medical school | doc w/ Pen

August 3, 2017

Good hospital food?

On Tuesday, I was scrolling through Yelp listings, looking for a place to dine that was located near my apartment on New York’s Upper East Side (UES). I saw the standard fare, as expected — Italian, Indian, Japanese, Thai, and so on. And then I saw this:

I did a double take. I expect Yelp to be comprehensive, but Memorial Sloan Cancer Center’s hospital cafeteria? I wasn’t expecting that.

I’d actually just been to this cafeteria the day before, the morning I started a four-week rotation on colorectal surgery. (This is the second four-week block of my eight-week surgery rotation.) I didn’t buy anything at the cafeteria, just peeked in. But after reading some of the reviews, I have high hopes. As usual, there were complaints. But there was a positive theme to the reviews, as evidence by this pointed comment:

It really is the best when it comes to hospital cafeteria food. Crab cakes, paninis, chicken pot pies, macadamian crusted fish. Enough said.

I’m not sure if the same could be said about the Garden Cafe at Cornell.

The Garden Cafe, for those not familiar with the UES hospital scene, is the cafeteria at New York Presbyterian Hospital. This is the main hospital affiliated with Weill Cornell Medical College, and where I do most of my clinical rotations. I agree wholeheartedly with this reviewer that the food there is nothing to write home about.

Even though it takes extra time and effort in the morning, I usually bring my own lunch — both to save money and because it’s healthier. But one of these days, I’ll have to try the cafeteria food at Memorial Sloan Kettering. See what all the fuss is about.

July 29, 2017

Four weeks of trauma surgery: lessons learned

Friday marked the last day of my four-week rotation on the trauma surgery service. As expected, it was an exhausting four weeks. But it was also incredibly exhilarating and educational. And it was filled with many profound moments that will stick with me forever.

This, in large part, was due to working with such a phenomenal team: An attending who taught me that if a trauma surgeon can take 10 minutes to sit down and talk with a patient, every physician should have time to do so; who inspired me to learn and ask questions; and who made me excited to go to work every day — even when that meant waking up at 3:30 a.m. A chief resident who carefully followed a patient’s blood tests after I got splashed in the face during a case, and personally kept me updated. A senior resident who was willing to put a nasogastric (NG) tube down my nose and throat because I wanted to know what our patients with small bowel obstructions were going through. (I’ll be writing more on that soon.) Interns who clearly wanted these four weeks to be an educational experience — and proved it by inviting us medical students to practice starting IVs on them. A fellow medical student, one I barely knew going into the rotation, who quickly became a confidant.

These are just a few examples of how my team helped make the oft-feared surgery rotation such a meaningful experience.

In medicine, you learn from your team. You also learn from your patients. Working on the trauma service for four weeks, I am now acutely aware of how a person’s life can be permanently changed — or even snuffed out — in the blink of an eye. I helped care for patients whose legs were now useless after a car crash, a gun shot wound, or even a freak fall from standing. “Pedestrian struck” was another too-common reason for admission to our service. Usually, the result was a laceration or some broken bones — things that were painful, but that would heal, with time. But sometimes the trauma of being hit by a car results in a brain bleed. Sometimes these resolve. But sometimes, they result in irreversible brain damage, or death. All because you were walking on the sidewalk, or crossing the street, at the wrong place and the wrong time. This hits especially close to home when the patient is close to my age, or reminds me of someone I know. This could happen to me. It could happen to any of the people I love. As could appendicitis, cholecystitis, or a small bowel obstruction — three other very common complaints I’ve seen on this service.

So as I interact with patients and their family members, I attempt to do two things. I first try to put myself in their shoes, as best as I can. This helps me understand (and if needed, forgive) any angry outbursts or other nastiness. It’s not personal. Second, I do my best to treat the patient, and the patient’s family, like they were my own family. I would want a doctor, nurse, or medical student to treat my parents, sisters, or friends that way. One of the trauma attendings modeled this behavior so well. When patients and their families thank him for his kindness, he tells them outright that his goal is to treat people like his own family. I’ve taken to doing the same.

