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.

Tuesday, June 20, 2017

How to be Good

“Make me good God. Make me good. But not yet.” – Nurse Jackie

The literal dividing line between anesthesia and surgery is a rather thin, sterile paper, blue drape. Anesthesiologists have kind of a thing about it actually. Everyone likes to secure the drape differently. I swear as long as I live, I'll never do it right. Even the most laid back resident has redone my perfectly secure drape. The art of drape folding is shockingly not something taught in medical school, so the first time I clamped down on the IV pole, cracking the plastic clamp and sending pieces of it flying precariously near the surgical field.

I’ve never seen that one before,” the resident said, quickly fixing my mistake-- and never trusting me with his sacred drape again.

Starting IVs is another thing they let the med student struggle with. The very first time an attending suggested I start one, my hands were shaking so badly I couldn’t even grab the needle from the drawer. He took one look at me, and then kindly suggested we "do this one together." Even when I did manage to get to the stage where you poke the skin, I was missing almost every one. Even in the SIM session we did. Every single stick on those stupid unrealistic plastic mannequin arms I was missing. They bleed food coloring. After a while even the saint like patience of the resident I was working with was growing thin.

You’re not looking at the catheter,” he said grabbing it out of my hands. 

I am looking,” I say back rather annoyed.

Not you’re not,” he insists, "watch me," he says sliding the needle effortlessly into a vein. 

We would do well to be a little more real about the learning curve regarding practical skills—especially cynical, impatient little busybody me. I don’t know how to fill a syringe with propofol without spilling it all over the place.  But because I spilled it, I now know how not to. You get good by being bad. How unfair.

Struggling and messing up is where the learning happens. Its important to try to run into situations where struggle might be possible, instead of avoiding them. For example, I tried every IV I had the opportunity to. And I missed a lot of them. But I am getting better. Well…at least I can grab the needle out of the cart…and I call that progress.

Intubation is another one of those skills that's semi-important on the patient’s not dying front. It can be tough, because getting the feel of the blade, the tongue, knowing what it is you’re supposed to see—that takes practice and it takes struggle. During one such attempt I looked up at the resident with those big “help me I’m stuck” eyes. “I’m just going to let you struggle,” he said like he had read my mind. Ugh. And struggle I have. 

I have found a million things I’m terrible at doing. A million more ways to mess stuff up. Umpteen questions I cannot answer, words that I do not understand. My facial expressions as of late alternate between raised eyebrows, nodding and my personal favorite—the blank stare.

But the more I try, the luckier I get. The days where I get both the IV and the intubation have increased in number. And that makes me feel good. And then the thought creeps into my head that maybe I’m actually good at this. Maybe I can actually master the art of drape clamping. And just when my step has a little swagger to it, the resident asks me to grab the IV for her. I pull the bag off of the tubing and am promptly doused from head to toe in a liter of saline. 


“Make me good God. Make me good. But not yet.”


Saturday, May 6, 2017

You're Everything that I Want


Hello Dears,

I hope you are well. I just got back from Hawaii (I know, I know, don’t hate me). I am just the right amount of hung over, sunburned and jetlagged, which if you ask me is the perfect frame of mind to provide you with some unsolicited advice. You’re welcome.

I would bet, that if you stood in front of graduating medical school classes and asked everyone to raise their hand if they thought 3rd year was the hardest year of medical school, I would guarantee that almost everyone would raise their hands—that yes, indeed 3rd year is the hardest year you will endure out of your time here.

This is why I had to go to Hawaii. My soul had to heal. Because it was one helluva year. During my vacation I had time to think about what information and advice would have been helpful for me to have before starting the year. I also visited a Seahorse sanctuary and saw baby seahorses, so there’s that.

The thing is that most people who have done even 1 rotation, really want to tell you about their personal experience. Myself included. Can you blame us? We survived—and we want to tell you about how we did it. The thing is I can almost promise you that you will have a different experience than anyone you talk to. That’s just life.

So I have compiled some helpful tidbits of wisdom, mostly devoid of my own personal experiences with the rotations (email me if you’re going to Redding, I have things to tell you). I hope these little nuggets will be helpful to you. They are the things I wish someone would have told me. And if you read no further, know this—you will make it through this year. I promise. We’re behind you, every step of the way.

1.     Don’t lie, but you probably will.
You’ve probably heard this one before. Like don’t say the patient’s potassium is 3.5 if you are only sure that its 3 point something. Seems reasonable right? But sometimes a resident will be like hey, “is she constipated?” And you’ll be like, “Um…no, don’t think so.” And then it will turn out that she is and blah blah, makes you look not very good. This kind of thing actually happens fairly often—just try to make sure the response that comes out of your mouth is, “I’m not sure,” or “Hmmmm….unclear.” or “I did not specifically ask her about that.” Its just better for everyone you know. So have some response always on the tip of your tongue that resembles I don’t know.

