doc w/ Pen

journalist + medical student + artist

Necessity, that dear old mother

The room where I presented my educational modules at Masaka Hospital in Uganda. Setting up for a technology-heavy presentation in rooms like these can be a challenge.

If I were presenting my educational modules at New York Presbyterian Hospital in New York, I would take several things for granted. Access to a projector, for example. A screen to project images or videos on to. Electrical outlets. Electricity.

In the hospitals here in rural Uganda though, things can be a little more challenging.

At Nakaseke Hospital, for example, the electricity went out during a rainstorm. There went my access to power, and to my projector. Thankfully my laptop and little Bose bluetooth speaker had been charging the whole time. So Howard held up my laptop to show the videos, and I held up the speaker. It wasn’t ideal, but it worked.

Electricity was an issue at Masaka Hospital too, but in a different way. Electrical outlets here are sparse. Many rooms have only one. At Masaka, the only outlet was at the back of the long, narrow room. The projection screen had been set up at the front of the room, near the door. It was hanging from a nail tacked high on the wall. My cords wouldn’t reach to the front of the room where I needed to place my projector, not even with my extension cord, and they didn’t have another one.

Rubber bands connecting the projector screen to the nail underneath the window casing.

So a couple of the nurses who arrived early for my session helped me improvise. We carried the screen over near the outlet and balanced it on three heavy, wood chairs. But there was no nail here to hang the screen from. Not in easy reach, at least. And without something holding the screen up, it simply flopped to the floor.

There was a nail above the window, behind where we were trying to hang the screen. But the nail was obscured by a piece of window moulding. The hanger on the screen wouldn’t reach into the tiny, tight space.

One of the women asked if I had a piece of string. I didn’t have string. What I did have was rubber bands. It took a few tries to figure out how to combine them (think back to physics: in parallel? in series?) to hold up the screen. But we got it to work, as evidenced by the photos here.

My most recent adventure brought me to Gombe Hospital, this past Wednesday and Thursday. When I arrived Wednesday afternoon, I was ushered into the lecture room, and began to set up my equipment.

“Do you have a screen?” I asked the administrator who was helping me. “Or should I project onto the wall?”

I crossed my fingers for a screen, because the wall was a mint green color. Both the patients and the palliative care team in my videos would look permanently seasick if I projected their faces onto this background.

The taped-up paper “screen” at Gombe Hospital.

“We will use the wall,” she said. “I will get some paper.”

She disappeared. A few minutes later she reappeared, with sheets of butcher block paper and masking tape. We taped two of the sheets on the wall, contiguously to make a reasonably sized “screen,” as you can see from the photos.

The first day, participants told me it was hard to see the videos. I realized there was too much sunlight in the room. For Day 2, I closed all the curtains, and it was much better.

Would it have been easier to have projection screens and accessible outlets at every hospital? Of course. But being able to use what you have rather than what you wish you had is an important life skill, wherever you are.

This was good practice for me. It was also a reminder that when put to the test, I readily adapt. That’s a good feeling.

The room where I presented at Gombe Hospital, with the improvised, taped-up paper “screen” at the back of the room.

History lessons

My view of the beautiful Ugandan countryside — fulfilling a goal I set more an 7 years ago.

This week, I’ve taken some time to “clean house” here on my blog. Some of my first posts didn’t migrate over well from the Blogger platform to WordPress. There are formatting and image resolution issues.

As I tinker, I also read. With more than 350 posts behind me now, dating back to January of 2010, this is truly a chronicle of my journey. Here are a few things I’ve noticed from my review of about a year of posts (2010 and the beginning of 2011).

Posing with one of the Ugandan nurses who attended my palliative care educational session.

Sometimes a post elicits a shiver down my spine. Like one I read from January of 2011, where I talk about one of the things I was looking for in a medical school. The post details how “I want to do at least one international rotation as a medical student.”

The timing of this … to read those words, penned more than 7 years ago, about wanting to go abroad during medical school, while sitting outside and enjoying the cool breeze of Uganda’s rainy season. Not during my first medical school trip abroad, either (this is my second). And not my last! (I plan to go to Spain for 4 weeks next spring.)

