Tuesday, November 29, 2011

Outpatient surgery

Six weeks of waking up at 4:15 AM six days a week, albeit learning a ton about the field of surgery and management of patients, and it's now six weeks of sampling.

Outpatient is all about getting exposure to as many surgical subspecialties in one week increments. This is both awesome because 1) weekends are free, and 2) outpatient (well, predominantly outpatient) surgery services tend to operate at more reasonable hours (no earlier than 6 or 630 start times), while less awesome in that your participation is less essential (you can't really contribute a lot when you get only one week on a service). But this is fine because it gives time to attend to other things in your life. Like writing on some blog.

Third year keeps moving along: so much shit to learn, so many more experiences to be had, so much so much. So much to constantly both pick up, question, and actively and passively absorb. It's a learner's playground. The only challenge is staying constantly vigilant, enthusiastic, and inquisitive. Sometimes this is more easily said than done.

An intern on a previous rotation summed it up best, speaking to me after I'd made a small error in patient management: "It's OK, we picked it up. No harm done, no need to apologize. We do this and learn for our patients' sake. Patients first."

Indeed.

Tuesday, November 15, 2011

S@&! just got real, part 3

Had to break some bad news to a patient today. Not fun, obviously. But it's what I signed up for.

Sunday, October 23, 2011

Specialty Watch

The most likely specialty I will choose, as of 23 October 2011 is:

Obstetrics and Gynecology

Thursday, September 22, 2011

Black cloud

Second Peds overnight call, almost just as crazy as the first. The residents, for good reason, don't want to look me in the eye. I'm a black cloud. Take that for sending me out to Riverside County for peds. Ha.

But the learnin' and "stick with you for a long time" type of experiences are plentiful during the wee hours, so I ain't complainin'.

Saturday, September 17, 2011

No Joke

5 admissions, after midnight, that's a call night, ladies and 'gents.

Monday, September 05, 2011

Tom Cruise for leishmaniasis?


Today the Muscular Dystrophy Association (MDA) hosted its 46th annual telethon, the first without its poster boy, Jerry Lewis. The broadcast raised 61.5 million dollars for its array of services related to neuromusuclar disorders like muscular dystrophy and amyotrophic lateral sclerosis.

The MDA is vague about its origins. The website states that the association “was created in 1950 by a group of adults with muscular dystrophy, parents of children with muscular dystrophy and a physician-scientist studying the disorder.” Whoever helped jump-start and manage the organization did an excellent job. The MDA is incredibly visible and vocal. The website lists abundant corporate sponsors: 7-Eleven, Taco Bell, 7UP, Harley Davidson, etc.. The telethon attracts the public eye with its celebrity hosts: this year alone Celine Dion, Boyz II Men, Jennifer Lopez, Barbra Walters, Whoopi Goldberg, and Dwight Howard donated some face-time.

I want to know how the MDA is so successful and how this success can be transferred to other conditions.

Physician scientists in-training learn how to do science: research, generating data; write grants, acquiring funding; write papers, publicizing our findings. Physician scientists, for the most part, stick within that system, writing grants and papers. I want to know how things work outside of the system; how the government and private institutions obtain funding; and how they fund the research that interests them.

A recent and interesting example of organization-driven research is the California Institute of Regenerative Medicine (CIRM). CIRM, California State-funded research initiative, was passed in 2004 as Prop 71. Over ten years, CIRM will distribute three billion dollars worth of grants to human embryonic stem cell researchers. While CIRM has not provided any immediate cures, it has driven a lot of fascinating basic research that would have not been funded in past years due to the controversial Dickey Amendment.

How did CIRM come into existence? With a lot of hard work, money, and star power. See Robert Klein, Bill Gates, Micheal J. Fox. Maybe it's time for me to start networking... I do live in LA.  