2.     You’ll never find anything or know where you are going.
You are going to be asked to grab things. And its completely unfair because likely you will have no idea where anything is, let alone the code to open the clean utility room. You ever used to watch the show Legends of the Hidden Temple? Used to be one of my favorites. Anyway if you didn’t experience Nickelodeon in the 90s, its basically kids running through a maze trying to find a statue—you see them rummage and fumble around trying to find this impossible-to-find thing quickly. That will be you. Go Team Barracuda! You’ll never find anything (at least not within the predetermined time limit). Honestly, best thing is to ask someone else—beg for help—usually works.
Okay I know I wouldn’t tell you about my own experience, but just this once. On the last day of third year, on the last day of my surgery rotation, we were in the OR and the attending looks at me and says, “find me a piece of blue foam.” Yea, sure buddy. That sounds readily available and easy to find. So I knelt down next to the supply cart, about to announce that I—once again—was unable to procure the needed item….when, there it was. A perfect piece of random blue foam sitting where it definitely should not have been. I grabbed it, still kneeling, and held it up to the surgical lights. The heavens opened and the Hallelujah chorus played. And that my friend will never happen to you.

3.     You want to be a doctor when you grow up, not a third year medical student. This one really should go without saying, but as you go through this year, remember that this is just temporary and not the state of being you will be in for the rest of your life. You will be in charge and make decisions and command other people. Being the bottom of the rung and constantly following behind other people—that won’t always be you. No one puts baby in a corner. Except you this year—sorry.

4.     Your white coat will not stay white. Whether you spill coffee on it, or perhaps have a very unfortunately incident with a blueberry yogurt, its just going to get gross. Try to get a spare one if you can. I still have no idea how to do that. Drying cleaning is your friend. Blueberry stains no matter how much bleach you use.

5.     You are never alone. I mean, at 4am pre-rounding on East 6—yes you may physically be alone, but we’re never far away. Lots of people are doing this with you. Get together and talk about what’s its been like. It feels so good. Use the doctoring check in time. Amazingly cathartic.

6.     Let yourself off the hook. Not everything and every interaction is going to go right. Trust me I wish it did, but it just isn’t going to. That’s okay. You’re human and you’re trying your best and that counts for a great deal of this year. Show up on time, have paper and pen (I refuse to carry those stupid folding clipboards because I pinched my hand in it once—never again), try to look interested or at least awake. Getting up early does sort of get easier—remember I said sort of. Warning: you will likely loose the ability to sleep in (at least temporarily). Try not to be the dick who wakes up your whole house, dog, significant other when they are trying to sleep like a normal person. Its rude. And you are now a morning person. Welcome.

7.     Drink hospital coffee with caution. You know usually its lukewarm. Like everyday for the last year it has been—the one time its piping hot you’ll burn your mouth. You’ve been warned.

8.     Some doors in the hospital you have the push to open them. Some doors in the hospital you have to pull to open. Good luck figuring out which is which.

9.     You are loved. You are so desperately and insanely loved and valued. And this year it may not often feel that way. Just because you are now a 3rd year does not change the fact that you are a good, loving, kind human being who should be shown respect and kindness. People may be mean or ignore you. That’s on them, not on you.

10. It doesn’t get easier or better, but it does get over. The same struggles I had during my first rotation, I had during my last. There are just truths about being a 3rd year that never change. I still struggle with feeling confident and knowing what I’m doing. And I still feel like I have lots to learn. But you’re going to do it all in spectacular fashion and at the end of it all you can drag yourself to Hawaii like half of my class did.

11. For God sake do not leave studying for the shelf until the last minute, you’ve been warned. These are good lectures for most of the rotations.http://som.uthscsa.edu/StudentAffairs/thirdyear.asp

12. You will do good things that help people that will never show up on your evaluations. Holding someone’s hand, making someone more comfortable, whatever it is-- you’ll do good in a million tiny hidden ways. Just because they are not seen or not documented does not mean they didn’t happen and it doesn’t make them less important or meaningful. I see you and you see you—that matters most, keep at it.

And if you lose your motivation I like to watch these, I find the intro oddly inspiring.
Go forth my brave warriors. The Class of 2018 is here if you need us, anytime, all the time.
Third year looks good on you.



Thursday, April 6, 2017

Your heart or mine?