To be reminded of this dream, envisioned what seems like a lifetime ago, which has now come true.

Tropical cocktail with a 3-D protein structure as a garnish. My kind of beverage.

Sometimes a post makes me groan at my own corny sense of humor. Like this one, about a “dream vacation,” complete with what I’d like to be drinking on said dream vacation, a tropical cocktail with a 3-D protein structure garnish (see my photoshopped beverage at right). I’m still making silly photos like this one, cracking myself up as I do so. I’m not sure whether anyone else laughs at these, but I sure get a kick out of them.

As I read a post about my Grandpa’s death from cancer in 2010, I realized that it has always been important for me to reflect on how medicine and my personal life intersect, both then and now.

The posts, in their entirety, also prompt me to think about how things have changed, both personally and professionally.

On the personal front, I’m divorced now rather than married, as I was back then. Reading about how much I loved my then-husband, how much I enjoyed time spent with my wonderful in-laws, brought back so many happy memories, tinged with sadness that such a significant chapter of my life came to a close.

Professionally, my experience of medicine has evolved from abstract to real. Back then, I wrote about research articles and news stories related to medicine, things I was learning in my pre-med program, my hopes and dreams for medical school. These days, I write about what medical school is actually like for me. I chronicle my own experiences with patients, not research studies, not news stories. These days, I also often write about things that have nothing to do with medicine, like going for a walk in Central Park and how lovely the turning leaves are, because there are moments when I need to step away from it all.

I’m less wild-eyed about it now, less naive. Medicine is exciting, just like I thought it would be, and more so. But it’s also incredibly demanding and difficult. Some days I come home exhilarated; others exhausted. My writing reflects this internal maturation. I use fewer exclamation marks, put fewer words in all caps, don’t emphasize so many of my thoughts with bold or italicized font.

Even as I’ve experienced the difficult parts of medicine, the parts I couldn’t truly imagine when I was a pre-med student, even as my life has changed in ways I couldn’t anticipate when I started this process in 2010, I am glad to be here.

At this very moment, I am glad to be here in Uganda, learning more about this country, its kind and welcoming people, and about palliative care. In a more general sense, I am glad to be in medical school, glad to be applying for a psychiatry residency, glad to be starting my career as a physician soon.

I wonder what I’ll think when I read these words 5 or 10 years from now, reflecting on my time in medical school.

I’ll let you know.

Missing New York City, for an unexpected reason

Brevity is not my strong suit. Just ask my editor at The American, the online magazine for which I write a monthly column called Bio-Lingual.

But I’m working on it. And Uganda is helping.

A week and a half ago, a surprise reptile encounter inspired another one of my six-word stories, Hemingway style (only my second ever; I penned the first in January).

Today, I find inspiration for another brief burst of prose from the local schoolchildren:

I miss NYC. It’s quieter there.

One of the chickens that roam the yard in front of the guesthouse here in Naggalama, scurrying away as I snap a picture. A sign of a peaceful countryside, right? Sometimes, yes. But not this week.

I never thought I would call NYC “quieter” than anywhere else, much less rural Africa. For me, the countryside in any country connotes the cheerful sounds of birds chirping and bugs buzzing. Naggalama has these. Here I also hear roosters crowing in the morning, and the tap-tap-tap of hammers as men build a new home for the nuns. (I don’t mind the hammering; it’s an improvement over the jackhammers the workers are using at my New York apartment complex right now.) Sometimes the sounds of choir practice waft over from the church down the road. Or I will hear the voices and laughter of children from the secondary school nearby.

This week, it’s been more than their voices and laughter. Much more.

I think it started Monday morning. I was awake, but enjoying the fact that I didn’t have to jump out of bed. I could lie there under the sheets, in peace, and just be. This is a luxury when you’re a medical student.

Then came the bass.

thump – thump – thump

I rolled over and checked my phone. Just after 7 a.m. What was going on?

