Appreciation

There is little glamour in medicine. At least for a third year medical student like myself. One of the things I’ve noticed about these long hours on call and being an incessant busybody is that it makes you appreciate small things in life that you just don’t really appreciate otherwise. Such as, in no order of importance:

1) Chairs

There is hierarchy in every branch of medicine called the Chair Usage Index. Now, as an experienced third year student, I’m more and more aware of the acute deficit of chairs in every room. So the CUI is an unspoken measurement of who gets to sit in the chairs that truly do exist in the room. It is based on the following criteria:

1. Age
Greater than 60: +2
Less than 27: -1

2. Sex
Female: +1
Male: 0

3. Characteristics of hair
Gray: +2
Receding/balding: +1
Full, lush head of hair: 0

4. Status upon presentation (MOST IMPORTANT DETERMINANT)
Attending physician: +5
Senior resident: +4
Junior resident: +3
Intern or dog/pet therapy animal: +1
4^th year medical student: 0
High school shadow student: -1
Patient charts, attending physician’s snacks/designer water bottle: -2
3^rd year medical student: -3

Using the CUI criteria, my total Chair Usage Index score is -3. Thus, in rounds and sign-out I am often found leaning against and at best scooting half my butt onto random sinks and counters. Sometimes I make the mistake against leaning against something particular unstable and finding an entire rack of carts or important papers being scattered throughout the room. It is at this point that someone takes pity on me and offers me a chair, or a stool, or an upside-down plastic bin.

 

2) The bathroom

Obviously it is used for its obvious purposes. But lately I’ve discovered that there is a deeper meaning to the bathroom. In the bathroom you find peace and quiet, as well as a place to sit (see my issues with point #1). You can nearly hear the tranquil sounds of the tropics and gentle waves on the shore (such is the illusion of the air vent after three hours of sleep). Please, just 30 more seconds, my tired body says to my mind. Just 30 more seconds of serenity and rejuvenation. Alright now, I hope I’m not sounding too weird here. Within me are slight tendencies towards introversion, and I find being alone for a minute or two is recharging – and it’d be far too odd to sit in a supply closet. So bathroom it is, and a new appreciation for it as well.

 

3) Femininity

The shoddy makeup I put on in the morning is a feeble attempt to look more awake and alert and like a normal 20-something girl. At times it doesn’t even work in that regard, and of course at times I don’t even bother to put any on. Also, scrubs on my frame look like frumpled blue sheets randomly vomited onto me from the dryer – static-y, clingy, and simultaneously making me look both emaciated and oddly plump. Seriously, I would like to meet the person after whom the basic scrubs pattern was modeled, because that would mean meeting the most oddly disproportioned man in the universe. And yeah, it’d definitely be a man. However, I’m okay with the whole situation, because whenever I’m not wearing scrubs now, I consider myself “dressed up”. The other day I put on a t-shirt I got at a high school soccer tournament , blue jeans, actually brushed my hair, and thought, Dude, I look amazing right now. Absolutely stunning. I took a trip to Petco to show off my looks.

 

4) My name

Usually there is one and only one student per team, i.e. attending, physician, senior or junior resident, intern, and myself. You would think that with such a small team, people would come to know me by name. Yet, it has been nearly the opposite. I am affectionately known as “A Student Physician.” Or, better yet, when with coed classmates, “The Female Medical Student” (see point #3! This is a good thing, that I am recognized as being female!). A conversation goes something like this:

Attending/Dr. X: Where is the emesis basin [layman’s terms: barf bucket]?
Senior resident: This patient does not have one in here.
Attending/Dr. X: Tell The Medical Student to get one for this patient and help the patient use the basin.
Me, a lowly student: Oh Dr. X! How I desire to do whatever menial task you set me to do!
Senior resident: Er, what?
Attending/Dr. X: The Female Student. Have her do something useful.
Me, a lowly student: Yes Doctor! Emesis basin-ho!

So, you may understand that when one of my authorities addresses me as “Leanna”, I nearly wallow over starry-eyed and die, struck to core by this gracious acknowledgment of my individuality, uniqueness, heritage, special place in the universe. Had this same person dropped to one knee and proposed in the next sentence, it’d definitely seal the deal.

 

5) Life

Okay, a serious note, but I don’t have to explain this one. Obviously, while working in the hospital, you are surrounded by death. People dying alone, dying estranged from their wives, elders neglected or even abused by their children, dying from the side effects of 30+ years of IV drug use or alcohol. At times this really gets to my head and if I may say, is very depressing and seems to affect me more than I would’ve guessed. There was a little part in me that assumed I could compartmentalize better than I actually can, that I could easily find a balance of separating the disease from the patient. Even in the first year or so of school, I found myself figuring out how to numb down emotions or at least suppress them to a healthy measure. But now, well, I can’t, and I learned this year that I really don’t like seeing people die.

