doc w/ pen

a journalist becomes a doctor before your eyes

Six-word stories: doing more with less

When you have limited space for your words, you choose those words very carefully. I learned that lesson well when I was working as a reporter for the weekly newspaper The Forest Park Review. Each week, I was given a newspaper page plan with allotted space for my stories — space that was, for the most part, set in stone. I learned to condense my thoughts into 500- to 750-word stories without compromising the content.

Ernest Hemingway set a much higher (or lower, depending on how you look at it) bar for word precision with this famous six-word story.

For sale:
baby shoes,
never worn.

In a half-dozen words, Hemingway conveyed a grief and emptiness that are all the more profound and affecting because of how short the story is.

I came across the six-word story concept recently while toodling around the Internet. Apparently, it became quite the sensation on Tumblr and reddit awhile ago. (I’m a little behind the times, I know.) I recommend doing a Google image search for “six-word story” — it’ll make you smile, laugh, think, and sigh, all in a few seconds’ time.

Here is my own attempt at a six-word story. Note that I am not a fiction writer. This is an autobiographical piece based on something that happened to me this past summer.

Manhattan morning stroll:
sandals, pigeon diarrhea.


Friendly inspiration

When I was in Chicago over winter break, I spent most of my time with my family. But I also caught up with my old “crafternoon” buddy. We talked shop, discussing the best paper collage glue and the sharpest scissors for maximum cutting precision. We also wandered the aisles of Hobby Lobby, picking up random treasures to use in our respective craft projects. Going to Hobby Lobby with a fellow craft addict is both marvelous and dangerous. Marvelous, in that you inspire each other with ideas on how to use this or that trinket; dangerous, in that you rationalize each other’s ever-expanding pile of purchases. But it’s mostly marvelous. My friend also graciously gifted me some vintage children’s book and magazine images, as well as other colorful paper.

Below are some of my recent origami crane cards, made with these new acquisitions. Click on any photo to open up a slideshow with larger images.


Only in medical school … (#2)

The other morning, I was standing in front of my bathroom mirror, getting ready to head to the hospital. I had planned to leave at 6:50 a.m. It was already 6:45.  I felt rushed, running late. I still needed to put my make-up on. But in this moment, I was struggling with my hair. My springy red curls just weren’t sitting quite right around my face. So I grabbed a comb out of a bin on my bathroom’s narrow windowsill and with it parted my hair just left of center. I examined the new distribution of my curly locks.

“There,” I thought. “That looks better.”

But as I stared at myself in the mirror, I noticed that the hair on either side of the part wasn’t laying down flat. It bowed upward, each side threatening to defect to the other. I reached into that same bin and pulled out a bottle of hairspray. I spritzed the part and gently smoothed down both sides to prevent mutiny.

“That will keep my part patent,” I said aloud, to no one but myself.

I laughed. “Patent”? Who uses that word to describe hair? That’s a word we use in medicine to describe tubular structures in the body that are open and unobstructed, like healthy veins and arteries, or a stent that has been placed to keep a diseased artery open. Only someone in medicine would describe a part in their hair as “patent.”

Later in the day, I thought again about what I’d said, and how I should write this blog post. Again, I laughed, but for a different reason. I’d inadvertently applied one of my favorite literary elements, alliteration, to my inadvertent use of medical terminology in a nonmedical context. Alliteration is repetition of the same consonant letter (or sound) in adjacent or nearby words. In my statement: “patent part.” Only a writer would be likely to notice that.

In the busyness of clerkships, I find humor where I can. Sometimes, that means laughing at myself, and the funny fusion of my many facets.

Understanding the umbrella

I quickly snapped this picture while walking to the hospital this morning.

In Chicago, where I spent most of my life, “winter” means having to dig your car out from a mountain of snow and bundling up against sub-zero windchills. In New York, I’ve seen people wearing down jackets and gloves when the temperature plummets to *gasp* 50 degrees. When I see these people, I chuckle to myself.

“Wimps,” I whisper under my breath. “They think this is cold?”

But finally, today, we got a real winter day in New York City. It’s been snowing for hours now, with several inches predicted. And it’s coming down pretty hard, even by this Chicagoan’s lofty standards.