I closed my eyes again, hoping the sounds of music and exuberant singing would fade. They did not. They got louder.

After 5 minutes, I got up. It was too much, even wearing my earplugs, which I sleep with every night.

The music and singing were almost constant that day. When I last checked the time, it was 11:50 p.m., and they were still going at it.

Yesterday, I learned that this is the last week of the term for these students, which means they have a full week of singing, worshipping, and celebrating. Essentially a week-long party. I’m sure it’s loads of fun for them. Not so much fun for those of us living next door.

In New York City, I frequently bemoan the noise. The cabs constantly beeping, the clamor of construction and traffic. But my little 1-bedroom apartment, which faces an inner courtyard rather than my busy street, is surprisingly peaceful. This week, I’ve been reminded just how peaceful.

Don’t get me wrong. I’m glad the kids are having fun. I remember how excited I was at the end of a high school semester, so I don’t begrudge their celebration. Heck, my friends and I certainly made plenty of noise in our day. And sometimes I still do, like when I’m listening to a new album from one of my favorite bands.

Thankfully, I’ve figured out how to manage the noise while the party continues. When it’s too loud for me to concentrate on my work, I shove in those purple foam earplugs, even during the day. I’m wearing them now, as a matter of fact.

Even so, I do anticipate a sigh of sonic relief when I get home. After I’ve lugged my two overstuffed suitcases up the stairs, and after my heavy apartment door clicks shut behind me.

Then I will close my eyes, and as Depeche Mode coos: Enjoy the silence.

Bright future? Or dark cloud?

You have a bright future in front of you
But a dark cloud over you

So stated a New York City subway ad for a student loan refinancing company. (My paraphrase, but that was the gist.)

I smiled as I read the words, sitting there on an orange plastic seat, the train clattering along. Smiled, because I could relate to the feeling. Smiled genuinely though, not in a sad, resigned way. Because while I could relate to that feeling, I no longer felt that way.

Medical school in the United States is insanely expensive. Each year at Weill Cornell Medical College, I borrow about $90,000 from the government for tuition, living expenses, health insurance, and so on. I also have loans from the two-year pre-medical program I completed — more government loans, and some private bank loans too. At the end of it all, I will owe the equivalent of a hefty mortgage. Heck, depending on where you live, I could’ve bought two houses with all these loans.

Residency is when you start having to pay things back. You’re a doctor, but not making a doctor’s salary. For the government loans, there are income-based repayment plans. But not for the private loans. I’ve had many moments of middle-of-the-night panic about this. How in the world could I afford to start paying back all this money, potentially three loan payments at once, while making around $50,000 a year?

“It will work out. It always does,” I’ve whispered to myself on more than one occasion, to still the panic.

And now I have a better idea of how it will work out.

The fact that I’m graduating in a year has forced the issue. As I’ve scrolled through psychiatry program websites and pondered my personal statement, residency — and the accompanying loan repayment — has shifted from the realm of fantasy to reality.

But I’m no financial expert. And the world of student loans is a quagmire. I’ve felt completely unprepared to figure this out on my own. So I turned to the Internet. I don’t remember my Google search terms. They were probably something desperate like this:

How do you afford medical school loans as a resident?

Bank websites came up, of course, promising special repayment deals for medical residents. I investigated, discovered that it’s possible to refinance private and/or government loans to drastically reduce monthly payments during residency. Interest continues to accumulate, of course. But you can now afford to buy groceries, pay your rent, and avoid default. Seems like a good compromise to me.

I even called one of these refinancing companies, heard their spiel, and learned that there’s really nothing for me to do until after I graduate. I can’t refinance until then, or even apply, until I have my diploma. I was glad to know about the option though, and now have it tucked away for next year.

I kept poking around the Internet though, in search of advice on how to create a more comprehensive repayment plan for myself. Or for the name of someone who could help me do that.