Sunday, August 28, 2011

week 2 goals

Goals for week #2 of peds (outpatient for two more weeks):

1. Don't make any more children >7 years old cry.
2. Introduce more kids to the Tickle Monster. (The lucky few who have been introduced are more than a little amused by him).
3. Use more suckers/stickers bribery.
4. Figure out how to seem cooler to adolescents (Probably impossible).
5. Keep wearing bow ties.
6. Don't get sick (Good luck with that).

Thursday, August 25, 2011

Pediatrics

It's sort of like seeing my entire childhood flash before my eyes, every day, for the next six weeks. What a trip.

Friday, August 19, 2011

Random thought while studying for a Shelf exam

I really like third year.

Sunday, August 07, 2011

Third year update

One month complete.

Each time I actually sit down to type up reflections about third year, I get all stressed out because the great insight had earlier is now gone. And so I sigh and go back to my reading. Or just sit and stare and think. Out of the blue another reflection comes along, and then before I am motivated to sit down at the computer, it too fades out. So then I'm left with a series of strands, unarticulated ideas; incomplete sentences. Which is to say, this will be appropriately scatter-brained.

The last month has felt like an eternity. My fellow med students keep remarking about how fast one month went by. Not so for me. One month has felt like one year. Not to get dramatic about it, because really that's not the point, but the clinical years of medical school are different than everything that came before. That constitutes one reason for third year's difficulty. It's just a steep learning curve -- learning to round on, examine, take histories from, develop plans for, and answer questions of one's patients, while working as part of a team where your role is entirely redundant and usually slows things down, and then finding time to go home at night and fill in critical gaps in knowledge, skill, and understanding. And then arriving the next day, rested, and ready to absorb more information and get just a little better at the other stuff. It's endless, and perhaps third year is one of the most humbling times of my life. Or it, better yet, makes the "constantly humbled and fine with it," the default setting from now on. Because as far as I can tell, third year of medical school is just the start of realizing how little we know and how far we have to go. It's deja vu all over again, because I felt exactly the same way at the beginning of this program in 2006. It's the same, rinse and repeat.

The extent of my naivete is overwhelming at times. It usually happens in the setting of a false light-bulb-going-off: I feel so sure that one thing should be done a certain way because I've done the hard work of thinking through a process, a treatment strategy, an investigative approach to a problem, and then I am gently corrected that in fact the opposite scenario is correct, and this is all for a series of very plausible explanations that I had not even begun to think of when I was crafting my alternative reality. So that's a scary moment, because I plead with the powers-that-be that this won't happen when more responsibility is in my hands.

Of course it's rarely so clear-cut such that I'm completely wrong, and in fact often several steps of my logic are decent. And that's when positive reinforcement of the entire process is crucial. You learn from what you did right, or that which you drummed up using sound logic, and the hope is  that the next time you amplify the good and squelch out the rest. As an example, in the OB world, there's a very scary group of conditions interconnected by their potential harm to both mom and fetus: Preeclampsia (gestational hypertension plus proteinurea) and HELLP syndrome. From what I've seen so far, the typical presentation of these diseases is found only in a textbook, and patients have slightly to significantly different presentations, and this makes deciding what to do for each patient such a challenge. When do you emergently deliver? When do you admit for further observation? What tests do you order and in what frequency do you follow them? How are decisions about ante- and post-partum care made? Much of the time, because the adverse outcomes in these pregnancy associated conditions are potentially so devastating to mom and fetus, one can't learn by seeing the adverse outcomes. Rather, prudence and a keen awareness of how to spot early warning signs is the learned skill. So we have to use our imagination, imagine how bad it would be for a woman to seize in pregnancy, and prevent it before it becomes a reality. And in what we hope will be events spaced far apart, never let important lessons be missed when things go terribly wrong.

At least that's the hope of this all. I suppose the key point here is that medical school in the third year is a lot about learning to triage -- to assess what's really dangerous to a patient and what is relatively benign. To at least get the "this is serious" vibe right is all we're being expected to do at the moment. The more subtle refinements come along the way. But for now, it's learning to triage, to learn the difference between a mountain and a mole hill.