For perhaps the third time this winter (not counting the days I spent with my family in Chicago over Christmas), I donned my long, down coat. For the first time this year, I tugged on my heavy snow boots. (And was reminded just how heavy they are.)

As I trudged down the slick sidewalk toward the hospital, I wondered how those people who wore parkas in 50-degree weather were doing. I hoped they were surviving. I thought about how ridiculous all this thick, winter garb looks on everyone, but how no one cares (or laughs) because we’re all just trying to stay warm.

In New York, some people attempt to fight the snow with an umbrella. I took this picture to prove it.

And then I saw the umbrella.

Yes, the umbrella. I’d forgotten about the umbrella.

Different cultures handle adversity in different ways. New York City definitely qualifies as a separate culture. It’s practically a foreign country. And as I was reminded today, some New Yorkers handle the adversity of blowing snow by shielding themselves with umbrellas.

When confronted with this fact, I did exactly what I’d told myself we don’t do in winter: laugh at how people were coping with the weather. It just looks so ridiculous. This is not rain, people! It’s not falling straight down. It’s not even falling sideways. In this wicked wind, it’s swirling and blowing in every possible direction. The only way to truly protect yourself from being pelted is to hail a taxi. And lord knows how rush hour traffic in Manhattan is when it snows.

This is the thing about New York, though. Walking these streets, you see a little bit of everything. Everything from a woman wearing a turkey stuffed animal on her head to a guy strolling down the sidewalk in shiny-cotton-candy-pink spandex to commuters hiding under umbrellas in the falling snow. Sometimes you’ll stare, laugh, or shake your head. Sometimes another person stares, laughs, or shakes their head at you, because they think you’re the weird one. Somehow the city survives on this invisible undercurrent of understanding that we’re all a little weird, all a little different, and that’s ok. It’s actually pretty cool. Even if you carry an umbrella in the snow.

Be my doctor

Like it or not, medical school is full of tests. Some are useful. Others seem pointless. In a recent clinical assessment, I received important feedback that let me know that when it comes to patient care, I’m on the right track. I tell the story in this essay, which was originally published in the online magazine The American. You can see the original version here.

Be my doctor

On every medical school rotation, we have at least one OSCE, the clunky acronym for Objective Structured Clinical Examination. If I had my way, “structured” would be replaced by “stressful,” because that’s what it really is.

You’re asked to interview and examine a standardized patient (aka actor) while being both videotaped and watched live by real doctors, usually the people in charge of your clerkship, and your final grade. The observers work from a checklist (that’s where the “objective” comes from, I think) to measure your performance. Your “patient” has a different checklist.

I confess that being watched, videotaped, and assessed against a detailed to-do list makes me nervous, which makes me more likely to forget things that I otherwise wouldn’t.

Two weeks into my eight-week internal medicine rotation, I endured a particularly stressful OSCE. You had 20 minutes to conduct a focused history and a physical exam. (In an encounter with a patient, “focused” means tailoring your questions and physical exam to respond to the person’s “chief complaint.”) You’re given five minutes to discuss your diagnostic impression and develop a plan. On the spot, you needed to figure out what was wrong and what to do about it. After which you left the exam room, had five more minutes to organize your thoughts, before explaining your findings, assessment, and plan to the observing “attending” in a three-minute presentation, morning rounds-style.

Unlike most OSCEs, you didn’t know what was on the checklist ahead of time. As with most OSCEs, you had to make good on a certain number of items to pass. If you didn’t pass, you had to repeat the exercise.

Anxiety is built into this territory. But once I get going, I’m fine. Early nerves give way to clinical instincts.

This OSCE was no different. About 10 minutes before we each met our patient, we received a clinical scenario along with some lab values and vital signs. After reading up and thinking through what I’d ask and do, I met with and assessed the patient to synthesize her signs, symptoms, and story with what I’d read. I asked my questions, examined her, and quickly thought through my differential diagnosis. I then presented her with the most likely diagnosis, along with my proposed treatment. As a medical student, I informed her I would discuss everything with my team before proceeding.

I asked if she had any questions. Though she’d been hospitalized with pneumonia, she was most anxious about her breast cancer, which had been diagnosed earlier. She told me she wanted her family involved in understanding what was happening. I was impressed with her acting skills – tears seemed to well up in her eyes as she lay supine on the examining table. I put my hand on her shoulder and reassured her we would bring her family in, and together discuss everyone’s questions.

