doc w/ Pen

During medical school, I hope to go abroad for at least one international medical rotation.

It’s important to get in to medical school, obviously. But it’s also important to fit in to a medical school. Because you will be there for four years. A tough four years. That means thinking about what kinds of criteria are important to you (or in this case, me) as a potential medical student.

I’ve done some thinking about this. And while I haven’t come up with an exhaustive list, I have developed some ideas on what I am looking for. If I developed these criteria in one blog post, it would be rather onerous to read, so I have decided to divide this into a series of posts. (At least, that’s the plan.)

So how do I know what I want? Figuring that out involves knowing myself pretty well. Which is one benefit of being a “non-traditional” (translate: older) student. I’ve had more life experiences — and time — to learn about myself, what works for me, and a little bit more about what I want out of life. I have a much better idea of these things than I did 10, or even five, years ago.

One characteristic I am looking for in a medical school is the opportunity to do at least one international rotation as a medical student. That means going abroad during my time as a medical student (typically during the third or fourth year, when I would actually have some clinical skills) and working in a clinic or hospital in that foreign country.

Why would I want to do such a thing? After spending a semester abroad in Chile while I was an undergraduate student, I realized the importance of gaining exposure to other cultures, other languages, other people, other ideas. Not that I hadn’t thought that was important before — but its importance was impressed upon me more than ever. Being in Chile was, by far, the best experience of my undergrad education. I think everyone should study abroad, if at all possible. It was an invaluable educational experience — not so much in the classroom, as out in the streets of Chile, Peru, Bolivia, and Argentina.

Of course, I would love to hit those same street again — this time as a third- or fourth-year medical student (or resident) — but I would also be interested in seeing other parts of the world.

Fortunately for me (and others), the Association of American Medical Colleges (AAMC) and Foundation for Advancement of International Medical Education and Research (FAIMER) have put together an online database of medical schools that offer such opportunities, called “International Opportunities in Medical Education,” or IOME. Click here to visit the database.

According to a basic search I did on that database, 74 medical schools offer international opportunities to their own students (you can also search for resident opportunities, faculty opportunities, etc.).

That’s pretty amazing. And I can’t wait.

A couple of weeks ago when I left the free clinic where I volunteer as a Spanish medical translator, I thought to myself, “I belong here. And I like that.”

Not that I hadn’t had this feeling of belonging before — but it has definitely cemented over the last few shifts I’ve worked.

On a basic level, part of it is knowing my way around the neighborhood — the quickest route to the clinic, where to find parking even during rush hour, what drink to order at the local cafe when I need a caffeine boost.

There’s also something to be said for now being on a first-name basis with the clinic coordinators and the volunteer coordinator, and being known as someone who can be relied upon to come through when the clinic is especially short-staffed.

My Spanish — which was excellent to begin with — has improved as well, which helps me feel more comfortable in my role as an interpreter for the patients, doctors, nurses, and other medical practitioners.

My Spanish skills were particularly tested, and mostly affirmed, recently. (Although I was also dealt a bit of humility in the process.)

Typically, I translate for primary care appointments — medication refills, diabetes check-ups, pap smears (a papanicolaou, in Spanish — try saying that 10 times fast!), that sort of thing. This appointment was a little different. The practicioner was a registered dietitian, and the patient was there to get some tips on how to eat healthier and lose weight. Which is knowledge many of us take for granted. But, as I learned, is knowledge that is very cultural in nature.

Juan* was from Ecuador, and had been in the United States for about 15 years. He had put on 30 or so pounds in the last few years, partly as a result of American food — a few too many hamburguesas at McDonald’s, he said. He had developed severe sleep apnea, which required surgery. His doctor said he needed to lose weight before having the operation. So he was quite motivated to get in better shape.

But he had no idea where to begin. And he had a lot of misconceptions about healthy eating and weight loss that needed challenging and changing.

“Whenever I go on a diet,” he said, “My stomach acts up. So how can I go on a diet?”