However, there are two sides to even the flattest pancake (odd but true words of wisdom from my dad). The constant exposure to dying and suffering also has the potential to remind me of the subliminal greatness of the everyday things in my life. I’m not talking along the lines of appreciating all the fun things like warm socks and shopping and baby animals though; I mean the parts of your life that, were they gone, you’d experience more sorrow than you thought possible. People mean more to me than they used to – even the most precious people in my life, who I believed I valued to the most of my ability, I see them in a different, almost more sacred light.

This week finishes up four out of six psychiatry weeks for me, and of course there are extremes of humor and isolation and sadness and peculiarity in psych. My boyfriend also gave me a special piece of jewelry about a week or so ago; looks like my future diploma will have a different name on it than when I started – and I’m completely fine with that!

Burnt

Frankly, I’m not sure how to phrase this post. For a month or two now I’ve been wanting to write about feeling burnt out. Yet each time I’ve started an entry, it becomes a bit of a downer, and not representative of who I am as a person or as a medical student. Becoming a physician is difficult in all sorts of aspects, and with every phase of medical school there are new joys and rewards, as well as disappointments and frustrations, but for some reason this stage of school seems to have beaten me down a little more than I would’ve imagined. And so, recently I’ve been challenged to really peek around in the recesses of my mind to fully process every single thought I’ve had regarding school.

If I could say any one piece of advice to anyone, regardless of what field he or she is studying in, is that you must live for something bigger than yourself. I suppose this is something cute that could be written on a refrigerator magnet or on a social networking profile, but you must, must, must give deeper thought to it. With each day’s new challenges and unknowns, it seems to me that as humans we get so frustratingly focused on ourselves. I see this in myself tremendously––coming back to my apartment at the end of the day I find myself exhausted, whether emotionally or physically, and I start to dwell on all the things in my little life that I wish were different. A different attending physician. More opportunities for practicing procedures and having more responsibility for patient care. Placement at a different site. More time off. A better understanding of the future. More time with my boyfriend/family/friends. As you can see, I could go on and on, and still, not all these things I’ve listed are wrong to hope for. But really, they revolve around I, I, I, me, me, me, and when my life does not reach the standards and expectations I’ve set for it, it falls short into a place of frustrated futility, tiredness, and intermittent self-pity.

However, back to my point––you must be far-sighted, you must have a great purpose for why you want to be in medicine (or in whatever field you have chosen!). Not because the day-to-day rewards are so fun, although they sometimes are. You need to come home at the end of the day, and whether or not you were treated unfairly, or spoke to condescendingly, or feeling personally rejected and exhausted, there must be a clear focus as to why you are in medicine and not in something with more immediate, comfortable benefits. I can’t stress the importance of loving, adoring, and treasuring the field you’ve chosen, making sure that it something you want for the rest of your life and something with a greater purpose than yourself.

Speaking of myself, I am in medicine because I cannot see myself being satisfied doing anything else. And I’m not saying I’m in it by default––if you knew me, you would know that my passion for what I am studying is enormous, and that it’s the undeniably perfect fit for me. It’s ironic and amusing, how in the days and hours I feel most exhausted there is some unexpected form of encouragement and support further acknowledging the fact that I am indeed in the right field. There are many hobbies and topics that catch my eye, and yet at the end of the day I know that nothing would bring the same feelings of gratification as restoring people’s health to the best of my ability––or doing my best to prevent disease in the first place, and as a Christian, hopefully using that as a vehicle to show God’s love and kindness towards broken humanity.

So, at the end of the day, all that said, remember the big picture––whatever your big picture is for you personally. With everything that you are, love what you do, and make sure you are in it for the right reasons, for the long haul, even when at times the day-to-dayness of it becomes less than thrilling!

Los Angeles and beyond

Hello again, I’ve returned. The past six weeks I was on my OB-GYN rotation. Highlights include delivering five babies (with the careful help and instruction of both senior residents and attendings). Let me tell you, I held them all very carefully and securely because those little boogers are incredibly slippery. Other than that, I can’t say I was a fan of that rotation, and since I don’t really want to write about it, I think I’ll write a little about moving back to L.A. for a good part of third year––the first six months to be exact, and the things I’ve enjoyed and discovered anew (I’m originally from the area) since being here. If you are just dying to come to L.A. to bask in the sunlight that is composed of movie stars, plastic surgery, and materialism, as well as poverty and violence, then let me tell you good folk, this is the blog entry for you.