Greetings Gentle Reader, 

If no one told you today, thank you for everything you do. Your hard work is appreciated and it gives me strength and joy to know that I live in a world with such wonderful people in it.

I also hope that you are treating yourself gently. God knows you deserve it.
***
I want to talk about people who throughout this year have treated you badly, who may have wronged you or ignored you, those people who only seem to remember your name when they need something or want to ask you ridic questions in front of large groups.

At some point this year, maybe this week, you were not treated with kindness and mercy and grace and humility, but with anger and frustration and fear and dare I say even malice.

I was recounting to my doctoring group this evening that emphatically these people should step on a lego. No doubt. Being anything less than gracious and kind and respectful to our fellow human beings isn’t how we should be treating each other, seeing how short human lives are n stuff. Ironic that in a hospital (a building which sees death on a daily basis) we should forget this fact. 

So after a frustrating day attempting to interact with the most type A-e-ist of type A people (who just want to break off the tip of the A and stab you in the eye with it), I was really having fun thinking about how karma will smite them and how I’d like to give them a piece of my mind (theoretically that is).

But then I got home, carrying a fresh bunch of daffodils Emilie got for me. I took a shower, I put on clean pajamas, I sang along to Tale as Old as Time and curled up in bed with a new book by my favorite author Anne Lamott (or St. Anne as I like to call her). I thumb through the first pages and it reads;

“Mercy means that we soften ever so slightly, so that we don’t have to condemn others for being total shits, although they may be that, (okay: are)….Kindness toward others and radical kindness to ourselves buy us a shot at a warm and generous heart, which is the greatest prize of all.”

Dammit. I’m so screwed. I don’t feel like being merciful or kind to people who make me and my friends feel bad. I’m just not that mature. And I doubt that these people will know or care that I have softened my heart towards them, or dare I say forgiven them for being wrong, for being rude, for being mean, for using their power to belittle instead of lift up, they were wrong and I want justice. Justice I say. 

As I type this, I am reminded of two things. #1. I have been so very undeserving of the mercy and forgivness others have granted me in my life. And so very grateful that I have crossed paths with lovely, kind people who say in spite of my mistakes, in spite of being rude and self-centered and lazy and dumb, that they still love me, still think I’m okay and the biggest gift of all is their forgivness and forget-y-ness of my messy interpretation of what it means to be human. Thanks.

Thing #2 I am reminded of an 83 year old real estate agent from Terre Haute, Indiana. Her name is Eva Mozes Kor, a survivor of medical experimentation in a concentration camp at the hands of Dr. Mengele—a Nazi doctor conducting “research” under the name of the Max Planck Institute. Eva lost her entire family during the Holocaust and was very nearly killed herself. Eva came into the public eye when she announced that she forgave Dr. Mengele for what he did to her and her family. She issued a written statement of forgiveness to the Planck Institute and was featured in a documentary about her choice entitled, “Forgiving Dr. Mengele.” (Netflix it, its amazing). Her decision to forgive shocked a lot of people and actually upset a great many in the Jewish community who believe that the Holocaust is unforgivable. I can’t disagree with them, but Eva explained that she decided to forgive Mengele for her benefit, not for his. You go girl.

Don’t worry, I’m not trying to compare WWII or Hitler to being treated like crap on a rotation. My point is, that if Eva can soften her heart against the war crimes and human rights abuses that were committed against her-- then I guess I can forgive the people that were mean and rude and ignored me. I guess I’ll work on it anyway, not for their benefit, but for my own.

So dearest fellow human beings--wherever you are--who have been rude and mean and unkind. I forgive you. I know you could have done better. We all can try to do a little better—even me. What do you say we chalk this one up to life eh? Our very precious, way too short, beautiful-in-spite-of-everything life.


My daffodils remind me that spring is coming. And my calendar reminds me that there are two weeks left in this rotation. And my heart…well it reminds me what love and forgiveness feel like.

I guess its starting to soften it just a little.




Friday, March 17, 2017

Fear and Loathing in French Camp


Hello My Beautiful Reader,

I hope you are well. I feel like we should just hug each other next time I see you. As you probably heard from my incessant whining and complaining- Steven and I are doing part of our surgery rotation in Stockton. We live in a shitty building with no hot water and there are spiders. Spiders. Ugh.

But it is important for me to tell you more about what this county hospital--built on an alpaca farm--on the outskirts of one of California’s most dangerous cities, is like.