It turned out that to Juan, going on a diet meant eating puras frutas y verduras — all fruits and vegetables — which would make anyone’s stomach unhappy. Not to mention that it’s unhealthy, because you’re not getting balanced meals.

So far so good, as my Spanish was concerned. Then things got tricky. The dietitian started explaining the chemical mechanisms as to why eating a balanced meal is important — you need protein at every meal so that your body doesn’t start to digest your muscles. That was certainly something I’d never translated before! And you need fiber to help pass the food along in your system. To my embarrassment, I translated that as: Necesita fiebre para ayudar en pasar la comida por su sistema. Juan looked really confused for a moment. Then clarity hit him. Quiere decir fibra, he said. Oops. I’d been saying “fever” instead of “fiber.” Luckily, we both got a good laugh out of it. So did the dietitian.

Aside from my fever-fiber faux pas, I seemed to be able to get everything else across. Juan asked question after question, wanting to understand every little detail of how to proceed. “I want to know what to do so that when I get home, I’m not confused,” he explained.

I was impressed with his motivation and dedication. This man knew next to nothing about healthy eating, and he wasn’t afraid to admit it. On the contrary, he brought up every question he could think of — including plenty that to those of us who grew up learning about the food groups and the need for balanced nutrition, might seem ridiculous. “One of my friends told me that if you drink water right after you eat, your stomach gets fat. Is that right?” he asked. The dietitian patiently explained that no, you can drink water whenever you want to, that it actually helps with digestion. Juan soaked it all up like a sponge.

The dietitian had prepared a week’s worth of meal plans for Juan, and we spent a lot of time going over that, as well as determining correct portion size. I reached back into the past, to my high school days, trying to recall all the food vocabulary I’d learned back then. To my (pleasant) surprise, it came back, for the most part.

There was so much information to translate (I kept having to stop the dietitian so I could remember what he had said and make sure to translate it all), so much different vocabulary from what I usually translate in an appointment, so many explanations that I’d never had to make before. But the satisfaction of seeing how much Juan learned, and how excited he was to now have these tools, was so worth it.

I don’t know how Juan is doing. Obviously, it’s up to him whether he will use the tools he has acquired. But truly, knowledge is power. And I feel so honored that I had even a small part in helping him gain that power.

*Name and some details have been changed to protect patient privacy.

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

It was like a two-person game of telephone. You know, the childhood game where one person whispers something in a person’s ear (“I ate pizza for dinner”) and the next person hears something totally different (“I hate Lisa Windsor”) and it gets passed along until the beginning phrase is no longer recognizable. Silliness usually ensues. This time was no different.

My mom and I were talking (and we were actually on the phone). I told her I had been searching for some protein research topic on PubMed (the National Institutes of Health online article database). After I had been talking for a few moments about the articles I found, she burst into laughter.

“I was really confused there for a second,” she said. “I thought you said ‘Club Med,’ not ‘PubMed.’ ”

I started laughing too. But then I thought about it. Maybe she had something there. And somehow my dream vacation took form over the phone — in the union between Club Med and PubMed.

Picture this: a giant cruise ship sailing in the Caribbean. Swimming pools, tennis courts, a fancy restaurant and bar. Stops at various islands for exploring, shopping, hiking, beachcombing, fishing, etc. But this is no ordinary cruise ship, nor an ordinary cruise crowd. On board is a fully equipped, world-class research lab and a mini convention center. Those aboard the cruise are scientists interested in protein research, and they have come together to collaborate on research and present their latest findings at a floating scientific conference.

Since my mom helped me come up with the idea, I wholeheartedly agreed that she could be my “plus-one” at the conference. She said that sounded great, as long as she could bring a drink into the conference room. Fine by me, as long as the drinks have edible 3-dimensional protein conformations as garnishes. And as long as the drinks are named after proteins.

Tom cholinesterase, anyone?

I know, I know — 2011 has just started. So unless I count things like sleeping and eating, I couldn’t come up with a true, best-of, top 10 list for this year yet. That said, I do have a different kind of top 10 list to write about for 2011 — a list of things I’m looking forward to, as well as some goals. (And I promise, this is my last top 10 list.)

