Jean

Yesterday we had our third exam of the semester. There were 23 lectures, a ream of powerpoint slides, and a 78 page review sheet. I worked hard to get the information, but it really is a deluge and it's hard to just keep one's head above water. Studying with a group of kind and brilliant people has helped tremendously this semester and talking through things looking for keywords feels like good strategy. But before starting med school, I never thought I'd be so willing to settle for keywords. (Ash leaf spots-->tuberous sclerosis, but why?)

On the exam there was a question about the treatments for Alzheimer's and I knew for sure that there were only two FDA approved pharmacological strategies for treating Alzheimer's. Then I looked at the answers and the question was set up so that you choose which one of the the 6 strategies is NOT used. I looked at them and 4 were research techniques, with a plausible but unproven mechanism of action. The question really bothered me because the treatments we need to know are the ones that are effective not the ones that are unproven.

I would never have been angry at that kind of a question before. When I left my old job, my adviser told me to "continue asking the why questions," and I was so eager to do so. Somewhere deep down I still am, I hope. What kind of doctor is really satisfied with two treatments that barely improve outcomes for a limited time? When your known treatments aren't much good isn't it good medicine to read the literature, join a trial, test something new?

There was toast I made about this time last year, when we'd finished our first big course. "To being better doctors than multiple choice tests would make us." I hope I can still live up to that, but it's going to be a long year.

In one of the hostels I picked up a copy of the kite runner and was engrossed--It is a portrait of a man haunted by the sins of his childhood in Afghanistan. Khaled Hosseini succeeds in writing a powerful family story with complex, burdened characters, lovingly rendered and set in the context of contemporary Afghanistan.

The compelling nature of the family drama and depth of the characters makes the violence rendered all the more shocking. I've read in passing about what happened in the stadium at Kabul and have hardened my heart towards stories of civilians being killed by ruthless governments or chaotic military offensives. Here though, with so much of the story told away from the war, with the full rendering of lives thrown off course by violence I found myself biting my knuckles with tears welling in my eyes. There's a powerful sense of what might have been, some regret at glimpsing a life that might have been better through the far hazy distance and gut-wrenching sadness at what has come about.

It's the kind of bleak, beautiful, redemptive story that I believe has the capacity to make one a better person in the way art should.

I was hanging out with a midwife in Guatemala, Doña Ana. She herself has had a tough life. She started working before she was 10 trying to feed her younger brothers, and some days she would go without food so they could eat, but often they would cry because of the hunger. She got married at 15 to get away from the poverty of her mother´s house. She had her first child at 17. She trained to be both a nurse and a midwife and works profoundly hard to provide for her family and her community and give as many children as she can a better shot at life, a better childhood than she had. It was an amazing blessing to stand beside her as she welcomed a child into life. I was there and awkwardly wrapped him up in his baby clothes and held him in my arms. It was an incredible joy to be there with this child, fresh to the world, held warmly against my chest. I brought him over to the father and said he was very beautiful. The parents were both happy. Then Doña Ana scooped up the baby and prayed over him before placing him in his mother´s arms.

( Read more... )

I'd love to find a way to partner with her, to share in what she's doing--recognizing that she's managing really well in her community, but maybe our lives could be enriched through connecting more. What could that look like?

Poll #1427582
Open to: All, detailed results viewable to: All, participants: 9

What kinds of things would you like to hear about from Guatemala?

Ok it´s now the third weekend in Guatemala.  We´re planning a trip out the the black volcanic sand beaches of the pacific coast for this weekend.  I wanted to post more along the way, but I´ve been running around the country a bit much.  The first weekend we got rolled into a trip out to Semuc Champey that some of the other students had put together.  We did a day long bus ride from our Spanish School in the highlands down to the jungle lowlands and made it to the hostel an hour or so before dusk.  A pick up truck rolled up to the hotel about an hour later and we rode through the breeze to the Caves of Lanquin, a deep limestone cave that´s been explored 11km but goes further.  We only went in about a half km before we began to here the squeaking of bats from deeper in.  We came back to the entrance as the lights went out and thousands of bats fluttered around the chamber, their wings delicate and agile enough that they flew by in a huge swarm without a gust and you could hardly tell they were rushing by except when a camera flash lit the chamber and their tiny bodies were suspended all around.  They flew out into the rain for their feasting on bugs.  Oh, the bugs, there were a lot of them.  Somehow all the mosquitoes decided they liked me and between the hundreds of bites, a few abrasions, and a DEET burn, (100% DEET does not belong on raw skin!) my arms could have been a pathology slide set by the time I came back-- Several doses of anti-histamines later my skin´s nearly back to normal.  So random post.  More later, if there´s internet.

