doc w/ pen

a journalist becomes a doctor before your eyes

Only in medical school … (#1)

Medical school is a unique environment. It’s also an immersion experience. As such, over the last 2 years I’ve had all these moments where I’ve said/thought/done something that seemed natural, but upon reflecting I’ve realized that my words/thoughts/actions were a bizarre product of medical school. I had one of these moments yesterday, and decided I should start recording these experiences here, going forward. I think they speak to how much medicine seeps into you when you’re steeped in it all day, every day. I also think they’re rather humorous, but I’ll let my readers be the ultimate judge of that. Here’s what happened.

Medical school affects how I think about everyday, nonmedical things — including how to describe the direction I cut my sandwich.

I was making my lunch, a ham-and-cheese sandwich on sourdough bread. I’d had the same thing the day before. And the day before, I’d cut the sandwich in half diagonally, a little offset from the corners, the way we’d done it at the sandwich shop where I worked one summer in high school. Yesterday though, as I stared at my sandwich, I decided to shake things up. Since I live alone, I have a habit of talking to myself out loud sometimes, and said this to no one in particular other than me, quite definitively:

I think I’ll cut it midline today.

I started sawing at the sandwich, then stopped halfway through, realizing what I’d said. Three years ago, I would have said something quite different, probably that I’d cut it “in half in the center,” or “down the middle.” But now I clearly think anatomically, like an attending surgeon discussing with his resident where to make an abdominal surgical incision. That’s what 8 weeks of rotating through surgery will do to you, apparently.

I chuckled as I finished cutting the sandwich and wrapped in foil.

I hope this brings a smile to your face as well.

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Working in the psych ED

As many of you know, I write a monthly column for the online magazine The American. Here is my latest piece, describing my reactions to working in the psychiatric emergency department. You can see the original piece here.

 

“Repairing the mind”

Bless you,” one of our lecturers told me when she heard I’d asked to spend part of my six-week psychiatry rotation in the psychiatric emergency department (ED). I understand all too well why the psych ED is a place many people might want to avoid. Many patients in this locked unit are acutely and severely ill. One patient might come in talking about hanging himself, another of how how voices are commanding her to kill people. An ambulance might bring in someone found found running down the street in undergarments. A handful of these patients can turn aggressive or violent, yelling and threatening to harm the physicians and other staff.

Most can usually be talked down but some require sedation via an intramuscular injection — and in a few cases physical restraints. Safe to say there are few dull moments.

Before I discuss my own response to the psych ED, I want to talk about a tension that generally speaking exists in medicine. I’ll use hypotheticals to illustrate my point. Imagine a doctor sees a hospitalized patient afflicted with a rare, potentially fatal disease.

“Wow, what an interesting case,” the doctor tells a colleague when the patient is out of earshot. The colleague replies, “No kidding, I’ve never seen a case of that before. Let me know what the outcome is.”

This fascination with a rare, possibly incurable disease might seem cold-blooded to a non-medical observer. What kind of person would say something like that? But medicine is all about compartments. Doctors have compassion for their patients. They care for them to the best of their ability — applying empathy and professionalism. At the same time, they’re possessed with intellectual curiosity about the underlying processes of diseases. Probing pathophysiologic principles is part of the scientific method they’re trained in.

Though compassion and curiosity coexist quite peacefully, all this might sound callous to a casual observer uninterested in these medical compartments.

My years as a medical student have taught me that patients and their families are sensitive to remarks made in passing. Medical curiosity can seem unfeeling. As a result, I’m careful as to when and how I express it.

That preface in mind, let me move on to the psych ED, an assignment I found both medically and professionally exciting. The unvarnished truth is that patients need the service and the service needs a staff. The psych ED is a high-impact place with plenty of patients ill enough to pose an immediate threat either to themselves or others, or both. For a doctor, it’s a high wire act whose reward comes in the form of helping prevent a suicide or bringing someone down from a dangerous manic episode. Plenty of patients admittedly don’t want to be in the unit. Some refuse medication and protest their hospitalization. But even in such precarious situations, you’re still providing patients with short-term safety.