A third drum roll, please …

Top 10 of 2011: Looking Forward

10. Exploring new music.
Ever since I was a child, I have loved music. Back then, it was mostly classical, oldies, and church hymns; these days I listen more to electronic and industrial rock. I am a bit stuck in a musical rut, however. But with school, I simply don’t have time to comb through the (daunting) depths of material out there. That’s where my husband, Geoff, comes in. He is a true music aficionado, a lover of jazz, blues, new wave, rock, soul, electronic, dance, you name it. We have dedicated an entire room in our house to his music collection (all in all, a few thousand CDs and LPs) and stereo equipment. So his mission is to help me find some new music. Luckily, he knows very well my tastes, while at the same time knowing how to stretch me and encourage me to listen to things that I might find a bit challenging (but enjoyable in the end). It will be a fun, cultural, enriching, joint project that we will do together, and one that will fill our home with beautiful music.

9. Volunteering with Future Problem Solving.
Talk about a blast from the past. I was involved in Future Problem Solving — better known to me as simply “FPS” — when I was in middle school and early high school and living in Tucson, Ariz. Part of my schools’ gifted program, FPS is a written, team-based problem-solving competition. I absolutely loved it, and my three teammembers (one of whom I’m still in touch with), and my coach. We won our state competition twice, and did very well at the international competition level (Australia, New Zealand, and Canada also have teams). My coach also took us to Beijing, China, to present the basics of the FPS program to educators at a national Chinese education conference. But back to the present. My old coach recently contacted me and asked if I was interested in being put on the FPS alumni e-mail list. “Why not,” I said. A few days ago, I got an e-mail from the FPS program. A wave of nostalgia hit me. And I thought how wonderful it would be to help out in some way. I’ve gotten in touch with the Illinois FPS director, and hope to get involved (I’m not sure how yet) this year. Go FPS!

8. Keeping the house cleaner.
I will admit: I am not the greatest housekeeper. Not that it’s the woman’s job to keep the house, of course … but Geoff does other things, such as taking out the garbage and mowing the lawn. So I take on the laundry and basic housecleaning. And I haven’t been keeping up with it lately. It’s hard, with school, to get those things done. In terms of priorities, I’ll put a physics exam above cleaning the toilet any day. That said, I can’t completely ignore the fact that I have a two-story house (three if you count the basement) that needs taken care of. And I rather let it go to seed last semester. I definitely did an early spring cleaning (in December), so it’s nice and tidy now. I intend to keep it that way.

7. Cooking more.
Again, it’s not the woman’s job (entirely) to cook. Geoff and I have always shared this task, thankfully. But last semester, as with the whole cleaning thing, I rather fell off the chuckwagon and Geoff wound up cooking most of the time. Either that, or we wound up eating out. (One of the reasons for #6; see below.) So this semester, I’m stepping up. Not to do it all — but to do my fair share. Because that’s how a marriage works.

6. Getting into better shape.
As I mentioned above in #7, Geoff and I did a bit of eating out (often at our fav local Mexican joint, King Burrito) this last semester / year. Not so good, healthwise. And with a new (and rather grueling) school schedule, I found it hard to fit exercise into my day. So this semester, it’s time to start breaking a sweat again, on a regular basis. No excuses.

5. Pre-med: year 2.
I know, I know … I haven’t even finished year 1 yet (haven’t even begun the second semester of year 1 yet!). But this fall, I’ll be starting year 2, which will bring with it the opportunity to take more advanced classes. I’m especially looking forward to biochemistry, advanced anatomy (with cadaver dissection!!!), and pathophysiology. I can’t wait to get beyond the basics. But I know I have to be patient, because it will be worth it.

4. Researching medical schools.
This is something that stresses most pre-meds out. But I can’t wait to spend more time (I’ve already spent some) perusing the MSAR, scouring med schools’ Web sites, flipping through brochures, calling admissions offices, visiting campuses … I find it incredibly exciting to imagine the possibilities. And they are endless.