These are not lessons I necessarily expected to learn on my surgery rotation. But they are important lessons that will remain with me, whatever I do in medicine.

Don’t get me wrong — I learned about surgery on my surgery rotation too — suturing, knot-tying, and so on. But I could learn those things from any surgery attendings or residents. My team helped teach me so much more.

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July 9, 2017

s/p surgery rotation, week #1

My 6-oz. water bottle, which fits in my white coat pocket, helps keep me hydrated throughout the day. Its small volume keeps me hydrated enough that I don’t get lightheaded, but not so hydrated that I have to go to the bathroom all the time. In surgery, hydration is a delicate balance.

Medical student with a past life history significant for journalism, art, and piano, s/p* starting her surgery rotation 1 week ago, presents with aching feet and legs. The symptoms are most consistent with walking all over the hospital and standing for hours in the OR with inadequate footwear. The student does note that these symptoms have not affected her enthusiasm for the surgery rotation, and that assisting in several surgeries last week has only enhanced her desire to improve her surgical skills. Recommend the student continue to read more about the field of surgery, practice suturing and knot-tying at home, and buy shoes that are more comfortable to stand in for extended periods.

Part of writing up a patient note is including your “Assessment and Plan.” It’s just what it sounds like — a very brief synopsis of the person’s presenting symptoms, what you think the cause is (and why), and what you plan to do about it. The paragraph above is my own Assessment and Plan after 1 week of my surgery clerkship. In other words, the main issue is that my tennis shoes simply aren’t cutting it. Aside from that (and being tired from waking up at 4 a.m. — which is just a given), I’m really enjoying the rotation so far.

Of course, I did learn some lessons from my ob/gyn clerkship that have helped. Those of you who follow my story may remember my near-fainting incident during a C-section earlier this spring (see “Getting back up” from The American, the online magazine I write for every month). After that experience, which I attributed to hunger and dehydration, I now keep quick snacks, as well as an adorable 6-oz. water bottle, in my white coat pockets. They come in handy.

I’ve found several flavors of KIND bars (high protein, lower sugar) that keep me fed when there isn’t time for a real meal. String cheese is great too.

On Friday, for example, we had a lot of cases booked, and in two different rooms — eliminating the room cleaning break in between surgeries that gives you time to get something to eat or drink, and use the bathroom. It was around 4 p.m., and I hadn’t had time for lunch. I was staying late that evening too, and didn’t anticipate time to eat dinner either. At the completion of one case, as everyone readied to go to the next, I approached one of the residents.

“Do I have for a 2-minute snack?” I asked.

She looked intently at me as she quickly thought about my question, knowing we were on a tight schedule.

“Two minutes,” she replied.

Thank heavens for that packet of string cheese in my white coat, which was hanging in the hallway just outside the suite of operating rooms. I ate it in three quick bites, and was indeed back in about two minutes.

The clerkship orientation I mentioned in my last blog post has also come in handy. During a laparoscopic cholecystectomy (gall bladder removal), I got to “drive” the camera for part of the procedure. I also did my best to suture closed one of the port sites used to insert the instruments. Getting that needle just where you want it is harder than it looks though, so the resident had to rescue my effort. But I’m resolved to improve.

Those were things I’d practiced (a little), and expected to try. I didn’t expect to get to help with an ulcer debridement. Debridement is the process of removing dead or damaged tissue from a wound, and in this case it was done to try to help the wound heal. After watching the resident and intern, I was allowed to snip away bits of the yellow, gooey fibrinous exudate that we wanted to eradicate. But even after we cut away as much as we could, there were little bits still stuck down, too small to remove with scissors. So we (that includes me!) used another tool.

Before we started with it, the resident picked up the handheld device, and asked me what I thought it was.

“Well, it looks like a water gun,” I told her.

She told me that’s essentially what it was — a combination water gun and suction device. It sprays a high-powered stream of water into the wound, loosening the remaining gunk, and simultaneously sucks it up.

The resident then pointed to a shield surrounding the nozzle.