The psych ED encouraged me to use both my journalistic and my medical training. Skepticism is essential in any kind of psychiatric work. Some patients will lie and behave manipulatively. They’ll do whatever they can to get out of the hospital, or remain inside. Others will try to lie their way out of medication, or into it. Part of the history-taking process includes gathering what’s called “collateral information,” which involves calling around — psychiatrists, therapists, social workers, and internists — to verify a patient’s details. With permission, we’re also allowed to get in touch with family and friends to get the fullest possible portrait of the person, assess his condition and safety, and create the best treatment plan. The number of phone calls and the tracking process can revive old investigative journalist training. You doggedly hunt down clues, refusing to back down when one lead dries up. Persistence comes in handy.

As a medical student, I’ve spent a significant amount of time with patients themselves. Once a patient is safe and secure, students are often tasked with conducting the initial psychiatric evaluation. They then present their findings, assessment, and a proposed plan to the resident and attending, afterwards writing up a note about the encounter.

This sense of teamwork, of contributing to hourly and daily goals, is uplifting. In other clinical environments, my work was duplicated — often in front of me. I’m a student. Obviously, some of my moves require double-checking for safety reasons. That’s normal. But the duplication often left me feeling redundant.

In the psych ED, when I called the patient’s psychiatrist, I wrote a note about the conversation and then presented my findings. If I missed key information, I called the doctor back. My work wasn’t repeated. I felt more trusted, more competent. Having spent a decade working in publishing, I’ve missed both the trust and the sense of competence.

There have been many challenges. The psychiatric patient interview differs from a standard medical evaluation. In the case of suicidal patients, for example, it’s essential to ask whether they have access to a gun at home. That’s not a typical question in other disciplines.

It’s a delightful combination — to feel both challenged and effective on a daily basis. Most important, I feel like I’m making a difference in someone’s life.

It’s the muppets! (and more)

I never thought I’d get a hug from Big Bird. Here I get hugged by Big Bird AND my sister at the same time. So amazing.

My youngest sister, Joy, is in town for the weekend. It’s her first time in New York City, and her main tourism priority was a little off the beaten path. Her #1 activity choice in the city was seeing The Jim Henson Exhibition at the Museum of the Moving Image. It’s something I’d wanted to see too, though not with quite so much fervor.

I’m so glad we went. The museum, which highlights and celebrates the evolution of cinema and television, was incredible. As was learning (and seeing!) all the muppets I’d grown up with. This was one of the most interactive museums I’ve been to, with stations that allow you to create your own frame-by-frame animations, add strange sound effects or music to well-known films like “Jurassic Park” and “The Terminator,” and dress up your own muppet.

To the latter, I added an additional educational layer. I’m on my neurology clerkship now. One of the issues neurologists frequently get called for is eye deviation. This can be due to a number of things, including failure of one or more cranial nerves to fire and signal the eye muscles to move. I created two different muppets, as you’ll see from the photos below. The one with the red hair has a cranial nerve VI palsy, because he’s trying to look right, and his right eye cannot move laterally (lateral gaze is mediated by cranial nerve VI, while medial gaze is mediated by cranial nerve III). In the picture where I’m smiling with my lovely platinum blond-haired muppet, she’s doing fine, looking down and in toward her nose. In the image where I’m frowning, she’s undergone some sort of trauma, and cranial nerve IV isn’t working, because her left eye can’t make this down and in movement, which is called “intorsion” (cranial nerve IV is the one most likely to be damaged in trauma because of its long course). I know, I’m a nerd.

But it’s not just the muppets. There’s so much more. Of course, you can’t have a museum dedicated to TV and movies without a section on sci-fi. I enjoyed seeing the paraphernalia from Star Trek (I grew up watching The Next Generation series) as well as Star Wars. Some of the Star Wars stuff was bizarre, including mugs featuring the mugs of Princess Leia and Luke Skywalker, a teapot with Luke riding a tauntaun, and a scotch tape dispenser with C-3PO.

As a writer, I also couldn’t help but take a picture next to the sign emphasizing the essential contribution of screenwriters. I especially like the quotation it includes from “Sunset Boulevard.”

Audiences don’t know somebody sits down and writes a picture. They think the actors make it up as they go along.

While that may not exactly be true, I do think the writing is often taken for granted because it takes place behind the scenes, rather than directly on the screen, like acting or special effects.

If you’re in the city and haven’t been to this museum, I highly recommend it. It’s a good time, a perfect mix of learning about the moving images that are such an integral part of our culture, of making and doing things, and of laughing. For me, it was especially wonderful to share this experience with my favorite youngest sister. Thanks, Joy.