3. Spring 2011 research seminar with Dr. Kreher.
Last semester, I spent a good amount of time in my bio professor’s office. Not because I was struggling in the class — I finished the semester with above 100% — but because I enjoyed the material and wanted to … well … go beyond what we touched on in the course. I had questions. Lots of them. And I found Dr. Kreher to be a good sounding board, as well as a passionate teacher and researcher. Midway through the semester, he sent me an e-mail inviting me to take another course with him this upcoming semester — a research seminar course. I was thrilled (and flattered, because I technically hadn’t met the pre-requisites), and found a way to work it into my schedule. Thankfully. It’s a small class, limited to 10 students, and we will be working with fruit flies, bacteria, genetic sequencing, all kinds of cool stuff. I can’t wait.

2. My summer triad.
Yes, this is a rather cryptic heading. But I wanted to mention all three pre-med-related things I hope to do this summer, so I have wrapped them all up into one item here:

• volunteering more at the free clinic as a Spanish medical interpreter
• working at the UIC research lab (and hopefully working on my own project, or at least more independently)
• interning with a physician at a local hospital (part of my post-bac program requirement)

1. Saving up for an iPad (and an iPad bag). 
Am I a techie? I don’t know. But I do know that I desperately want the new version of the iPad when it comes out, supposedly this spring (according to rumors circulating the Web). For e-mailing and Web surfing, of course. But also for reading: I would very much like a portable way of reading books and articles, and of carrying them around with me without carrying around a brick-laden backpack. And I’ve already got an Amazon.com wish list set up of titles that I’m planning to download (eventually). Here are a few of them:

• Nature’s Robots: A History of Proteins (it’s obvious why I want this one)
• Zeitoun (the relatively new Dave Eggers book)
• Generosity: An Enhancement (by Richard Powers, one of my favorite authors)
• Several Richard Dawkins titles (famous biologist)

OK, so I know I just did a post about my Top 10 of 2010. But that post was about my “personal” life. I’ve got another top 10 list — this one is related to school, education, that sort of thing. So here we go again.

Another drum roll please …

Top 10 of 2010: School’s In

10. Being chosen for a faculty assistant position.
About a month into my post-bac program, the director of the post-bac program approached me about coming on as a faculty assistant. There are a number of FA’s in the program, and they do things ranging from TA the anatomy course to organize the internship program. Clearly, I’m in no position to TA an anatomy or pathophysiology course. But I do have some skills that the program needed: writing and editing skills.

9. Physics I.
Those of you who keep up with me on Facebook are likely scratching your heads and furrowing your brows at this one. Because throughout the semester, I definitely did my fair share of griping about my physics class. Mostly how difficult the exams were and how impossibly long the lab reports took to write (my record was 18 pages and about 8-10 hours, if I remember correctly). However, that said … I found physics to be an incredibly valuable experience, all told. Unlike biology and chemistry, much of the material I learned in physics was new to me. And the material that I had touched on in high school physics we took to a whole new level. So I had to work my ass off in this class. I had to ask for help. I had to battle confusion. I had to work problems over and over and over. But in the end, I proved to myself that I could learn something new and challenging and outside of my “comfort zone,” so to speak. I gained confidence in my scholastic abilities. FYI, I’m taking physics again next semester. And I say: Bring it on.

8. Caritas et Veritas Symposium.
I like to pretend this symposium was Dominican University’s birthday present to me, because it fell directly on my 29th birthday. (Note: I did write a separate post about this symposium. See “Caritas et Veritas: Love and Truth,” posted on Oct. 3, 2010.) I was especially intrigued by a literature theory called consilience (the union of science and literature, in short), introduced to me by Dr. Ellen McManus at one of the lectures. I got in touch with Dr. McManus and she recommended two books for me to read on the subject. As I was incredibly busy with school during the semester, I have just now started the first one. But I am already enthralled. I’m sure I will be posting about it as I make my way through the book.