“This is to keep us from getting sprayed,” she said. “Don’t spray us.”

Then after a brief demonstration, it was my turn. I considered my time with the fancy water pistol a full success: I helped clean up the dead tissue, and I avoided spraying my resident and intern in the face. Even with our eye protection, that would have been … less than ideal, to say the least.

The ulcer debridement was a procedure I had really wanted to scrub in for. Having talked so much with my mom, a hospice and palliative care nurse, about wound care, I wanted to see it in action.

Along those same lines, it was interesting for me to see bedside wound care too. Several times last week, I went along with an intern to change a dressing. The intern did most of the medical work. My main role was to distract the patient from the pain, inevitable in spite of pre-medication. So I put my palliative care hat on, glad to help ease a patient through this temporary, painful event.

More than once, an intern has apologized to me that there isn’t anything “interesting” going on for us to see. The intern was referring to the fact that some days, there are few, if any surgeries going on while us medical students are there. On the other hand, there are also days when we’re booked back-to-back, plus emergency add-on procedures. You simply never know. My response is always that (of course!) while I’m excited to scrub in for surgeries, I’m also just glad to be part of the team, helping with the little things like gathering supplies for a bedside dressing change or procedure.

It’s all part of the learning process. And that’s why I’m here.

*s/p, which stands for “status/post,” essentials means “after.” It’s often used in reference to procedures, such as surgeries. For example, a patient who had their gall bladder taken out 5 days ago would be referenced to as “s/p cholecystectomy 5 days ago.”

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May 23, 2017

Enjoying San Antonio

Posing along the lovely San Antonio River Walk

While I was in San Antonio last week, I enjoyed not only the conference I was attending, but the city too. I took several strolls along the famous San Antonio River Walk. As I discovered, you can follow the bank of the San Antonio River for several miles along a network of paths that are inset one story below the hustle and bustle of automobile traffic. For part of the River Walk, you’re surrounded by hotels, restaurants, and shops, with river taxis and tour barges whirring by. But past the commercial district, it’s all peace and quiet. On that leg of my walk, I saw more ducks than people. This was quite the change for me, coming from New York City. The place to go for “green” in NYC is Central Park. No matter when you go though, there are gobs of people there, on all the paths and lawns. I definitely enjoyed the solitude and silence I found in San Antonio. Here are some photos from my excursion on the River Walk.

View of the San Antonio River Walk

Map of the San Antonio River Walk

Flowers along the San Antonio River Walk

Wildlife along the San Antonio River Walk

View of the San Antonio River Walk

Being in the Southwest, I also enjoyed the prevalence of Latino culture. As I made my way along the River Walk, I stopped for lunch at a Mexican restaurant. While waiting for my enchiladas, the table decor, a large sheet of paper protected under a layer of glass, caught my eye. At the top of the paper, the title read “Serpientes y Escalaras.” I realized this was a game board — in Spanish — for “Shoots and Ladders,” which I’d played so many times as a kid. I couldn’t resist taking pictures of the board, including the Spanish-language instructions.

Instructions for the Spanish version of “Shoots and Ladders”

Instructions (continued) for the Spanish version of “Shoots and Ladders”

Spanish “Shoots and Ladders” game board, my table decor at the Mexican restaurant where I ate lunch on the San Antonio River Walk.

Another view of the game board

All in all, it was a wonderful trip — I got to both learn and unwind. Still, it’s always good to be home.

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May 22, 2017

Presenting a poster, and reigniting my passion

Posing with the poster I presented at the American Geriatrics Society’s annual meeting this past week in San Antonio.

I spent the last few days in San Antonio at the American Geriatrics Society’s annual meeting. I wasn’t just an attendee — I also presented a poster on the palliative care research I did last summer in Uganda. It was a wonderful experience to go through the process of writing and submitting an abstract, creating a poster, and then presenting my work to other medical practitioners.

Talking with people about my research, getting feedback on what we’d done in the past and hope to accomplish in the future, also reignited my passion for the project. I’m ready to dive back in and use the information we learned last summer to try to make positive change. I won’t have to wait long to do that. I will be continuing my work in Uganda during my four-month “Area of Concentration” research block next year.