Oh and…some of these pictures were taken by yours truly, and some weren’t. Just to keep you on your feet and all.

 

1) White Memorial Medical Center

If you’re a third or fourth year medical student at Loma Linda, you can actually do about half of your required rotation at this lovely hospital here in East L.A., specifically, Boyle Heights. Most of the patient population is indigent, and about a third speaks little or no English, so be prepared to work on your Spanish. Now, my Spanish is passable, but there is one problem. I spend a few minutes on my computer to figure out how to perfectly say a set of phrases, perhaps regarding characteristics of chest pain or something, and then I proudly walk into patient’s room, head held high, as if I have some semblance of an idea of what I’m doing, and chatter them off to the patient. And what do you know––this understandably gives the impression that I speak fluent Spanish, and of course then they ramble back to me all about the health issues and problems they’ve had for the last 28 years, give or take. At this point, I have to admit to them I’ve cheated. I’ve cheated on this week’s Spanish practical––I’ve looked this all up online. My Spanish isn’t quite that good (yet), and I realize I need to hold on to my American accent as best as possible and speak like I really don’t know how to say these things, which is, of course, very close to the truth. Then in return they slow down and speak more simply, and all is good.

I’ve been here for the majority of third year and overall would quickly recommend it to any of my fellow students. One of the things I’ve also noticed is that due to everyone’s changing schedules, you’re forced to make friends fast if you want a buddy to talk to and to make you feel like a normal human being with a social life. At times, doctors and residents are a little too busy for this, or perhaps crossing into personal territory is a little out-of-bounds for a student. As a result, I’ve come to know the chefs and workers in the cafeteria on a first-name basis, and the random students from all across America with whom I’ve come into contact also quickly find themselves as my friends––whether they feel the same or not…

Here’s a little glimpse of the hospital.

 

2) Little Tokyo/Ethiopia/Armenia/K-town/Chinatown/whatever

L.A. is known for all those fancy things that the media portrays, and truly, that’s not that far off. Do you want me to show you some pictures of plastic wealthy people in fancy cars? No. No, you do not, and I am glad. Some of the lesser known gems of L.A. include the different cultural districts. Right now I’m two Metro stops away from Little Tokyo––a funky area full of sushi and sea creatures I didn’t know were edible, expensive Japanese stationary, and some of the best boba tea around. Oh, and there is also a Korean district, Ethiopian district (vegetarian Ethiopian food = amazingly tasty blend of Moroccan and Indian, with a milder touch), Thai district, Armenian district (well, technically, but it’s a bit of a deserted ghetto––I wouldn’t recommend going there to sightsee), and Olvera Street (Mariachi bands galore, lots of little trinkets, decent Mexican food). If you’ve chosen to spend some prolonged amount of time in Los Angeles, Google one of these districts and go eat and walk around somewhere fun and prove to your friends just how wonderfully cultured you are.

Ethiopian food. I don’t know what half of the food is on this platter but I can guarantee you it is DELECTABLE!

Bibimbap; my favorite Korean dish.

 

3) On your feet stuff.

Unfortunately, a lot of people come to L.A. with the exact same itineraries, causing for huge touristy congestion in just a few main areas. If you want to spend time in L.A. or in the L.A. area, I would steer people towards towards the following rather than to the Hollywood Walk of Fame or Santa Monica:

Topanga Canyon State Park

Part of the small mountain range between L.A. and the San Fernando Valley; there are amazing views of L.A., the Pacific Ocean, and the Valley as well. There are several hikes in this park, so just use Google once again to figure out which one is right for you. If you go on a clear day; say, late fall/winter/spring, you can often see snow on the mountain ranges just east of L.A.. Plus, you get to see deer and fun wildlife creatures instead of droves of other tourists; how can you argue with that?

View of the Pacific from one of the hikes

Museums

I guess the general consensus is that you’re either a museum person or you’re not. If you’re not, you’re missing out. L.A. has a massive variety of museums for every type of person––but I’m guessing if you’re reading this blog, either you or someone you dearly love is into science. Oddly enough the science museums are never too crowded, they often have competitive student prices, and they make you feel very young again (which probably has to do with the fact that 90% of people in attendance are under the age of 12). Me personally, I would recommend the Natural History Museum of L.A. (your basic dinosaurs/wild animal museum), the La Brea Tar Pits Page Museum (active and inactive tar pits with ongoing excavation of Pleistocene mammals), or the Norton Simon Museum (half anthropology/half art/100% very classy and more grown-up-esque). Of course, there is also the Getty (admission is FREE!), the Getty Villa (Greek/Roman archeology), a huge variety of art museums (Museum of Contempory Art, Los Angeles County Museum of Art, Japanese American National Museum, Hollywood Wax Museum). Seriously, you non-museum people, you’ve got to enjoy at least one of those.

