the chance I will fly into a rage about the patriarchy and how women make better doctors (duh its science), but then I am reminded of the words of Dr. Berkowitz—the first woman to graduate from UC Davis, who said,

“if I had no male mentors, I would have no mentors at all.”

The ortho service was not where I expected to find mentors, let alone people interested in learning my name. I had so deeply ingrained the stereotypes of this specialty in my mind (sorry Max), that I am guilty of imparting the bias I was so ready to accuse others of. When meeting a woman ortho attending, who introduced herself to me and then said she was faculty, all while the green stripe on her badge was visible—I proceeded to ask her what year resident she was.

But luckily, most of the ortho residents and attendings I worked with are committed to promoting women in medicine and particularly in orthopedics. One of the attendings who is literally a foot and a half taller than I am—challenging stereotypes in his own right that white men can’t jump---is the last person I would expect to be an advocate for women’s health. But as it so happens menopausal women break bones, and often require the services of an orthopedist- meaning that these doctors find themselves as part of the care team for women. I was touched to see the level of commitment and advocacy these practitioners have to their patients. Something all specialities should strive for. 

I am grateful to have been included as part of the team, something which has never happened to me in an OR before. I was involved in all things, including holding a leg over my head for an Achilles release all the while trying to look relaxed. Noticing my arms were starting to shake the fellow used one hand to hoist the heel skyward, giving my shoulders a much needed rest.

Just pretend you’re at Crossfit,” he said. We both laugh.


And with that, maybe, just maybe, for two weeks…ortho was in my bones.

Thursday, December 14, 2017

Words with Friends


Greetings gentle reader! I hope you are well. Sorry for being away for so long. As you may have guessed I have been on the interview trail for anesthesia, and then came down with the worst cold in human history. But alas I survived and here I find myself in bed on a morning off, laptop on lap, New York Times open and coffee in hand. “Jewish Sunday” my friend Emily and I like to call it. With the colder weather, I hope you are finding your own warm and cozy spots these days, hopefully one spent surrounded by loved ones, whether they be of the human or four legged variety. As we gather for the holiday season, many traditions involve reminding ourselves that the light will return, whether its by lighting candles or untangling masses of LEDs on a string, or lighting a fire. But let us not forget we bring light into the world in other ways as well, with our words and with our actions.

As I (begrudgingly) listen to the news these days, I am reminded of how important it is that we not ignore the power of our voices. It starts with framing a situation or a problem so that we are moved to action. First we are changed, then we change the world. Dumbledore said it best, “words are in my not so humble opinion our most inexhaustible form of magic. Capable of both inflicting harm and of remedying it.” Sometimes we forget the magic inside of us, and the power our words have to create change.

When I’m having a low moment (or day, or week for that matter) I open a folder on my computer full of screen shots I have saved over my four years of medical school. There are only a handful or so, but they are of the kind words attendings and residents have written about me. The first in my collection was from an internal medicine doctor who was so kind to me during my first rotation of third year. He has even continued to help me even though I’m not going into IM. He didn’t need to write such kind and lovely things when in fact I am almost certain I was a fairly average medical student on service. But his gracious words have stayed with me since he wrote them. They have become more powerful and more impactful on my life than whatever final comments or grade I received for the rotation. And if I think about it, writing those words was not really that hard. It probably didn’t take him very long and yes he could have mentioned stuff for me to work on or whatever—but instead he gave a third year medical student the belief that she is going to make a good doctor. His words became something for me to live up to and for the first time really made me think about the choice we have to lift others up with our words, and how very little it costs us indeed.

There have been times since then when I’ve filled out evaluations of other people or responded to slightly annoying emails. Opportunities where my words could go either way. Let me tell you—the pull to type a curt email and use the most delightful of passive aggressive phrases, “per my last email,” is really strong sometimes, mostly when its early, mostly before coffee. But when my fingers hover above the keys, I ask myself WWJD or rather “what would Dr. Jones do.” I cannot tell you the kindness that man has shown me, mostly when I sent rather annoying emails or a time when he lead rounds on PSM and I found myself ever so slightly underprepared. People like him make me want to do better, to be better. And his graciousness and patience (Lord help me get some of that) add up to him becoming someone in my life who I know I can go to for help, someone who I regard as especially wise and humble and a role model. How did that happen? What magic is this? How do the words that we say change us so deeply.