A website called The White Coat Investor popped up. The person who runs the site is an emergency medicine doctor who got sick of “financial professionals ripping me off.” This seemed promising. Specifically, I landed on a page titled Student Loan Advice. The page gave me some information I already knew — how complicated student loan management is. It also gave me information I didn’t have — the names of people who specialize in helping medical residents manage their student loans.

I scheduled a free consultation. A specialized financial advisor and I discussed my options (in broad strokes), what his company could do to help me, and how much they charged for their services.

After the call was over, I felt a sense of relief. More than that: pure peace.

The exact details of my plan are yet to be determined (and can’t be, not fully, until after I graduate next May). But there are doable plans, and people who can help me map them out at a price I can afford.

Rather than that dark cloud, I can now focus on my bright future.

On this day …

I don’t normally look at the “On this day” posts on Facebook. I don’t normally spend much time on Facebook at all. But today, on a whim, I did. This came up, a 5-year-old memory:

As did another post from a dear friend exactly a year later, which I’ve copied below. If I remember correctly, the first sentence, in quotation marks, is her quoting me; the second sentence is her reaction to my words:

“Holy shit. That is an acceptance letter.”

Discussing the MCAT on this day in 2013, and a medical school acceptance letter on this day in 2014 …

I’ve come a long way since then. I’m now discussing medical school graduation (in 13 months!) and where I will apply for my psychiatry residency (in 5 months!).

Thanks to all of you who have helped make this possible, and to all of you who have followed me on the journey. I couldn’t have done it without you.

Uganda: Learning to live with limits

So much in the United States is unlimited, like our wi-fi access. Not so in Uganda, as I was reminded after a thoughtless frenzy of downloads.

Living in a foreign country means making adjustments. To respect the conservative dress code here in Uganda, for example, I wear a skirt that falls below my knees, and cover up my sleeveless blouse with a lightweight shrug.

There are technological adjustments too. The wi-fi here at Naggalama Hospital only works three weeks out of the month. By the fourth week, they’ve used up all their data.

That’s the general principle here, for technology, and otherwise. Resources are limited.

To make sure I could access the Internet for my entire four-week stay, I have a “Uganda phone.” It’s an iPhone from the United States, but with a Uganda SIM card inside, and a Uganda phone number. When I arrived, the phone was loaded with 10 GB of data, and what’s called “airtime.” Airtime can be used to call within Uganda, any phone carrier, and also to call internationally. Airtime is not to be confused with “minutes,” which can only be used within Uganda, and only with people who share your same carrier (in my case, MTN).

I didn’t plan on doing anything crazy on the Internet while here, mostly checking e-mail and writing blog posts. But I hate using the Internet on a cell phone. So mostly what I’ve been doing is using the phone’s data to set up a hotspot for my laptop, something I’ve never done in the United States (because I never had to). I’ve been religiously keeping track of my data usage, dialing the MTN “data usage” number to find out my balance every few days. After more than a week, I hadn’t even used 1 GB. Then I checked this morning. 3.5 GB gone. Somehow, over the span of a couple of days, 2.5 GB had … disappeared. How did this happen? Was there a data monster lurking somewhere, biting into my bytes while I slept? I inventoried my Internet use over the last few days, trying to account for the missing many megabytes.

An hour later, while I ate breakfast, it dawned on me. The day before, while waiting at Masaka Hospital for someone to pick me up and drive me back to Naggalama, I’d downloaded a half-dozen audiobooks from the New York Public Library. I did it without thinking. Because at home, I’m almost always on a wi-fi network. In my apartment, at school. And when I’m using my data, I’m only checking a handful of websites, maybe Google maps, or looking at e-mails. Not exactly high data use activities.

I’d downloaded so many books — hours and hours worth — because I’m picky about my narrators. Their voices, that is. So many grate on me, rub me the wrong way, for reasons I can’t always articulate. And I can never tell by the brief sample they give you. I need 15 or 30 minutes to decide whether I want to invest myself in the story, and in the voice. My dad used to read aloud to my family every night when I was a kid, and he set a high bar, it seems.