Charting new creative territory

I’ve shared some of my origami crane notecard creations in another post. Over the last couple of weeks, I’ve expanded into new territory. One of my new directions even relates to science.

I have plenty of paper — rolls upon giant rolls, all stored under my bed. But I was getting bored. I needed something to spark my creativity. When I was flipping through a box of cardstock recently, I came across some calendar pages I’d collected while working in a research lab years ago. They had colorful microscopy images on them.

“Huh,” I thought. “I could use these.”

And I did. Here are the results of my science collection so far:

With these cards now complete, I’ve basically used what I have in terms of glossy magazine-type pictures. But a classmate has promised to get me more science/nature magazines from her parents, so I should be getting additional inspiration soon.

Against my better judgment, I also headed to my favorite paper website, Paper Mojo. They have an insanely huge collection of both solid and printed paper. Specifically, I wanted to peruse their collection of chiyogami (a type of Japanese printed paper) and marbled paper. As I was scrolling through the pages of paper patterns, I was reminded that for many of them, you can buy 5″ x 8″ sample pieces rather than a large sheet. I only needed small squares or circles for each card, so this was perfect — I could get many different patterns without spending too much money.

My chiyogami and marbled prints arrived Friday night. I dove into using them yesterday, with great delight.

Here are the cards I made using two of the marbled prints:

And the cards I made using four of the chiyogami prints:

I’ve still got more chiyogami and marbled patterns to play with, and the promise of magazines soon, too. Working with paper, mixing colors, matching prints and solids, is a wonderful study break. And when so much of my time at home is spent with my nose buried in a book, it feels good to hold something tangible that I’ve made with my own two hands.

Note: For each of the photo groupings, you can click on any of the pictures to open a slide show with larger images.

Once a copy editor, always a copy editor

Having worked as a professional copy editor, grammatical mistakes make my hair stand on end. Especially when they’re printed on signs in public places. I’ve never actually done anything about this, other than to internally cringe. Until this past week.

Below are photos I encountered on a handwritten notice advising that a drinking fountain was out of order. I immediately noticed the error in the message. I started to step away, but felt drawn to return. To fix what was wrong. I pulled a pen out of my pocket and quickly did just that. My handiwork is subtle, matching in ink color so as not to draw too much attention to itself. My goal was not to shame the writer, but simply to correct the mistake.

I’ve included before and after photos to illustrate my good grammatical deed.

Before / After:

I left the drinking fountain with a smile on my face, feeling I had done the right thing. Feeling I had done a necessary thing.

Ah, saving the world, one grammatical error at a time …

“Dr. Dating”

In a recent post, I shared one of my early online magazine columns from several years ago. Today, I’m sharing my most recent column, published this week. Most of my pieces (both for the magazine and here on this blog) explore science, medicine, and life in medical school. This piece, however, explores new territory. It’s called “Dr. Dating,” and as the title suggests, it delves into what it’s like trying to find a partner while surviving as a 35-year-old medical student.

This piece was first published in the online magazine The American. You can see the original version here.

Dr. Dating

Dating in medical school is hard. When your 3:30 a.m. alarm heralds a 15-hour workday, you have little time left for yourself, much less a partner.

Dating as an older medical student is even harder. When most of your classmates are a decade younger than you, your dating pool automatically shrinks. Dating apps make the whole thing almost impossible. When Cupid’s main criteria is pixelated faces there’s little room for meaningful romance.

I tend to post on sites that allow a more freeform profile, minus images. I want responses to my words alone. So far, I’ve had mixed results. I’ve dated two men seriously; one for a few months, the other for a few weeks. I was comforted to know there were people out there who shared my mindset. I’ve also gone on a number of dates with like-minded people who weren’t the keeping kind. There was either no physical chemistry or political differences of opinion too deep to overcome. I can’t date someone who doesn’t believe in the importance of social welfare programs, for example.

My online profile says I’m an intelligent, attractive, ambitious woman. I mention I’m a writer who wants to be wooed by words. I say I want more than a laundry list of hobbies. I ask for a photo or two, clothed please, promising to return the favor.