And life gets a bit triaged as well. Not much more to say about it than that -- there's less down time, more structure, and in a way that's the best litmus test for deciding on whether a specialty is right. You either manage to enjoy your life outside the hospital and can get everything else taken care of, while also getting sufficiently rested, such that said specialty is The One. And if everything can't be satisfied appropriately, other options are entertained, or the grumbling begins. But it's fine, may as well deal with triaging from the beginning of the clinical years. And more than anything else, the bottom line is that it's not that bad. It's not easy, but it seems like things will work out.

Sunday, July 31, 2011

Summer time and OB living is easy

Well that's sort of a lie. But third year started out with a bang: Gyn surgery, followed by the obstetrics service, at Olive View Medical Center.

A few tidbits (longer post to come at end of rotation):

--I hate myself for taking French growing up at the expense of my Spanish.

--Love the OR. Love it.

--The birth of a baby is pretty neat, either naturally or by C/S. The first screams are oddly reassuring and wonderful to hear.

--Being a third year med student is a weird balancing act.

--Did I mention I love the OR?

Friday, June 10, 2011

New normal, continued

A new piece on Gabby Giffords sheds light on the continued struggle of adapting, and improving upon, her new normal, post-traumatic brain injury. Seems like there's a long way to go...

Monday, June 06, 2011

On the occasion of recently filing a doctoral dissertation

There are two primary steps to officially filing one's doctoral dissertation at UCLA:

1. Bring the following documents to Murphy Hall, Graduate Division, Room 1225: The doctoral dissertation approval form, with the title matching the dissertation title exactly; this form shall include the name of the committee chair, spelled exactly as it appears in the dissertation. The candidate's name, too, includes in the precise form in which it appears on the University Records System Access (URSA) computer system. Along with this, bring a title page of the dissertation, the dissertation approval page (not to be confused with form), which is page iii of the dissertation. The names of candidate and committee members must match exactly with those on the final oral defense approval form, which, by the way, should have been sent to Murphy by the graduate department in which you completed your doctoral work, upon passage of the final defense. However, if filing close to the same day as defending, this form may be brought by the candidate. Also, bring printed-out verification that one has completed the Doctoral Exit Survey (through UCLA) as well as the Survey of Earned Doctorates (through an outside organization), both online.

2. Once these documents are approved at Murphy Hall, proceed to the Young Research Library, Thesis and Dissertations Office (on the second floor of the library), and bring the following: 1) two (2) manila envelopes, each containing a full copy of the dissertation, with the approval page (iii) being a copy of the original, which was submitted above to the Graduate Division in Murphy Hall. Each envelope should have a copy of the title page taped to the outside; 2) one (1) manila envelope (title page taped to the outside as well), containing copyright forms for ProQuest (must be signed), a copy of the title page, a copy of the abstract page (remember, the title on the abstract page must match exactly the title on the title page, which should in turn match all forms; they will most certainly verify this).

On Thursday, June 2nd, I completed the above two tasks, successfully, at which point I gave the UCLA Registrar's office the fully-signed Doctoral Dissertation Approval Form, which they took from me; ten minutes later, they returned to me a new form, this one stating, "Let it be known," that I had completed all the necessary requirements for becoming a Doctor of Philosophy in Molecular, Cellular, and Integrative Physiology.

"Congratulations, you're all done."

That was it, the form was in my hand; at that moment, I stood alone in Murphy Hall, finally having earned my Ph.D.

How fitting, that the actual moment included no fanfare, no one next to me, in front of me, or behind me. It just, sort of, happened.

And with that, I returned to the lab and began to pack up my desk. The end of one stage; the beginning of another. One cliché after another...

I also know this all sounds sort of melodramatic: "Ooooo, loooooook, a Ph.D.; what does it mean? How does it feel? What a moment. What a moment? Too self-aggrandizing? Too self-congratulatory? But what's in a moment anyway? And it's not like I'm any different than I was yesterday. But I kind of am. Am I really satisfied, or is it just because I should be? Do I really feel like I deserve it? etc etc etc."