I know streaming and downloading eats up your data like nobody’s business. I know that. But I clicked the “download” button a half-dozen times with nary a thought because that’s what I always do. In the United States, data is dispensable, limitless. Like so many things.

Not so here.

I really should have known. Because after three phone calls home, I suddenly ran out of airtime last weekend, my phone call cut off mid-sentence.

Well, I have the books now, 2.5 GB later. They’re checked out for three weeks. By then I’ll be home, back to limitless wi-fi.

Lesson learned though, for while I’m here. Hopefully …

Uganda, delivered

A “six-pack” (well, six loose bottles) of Club, a popular Ugandan beer, on my doorstep. It’s not a New England-style IPA. But as the saying goes: “When in Uganda …”

One of the things I love about New York City is that you can get just about anything delivered, with minimal or no extra charge. Groceries, alcohol, and take-out food of every ethnicity you can imagine are standard fare. I take advantage of the grocery services the most often, because I hate grocery shopping. I’d much rather someone else do it for me. I happily tack on a nice tip since they carry all my bags and boxes up the stairs to my fourth-floor walk-up apartment. (No elevator.)

To my surprise, there is grocery delivery here in Uganda, too.

Lately, I’ve gotten into craft beer. I’m pretty sure they don’t have IPAs here, but lager, yes. I’d run out of the Nile (a popular beer here) that we’d gotten in Kampala. I was told that Sandra, the housekeeper where I’m staying, could have beer brought to the guesthouse. I gave her 24,000 shillings (less than $7 USD), and about 30 minutes later, there was a guy ringing the bell at our front gate, carrying a box containing six bottles of Club (another popular Ugandan beer).

A couple of days later, I discovered we’d run out of milk. I prefer half and half for my coffee, but milk will do. I texted Sandra to bring some when she came to make lunch for us. She texted back that she’d send someone with it now. In less than 10 minutes, there was a man at the front door, carrying a little black plastic sack with two pouches of pasteurized milk inside.

Talk about service.

My first palliative care presentations in Uganda: Naggalama and Nakaseke

A group photo from an educational session I led in Nakaseke, Uganda.

Last week, I started pilot testing our curriculum, “Digital Modules for Palliative Care Education in Rural Uganda.” Through these three sessions, the participants have learned from me. And I have certainly learned from them.

Leading a palliative care educational session in Naggalama, Uganda.

I began by presenting the first module, “Basic Communication Skills in Palliative Care,” at my home base, St. Francis Naggalama Hospital. Naggalama is where I came to experience palliative care in Uganda in 2016, and where I am staying in between my forays to other rural locales.

Then I traveled to Nakaseke, a rural hospital about 2.5 hours from Naggalama. I presented the first module again, as well as the second, “Delivering Bad News.” We got lost on the way (PSA: don’t rely on Google maps in rural Uganda). And then the electricity went out during a rainstorm midway through my first presentation (but we adapted; Howard held up my laptop so people could see the videos, since we could no longer project them onto the wall). So in the end everything worked out there, too.

I’m now entering my data from our pre- and post-presentation surveys. And I’m processing the lessons learned from these three sessions. What is clear, though, is that people want this kind of teaching. They struggle with communication skills and delivering bad news just like we do in the United States, but don’t have access to the kind of educational resources we do. And they’re hungry for it.

-reading guide

The participants all wanted to keep the teaching guides that I brought for the sessions. I took this as high praise.

I got a variety of feedback from the three sessions, but one comment was constant. When asked what we could change about our printed teaching guides to make them better, I was told, “Let us keep them!” Suitcase weight limits (2 suitcases per person; 23 kg each) prevented us from bringing enough printed guides for everyone. But the message was clear, and I took it as high praise.

At Nakaseke, at the end of each session, the participants also did this amazing thing to show their appreciation where they clapped several times in unison and then threw out their hands toward me like they were showering me with thanks. It seemed like their version of a standing ovation. Below are still photos from this beautiful gesture.

Apparently, I’m pretty into the material too. I didn’t realize until I saw photos of myself (below) from the sessions how animated I can get.

