Clarity. January 21, 2011

“He asked you if you were a bear?? I don’t…mean to be
rude, but that reminds me of
Joey. You know,
how he’s always talking about how there are no bears in Jamaica?”
And simple as that, Corinne pointed out what I’d been missing the
entire month of November. Boy Wonder had
NOT been dissing me in a
frat-tastic
manner unseen since my näive undergrad days. He was just
oblivious. Because he’s a med
student. And med students, by definition, are
space cadets.
Example: another med guy I know was waxing romantic the other night
about how he wanted to “find his Elliot” (from
Scrubs). To support this argument, he
told the story of how the she punched her JD
in the face when he broke up with her. What ever does it
for you, I guess. I’m around so few non-meds these
days, I forget we used to make special allowances for them
when I was in Houston. As in, I’m sure only the most stable of the
lot made it into my H-town circle of friends, and yet, we still
took it for granted that med student =
awkward. Now that I get to see the full range of med students
every day, I am acquainted with maladroitness of mythical
proportions. You don’t believe me? Of the coolest guys I know, one
named his dog after a type of cell found in your brain
(“Oligodendrocyte“), and another
buys flowers for his
cat. Literally, these are two of the
most well-adjusted
friends I have. You don’t want to hear stories about
the charity
cases. This zoo distorts your perception.
What has medical school done to
me? I used to drink
cocktails with
millionaires and party with
trust-fund socialites–now I’m
intimidated by the socially challenged.

Coffeeshop Demographics September 4, 2010

***In El Paso, I would see college kids, business people, and occasionally overhear nascent filmmakers discussing their newest projects.  (Because Hollywood is so expensive, and southern New Mexico is so sunny, there’s actually an indie film community out there.)

***In Lubbock, I hung out at J&B’s amongst the Tech intellectual community, sorority club meetings, and church groups while drinking cappucino.

***Now, in New Orleans, I drink cafe au lait amongst novelists–I’m always overhearing writers discuss how to manage this plot point or that theme, etc.  I regularly see & chat with med students & residents–people say hello and know me by name after I’ve only been here a week. What is it about New Orleans that makes me feel so much like I belong?

Houston, can you compete with this?

Eeek! A Personal Statement. August 30, 2010

Since I know all three of you readers out there were dying from suspense, here’s my final draft of  “the real thing.”

Personal Statement.

“The lure of the distant and the difficult is deceptive. The great opportunity is where you are.”—John Burroughs

What’s the difference between children growing up in inner city Houston, rural Texas, and rural Africa?  Don’t all children deserve to grow up healthy and free of disease, well nourished, with the opportunity to meet developmental milestones, in a safe environment that allows for play and encourages literacy?

To a girl who grew up reading fairy tales and adventure stories, dreaming of exotic places, Burroughs’ quote was problematic. Along with my extended family’s assortment of teachers and globetrotters, I wanted to experience everything the world had to offer. My parents are the sole members of their respective families with feet firmly planted on the ground. They encouraged me to be inquisitive, liberal-minded, and charitable—although their personal preferences contradicted with my wanderlust, the values they taught me did not.

At fifteen, a teacher gave me a book of field accounts about the Centers for Disease Control Epidemic Intelligence Officers, and my fate was set. I would pursue a life combining adventure, intellectual discovery, and altruism, even if I wasn’t sure exactly how. At Baylor University my beliefs were informed and refined by social justice concepts, which led to graduate studies in Epidemiology and Global Health.  When applying to medical school I thought both of my personal goals, and again of Burroughs.  Texas Tech presented an opportunity to serve my native West Texas, and to train in El Paso, one of the most exotic locations a U.S. medical school could offer. I took it.

I entered school expecting to specialize in Internal Medicine and later pursue a fellowship in infectious disease, but the contrasts between my Internal Medicine and Pediatrics clerkships left me favoring children’s medicine instead. In adult medicine, clinical miracles seem to mostly postpone, not alter the negative consequences from a lifetime of societal circumstances and personal choices. At my hospital, physicians are often so overwhelmed that it is all we can do to stabilize immediate problems rather than holistically promote the health of a patient.  More than once I was accused of  ‘thinking like a pediatrician,’ when philosophy from my public health training surfaced. In January, I found myself helping care for a girl with congenitally acquired HIV.  She hated the way trips to the hospital interrupted her college education, her attempt to be a normal teenager.  I was struck by her wasted potential, the carelessness of her parents, our societal failure to treat her condition definitively.  Of course, we can often prevent vertical transmission, and in the U.S., cases like hers are now blessedly rare. A pediatrician’s optimism rests in the chance to make major quality-of-life impacts through prevention and early care. Care for the acutely ill can be rewarding, but I want to be a part of long-term solutions as well.