7. OldPreMeds.org.
This online community, of which I am a member, has been a warm, welcoming place — as well as a great resource. I have met so many wonderful and fascinating people, and learned so much. I have also had the opportunity to share my own knowledge and expertise. In addition, OPM hosts an annual conference — and last summer it was (fortuitously) held in Chicago. I decided to attend at the last minute, and it was amazing. I met a woman who has turned into a dear friend, I was able to network with all kinds of people (including ADCOMS), and I learned a great deal about the application process and timetable. I can’t wait for the 2011 conference.

6. My blog.
Keeping this blog has been so wonderful for me — a chance to continue writing, a chance to tell my story, a chance to get feedback about what I am doing. Thank you to everyone who is following and reading. I hope you are enjoying yourself.

5. Superb Dominican faculty. 
One of the best things about being at Dominican University is that the class sizes are so small and you can get to know your professors personally. Of course, that would be useless if the professors weren’t any good. But my professors have been stellar. Thank you all: Dr. Scannicchio, Dr. Hughes, Dr. Kreher, Dr. Gulley, Dr. Sagerer, Dr. Andrei, and Prof. Buber. Thank you so much for your time, energy, effort, and help throughout the semester.

4. UIC lab research.
When I decided to embark on the journey toward medical school, I never imagined I would have the opportunity to do research. Thanks to a very generous and helpful fellow UIUC alum (an anesthesiologist), I landed a job (albeit unpaid) as a research assistant at UIC. Those of you who read my posts over the last summer know how much I learned, and how excited I was about this position. It has inspired me to want to do research during my career as a physician (in addition to clinical work). Thanks especially to Olga and Rich Minshall for letting me tag along and soak up so much. And for giving me the chance to come back again in 2011. I can’t wait!

3. Volunteering as a Spanish medical translator.
This has been another amazing opportunity, chronicled (again) by a number of blog posts. It has been a chance to really help people, to empower them in their need for health care. And also a chance for me to learn about ambulatory medicine, Spanish medical terminology, and so much more. I look forward to continuing to work there in 2011.

Computer-generated 3-D protein structure

2. Proteins!
No, I’m not talking about a love of steak (although I do love a good filet mignon). I’m talking about the macromolecule. The intricate structure, the precise formation, the functional group interactions, the diverse processes … I find it all fascinating and amazing. Honestly, I can’t wait to take biochemistry and learn more about these little guys. (I know, I’m crazy. I have accepted this fact.)

1. Physician shadowing.
It’s one thing to watch “House” or “ER.” It’s another thing entirely to stand in the hall of the ICU as someone in the room in front of you is about to die. It’s another thing entirely to stand in the OR as a surgeon puts a metal pin in someone’s broken hand. I have witnessed these things. And I still want to become a physician. In fact, the shadowing I have done — in anesthesiology and critical care medicine (thus far) — has only intensified my interest in this career. I plan to spend more time in the hospital in the coming semester, thanks to the generosity of a local ICU director. And when I am a physician, I will return the favor to some budding pre-med student.

When you bake bread, there are some essential ingredients. Yeast, for example, as well as flour and water. You can’t make the bread without these. Depending on what type of bread you are making, you might add raisins, eggs, or cheese. But these are non-essentials.

Life is a little like bread. You need six ingredients: carbon, nitrogen, hydrogen, oxygen, sulfur, and phosphorus. Or so scientists thought.

According to a recently published paper, the bacteria pictured here was able to survive when fed arsenic rather than phosphorus.

This week, researchers announced that they had discovered a bacteria at the bottom of a lake in California that was able to grow in arsenic instead of phosphorus. This might not sound like a big deal, but it calls into question basic assumptions about the nature of life, and its requirements. It also opens the door for an understanding of life that could exist in a different way — possibly on a different planet where different elements and nutrients are available.

Phosphorus was thought to be more or less irreplaceable because it forms the backbone of DNA. It is also a key player in a molecule called adenosine triphosphate (commonly abbreviated as ATP), which is the molecule the body uses for energy — and therefore survival. Arsenic, on the other hand, while very similar to phosphorus in its chemical properties, is toxic to many animals.