This week, I travel to Masaka and Kitovu, two other rural sites. I will be presenting four times in two days – a much more grueling schedule. These sessions last 2-3 hours each, and at the end of each I’m exhausted. But after last week’s successes, I know I’m up to the challenge. I know there will be bumps in the road, too (both figurative and literal, given the quality of rural dirt roads here). But I also know it will be worth it – for them, and for me.

Lions, tigers, and … lizards?

Some time ago, I wrote a post about Ernest Hemingway’s use of the so-called “six-word story,” its explosion on the Internet, and my own attempt at a tiny tale. Good six-word stories, like Hemingway’s, convey an entire world with only a few strokes of the pen (or keyboard). Writers accomplish this by what they do say – the imagery and feelings they conjure directly – as well as what they don’t – the questions and curiosity they raise.

You want to know more. But there is no more. It’s delightfully frustrating.

Here is my second attempt at a six-word story. After you take in the words, think about your own interpretation. What do you think the backstory is? Then scroll down to find out what it’s really about.

There’s a lizard in my underwear!





So. Where did your mind rush to when you read those words?

Those of you who know me well may have guessed that like all of my writing on this blog, this, too, stems from reality.

I fail at fiction. Trust me. I’ve tried.

This is truth.

In fact, these very words flew from my mouth in a gasp (or maybe a growl?) of surprise this morning as I was about to sit down and drink my morning coffee.

I’m in rural Uganda. There’s a washing machine here, but no dryer. I’d gone out to enjoy my coffee on the back patio. Where, I discovered, my recently laundered undergarments were hanging, ruffling in the breeze. One had slipped to the brick floor of the patio. I stooped to pick it up and lay it across the bars of the metal clothes rack. As I did so, something small and black flopped out.

“A stick,” I postulated.

And then the stick moved. Darted is more like it.

I saw it in one spot, near my foot. Then a quick black blur, and my black stick was suddenly 6 inches away. And then another 6 inches. And another.

I realized my so-called “stick” had legs. I know it actually did have legs because when it paused briefly, and I counted them: Tiny. Four.

I grabbed my phone, the journalist in my dying to capture the evidence. In a stroke of pure luck, my hurried snapshot caught the critter next to an actual stick (a brown one) that was the same length as the lizard. That picture, and a picture of my left hand next to the same stick to provide scale, are below.

These two words, “lizard” and “underwear,” are words I never thought I’d hear in the same sentence. This is certainly not an autobiographical tale I ever planned to tell. Or yell. Or think! Not anywhere. Not even in Uganda, where I’ve learned that anything can happen.

In these anything-can-happen environments, people always tell you to “expect the unexpected.” But if it’s unexpected, how can you expect it?

After today, I know that you really can’t.

Home-grown exotics

A few days before leaving for rural Uganda, I had an exotic adventure right in my own backyard. I trekked out to the Bronx to visit the New York Botanical Garden, one of my favorite places in the city. It’s always a fun trip, and I walked through some of my favorite haunts, like the ornamental conifer garden. But I made this particular visit to see the annual orchid show, which would conclude while I was out of the country. This week was my last chance.

The show didn’t disappoint. I ooooohed and aaaaahed as I made my way through the greenhouse, stunned by the magnificent and many colors, shapes, and sizes. Some blooms hung in clusters from trees; some strutted in giant pots on the ground; others wound their way like strands of delicate glass beads around a gigantic frame of green bamboo-like rods, a structure which reached up for the ceiling, and for the sun.

My photos don’t do these beautiful blooms justice. But they give you a glimpse at what the show was like:

Outside, the Japanese apricot trees (below) were blooming, as were the azaleas. It was early April, too early for many of the spring bulbs, but some precocious daffodils (also below) and even a few tulips had popped up to say their spring “hello.”

All this green (and pink, orange, yellow, purple, and so on …) was so refreshing to see. It was a pleasant respite from all the concrete and steel that surrounds me on a daily basis. It was also a lovely reminder that someday, I want to have a house again, with a backyard, and my own garden.

japanese apricots