Recently I bonded with Dean Henderson over the use of paper charts—something this hospital still uses. In the mornings, before rounds, the med students have to get there several hours early to run around and write down all of the vitals from the paper charts overnight for the residents—something Henderson himself remembers doing when he was in med school—like 30 years ago. I’m not bitter…not bitter at all. But paper charts are dangerous and they waste everyone’s time. I know EMR has its problems but its 2017 people. Get with the times. You cannot check medication interactions on paper and I can’t read your god damn handwriting.

Another absurdity that takes place here is the design of the hospital building itself. Let’s just say it puts the east wing of UCD to shame. There are two buildings, the newer part and then an older building called the towers- a medieval looking building made of stone bricks. Interestingly enough if you are standing on the third floor of the new building and then walk across the completely flat breezeway to the towers—you would find yourself on the 4th floor—without actually going up a floor. It’s a relic of how the floors were numbered and its super weird. Steven likes to tell me where to go in the hospital by using words like, “north”  and “south.” These words mean nothing to me Steven. Nothing.

Amidst this rather shitty building, with its shit system of patient record keeping and stupid layout, there are some really sick folks.

This morning when I was walking through the ER waiting room, the inscription of the Statue of Liberty came into my mind.

"Give me your tired, your poor, your huddled masses yearning to breathe free, the wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed to me, I lift my lamp beside the golden door!"

I know it sounds a little saccharine, but the people sitting in the ER waiting room, in Stockton at 4am—well they look pretty tempest tossed to me. The hospital is full of people whom society has forsaken and forgotten about. One of the features that was advertised to us at the start of our time in Stockton was that the pathologies of patients were “really good.” And of course by really good, they mean really bad. Disease so advanced we might only expect to see it in other, underdeveloped nations. And yet here they are, right in our own backyard. We see patients so in the grips of poverty or mental illness or drug use or victims of violence and tragedy of tremendous proportions.

We often visit the room of a recent trauma patient we saw. We peak our heads in and see family and friends visiting, leaving pictures and notes and whispering words of love and encouragement. We look up recent labs and imaging and physician notes—anything that might give us a glimmer of hope that things won’t end terribly for this family. Sometimes we glance in the direction of the room and shake our heads or ring our hands.

Stockton is a place of paradoxes. In spite of limping along with paper charts and poor design, this hospital catches our most vulnerable and for the many victims of violence in Stockton has often been the only thing between those people and death. Our trauma patient is getting good care. People who come to this hospital get help—although its often not nearly as much as we hoped. I think the woman who delivered her baby on the floor of the ER waiting room might attest to this. It’s a miracle-- but its messy and not anything like we thought it would be.

We only have a week left in French Camp, and while I can’t wait to get back to Davis, I am reluctantly grateful for my time here. While I will continue to fly into a rage about the copious amount of carpeting in the hospital (who does that?) and the fact that I spend my day tracking down charts, I have nothing but respect for the men and women who show up everyday to an imperfect building, with an imperfect system, in city rife with problems, to help people with no where else to go.


Thursday, March 9, 2017

Admit


I have often wondered what it feels like to be a patient in the hospital.

My personal experiences as a patient have been limited to the occasional clinic visit, having my wisdom teeth removed and a brief visit to the ED when I was 17, after cutting my foot open while backpacking in Point Reyes.

For all intents and purposes I stay securely and safely on the provider side of things. We get to keep our clothes on, we can for the most part eat what we like, drink what we like and unless you happen to be retracting in the OR for hours on end, we can use the bathroom when we want to.

Sure it can be a little uncomfortable and down right exhausting to be working in the hospital taking care of patients. I’ve started to refer to all the walking and rounding and standing we do as ‘slogging in my clogs,’ and I know you know the feeling. But when it comes to actually being a patient, no less one who is acutely ill, we don’t know the feeling—at least not most of us anyway. So we are left to imagine what it might be like.  

The other day I was helping an intern pack a horrendous and impossibly deep abscess and as we pulled miles of blood soaked curlex out of the wound I got to wondering what that must feel like. Vomit started to well up in the back of my mouth.

I don’t really want to be sick or hurt. Because who the hell does? But I do want to understand just a little bit better the loss of control patients must feel, the fear, the embarrassment and the sleepless noisy nights and rude early morning wake up calls.

Back in the day it used to be a fairly common practice to admit medical students to the hospital under a pseudonym and a fake (albeit mild) diagnosis, in order to allow them to experience the hospital as a patient. The Long Beach Medical Center still has a program like this—the only one left in the country started by an Australian Family Medicine physician, Dr. Stephen Brunton. You can read more about that program here. 

Programs like this one are insanely difficult to do. Hospital resources are stretched so thin these days, they aren’t about to waste them just so trainees can try on a hospital gown for the evening. But I maintain that the lessons the participants learn from a brief time in the hospital is immensely valuable. And if hospitals care about patient satisfaction the way they claim, then I’d like to see programs like this become common place.