I see it in other ways too. Like a great many, I fell in love with the play Hamilton, and a highlight of 2017 was getting to see it in Hollywood (and it was all I ever thought it would be). Living only a block and a half from the Pantages Theater in a fairly shitty part of town did end up having its perks. And while listening to the mixtape, I started to learn more about Miranda and how he wrote his most famous play. He was on vacation in Mexico and was reading Hamilton’s biography and decided to write a play about his life. It sounds crazy on the surface or like he had one too many pina coladas. But if inspiration strikes, don’t ignore it. Give in and see where it takes you. The words in your head are powerful beyond measure. And God love his friends and family who supported a rap musical about our first secretary of the treasury—those people are saints. Miranda has gone on to use his talents to raise money for Puerto Rico with his song Almost like Praying. How did he do that? The song is only 3 minutes long and yet has raised millions for people on an island the United States has forgotten. How do words move us so? He has also become one of my favorite people on Twitter (besides @KeyonRMitchell and @chicanobrother of course) and let me tell you for those not on Twitter—it can be a dark place these days, but Miranda has a way with precious few characters to impart strength and motivation to all who follow him—and to lead us to action with his words. You can learn more about his Toys for kids in Puerto Rico drive here, trust me your soul needs this right now. https://www.toysrus.com/toys4PuertoRico.

I have to be honest Gentle Reader, that most of the time I don’t feel very powerful. I wonder if the things I do and say really matter at all. Reading the news gives me the feeling we are on a high speed train going to hell and I wonder if I dare stick my baby toe out of the window to slow it down just a little. But then I look at all of the words that other people have told me and I hear their voices in my head and I feel the earth beneath my feet getting stronger and the tiny piece of the world I live in doesn’t feel so small. And the words and ideas in my head have more power and strength than I give them credit for. So my wish for you this holiday season is that we remember to turn on the light when things are most dark. May we use our words to move ourselves and others to action in creating a better and more equitable world. Together we light the way for each other. Together we find our way through the dark. 

And in the time it took you to read this, the world didn't change, but you did. Magic. 

Happy 2018. 

Sunday, October 8, 2017

GimmeSOMM

I think its no secret that I am partial to a glass of wine every now and then—in the most responsible and adult way of course. What pairs perfectly with wine you ask? Ahh yes….Netflix. While I was studying for Step 2 I would reward myself after a hard day of highlighting and question banking (it’s a verb okay) with a documentary. So one evening after a hard days graft, I stumbled on a rare gem of a film called SOMM. Its short for sommelier and it follows the journey of 5 young men (ugh I know, I know, patriarchy and things) on their journey to become Master Sommeliers. 

Not only was this film the fusion of my two life passions, wine and documentaries. It also looked a lot like studying for the boards. Because the master sommelier exam is hard. Like really hard. Like there are only 124 men and 25 women in North America (including Canada) that hold the title of master somm. The film details the arduous studying they have to go through, including pain stakingly drawing maps of the different wine appellations (btw there are over 350 in France alone), making flashcards and blind tasting wine after wine after wine in hopes that by look, smell and taste they will be able to correctly name grape varietal, country of origin, appellation, level of quality and vintage. Its pretty freaking magical to watch and I knew I had to find out more.

I looked up the Court of Master Sommeliers website and as luck would have it there was an introductory course taking place in San Francisco in 5 days time. Wine in one hand, credit card in the other I signed up. This is going to be magical. But then I was perusing the internet and reading other people’s accounts of the class and as it turns out they recommend you study ahead of time, because the test you have to take at the end of class is actually hard. Shit. More credit card, more wine, I ordered a wine book off of Amazon so I could read up.

Come Saturday at ‘its-too-early-for-wine o’clock’ I found myself in a gilded conference room at the Sir Francis Drake Hotel in Union Square with 80 other Somm hopefuls. We find our seats and the Master Sommeliers introduce themselves. I have the biggest fan girl moment at meeting (aka seeing from across the room) Reggie Narito—a master featured in the documentary Somm. A master from Australia stands up. “You’ll never guess what happened yesterday,” he says, “a customer said he liked full bodied wine like Pinot Noir.” The whole room erupts in laugher.

I’m so screwed.

What follows is a Q&A account of the next 48 hours, and my journey to sommelier.