Yours truly a few years ago, volunteering at the La Brea museum, cleaning…the femur from a sabre-toothed cat.

For extra credit, visit Leo Carillo State Park, Dana Point Harbor, or Frazier Park for some hiking trails.

Don’t worry my friends, I’m still doing well in school, in between running around visiting here and there and getting the most out of third year, academically and activity-ly.

An unadulterated view from my apartment at White.

Half Hye

Family medicine, your quintessential primary care doctor, the “I’m going to get a check-up at the doctor’s” doctor. Here’s a snippet of my day as a family medicine student doctor.

It’s 5:15am, another new day, another round. It is supposed to be the most still, quietest part of the day.  Despite multiple people telling me I would start drinking coffee in medical school, I’ve defied them. Instead, I down copious amounts of green and black tea in the morning, because despite the silence of the early morning it is my most frantic part of the day, trying to leave early to beat rush hour traffic and trying to remember to brush my teeth. Even the crickets outside and our psychotic dogs know this ungodly hour is best for sleeping, not for gathering up my half-used pocket-sized notebooks and pens and wallet and stethoscope and mints and melted chapstick and skills log and flash drive and phone and cheat sheet drug guide into the pockets of my stubby little white coat (to my readers who are familiar with Harry Potter––you know Hermione’s never-ending purse that is the size of a tiny knapsack and yet it holds books and all that wizardy junk? I covet it tremendously).

Back to the present, it’s about 8:00am; the beginning of clinic. In the past weeks I’ve learned that family medicine not only calls for thorough medical knowledge, but also for emotional stamina. In the past four weeks on my rotation here, I have helped with the care of suicidal patients, newly-pregnant patients (I got to tell a young woman that her pregnancy test was positive!), bulimic, anorexic, and morbidly obese patients, immigrants from all sorts of longitudes and latitudes, and approximately seventy bazillion frustrated diabetic patients. I am not exaggerating when I say that at the very least every other day a patients breaks down in tears during the appointment, sometimes over a recent miscarriage, a boyfriend’s infidelity, or from unrelenting chronic pain. There is no happy median for dealing with emotional issues––if you stay distant and removed, you alienate and discourage the patient; if you come closer and put yourself in their shoes, you will eventually deal with the same emotions yourself. The middle ground of just enough emotional involvement with just enough distance from the patient’s issues is pretty shabby still, in my opinion.

It’s about 2:30pm. I’m back at Glendale Adventist clinic, just returned from lunch. One of the lessons I’ve quickly learned is that if you’re toting around an ethnic last name, like, oh, I dunno, say an Armenian last name, in a location where Armenians tend to congregate and rapidly multiply, it is to your advantage that you SPEAK ARMENIAN FLUENTLY. Please understand that when I write in all caps, this means that I am shouting this advice to you at the top of my voice. Unfortunately, I learned this lesson a few decades too late. Several times a week I am chided for not speaking what apparently Glendaleians consider the language of God, Armenian. The shame and rants and curses (okay, slight hyperbole perhaps) alternate between falling on me and on my dad (the source of these surname issues), if I’m cowardly enough to blame it on him for not teaching me. Thankfully, I usually just bite my tongue for the first few seconds and then lapse into apathy as I am again reminded that I have somehow failed my ancestors as well as my unborn descendants. My appetite for lahmajune and kufta is ever-present, and my backgammon game is improving daily, so I think that makes up somewhat for my lack of Armenianness. But, there is still a twinge of desire to better fit into this unique and tightly knit culture.

It’s 5:00pm, and the day is done, and I’m about to sit in traffic on my way home. L.A.’s smog and random summer humidity actually makes for some of the most beautiful sunsets. The worse the smog, the more brilliant the sky’s last colors. In juxtaposition to the morning, now my rush hour environment is hectic but somehow I am at peace and able to think during the commute home. Today a 50-something year old patient told me that she was ready to die, and was sick and tired with having to deal with the death of immediate family and very close friends, and no longer wanted to closely manage her heart disease. How do I respond to that? Some sort of every-cloud-has-a-silver-lining spiel? Anything at this point would’ve been too cliche, so I did my best to sit back and listen to her talk. Although I said very little, after she finished talking she decided to refill her heart meds and see a counselor. Being naturally introverted, there is always the concern that I come off aloof or snobbish, but in hindsight of today, I realize that being quiet was one of the most impactful parts of my day.