So I started sending emails out to hospital CEOs and CMOs, ER directors and the like, asking if I could spend a night in their hospital. The answer was a swift and resounding absolutely not. Even the task of having the IT department create a fake EMR for me was too great a task for most hospitals to manage. Additionally, I think that hospitals also feared that real harm might come to me. And perhaps they are right to be concerned, after all medical mistakes result in thousands of deaths across the country each year.

For now, I have been attempting to experience patient life in other ways. For one, I tried patient coffee the other day. No—not the coffee in the cafeteria, but the brown liquid served up in miniscule Styrofoam cups. I don’t know what it was, but it sure as hell wasn’t coffee. I also let my friend Millie put me in an MRI machine for two and half hours to study my brain for her PhD. It was okay I guess, a little loud for my liking, but at least now I have confirmation that my headache isn’t a brain tumor. And finally, I am feebly attempting to live my life as a diabetic—a diagnosis I do not really have. I have tried to write down my carbs and test my blood sugar, but after bleeding like a stuck pig all over our kitchen after repeatedly stabbing my finger with a lancet I am taking a bit of a break. Because being diabetic sucks and I can’t do it.


I hope you never actually get to be a patient in the hospital. And unless we are actually facing illness or injury our experience will always be limited. But let’s challenge ourselves to experience more of what it might be like. Try laying on one of the gurneys to see how it feels. Let someone practice starting an IV on you so you can know how badly it hurts. Try on a Philadelphia collar (literally the most uncomfortable neck brace ever). 
And if in doubt about where to start to get to know hospital life, talk to your patients, ask them more, drink the coffee—I dare you.


Monday, February 6, 2017

Medical School: a fairytale


Once upon a time, there was a princess, who had decided to go on a long journey.

She had been told about what lay at the end of a long and winding path. It was all of the good things the princess had been wanting; happiness, joy, satisfaction, riches, success and the ability to cure the sick.

The princess prepared for the trip for many years. She had heard of others who had made the long journey and asked them what it was like. She read books about the road she was to travel along and slowly she gathered everything she needed to make the trek.

The princess knew that she was very lucky that the King and Queen were able to help her. For the path the princess chose had many trolls who lived under bridges who would demand payment for her to pass.

Finally, the princess set on her way. It was sunny and the although the road was cobble stoned and bumpy, when she stumbled, she always managed to catch herself. There were many other princes and princesses walking with her. And this helped the princess to not feel so alone, for she would have certainly been afraid without them.

As the path wore on, she grew tired. Some of the princes and princesses that had started on the journey weren’t with her anymore. Some walked slower, some walked faster and some had taken different roads altogether.

Along the way the princess was tested. Sometimes she had to stay up many nights in a row without sleeping. And other times she had to walk in the pouring rain and the blistering sun.

She met all sorts of creatures along the way. Some were kind and tried to help her. They would say nice things to her and encourage her to keep going. But others were mean and made her feel afraid. Sometimes a strange beast wearing all blue robes and a mask, would test the princess by making her stand very still for hours without eating or drinking or moving. The princess hated this creature the most.

But the princess kept walking. She walked uphill, and downhill. She walked on straight paths and narrow, twisted ones. Sometimes the path was paved with stone, and other times it was dirt. And sometimes it was mud.

One day, she came to a rope bridge lashed together between two high cliffs over a river. She wondered what would happen if she fell into the water. But she did not fall, for the other princes and princesses held her when she felt unsteady.

Finally, the path was straight again. It was sunny and warm and the road was paved with golden bricks.

“This is easy,” she thought. “I’m almost there.”

But then the path broke into six equal parts. The princess didn’t know which one to take.

She stood in the same spot for a year.

She asked the birds of the sky what the paths looked like from above and the fish in the stream what they looked like from below. But the princess wasn’t sure. The paths all looked different, but one didn’t look any better or worse than the other.

After a year of waiting, and asking every passing creature, the princess picked one. She still wasn’t sure she picked the right one. But the path she chose became hers. And it lead her to many of the things she was hoping to find, like happiness and love and joy and the ability to cure the sick.

The other princes and princesses chose their paths too. For some, their paths crossed a lot and some never did again.  The journey made them older, and gave them more grey hair and wrinkles. They were all less rich than they were before. And more tired. For they had faced monsters, and stayed up many nights in a row, and walked uphill and walked downhill, in the pouring rain and the blistering sun. But they found what they were looking for....and they all lived happily ever after.