1.     Is this all bullshit?
So the short answer to this question is yea, probably. And the long answer is…well, maybe. It does sort of feel like the emperors new clothes at first. Especially where the tasting is concerned. During the class we passed a microphone around the room so that each student—aka me and other 79 people now gripped with panic, could practice blind tasting. You say what the wine looks like, smells like, tastes like and then you take a stab at grape varietal, region of origin, vintage and quality of producer. You’re going to have to trust me that its stupid hard. The first guy to give the nose a go said everything he could think of. “Leather, gravel, spices, lemons, cherry, nutmeg.” You can’t just name off random things, but as it turns out, different wines do smell differently. Take for example my personal favorite the Sauvignon Blanc, it smells like green peppers, grass and grapefruits. There are some wines that smell like diesel fuel, others like flowers. The more you do it, the more you notice. A word to the wise—wine can smell like basically anything, but for the love of God do not say it smells like grapes. Now take a deep breathe and tell me you aren’t getting a wiff of fresh tennis balls ;)

2.     Surely the room is full of stuffy old white guys?

It probably used to be. The majority of somm’s are still white men, but as it turns out the tables are turning both with respect to gender and race. Women outnumbered men in my class. There was a great deal of diversity regarding race and age—as it turns out younger people are getting wise to just how lucrative wine can be. Each year the class of people passing the master somm exam becomes more diverse. The world of wine is being a more inclusive place. The Court of Master Sommeliers has a strict no discrimination policy and the times of men’s only clubs and smoking rooms has faded in exchange for a more diverse, younger, less white and decidedly more female crew. As it turns out, wine really is for everyone.


3.     Its just wine right?

Oh my God, I wish this class was just wine. In fact the purview of a sommelier covers spirits, sake, lager, ale, cider and cigars. Not to mention a sommelier must be well versed in all aspects of service and wine law. Wine law and wine production is conducted in 5 primary languages. I’m just going to venture a guess that you probably only speak one of them. Our class on the first day covered France and was taught half in English, half in French. Additionally wine laws, taxation, importation tariffs, labeling requirements, font size of the label, on and on, and in French no less. The importation of alcohol used to be grouped with tobacco and firearm importation, leading to the nickname ‘bullets, butts and booze.’

4.     How expensive is it?

Everyone except my Dad is allowed to keep reading. It was stupid expensive. Look away Dad, look away. The thing is that I signed up for the class while awaiting my step 2 scores, which I decided I had failed. I was going to need to find a back up career and pronto. They have a saying in wine, “how do you make a small fortune in the restaurant biz?” “Start with a large fortune.” The only way to make it as a Somm is to work for no money and be able to taste for free. Otherwise you have to be very very wealthy. At the very least compared to med school it’s a drop in the bucket.

5.     What can we learn from wine?

We rush though life these days. Constantly glued to our phones, demanding instant gratification. The monkey mind is always on. Additionally, working in the medical field we aren’t necessarily encouraged to take full advantage of all of our senses—particularly smell and taste. That’s probably a good thing where hospital life is concerned—I’ve done a lot of mouth breathing and having the nurses put peppermint oil on my surgical mask these days. But always forgoing smell and taste means that we are not fully experiencing the world. Taking the time to look at, smell and taste what is essentially a glass of fermented grape juice really can awaken our senses in all other aspects of our life. Savoring something instead of just horcking it down all the time can add a richness to our crazy, phone filled lives.

6.     What does it take to be a Master Somm?

I asked the only female master sommelier who taught our class this question. “How many seasons was Sex and the City,” she asked.  “Ummm….seven,” I reply. “Exactly,” she said. She went on to explain that she worked for seven solid years to not only study for the test, but to practice her blind tasting skills. She moved to Italy, she worked for next to no money in order to taste, even splitting tastings with a friend. The sacrifice it takes is definitely on par with medical school.

7.     Do you really lick rocks?

Yes.

8. What's on the test?

Yea....I can't tell you that. I was sworn to wine secrecy. But I can tell you that studying is most definitely necessary. Word to the wise, drinking wine and studying wine are decidedly different things. 


And at the end of a grueling 48 hours, 24 glasses of wine, 2 glasses of champagne, 518 pages of lecture notes and a 75 question test. You’re looking at the newest Introductory Sommelier.