I was about to continue comforting her when a loudspeaker announcement abruptly informed me the encounter was over. I should leave the room immediately. I felt myself flush with frustration. My patient was in distress, on the verge of tears, and I had to abandon her — something I’d never do to a real patient.

I followed protocol: I left, thought through my findings, and returned to present them before my attending and the patient. Then came the feedback. The physician asked how I thought I’d done. I said I thought my physical exam skills were rusty since I hadn’t been practicing them much since an earlier rotation several months before. The “patient,” who apparently has been performing this same OSCE for years, emphatically disagreed. She said I’d just performed one of the most thorough physical exams she’d experienced in this OSCE go-round. More significantly, at least to me, the patient told me she wanted me as her doctor. “What kind of medicine are you going into?” she asked me. “Are you going to be practicing in New York?”

Yes, the patient was an actor, but I got the feeling she was only half joking. She said she felt genuine empathy and compassion from me, things she doesn’t sense from everyone. When she was distressed, I stood closer to her (but not too close) and actually touched her. I offered to bring in her family to answer their questions. She described me as confident but not arrogant. For example, while I was sure of myself in explaining my diagnostic impression and treatment plan, I also emphasized my role as a medical student, and how I’d first confirm everything with my team. She said I had a sense of humor – I’d made an impromptu joke about hospitals based on something she said, and I’d gotten her to laugh. She told me I was a good listener, explained things well, and made her feel comfortable.

Her compliments disarmed me. All I could say was “thank you.” Both patient and preceptor also offered constructive criticism, which is essential so I can improve.

But when it comes to improvement, compliments can be just as important as criticism. My patient’s invigorating observations reminded me that I was on the right track and needed to stay on it.

The experience was a boost on a number of levels. Maybe it’ll help calm my nerves before the next OSCE. Maybe it’ll help bolster my confidence when I finally treat real-life patients on my own. Though I haven’t even graduated from medical school yet, I now know there’s at least one person who wants me as her doctor.

Seeing the NYC street art scene

Joy (left) and me posing in front of one of the Bushwick Collective murals earlier this fall.

When my youngest sister Joy came to visit me earlier this fall, she had an offbeat itinerary. I previously wrote a post about our exploration of the Jim Henson Exhibition at the Museum of the Moving Image, which I highly recommend visiting. I also wanted to share some photos from another one of our excursions. Joy wanted to get in on the NYC public art scene so at her behest, we headed to the Bushwick Collective in Brooklyn. It’s an out-of-the way collection of vibrant street murals that run the gamut from political commentary to psychedelic-trippy. The art is all temporary, with pieces constantly being added or replaced. So the images I’m sharing here are a simply snapshot in time of the day we visited. It’s a quick cab/Uber or subway ride from Manhattan, and it’s definitely worth the trip.

Click on any of the thumbnails below to open up a slideshow with larger images.

A message of solidarity and encouragement in times of struggle

Medical school is hard. Life is hard. However you identify yourself — student, employee, patient, mom, dad, child, sister, brother, grandma, grandpa, the list goes on — we all have to scramble, strive, scuffle, and struggle sometimes. Sometimes, it feels like most of the time.

That’s how I’ve felt lately. I’m guessing some of you have felt that way recently, too.

I was out walking on 2nd Avenue the other day, running a quick errand, when I saw a sandwich board sign in front of a fitness studio called Pure Barre that stopped me in my tracks. In New York City, with so much weirdness and activity all around, which you just come to accept as normal, it takes a lot to stop me on the sidewalk. But it was like this sign was talking directly to me. So I paused, and allowed myself to fall into the category of “annoying person stopping on the sidewalk taking a picture with their phone.” This wasn’t a stupid selfie though. This was important self-talk aimed at self-soothing and self-preservation.

So I took a picture of the sign, and walked to look at the other side. Lo and behold, it had a personal message for me too. So I snapped a photo of it as well.

I share these pictures here for multiple reasons. So many of my posts are uplifting and positive. That’s not me faking anything. But I want my readers to know that I’m human, and I tussle with human emotions, trials, and tribulations. I also want to let other people know — other people who may be struggling themselves — that they’re not alone. And last but not least, I want to offer a public message of encouragement to all of us, myself included.