I put replies in folders so I can keep track of my suitors. My folders are labeled: “reply!,” “maybe,” “nope,” “compliments,” and “LOL.” The most interesting responses usually don’t lead to dates. Many say a lot about the people — I can’t say men, since until you meet the person it’s impossible to know — who wrote them and society at large. I’m part-lover and part social anthropologist. Human behavior intrigues me.

The messages in the “nope,” “LOL,” and “compliments” folders have taught me a lot.

But let me break it down. The “nope” e-mails are usually one- or two-liners like this:

Hi, I’m interested in you, hope to read back from you.

Or vague:

Good evening, how are you? I hope all is well. I am reaching out regarding your post. I am in my early-30’s, 5’10”, and looking to meet someone new outside of my social circle. Hobbies and interests?

I hope we have a chance to chat soon. Take care and enjoy your weekend!

If you’re looking for a wordsmith, you skip past these.

The “LOL” responses exist to remind me there are still plenty of misogynistic men who feel threatened by confident and capable women. Some believe a bad marriage is better than divorce. Many can’t imagine they might be the source of a divorce. I try not to respond to such messages. Here are a few examples, as well as my potential responses. I’ve made some minor grammatical changes for the sake of clarity, and have removed identifying details.

On divorce:

I’m white, live in [NYC borough], and [am] looking for a relationship hopefully leading to marriage and raising a family. I’ve never been married, no kids, don’t smoke or do drugs, rarely drink, no pets, not a vegetarian, and am Catholic. And you? You seem like a nice person. Why did you divorce?

Another:

The most interesting thing about [your profile] is the part where it notes you’re divorced and that you chose not to offer an explanation re: same. Thoughts?

I might reply this way:

Just because I posted an online profile with some vague details about my personal life does not mean that I owe you — someone I have never met, and know nothing about — an explanation. To be honest, I mentioned that I’m divorced for one purpose and one purpose only — to screen out people who have a problem with dating divorced women. Looks like my strategy is working.

One man responded every time I changed my profile. Here are excerpts from what I received — so delightfully — over a two-week span.

1. You’re pedestrian and obvious, you’re a plebe and a wannabe. You’re a middle-aged … student. Not sure where you get the right to be that pretentious. I wouldn’t even consider bedazzling your face with my semen.

2. I see you started four out of five paragraphs with “I.” Do you lack such an imagination as a writer that every sentence needs to start with “I” or “I’m”? Also — SELFISH. Your ad reads as “me me me me.”

3. You’re fucking stupid.

To this eloquent man (assuming he is one), I would reply:

Given that you have replied not once, not twice, but three times to my profile, not with the goal of meeting me, but of insulting me — and are therefore wasting your own time — I have no choice but to conclude that it is you who are stupid. Best wishes in your own search.

Some just don’t understand intellectual attraction:

What planet are you from where men will be drawn to your words before they are drawn to your body?

To which I would say:

Dear Sir, I am from Earth, a planet where a minority of men still desire not only physical but intellectual intimacy with their partners. This may not be your goal, but it is the goal of dozens of people who have replied to my profile. I do thank you for your kind concern, though.

My “compliments” folder exists to remind me good men are out there. Three snippets in that vein:

1. If you don’t mind me saying, this was probably the most well written and grown-up post on [this website]. I’m impressed, most everything else is devoid of any type of substance. Although I would love to go back and forth with you about any and all topics, I’m probably not what you’re looking for. But I felt compelled to write you. Anyways, I wish you the best in your journey!

2. Hi, seriously I wished I was 35. I loved everything about your ad. Unfortunately I’m [in my mid-20s]. Been looking for a woman like you for awhile but it’s so hard to find. My last relationship didn’t last long because she was more of a Nympho and I wasn’t unfortunately. But I need someone like you in my life. I hope to find my own … soul mate. I wish you all the best.

3. I just wanted to say I really enjoyed your ad. It was a pleasure to read such a well-written, clever ad. It brought a smile to my face as I perused the rest of the junk [on here] today. … Unfortunately, I’m not your type. (I fail in one important category. I’m married. Otherwise, it would be a great match.) But I wanted you to know that your ad brought a smile to my face and gave me hope of finding someone decent on [this website]. Good luck.

So there are kindred spirits out there. Somewhere. And one day I’ll find a smart, funny guy who isn’t married, isn’t crazy, and I click with. For now I’ve got medical school, and she’s a demanding mistress.