The work we did last summer was a pilot project that aimed to better understand why some patients in rural Uganda do not seek medical treatment until their condition has progressed to being terminal, and therefore present for palliative care. We also hoped to learn what the patients understand about their illnesses, and what both patients and medical workers see as barriers to seeking medical care. Here is a link to a larger image of the poster I presented, detailing our results and conclusions: Understanding Illness Perceptions and Care-seeking behavior in Older, Palliative Care Patients in Rural Uganda.

One key thing we learned last summer is that poor communication from providers to patients is a factor that affects whether people seek medical care. Patients don’t trust the medical establishment because they feel belittled rather than heard or understood. So they are discouraged from seeking medical care from physicians. Instead, the patients turn to traditional healers who actually listen to their concerns. This is a problem when a patient has breast cancer, for example, and months or years of using ineffective herbal treatments means that her cancer progresses beyond the point where it can be cured. So my project for next year is to develop a multimedia educational module to teach better communication skills to medical workers. Specifically, the module will address the topic of how to deliver bad news to patients, such as a frightening diagnosis. We’ll be using film footage that was taken during palliative care home visits in rural Uganda last summer. The project has yet to be formally approved by my research committee, but so far I’ve gotten very positive initial feedback. I look forward to sharing my progress as this new project moves forward.

It truly takes a village to make a project like this possible. It’s impossible to mention everyone who played a part, but these are the key players. Thanks to my research mentor, Dr. Randi Diamond, for her hard work, dedication, and ongoing support. I also want to thank Weill Cornell’s Division of Geriatrics and Palliative Medicine for sponsoring my trip to the conference, as well as my initial research funding from the Howard Olian Endowed Scholarship in Geriatric Medicine. I also want to acknowledge those who worked with me on the project last summer. From New York: Dr. Howard Eison, Dr. Jemella Raymore, Dr. Carol Capello, Dr. Veronica LoFaso, Dr. Cary Reid, Dr. Ron Adelman, Dr. Kelly Trevino, Lauren Meador, Allison Maritza Lasky, and my fellow MSTAR/Adelman scholars. From Uganda: the St. Francis Naggalama Hospital administration, physicians, and staff; and the Naggalama Hospital Palliative Care Outreach Team.

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May 14, 2017

My own unsolved mystery

I’m a mystery junkie. My favorite TV shows and podcasts all involve drama, sinister intrigue, and crook catching. Right now I’m immersed in “Accused,” a nine-episode podcast about the unsolved 1978 murder of Elizabeth Andes.

And now I have an unsolved mystery of my own.

My unsolved mystery is not at all sinister though. Quite the opposite — it’s sweet; a puzzling act of kindness that I can’t completely explain.

Allow me to present my case, and the physical evidence I’ve collected.

I don’t get much mail. Not even the junk mail senders or credit card companies have found me yet. But about two weeks ago, a nondescript, cream envelope appeared in my mailbox. It was hand addressed to me in black ballpoint pen — clearly not an advertisement — but there was no return address. Curious, I opened the envelope and found a lovely card inside. The message — “Always remember … You are doing your best” — was exactly what I needed to hear that day. I’d had a long, rough afternoon at clinic and really needed some encouragement.

I was so grateful for this surprise act of kindness. But I didn’t know whom to thank.

The card itself looks handmade, which makes me think maybe it came from someone artistic. But that’s not much to go on. So I scoured the envelope for clues. I tried to make out the blurred postmark (of course the postmark would be blurred!). I think part of it says “SUBURBAN IL,” but I’m not sure. No other revealing markings on the inside or outside. I didn’t recognize the handwriting either. This wasn’t from either of my parents, my two sisters, or the friends who send me mail from time to time. My mystery writer would have needed help finding me, though. So I could try asking my parents and sisters whether they’d recently been asked for my address.

But here’s the thing: I’m not sure I want to solve this mystery. Which surprised me at first, since I’m all about the thrill of the chase. But the fact that my mystery writer sent me this beautiful card in an envelope without a return address was no mistake. She or he wants to remain a mystery. And I want to respect that.