So whether you’re grappling with a difficult boss, a difficult patient, a difficult family member, a difficult illness, or something else, know that you’re not alone. And hard as it is, for you and for me both, we will get through it, like we always do.

Thankgsiving thoughts, circa 1993 and now

Growing up, our Thanksgiving dinner “meal ticket” was writing down what we were grateful for that year in a notebook that my mom put together. While we’re not so formal about this process anymore, we do still count our blessings together at this time of year, though it may be over the phone or via text, since we’re spread across the country now. My mom was flipping through our old Thanksgiving notebook yesterday, and when we talked on the phone this morning, she said she just had to read my entry from 1993 to me.

1993 … that was 24 years ago. I was 12. My sisters were 10 and 4. My family lived in Tucson, Arizona. It was a different time, before most people had heard of the Internet, before widespread use of cell phones, before 9/11. So much has changed since then. But in some important ways, nothing has changed. The top two items I discussed in my 1993 gratitude essay (typed, with near-perfect grammar and punctuation; the budding writer in me already making an entrance) would top my list today too. Here is an excerpt from that essay:

I am definitely thankful for my parents. I am very lucky to have parents that are always there for me, no matter what. If I had a problem or something was wrong, I could talk to them about it. I know my dad thinks I’m special because he takes me out to breakfast and we talk about anything from sports to the Bible. He also plays things like football and basketball with me. I know my mom thinks I’m special, because she does a lot of things like do my hair, make my lunch, and talk and pray with me at night. They also help me with my homework. When I first started at Cross [my middle school], there was a lot I didn’t understand in some of my classes. But my parents helped me, and now I do!

Another thing that I am thankful for are my sisters, Sarah (10), and Joy (4). I’m thankful for them because they love me very much. Some of the ways that they show this are when I’m sick, they’ll always ask if I’m feeling better. They’ll also get things like drinks for me. When I’m bored, they ask to play some kind of game with me. Even though sometimes they’re annoying, I can also babysit them, and earn spending money. During the summer, when everyone was asleep, Sarah would come to my room and we would talk for an hour about lots of things. When I’m sad or disappointed about anything, Joy will come up to me and give me a kiss and hug. Both of them mean a lot to me, and I don’t know what I’d do without them.

That last sentence says it all — I don’t know what I’d do without you, Mom, Dad, Sarah, and Joy. I love you all dearly. I’m so grateful for you, and the integral part each of you has played in my life. The only thing I’m not thankful for is that I didn’t get to spend this Thanksgiving holiday with you. But I’ll be home for Christmas, and we’ll all be together then. I’m counting down the days.

The order: An important first

As many of you know, I write a monthly column for the online magazine The American. Here is my latest piece, describing an important first of my medical career. You can read the original article here.


“The order”

I placed my first medication order yesterday. Nothing exotic. It was a one-time dose of the drug Labetalol for a patient, my patient, whose blood pressures had been elevated. As I typed in my password to sign the order, I took a deep breath.

“By signing this,” I thought to myself, “I’m telling people that I think my patient needs this exact medication at this exact dose at this exact time.”

Suddenly, caring for this patient was no longer abstract or hypothetical. It was as real as the prescription I was about to issue. I wasn’t just writing out my daily plan for her care in my morning progress note. I was putting it into action.

As a medical student, any orders I place require a physician cosigner, either my resident or attending. The safety net exists for obvious reasons. Still, learning how to issue orders for my patients — whether it’s for laboratory tests or medications or fluids — and then doing so is part of assuming greater clinical responsibility. It’s also part of progressing from student to doctor.

But from a logistical perspective, just entering these orders is far from easy. Take the blood pressure medication. It is normally dosed twice a day, morning and night. It was about 1 p.m. at the time. If we ordered it twice a day to begin immediately, the patient would get it at 1 p.m. and 1 a.m. — not ideal if you’re the patient. You’d have to be awakened in the middle of the night to take a pill.

So I placed a one-time order for the medication to be given by the nurse immediately. I then placed another order for the same medication, same dose, this time twice a day, but starting that night. Going forward, the patient would be getting her pill at 9 a.m. and 9 p.m.