An origami crafternoon

When I was living in the Chicago area, a dear friend of mine and I would get together for what we called “crafternoons” at her house. We each had our respective activities, but would do them side by side, chatting and listening to music or having a movie on in the background.

Last weekend, a rare “free” weekend in between my surgery and psychiatry clerkships (so no studying to do), I indulged in an origami crafternoon of my own. I caught up on my favorite podcasts while folding crane notecards. The cards have an origami crane on the front, and then unfold to reveal a blank space to write a message. Below are the exteriors of four of the cards I made, with one of the interiors shown as well. Click on any of the cards to see an enlarged image.

Given that I’ve got a long weekend starting today, more origami is definitely on my to-do list.

A story from the past that explores life and death, and what makes us human

As some of you know, I write a (mostly) monthly column for an online magazine called The American. I have occasionally posted the link to that column here on my blog. But it dawned on me that those of you who read my blog might like to read these columns as well, and are unlikely to come across them unless I share them directly.

So here is the first column I wrote, published online on April 3, 2014. At this time, I was working in a neonatology research lab at Northwestern University in Chicago. In this piece, I tangle with the themes of life and death, and what makes us human.

Note: This column was first published in The American. You can access the original version here.

The taut line

As the freezer door swung shut, the gravity of what I had just done sunk in. Just 15 minutes ago, the body now stiffening inside had been running, climbing, eating, drinking. I injected it with ketamine/xylazine to anesthetize it. I cut its chest open. I put it on a ventilator. I snipped out its heart and lungs with tiny scissors.

When it was all over, I wrapped it in scratchy, brown paper towels, sealed it in a gallon plastic bag, and tossed it in the freezer. Crush a cricket and I cringe; bleed out a mouse and I didn’t blink. What did this say about me? I left the research lab that day with a furrowed brow, but without an answer.

As if I weren’t troubled enough, I realized that in medical school, which I start this fall, some professor will no doubt utter the phrase “life is sacred.” I agree. How, though, to reconcile that idea with the fact that to save human lives, to improve them, we kill other animals?

These questions have nagged me since that first mouse almost two years ago. They haven’t prevented me from working in biomedical research. But asking them forced me to probe what I am doing and why. Along the way, I have asked other questions and made other observations, which I will explore in this column. As a former reporter and editor, I come by such questions and observations naturally. For years, publishers paid me to query and conclude on matters of public interest, such as zoning laws or school board elections. I stick to science and medicine these days, since “physician-scientist” is what I want to be when I grow up (or finish medical school, at least).

That career path means working with animals — probably mice, and probably killing them in the end. Some people might say, “Oh, it’s just a mouse.” When I stare down into a yawning chest cavity, though, at a pulsing heart, that gap between man and mouse narrows for me. Life is life. Death is death. I dole out the latter. (Count for last week: 22 rats, 18 mice.)

Watching a life come and go, instigating that coming and going, unsettles me all the more because its inception is such a miracle. Even now, every time I find a new litter of pups, called “pinkies” on the first day of life for their rosy skin color, I am awed. That first day, we don’t disturb the mother or the pups. To make sure they are alive and wriggling, we peek underneath the clear, plastic cage. From that vantage point, I can still often make out the little white “milk spot” on a translucent abdomen or two. “Good, they’re nursing,” I tell myself. The pups, born naked, blind, and deaf, grow and change daily. Within one week, their ears are fully developed and fur starts to appear. By 14 days, their eyes open. That’s when we kill them.

“Kill,” though, is weighty word, rife with connotation. Instead, we usually say, “sac,” short for “sacrifice.” Though using another word changes nothing, it can allow for a change in attitude — if you let it.

It can lend some respect and dignity to the animals’ lives, some purpose in ending them, and remind us to use only as many as are necessary.

As the word “sacrifice” suggests, there are elements of ritual in what we do, at least unconsciously. The animals are housed in a separate facility; we “sac” them in our lab. After we bring the plastic cage in, one of us drops a few Cheerios — a rare, exciting treat — onto the shredded, woody bedding. I work in a neonatology lab where we study (and hope to one day prevent and treat) a chronic and sometimes fatal lung disease. This disease affects premature babies exposed to high oxygen, so the mice we sac are juveniles, usually 14 days old. The way we induce this disease in the pups is to put them into an oxygen chamber, along with their mothers. So we have to sac the moms as well. This is the hardest part for me.