Since I don’t know who sent this to me, I can’t thank them directly. But just maybe, my mystery writer will see this blog post and know how much this seemingly small act meant to me, how it truly lifted my spirits when they were low. I want them to know that I keep the card on my refrigerator to remind me that I am doing my best, and also to remind me that there are so many people out there who have my back — more than I even know.

So if you’re out there, mystery writer, thank you.

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May 12, 2017

Subway syncope

The view from inside a NYC subway car, where I evaluated a woman for syncope (fainting).

Sitting on the New York City subway, immersed in the world of my true crime podcast, I suddenly heard a commotion. I looked up and saw that a group of passengers had stood up and gathered in front of me, staring at the woman directly across the aisle. She was slumped over against the shoulder of the woman next to her.

I pulled off my headphones, my ears alert. What I gathered from the murmuring passengers was that the woman had suddenly passed out. In doctor-speak, she had a “syncopal episode.” She was awake now, but obviously woozy.

Usually in this sort of situation, someone with medical qualifications presents to help — a doctor, nurse, PA, paramedic. No one did so. I realized I might be the person with the most medical qualifications in the train car. That was a scary thought.

You are 9-1-1.

The words of my CPR instructor from nearly two years ago rang in my head. That was his response when one of my classmates proposed “calling 9-1-1” as the appropriate course of action in an emergency. Of course, there is some truth to both perspectives. When an emergency happens outside the hospital, you should call 9-1-1 if that’s an option. The paramedics have equipment and knowledge that you don’t. The CPR instructor’s point was, though, that in that critical moment you are the one who is actually there and can make a difference. So if you are appropriately trained, you should act.

With that in mind, I yanked my stethoscope out of my backpack, slung it around my neck, and crossed the aisle to evaluate my “patient.”

By this time, we had pulled into the next train station. Someone alerted the conductor about the emergency, so we stayed put while the paramedics were summoned. In the meantime, I conducted my initial assessment.

I explained that I was a medical student. I cradled the woman’s wrist in my hand so I could take her pulse — faint and slow, I noted. I tried to listen to her heart but it was difficult to hear anything with everyone around me talking. I decided it was more important to take her history. I asked whether this had happened to her before, if she ate or drank sufficiently that morning, whether she had any medical problems.

“Are you a nurse or something?” asked the policeman who was standing in the open doorway of the train car, watching me.

I felt a prickle go up my spine. Clearly, old-fashioned assumptions about gender roles were very much alive, even in progressive New York City in the year 2017. I doubted he would have asked a man with a stethoscope around his neck the same question. But my goal here was to practice medicine, not feminism. So I swallowed, and calmly answered.

“I’m a medical student.”

This seemed to satisfy him. He told us the paramedics were on their way. Another passenger offered to stay with the woman who’d passed out until help arrived. The two women slowly stood up and exited the train car.

Minutes later, the doors whooshed shut, and we were on our way. I sat down, my own heart still racing.

My physician preceptor told me later that morning that as the medical professional, I should have stayed until the paramedics got there. Not necessarily because this woman was going to need more intervention. But because I could better communicate her condition to the paramedics, and because I could prevent bystanders from doing something like starting CPR if she passed out again. Lesson learned for next time.

I learned a lesson about myself that morning, too — about how I respond in an emergency. Namely, that I did respond. I remembered what I’d learned over the last two years and applied it.

In medical school, we hear about how being a physician entails great responsibility. There is a standard of professionalism, and the so-called “social contract” that we’re expected to maintain. As a medical student, I didn’t expect to put that into practice — at least, not without supervision — for some time. I’m honored I had the opportunity.