Though pediatric problems are challenging, the ideals of the profession closely align to my own aptitudes and principles.  From infections like malaria and HIV that disproportionately attack pediatric populations, to childhood obesity and diabetes, public health-focused pediatrics is needed now as much as ever.  The great opportunity of my life is now, in pediatrics and global health. To pursue anything else would be chasing after the distant and the difficult. By following my strengths, I plan to help children grow up healthy and strong and find their own strengths in time—no matter where I happen to be practicing.

How I became a doctor July 26, 2010

When applying to residencies, we must write yet another personal statement, which really isn’t personal at all. There are tons of rules/suggestions to follow for the best possible response from residency directors. Since I couldn’t get the idea of an actual personal statement out of my head, I wrote it down for the sake of clearing the desk for my “real” personal statement.  Here is the scrapped, but incredibly personal & honest statement I won’t be submitting:

For as long as I can remember, I wanted to travel, to see wild places, to experience new things.  Social Studies and Geography were among my favorite classes. The motivation we all talked about in medical school admissions interviews, that desire to “help people,” developed much later than my wanderlust.  As a teenager, I had a sense for the suffering of others in the world, but it was religion and seminary students in college who taught me the concepts of social justice and structural violence.  When I applied these new ideas to my education and career options, there was soon little doubt that my medical training would culminate in some type of healthcare for the underserved.  Missionary kids were easy to find in pre-med classes.  I eagerly sought stories from their childhoods and when I could, stories from their parents, seeking a way to integrate my new principles to my earlier ambitions.

Near graduation, I faltered.  Did I really want to be a doctor? Was I smart enough? Could I handle the rigor and responsibility of medical school?  I failed to turn in most of my secondary applications, and blundered through the few interviews offered.  My doubt must have been clear to every admission committee.  Not going to medical school gave me time to think.  What did I want to do? While teaching MCAT prep courses and serving cappuccinos to students with more singularity of purpose than I possessed, I decided to approach social justice and world travel more direct ly: I applied and was accepted into Tulane School of Tropical Medicine & Public Health.  My first classes were to start late August 2005, but Hurricane Katrina hit New Orleans the weekend before and I suddenly found myself drifting, again.  This time I soon found direction in a temporary enrollment to the University of Texas School of Public Health that eventually became permanent.  I felt at home in the Texas Medical Center, where it seemed as though everyone I met was studying and researching ceaselessly to improve the quality of health and life for people all over the world.  I was tempted to stay and pursue a Ph.D in Epidemiology, but at my colleagues’ and advisors’ urging, re-applied to medical school.  Texas Tech seemed like the perfect combination of familiarity (situated less than hundred miles from my parents and hometown) and the exotic—my clinical training would occur in El Paso, probably the closest U.S. approximation of the areas where I hoped to someday practice.

The first two years were a shock—I expected to share even more in common with my medical school classmates than my graduate school friends, but instead found myself immersed in an incredibly diverse group of people (almost all of whom were surely performing better on tests than me.).  Most were doggedly dedicated to a cause of their own—curing diabetes in this century, repairing the faces of burn victims.  I struggled to find common ground.  I rarely discovered someone who had heard of Paul Farmer, or who spoke of social justice, and began doubting my pursuit of medicine all over again.

But when clinical training began in El Paso, suddenly everything changed, again.  I love learning the practical aspects of treatment, from scut work to interview skills. We meet such interesting patients! We see the “classic” presentations that we were taught rarely occurred! This is why I wanted to be a doctor.

My renewed interest led to more focused studying, rewarded by happier exam grades.  I began to puzzle out how to best use my background and my strengths in making a specialty choice.  I considered psychiatry, family medicine, and med-peds, but kept returning to pediatrics.  Where else can one find patient, optimistic doctors as a matter of course, a natural emphasis on preventive medicine, and such a large proportion of infectious disease cases? I attended a conference last Spring, and a speaker reminded the audience how most global health problems disproportionately affect pediatric populations, and of the shortage of qualified pediatricians internationally.  My path was set.

Neutral Milk Daydreaming July 22, 2010

And one day we will die
…And our ashes will fly from the aeroplane over the sea
But for now we are young
Let us lay in the sun
And count every beautiful thing we can see…

–Jeff Mangum

Random Haiku Action July 5, 2010

Tomato soup for

breakfast? Eggs in the fridge. What–

was mama thinking?