“I’m sorry we have to do this, mom,” my lab manager often says as she grasps the female mouse by her tail. “Thank you for taking such good care of your babies.”

Then she gently lays the mouse, its nipples still swollen from suckling, into an anesthetic-filled glass jar. The mouse quickly asphyxiates.

Watching this for the first time shook me inside. It still does, a little bit. There is a tension there, a taut line between compassion, curiosity, concern, and conscience. Through it all, I believe in an honest search for personal reconciliation. That makes us different from mice. That makes us human.

Weird surgery perks

Beneath my white coat, you can see the maroon OR scrubs that I wore every day while on my trauma surgery rotation. Wearing these scrubs every day provided an unforeseen benefit: less laundry to do.

My enjoyment of this surgery rotation thus far has been a pleasant surprise. Besides learning about, well, surgery, I have encountered important life lessons. But I have also accrued some unforeseen benefits. I think that understanding these perks will provide additional insight into what life is like on the surgery rotation.

Chore relief. On trauma surgery, you wear scrubs all day every day, with the exception of Monday morning’s Morbidity & Mortality conference. That meant I had less laundry to do. Given that I have to lug my dirty clothes up and down several flights of stairs and down the block (I’m in a walk-up apartment, and the laundry room is in the basement of a different building), that’s no small thing.

Budget boost. When I was working with the trauma surgery team, I would leave my apartment at 5 a.m. and get home somewhere between 6 and 8 p.m. That’s a long day, by any standards. I noticed that over four weeks of that schedule, I bought significantly less toilet paper. Actually, my grocery bill was lower overall. I was so busy that I simply ate less. In part because the workday on surgery was so hectic, and in part because when I got home at night I was too exhausted to do more than shove some food in my mouth and collapse into bed.

Free medical supplies. Yesterday, while I was cooking a batch of chili, I managed to slice open my thumb on a can of diced tomatoes. I ran to the bathroom, thrust my thumb under a stream of running water, and scrubbed the cut with soap. Before reaching for the box of Band-Aids in my medicine cabinet, I turned to grab a Kleenex to dry my finger. Then I remembered that I had something much better — sterile gauze! A packet from the hospital had made its way home in my white coat pocket. Hm. Maybe I should grab some more?

I wouldn’t consider these reasons to do a surgery rotation, exactly. But since surgery is a medical school requirement, I certainly won’t turn down the random fringe benefits.

A newly prudent pedestrian

Medical school is one of the most intense experiences I can imagine. As such, I expected it to change me. It has. And in some unexpected ways.

On a recent summer evening, I walked some 15 blocks to a Thai restaurant to meet a friend for dinner. It was a lovely evening. I enjoyed the fresh air after spending so many hours cooped up in the hospital over the last several weeks. On my walk, I noticed something. Since completing my four-week trauma surgery rotation, I’d become a much more cautious pedestrian.

When waiting to cross a street with lots of traffic, I didn’t tip-toe into the street, or even stand at the edge of the curb. Instead, I hung back a few feet. I still jaywalked, but only if there were absolutely zero cars in sight. None of this dashing across the street to beat an oncoming vehicle. And when I saw someone else do that, I shook my head (literally). Even when simply walking on the sidewalk, nowhere near an intersection, I found myself paying close attention to the traffic running parallel to me — something I’d never really done before.

I had abandoned my aggressive pedestrian stance because darting into traffic saves you no more than a few seconds, and can cost you so much. I paid more attention to my surroundings because even when you’re on the sidewalk, minding your own business, a car could jump the curb and smash into you.

Technically, legally, pedestrians may have the right of way. But legality melts away in the face of a 2-ton steel monster barreling toward you.

That reality is now all too clear to me. While on trauma surgery, I’d seen too many pedestrians hit by cars. In medical lingo, this type of trauma is referred to as a “pedestrian struck.” Often the collisions resulted in simple lacerations or minor broken bones. But sometimes they resulted in coma, intubation, and craniectomy (removing part of the skull to relieve elevated pressure in the brain).

Maybe increased caution and attention won’t make being a pedestrian in New York City much safer. But they make me feel better. And that’s something, I suppose.