Making small things happen in the electronic medical record system is another thing entirely. It requires selecting or unselecting many checkboxes and highlighting the appropriate fields in various drop-down menus. I’m sure once you do it repeatedly it becomes second nature. But as a medication order novice, I needed someone to show me around the system. Thankfully, my kind resident took the time to walk me through the process step by step. Attention is paramount. If you don’t click (or unclick) one of the required boxes, you get an error message that reroutes you back to the order screen to fix your mistake. And if you don’t click (or unclick) some other box that’s important for your particular instructions but not technically required for the order to go through, your order may inadvertently tell the nurse to do something else altogether.

The “how” of these orders is the easy part. It’s the “what” and the “why” that require the real thinking. Why is the patient’s blood pressure elevated? Does she need a medication? If so, which one? At what dose and frequency? How long will you assess her blood pressure levels to determine if this medication is effective before either increasing its dose or adding another drug? And this is only her blood pressure. We haven’t gotten started on her antibiotic regimen.

It’s an iterative process that goes on throughout any given day. Sometimes you’re doing the investigating. Sometimes it comes in response to changes in vital signs or laboratory results (or urine output or an MRI). This means you’re monitoring all these details — vital signs, lab tests, urine output, and imaging, among others — over the course of a day to see if you need to change your handling of the patient.

To a third-year medical student just introduced to the world of inpatient internal medicine, it’s dizzying. But it’s also deeply exciting for obvious reasons. The more clinical responsibility I assume, the more I learn, and the more tangible the “live” practice of medicine becomes. And the more I am prepared for the time when I’ll be the one signing the orders on my own.

Much-needed encouragement

I’ve finished the first two weeks of my internal medicine clerkship, with six to go. On this clerkship, more than any other, it’s easy to feel clueless, since medicine deals in the entire body — every single organ system. As a medical student, I get asked questions many times every day to probe my knowledge and get me thinking about this field that is both fascinating and overwhelming. It feels like my most frequent answer is “I don’t know.” But I was recently reminded that while I have much to learn, I’ve come a lot farther than I realize.

About a week ago, a second-year medical student shadowed me during my morning pre-rounds routine. Together, we reviewed the charts of my patients, looking at their vital signs, labs, imaging, urine output, and other notable events that had occurred since I left the previous day. I’ve become pretty familiar with the electronic medical record (EMR) system now, but every action I took — selecting the correct tab to show the vital signs for example, or figuring out when the last dose of a medication was given — required a tutorial.

I showed him how to use templates in the EMR that automatically pull data like vital signs and lab results from the patient’s chart directly into your note. I started to show him how to write my daily “SOAP” note using one of these templates. And he asked, “Can you go over what a SOAP note is, exactly?” I was glad to, of course. (For those of you who are curious, here is what SOAP stands for. S = Subjective information from your patient about how they are feeling, such as pain. O = Objective data such as vital signs from the chart. A = Assessment of the patient’s condition. P = Plan for the day in terms of treatment, diagnostic studies, etc.)

Without thinking about it, I then described one of my patients as “being on PD.” I saw the look of confusion in his face, and realized I took for granted knowing that “PD” stands for “peritoneal dialysis.” So the next time I came to some medical abbreviation, I made sure to clarify its meaning.

There were lots of things I explained about treating patients too. Like how we put most patients on a bowel regimen in the hospital to make sure they have regular bowel movements. Or that when a person who has diabetes is hospitalized, we take them off their oral diabetes medications and put them on sliding scale insulin because they’re likely not eating the same way as they do at home.

We also saw my patients together, and I showed him how to do a brief, focused physical exam targeting potential findings related to each patient’s condition, and also assessing basic things like heart and lung function.

Having second-year students shadow us third-year students is a new part of the curriculum. It’s aimed at helping the second-years transition more smoothly into starting their own clerkships, which they will do in January or February. I hope all my explanations were helpful to my shadow. I know they would have helped me when I was a second-year student. As I was talking with him, I thought back nearly 9 months to mid-February when I started my first clerkship, OB-GYN, to when I knew none of these things either. To when I didn’t know how to write a SOAP note, or how to find things in the electronic medical record, or how to do a focused physical exam. I realized that I’ve come a long way in the last 9 months, much farther than I give myself credit for.

This encouragement couldn’t have come at a better time. Medicine is still overwhelming. But a little less so. And I have a newfound confidence in my ability to make significant strides in the remaining six weeks.