Feeling Strangely Fine June 7, 2010

Life has been really good lately. Not quite in the, “Wow, everything is going my way,” line, but not at all awful either.  I’ve had some good days, and some bad ones. Today wasn’t particularly spectacular.  The computers were still down and the novelty had worn off. Clinic was really slow, and slow doesn’t really mean less work so much as it means less interesting work.  The past few weeks I’ve had a lot of head & neckaches. But overall, I feel like I’m in control of my own destiny–as though I can be as successful, or as happy as I want, as long as I stay focused on the goal.

I’ve been able to sleep, work,  study, and even relax a little bit, making time for social stuff and for the inevitable solo goofing off. I’ve had time to let some big questions to surface.

What exactly do I want out of life? Do I want to be professionally successful, or do I want to be really happy personally? If I prioritize these two, will achieving one mean sacrificing the other? Which would make me a better person? Does it matter?

I know I want to travel. I want to make a difference somehow. And it’d be nice if I got to share my life with a man and a dog at some point. But do I really have that much control over whether any of this actually happens? Or should I just quit worrying and trust everything to be all right?

Sign of the cross wards off the evil eye…. June 4, 2010

Example of a pyogenic granuloma.

It’s all my fault. First all the clinic computers go down to a virus shortly after I arrive. By lunch we know all 4 campus of Texas Tech Health Sciences Center have been hit.

Then, my resident gets stuck on the wrong side of the border and has to cancel his afternoon appointments (What was he doing over there on a Friday morning to begin with?).

Two patients later, I have seen exactly one cat scratch fever & one CHF/Amphetamine abuse/chronic alcoholism/pyogenic granuloma–which translate neatly into 2 hospital admissions to my patient log.  Arranging direct admissions with pen & paper is a bit of a drag.

The clerkship director sent me home before I could do anymore damage…pray for the cat.

Rites of Passage April 14, 2010

I lost my first patient tonight. I’d been present at a final code once before, but that was hardly my patient, and the family had been expecting relief from his hard fought battle with cancer for some time.

This was different. Mr. Trauma Focus (all the male patients without names get a car code name when they arrive from the ER, and though I know his name now, I’ll remember him this way) came in as a level 1 trauma motor vs pedestrian accident. I was there when we intubated him, I was there when we opened his belly and packed his wounds with lap sponges. I found additional injuries during his transfer. I preened in the angio lab, after surgery, when Dr. Tyroch, the chief trauma surgeon asked me what I did before med school and complimented me on how helpful I was in the OR.

I waited by the patient’s side as we embolized three arteries to stop more bleeding and added a filter to his largest vein to prevent clots from reaching his lungs or heart. I listened, amused, as the interventional radiologists finished their work with the oft quoted signature, “another life saved!”

And then he coded. We couldn’t find a pulse in the angio lab. So we infused more blood and hurriedly transferred him to ICU. Over the next few hours, in spite of our best efforts and his, Mr. Trauma Focus slowly lost the warmth from his body, along with copious units of blood. His systolic pressure had been below sixty for more than an hour when his pulse suddenly dropped forty beats per minute, from 112 to 67.

I told my resident, and asked if we could fetch the family. As she rose from the nurses’ desk, our patient started to code. This time, he didn’t come back. After five minutes of chest compressions with no response, the code was called. We informed the family. His son began sobbing violently while his wife stoicly comforted her child and told us they would wait for the other children before viewing the body.

I wonder at her resolve, in the face of death. Were they religious people? Did she hope for a reunion at resurrection? Or was she just in shock, and doing what had to be done until she had time to process it all?

Sometimes, rites of passage come when we don’t expect them. Mr. Trauma Focus certainly didn’t expect to walk out of the bar and get hit by a pickup truck. I didn’t expect to lose my patient tonight. Not when I came on shift, not when he arrived, not after surgery, and not during angiography. It feels numb, and solemn. Two hours of sleep before morning rounds.

What? Life outside the hospital? April 12, 2010

I used to be so jealous of classmates who were far enough ahead in studies & budget to take little minibreaks on the weekend. I spent my first two years of med school in a constant struggle to stay in the black, catch up with my work, and catch up on sleep. Now that I’m just comfortable enough to allow little excursions every so often, I realize that 1) you never catch up, 2) staying on budget is overrated. Sometimes, the best thing you can do for yourself is take a few days off.

I’m sitting in a Reno airport after a lovely mountain holiday with my brother & company in & around Lake Tahoe. Climbing, hiking, sight-seeing, and as much raw fish as I could eat. How is it so easy to get wrapped up in work and career when there’s so much life waiting out on the other side?

I want to learn from these little side trips and use the lessons to make good specialty choices in medicine, but sometimes it feels like the choice is between the time vs. the money to enjoy the best things in life–like you can’t have both. But I know I don’t want to spend my entire life in the hospital or the clinic. There’s so much more out there waiting to be experienced.