Suddenly they're over and life comes pouring through.

I finished my test and rode into the city with friends for dinner and Avenue Q, which is fantastic.  ( denied my heritage, cut my hair, and loitered in Philadelphia )

I escaped by train to see aridice for margaritas and a brief wander through west philly followed up by ice cream when fireboy caught up with us. Early morning I woke up in Swarthmore, caught the train to the bus and came back to New York to pick up some things for travelling.  I missed another bus and caught the next one, grabbed my passport and vaccination record and went to my appointment with the doctor for malaria meds.  This took 3 hours and feels like about the longest time I've been sitting in one place since exams finished.

I'm 25.  That's a quarter of a century!  I've been around for a fraction of a historically meaningful chunk of time. Weird.  I feel blessed to have been around so long and blessed that I get to be around going forward.

I think I'm settling into life more.  My goals are more concrete-- to pass the boards, to learn the physical exam, to contribute to caring for patients, to work well with my peers and stay connected with friends.  I'm worried less about figuring how the world works or my place in it.  These things are still interesting but the spectrum of exploration is a little narrower.  I'm not going to be  a marine biologist or a bench researcher or even a particularly serious writer in the foreseeable future.  And that's ok.  I think it's taken me longer than most to get comfortable with the idea of not trying to do some of everything.

I've been at a church for a while that talks a lot about pursuing life in all its fullness.  A lot of the time this means taking on something new or additional, many of the suggestions are investing time in relationships or service or growth in community.  Med school and being outside the city, not quite on a subway line have really cut my capacity to be present in church or even spend time building friendships.  I've hunkered down into old friendships some and it took me a while to come around to seeing how much I needed to develop trust and friendships with my classmates.  I spent too much of this year thinking of them as colleagues rather than as friends and getting wrapped up in insecurities or pride or competition that was no good.  And then running down to the city for church a day every week sustained me gave me joy and strength as well as the encouragement to get over myself and get to know people up here.  It took a lot of time away from my life on campus though too and kept me from connecting with the community where I live.  Life in its fullness needs both breadth and depth and sometimes being a little bit present in too many things you end up with not much to show for it.

So I think I"m going to start coming to a church in the neighborhood regularly once I come back from Guatemala.

Did I mention, Guatemala?  I'm going there this summer to learn Spanish, do some volunteering, learn the lay of the land, and be with some awesome people from my class.  Modest goals, school sponsored-- Yay! Global Health Office!  Hopefully I won't get malaria or fall down a volcano but with my history...

Maybe this trip is a reaching for breadth.  The travel bug in me is kind of fading out, but I really would like to be able to talk to and understand my Spanish speaking patients.  Guatemala has great language schools.  I'll be staying with a host family which I'm a little bit nervous about, because who am I to receive hospitality? Hopefully though we'll be able to share and it'll be a mutual blessing.  Anyway, I guess I should write more about this later...

Ok so I met this guy while I was running with the town hall advocacy circuit in college and he really is an ornery jerk. But at least he's an ornery jerk who acts that way toward just about everyone and he's angled himself into a lot of power for the state. That and he's such a riot to read about that I'd sure like to keep him in office. What do you think the odds are I can get my folks to switch registration for the upcoming primary?

We finished anatomy--I am so happy not to be taking scissors through muscle and fat cutting for exposure rather than to repair anything. I'm glad not to come home smelling like embalming fluids and seeing cut tissue when I close my eyes. It's an amazing thing though to be able to take apart a body. We're having our convocation ceremony where we thank the families of the cadavers. I wonder if I'll meet our cadaver's family. I've no idea what I would say to them beyond thanks, maybe ask them something about who he was, but what? It's like asking someone you've seen everyday for a year their name or where they're from--shouldn't we know him better by now? We never met him alive--shouldn't we know him less?

During the course I thought many times about donating my body. I think it was psychologically helpful in saying these things that we're doing to this body are still ok because I would be willing to have them done to my body after death, right? Maybe I would get a tattoo to communicate to those dissecting me or make sure I lost weight before I died so that it would be easier to find things. Weird thoughts with only a few hours of hindsight even. This was by far my most intimate and prolonged experience with a body after death and it has done a lot to normalize this kind of passage.

I wonder how you go about setting up body donation legally?

OK I promise my next post will not be about anatomy!

I'd love to post some long vital piece about the new year or the joys of visiting in Japan, but anatomy beckons so here are the photos.