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May 8, 2017

Narrative medicine: my soul’s monthly nourishment

Once a month, a handful of people gathers in a small conference room on the 14th floor of New York Presbyterian Hospital’s Baker tower for an hour-long narrative medicine group. We discuss a poem or prose piece, sometimes about medicine sometimes not, then write a reflection to a related prompt. The composition of the group varies by who can come that day: librarian, doctor, social worker, medical student, chaplain. Just like our job titles, our experience with interpreting literature, with writing, and with life itself, varies. But that’s exactly what makes the group so rich. With my crazy clerkship schedule, I can’t always make it. But I know when I do, I will leave feeling refreshed, fed. Here is the poem we read last week, along with my written reflection.

“In a landscape of having to repeat”

In a landscape of having to repeat.
Noticing that she does, that he does and so on.
The underlying cause is as absent as rain.
Yet one remembers rain even in its absence and an attendant quiet.
If illusion descends or the very word you’ve been looking for.
He remembers looking at the photograph,
green and gray squares, undefined.
How perfectly ordinary someone says looking at the same thing or
I’d like to get to the bottom of that one.
When it is raining it is raining for all time and then it isn’t
and when she looked at him, as he remembers it, the landscape moved closer
than ever and she did and now he can hardly remember what it was like.
— Martha Ronk, 2004

Prompt: Write about a time you remember looking at a photograph.

When do memories begin? I think I remember being there, tell people I do. Sitting on my pink bicycle in a Minnie Mouse bathing suit, our golden retriever Jake-a-pup reclining on the lawn in the foreground. Flying high on the swingset in my dark blue jeans and the white T-shirt with the pretty blue flowers. Hanging upside down on said swingset, my face flushed red and my eyes half closed. Blowing out candles on the green-frosted caterpillar cake that my mom baked. But are they really memories? Or just pictures in a photo album?

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April 21, 2017

‘No one gets a diploma alone’

Almost every day, I pass by this bus stop billboard, which is across the street from Weill Cornell Medical College.

The message — “no one gets a diploma alone” — is so true. It’s true whether you’re talking about a GED, B.S., or M.D. So every time I see this advertisement, I think of all of you.

And when I say “you,” I’m talking about a lot of people.

My family and close friends play enormously supportive roles. I wouldn’t be here without them. I can’t thank them enough. My classmates, too, play a key part.

But “you” is even broader than my family, friends, and classmates. One of the most difficult things about medical school is the pervasive feeling of isolation. So knowing that there are people across the globe reading my story — many of whom I’ve never met, and am unlikely to ever meet — that helps too.

To each one of you, for your unique contribution: thank you, from the bottom of my heart.

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April 20, 2017

Central Park self-portraits

When I was in college, one of my favorite (and most time-intensive) classes was photography. This was before the ubiquity of digital cameras — we shot with 35 mm, 400 ISO film, all black and white, manually developed and printed in buckets of smelly liquids under red safety lights. My final project was to tell a “story” in a series of still photographs. I decided to share my daily jogging route. I started and ended with a picture of my running shoes to give context. In between were images of the route itself, the trees, bushes, houses, fences, and streets. I took each photo while slowly panning a scene, blurring the images slightly to give the impression of movement. For my presentation, I mounted each image on rectangles of black art board, with little cutouts along the top and bottom to look like segments of a film strip.

I don’t jog anymore; I prefer an exercise bike, an elliptical machine, or simply a long walk. The photos I present here (digital, obviously — how times have changed!) tell the story of my recent walk to, through, and from Central Park. I am eternally grateful to those who had the foresight to guard this giant swath of land as a nature preserve, and I visit it often. The park changes throughout the seasons. Here is what it looks like on a sunny, spring day.

The park has many boulders suitable for scrambling or simply sitting.

In April, there are patches of daffodils all over the park.

Blooming magnolias remind me of my childhood home in Forest Park, Illinois.

Central Park even has a castle — this is me against its wall.

From above, there’s a lovely view of one of the park’s ponds, a giant lawn, and the city skyline in the background.

The park paths meander, with many overpasses and underpasses. Here is one of them.

Commemorative statues dot the park, including this one of Balto, the sled dog famous for helping transport diphtheria treatment to combat an epidemic in Nome, Alaska in 1925.

My walk home was lovely too. This is me in front of the tulip-laden Park Avenue median.

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Tag: medical school