But according to these researchers, this strain of bacteria — when “fed” arsenic instead of the phosphorus that it normally would use — was able to survive, and actually incorporate the arsenic into the positions that phosphorus would normally occupy.

We’ll see if other investigation bears these results out. But if they do — what a beautiful example of adaptability of an organism, and of science pushing the limits of what we know so that we can gain a better understanding of our world, and of ourselves.

A “nerd,” by my definition, is someone who gets really excited about very obscure and detailed things.

I’m a nerd. I know it. And I’m proud of it. (Those of you who know me personally are, by this time, shaking your head in agreement. I’m sure of it. Go ahead, it’s OK. I understand.)

What do I get excited about? These days, it’s often biology lectures and readings. Yes, I find my biology textbook exciting (sometimes). But obviously, it’s not the textbook itself that excites me; it is the content. The amazing nature of … nature.

Here are some things that I’ve learned, things I think just about everyone will find pretty amazing.

1) I was going to save this fact (my favorite) for last, but I can’t help myself. It’s too incredible to leave for the bottom:

The total length of an average adult’s blood vessels (arteries + veins + capillaries) is equal to twice the circumference of the Earth at the equator. 

That just sounds huge … and it is … approximately 50,000 miles! Incredible indeed.

But why is this significant? Because this is how all of the tissues — and all of the body’s cells — get access to nutrients and oxygen, as well as dispose of their waste products (especially carbon dioxide). In creatures with one cell or just a few cells, all of those cells can be exposed to the environment. So oxygen, for example, can diffuse into all of the animal’s cells from the outside. But diffusion — the process of basically “spreading out” to an even concentration — only works over short distances. VERY short distances. It won’t work over many cells. So as multi-cellular animals evolved, they evolved circulatory systems with blood vessels that carry nutrients and oxygen (and remove waste) to and from all of the cells.

The veins and arteries in animals aren’t responsible for much of that transfer of substances; most of that happens in the capillaries — tiny vessels made up of a layer of what are called “simple squamous epithelial” cells, which are thin and ideal for allowing things to spread across them. We need so many miles of these vessels because we have so many cells, and they all need access to oxygen, nutrients, and a waste disposal system. Without this circulatory system, we would cease to exist because our cells would not receive oxygen, and oxygen is required for our cells to turn the food we eat into energy that the body can use to do work. It all goes hand in hand. See, I told you it was amazing!

2) Everyone knows that when we exhale, we get rid of carbon dioxide. But why? Here is the reason:

Maintaining a constant level of carbon dioxide — not too high, not too low — is essential for keeping the body’s pH at the proper level. 

OK, don’t let me lose you here. Quick chemistry lesson: pH is a measure of the concentration of hydrogen ions in a solution. In more familiar terms: a measure of whether something is acidic or basic. A solution’s pH is measured using a mathematical logarithm, so this relationship might seem backwards, but trust me on this … the more hydrogen ions, the lower the pH (this signifies an acidic solution). The fewer hydrogen ions, the higher the pH (this signifies a basic solution). A “neutral” solution has a pH of 7. Human blood has a pH of about 7.4 — just a tad basic. Change the blood’s pH and you’ve got BIG, BIG problems. Because a lot of the substances in the blood (especially a class of proteins called enzymes, which help facilitate all kinds of cellular reactions) only function at a certain pH range.

So back to carbon dioxide. Carbon dioxide can dissolve in the body, reacting with water to form carbonic acid. Carbonic acid is very unstable, and it “deionizes” — breaks down into its component parts of hydrogen ions and bicarbonate ions.

Did I just say hydrogen ions? Yes. So too much carbon dioxide in the body means that the blood will become too acidic — the pH will drop below the normal 7.4 level. On the other hand, if you get rid of TOO much carbon dioxide (for example, if you are hyperventilating) your blood will not have enough hydrogen ions in it, and will become too basic (the pH will go up).

It’s a matter of precise regulation, a biochemical masterpiece.