In summary: expect emotional involvement with your patients, learn Armenian, and don’t talk if you don’t have to.

Yummy treats: lahmajune––basically, Armenian pizza. And kufta, Armenian meatballs––super tasty!

Medical What?

Soggy graham crackers with a hint of Windex. That is the predominant scent in the waiting room. It’s undoubtedly a lot better than a lot of the other aromas I’ve smelled in pediatrics.

The one elective I have during third year finds me on peds/quasi-adult immunology at White Memorial Medical Center. The doctor with whom I am working, Dr. Patel, is an excellent teacher and I get the feeling she remembers exactly what it is like to be a medical student (as fellow med students will quickly attest, many attending doctors don’t seem to remember this stage of life so well). We are able to spend a pleasantly extended amount of time with each patient because it is a specialty practice, and it has exposed me to a variety of patients.

Dr. Patel sends me in to see patient X, one of her adult patients, and instructs me to take a more thorough history than I normally would for a follow-up appointment.

“So tell me patient X, other than the meds you’re on now, is there anything else you’ve done to help out with the eczema? Special lotions, wet towels, anything?”

“Yeah, I’ll smoke a joint to help with the itching. When I was seventeen I got a prescription for medical marijuana. Don’t worry, I carry my card with me everywhere. It’s right here in my back pocket if you want to see it.”

“Oh. Er, huh.”

“I always have my card with me. Oh yeah, and I tried a special oil from Mexico once, but it smelled too strong.”

“That’s great.” I hope my slightly confused, lackluster voice doesn’t come across as judgmental. I’ve thought about the use of medical cannabis, and I have a bit of an unformed opinion, but I’m a little at a loss for words right now. Now I know what I need to read more of over the weekend.

Cannabis for chronic pain or nausea/anorexia in chemotherapy seems legitimate, but for itching?

Patient X had the most horrendous, poorly-treated case of eczema I’ve ever seen. Since seeing our attending physician for the past few months, patient X’s skin has improved drastically. Yet in her 30′s, with impaired vision from over-prescribed oral steroids (as opposed to the normal topical ones for eczema), and widespread, disfiguring scarring from decades of uncontrolled eczema that wasn’t completely addressed by physicians in the past. Patient X’s ears, eyelids, and lips are hardened and disfigured by scar tissue, and there are open, mildly infected lesions on the waistline and both shins. And this is considered an drastic improvement.

“So the marijuana, does that help?”

“Oh yeah, yeah yeah, for sure. It cuts down on my focusing on the itching, you know, when I can’t control the itching, and then everything gets worse from there – I mean, you’re a doctor, you know about eczema. So yeah, I smoke it to keep the itching at bay and then I don’t scratch the sores. And really, I always have my card with me, everywhere.”

This isn’t a blog post of the pros and cons of an alternative, somewhat questionable treatment. But let me say, having a glimpse into the misery that this disease has caused this man, it is reasonable to say that I will give the benefit of a doubt to a patient if he goes outside of accepted Western medicine to try to alleviate the frustration of a chronic disease. I have much faith in Western medicine, but I would be naïve and prideful to say that it is always 100% sufficient. Alternative medicine, whether meditation or Chinese herbal medicines or medical cannabis – oh yeah, and there’s also Indian medicine, acupuncture/acupressure, and all sorts of psychotherapy, I do believe have varying degrees of usefulness in the everyday patient’s life, as long as personal safety and abuse issues are thoroughly addressed. And so although I am still not sure of my position regarding this alternative treatment, as far as I was concerned patient X’s need for relief and alleviation should be a top priority for me as part of the healthcare team, and I cannot blame him for searching elsewhere after seeing the almost horrific severity of his condition.

NOTE: None of the offices at White Memorial Medical Center prescribe the medical cannabis, nor do they refer patients to such clinics, and the same can be said for Loma Linda’s offices as well.

On a more peppy note: I went to Catalina Island this week with my boyfriend to visit our friend doing research there. Between the three of us we had a medical student, engineering student, and marine biology student, so it was a very nerdy, scientific day. And a great one!

Here is a picture of a BISON (!) in a utility yard!

And here is a picture of a medical student and an engineering student:

A word of advice to pre-med, 1^st, and 2^nd year students: make sure that you find people whom you love, and make sure you do things together that you both love. Then go back to medicine and make sure that you love that too.