Held here in Tokyo-- baaaaaaaaaah is waving fried eggs over happyanya 's vegan virgin lips.  She's got a steak in the corner waiting for me.  We were trying to escape tonight, grabbed our bags and ran for the door but baaaaaaaaaah leapt in front of the door with seaweed in her hands promising that she' s reformed her proselytizingly carnivorous ways.  In the moment of hesitation our carefully timed JR jailbreak pulled out and we were trapped again. Then she reached for the fridge and there inside were six shelves of meat.
happyanya 's screaming, her face smeared with egg yolk.  Oh the horror! Now
baaaaaaaaaah 's reaching for the beef!   NO!! NO!!! Somebody help!!

Help rescue me from baaaaaaaaaah shes holding us hostage at her apartment and demands cash, credit or comments in ransom. Oh look its 3 am japan time, wow is my sleep cycle ever messed up!

Anatomy grade: P! Wow, that was difficult, now on to other things in life.

I'm going to Japan! Right after Christmas I take off for Tokyo. I'll be traveling with happyanya who's teaching English with the JET program, also performing in a musical as a 'style samurai', also smiling so much her face hurts, and getting a look at office culture from the inside out. We're going to stay with baaaaaaaaaah in Tokyo. It will be nifty to see her and hear about life at the Ugandan embassy. Then we'll adventure through Tokyo and out near Fuji, weather-willing, after that up by Nagano and then around happyanya's home in Niigata. We get to see beautiful mountains and lakes and hot springs, temples, shrines and maybe a castle! I am extremely excited and rather in need of warmer clothes, but I really really can't wait. *bounce*bounce*bounce*

Scores on multiple choice pretest answers a-e for
Material I have reviewed: 79%
Material I thought I learned but haven't reviewed: 31%
Baseline probability of randomly choosing a correct answer: 20%
Proportion of material that I have reviewed thus far: 1/4

I guess I'll keep reviewing. Fortunately the test isn't until next Tuesday. Darn, I was hoping I might actually get out of the library this weekend.

( minor rant )

My father has developed a non-partisan tax calculator so that you can find out what the impact of the McCain vs. Obama tax plans would be on your bottom line. It's not quite ready for distribution yet, but we're trying to think about how to market it and get it out to a wide audience, particularly including undecided and independent voters. I'm fishing for suggestions on news outlets, blogs, and organizations that would be appropriate.

My, this is lovely. Air conditioned, confirmation number given, and connected a marked contrast to my last intercity hop. ( Riding the Chinatown bus from DC to Philly was painful, ) and that's why I'm now on the boltbus. I've been a loyal chinatown bus customer for three years, loved getting buns and cheap produce on the way, and never had problems like that. However, given the grief, I can learn to plan ahead. I still have a little hesitation about renouncing the chinatown bus entirely since Boltbus is far more the starbucks crowd than the corner deli crowd and riding the bus is one of my key moments of rest-- While not having a brawl in the aisle is restful, sometimes having the whole internet at your fingertips is not. For now though, here's to smooth sailing.

At my mother's church last Sunday there were several women with purple bracelets, embossed "Matthew Shepard."

( loving your neighbor... )

As the pastor put it, the destruction of Sodom has something to say about loving same-sex relationships only if the napalm bombing of villages has something to do with chemotherapy, and slash-and-burn clear-cut logging has to do with organic gardening.

No wonder the youth librarian I schemed with back in the day can bring her partner there. No wonder a 6'2" trans-woman helps to take the offering and the lesbian choir does their christmas concert in the sanctuary.

Things like this make me glad to have grown up PCUSA.
( but )

Early in the morning from the city, a walk by harlem meer and a few laps across lasker pool.
From the lab a szechuan lunch and a group photo (that I had photoshopped half a dozen people into) printed and framed up.
From the person I worked most closely with-- we had an intense working relationship with a deep if peculiarly expressed affection-- inclusion in his family's barbecue with their Chinese friends two weeks ago and an oddly shaped wooden bowl.
( And from my advisor... )

Wrapping up work, it's my last day. I have one notebook left with the hastily scribbled table of contents that needs to be entered into the Uber-excel table of contents then I'll be done with two years of work. I think I'm clinging on a little bit. I wiped the hood down an extra time as I was cleaning-- things like that. My replacement still gives me those oh-my-god-you-want-me-to-do-that-by-myself! looks but they've been increasingly interspersed with the sure-I-can-do-that looks so hopefully when I'm gone...

We had a spicy szechuan feast in honor of my departure with excellent tofu and what appears to be a soup of hot peppers and bokchoi that made everyone's mouths go numb. Me and the hot pepper soup are the only one's left in the lab now. As with so many nights around these parts... maybe it's time for me to go home.