3) In the last fact about carbon dioxide, I briefly mentioned proteins. Let me say this first: I LOVE PROTEINS. And I’m not talking about steak or pork chops. (Although I love those too.) I find proteins immensely fascinating. Their structure, their functions, what happens when you lose a particular protein function … everything. I have a whole “protein” blog post percolating in my head. But I will save that for later.

Here, I want to talk about high fevers, and why those are so dangerous. I’m not talking about a fever of 99 or 100 degrees. That’s not a big deal. It’s not fun, but it’s not dangerous. I’m not doctor, though, so don’t take my word for it. But according to the world-renowned Cleveland Clinic, a fever above 102 degrees F is “cause for concern,” and a fever above 105 degrees F is a “life-threatening emergency” and should precipitate a call to 9-1-1.

But why? It has to do (in part) with the nature — and denaturing — of proteins. In essence:

A very high fever causes the proteins (especially the enzymes) in the body to denture — lose their structure.

Let me explain. Proteins are a class of “macromolecule” (“giant” molecule) in the body. Each protein is made up of smaller units called amino acids that are chemically bonded together. Those amino acids each have particular chemical behaviors so that when the protein is put together, the amino acids interact to form a special three-dimensional structure. Think about two simple analogies and you will understand these interactions (on a basic level). Consider a magnet: opposite ends (positive and negative) attract, while same ends (positive/positive or negative/negative) repel. Same goes for the amino acids that are “charged” as either positive or negative. Then consider oil and water. Oily things mix together. Water-based things mix together. But oil-based and water-based things do NOT mix together. It is this way for amino acids with hydrophobic (“water-hating”) properties and those with hydrophilic (“water-loving”) properties. Put a string of amino acids together, each acid having one of these properties, and you will get a shape of some sort as there are chemical attractions and repulsions. That three-dimensional shape is very important for a protein’s function. Change a protein’s shape, and it can (often) no longer do its job. Or at the least, no longer do its job as well.

Back to fevers: how do these affect proteins? Well, temperature affects the chemical attractions and repulsions that the amino acids have with each other. If you raise the temperature of a protein’s environment too much, its structure falls apart. Which means it can no longer do its job. Which is why a high fever can be fatal — proteins, and a specific type of protein called an enzyme, are necessary for human life. They basically keep the body’s machinery operating full time. Without them, we just stop working. And being. Not good.

See, I told you proteins are cool …

4) OK, time to switch gears a bit here. I’ve been focusing, so far, on humans and human anatomy / physiology. But the rest of the animal kingdom is pretty nifty too. And there is a helluva great deal of diversity out there in terms of form, function, structure, etc. First on my list are ectotherms. More commonly (and incorrectly) known as “cold-blooded” animals. The proper definition of an ectotherm, in essence, is an animal that gains its heat from external sources. An example would be a lizard or a snake. An endotherm, on the other hand, produces its own body heat. An example of an endotherm is dog, cat, etc. (Humans are also endotherms.)

At first glance, you might think that ectotherms got the short end of the stick while endotherms have the more advantageous system, in all respects. Endotherms don’t need to rely on the sun or other environmental factors for body heat. And this is true. Endotherms stay plenty warm even in Arctic environments, where an ectotherm would freeze to death in an instant. That said, endotherms don’t have it all made. Think about it: How do you produce heat? You have to expend energy. So endotherms have to USE energy to produce their own body heat. Ectotherms, on the other hand, can use their energy for other things. And then they don’t have to eat so much. Meaning they don’t have to spend so much time looking for food. For humans who have access to Jewel, Dominick’s, Albertson’s, or Super Target, that’s not a big deal. But if you’re an animal that has to hunt for every morsel, having to eat less food is huge.

But how much less energy does an ectotherm consume, compared to an endotherm? We shall use an American alligator and a human (of a similar size) as comparisons. Take a wild guess here. What fraction of a human’s energy do you think the alligator consumes, at rest? One-half? One-fourth? One-tenth? Not even close. One-twentieth. Yes, you read right:

An American alligator, at rest, consumes one-twentieth the energy of a comparably-sized human.

That said, relying on the environment for warmth (and cooling) has its drawbacks. If it’s cold but cloudy, staying warm becomes more of a challenge. Endotherms have an easier time with thermoregulation — keeping their bodies at a constant temperature — because they produce their own body heat. And thermoregulation is important because of my favorite macromolecules again … PROTEINS! The specific kinds of proteins called enzymes, the ones the facilitate chemical reactions, are very sensitive to temperature as I mentioned before — both temperatures that are too high and temperatures that are too low. According to my biology textbook, for every 10 degree C (18 degree F) decrease in body temperature, the rate of those reactions that are helped out by enzymes decrease two- to three-fold. That’s the body starting to shut down. So for an animal (including a human) to keep its body within an optimal temperature range is key to survival.

5) Now on to insects. Which, thankfully, tend to be the size of peas, for the most part. But why?

Insects are restricted in size because they have relatively inefficient respiratory systems.

When we think of respiratory systems, we usually think of the lungs or of gills. But insects have a different system called a tracheal system. Here is a picture of what the system looks like, using a grasshopper as an example:

Insects like this grasshopper have tubes that open up to the environment. Air (and oxygen) passively diffuse in from the outside and spread into smaller branched tubes, which bring the air into contact with most of the insect’s body cells. Larger insects increase the efficiency of this system by using rhythmic body movements to compress and expand their air tubes to help spread the air through their bodies. Even so, this is a relatively inefficient system, compared with that of the lungs. The reason is that diffusion — the spreading out of a substance to an even concentration — only really works well across a short distance. In a small insect, this diffusion process works fine. But larger animals, from squirrels to humans, require a more “active” respiratory system. So no worries, you won’t see a cockroach the size of a minivan any time soon. Phew.

OK, enough biology and chemistry for one blog post. Class dismissed.

I don’t often describe myself as “flabbergasted.” First of all, I think it’s an odd word. Second of all, it takes an awful lot to shock me that much. But I was definitely in a state of flabbergast today.

The stimulus? A rather traumatic translating session at the free clinic where I volunteer.

It all started out rather routinely. The patient was a middle-aged woman with unregulated diabetes. Her blood glucose — which should be around 90 mg per 100 ml of blood — ranged from the mid-100s to 200, according to the self-checks she did at home. This morning at the clinic, it was quite a bit above 200, and her previous visit it had been above 300. Not good. Really not good. Clearly, her current combination of medication and lifestyle wasn’t working. But insulin wasn’t an option, as she had tried it previously and suffered side effects that made her afraid to take it again.

The physician I was working with was obviously frustrated at her lack of improvement. He asked me to ask her what she’d eaten for breakfast, thinking that perhaps a sugary meal was to blame for the high blood sugar that morning. Turns out she had a licuado (shake) made of banana, strawberries, and milk, plus an apple. My guess is that she thought she was being healthy, while what she was really doing was causing her blood sugar to skyrocket with all of that natural sugar. (Yes, it’s natural, and yes, it’s fruit, but it’s still sugar.)

The doctor shook his head. “She’s eating like she’s going to the electric chair,” he said, half to himself, half to me. But clearly not to her. “Don’t translate that,” he hurriedly added.

I just sat there, a plastic smile on my face. What was I supposed to say? As a translator, I’m supposed to repeat everything that is said in the exam room in the other language so that it is as if there were no language barrier. But I couldn’t bring myself to repeat those words. Less for fear of angering the physician than for fear of horribly upsetting the patient. But, I will admit, both fears were active.

I’m not saying the physician had any ill will toward the patient. Quite the reverse — he was vocalizing his frustration at her non-compliance, her lack of improvement, and her potentially grim future. (The complications of diabetes include kidney, heart, vision, and circulation problems, among others.) But he did it in a way that was not inclusive, that didn’t engage the patient, but rather left her out of the loop at her own doctor’s appointment — a place where she deserved to understand everything that was going on.

I don’t know what I should have done. But I know what I won’t be doing when I’m a physician.