But I digress in trying to present a few of my many internal dialogs of the past few days. In truth, I think, the main thing is I am relieved to be done, and I am perplexed: I am, in fact, as happy as I thought I would be, being done with my Ph.D. Not any more, not any less -- just as exactly content as I envisioned. Strange, because it seems that throughout my life, I usually over-expect or under-expect; I over- or under-speculate. Not this time. I am simply content.

Over the weekend, I signed a single email with the suffix, "Ph.D." By the time the "Undo" option on gmail had disappeared, I wished I could have not done it. It seemed really toolish. I'm not sure what this little personal anecdote means, but I guess it suggests I won't be signing emails to my like that friends anymore. Just once. It was more than enough; in fact, too much.

I guess my final point here is that the occasion of finishing one's doctoral dissertation is no different than any other "milestone" - like graduating from high school, undergrad, medical school, whatever - but there's an added sentiment in the case of a Ph.D: relief, and an acknowledgment of good fortune. Doing a doctoral degree requires research that is ostensibly successful, and I came to see how, at many steps along the way, I was just plain lucky. Things worked -- experiments yielded interpretable results, new insights were made, and stories primed and ready and successfully submitted for publication. Yes, I worked my ass off, but I was lucky. I also had great teachers, great collaborators, endlessly patient family and friends, and an institutional framework that supported what I was trying to accomplish. The United States Taxpayer supported me through my fellowship funding. I am blessed, through and through. Now I am eager to peel away to the next layer. Medical school, its years three and four, awaits, and I am stoked beyond belief about going back to thinking about medicine full time. It's been three challenging years, and now, onward.

It's been a great ride. I'm at the "right" place. Thanks for the fun, y'all. Let's keep it going.

Sunday, June 05, 2011

Out of the woodwork

Many congratulations to all the newly minted MDs and PhDs. A specific shout-out goes to ours truly, Chuck C, who finished his PhD at a torrid pace. Chuck, a job well done; now on to the wards and more boards! I haven't garnered any degrees yet. I did finish my first year of graduate school, though, which I'd like to think is a milestone. I don't have much to show on paper for this past year, but I've gleaned that this is quite typical.
As Chuck has alluded to in previous posts, graduate school is a time of personal growth inside and outside the lab. Some times the inside-the-lab growth bleeds into the outside-the-lab growth and vice versa-- I've had a lot of time to think about science, myself, and the people close to me. While I believe that this type of introspection and learning correlates with age and the reflection of our collected experiences, graduate schools feels like an incubator for these personal exercises. This is my personal experience, though. Unfortunately I do not have parallel-universe-Anthony controls. And I'd love to share examples with you, but I can't. It's not that I'm unwilling to share. It's more like I don't know how to share-- I'm in the midst of it.
With that said, I bid this blog adios. I will make no promises to post more consistently. I've already broken that promise. I will post when I can. Till the next time, Anthony.

Monday, May 23, 2011

Spinal cord injury repair update

Reggie Edgerton, and collaborators at U Kentucky, have successfully helped a paralyzed man regain some function in his lower extremities -- both with motor control and autonomic function -- thanks in part to the years of work Dr. Edgerton has done at UCLA in the study of spinal cord "learning," repair, and re-learning. Expect more to come from this work in the future. UCLA is an exciting place to be.

Tuesday, May 10, 2011

Losing one's voice

Christopher Hitchens is dying of esophageal cancer. Despite his diagnosis, grim prognosis, and aggressive treatment course, he continues to write, principally, for Vanity Fair. His most recent piece waxes about losing his voice, the inevitable result of the cancer interfering with the function of his recurrent laryngeal nerve. But never mind the anatomy, this is a beautiful piece, and more reason that I love the work of, and the man who is, Chris Hitchens.

Wednesday, April 27, 2011

Not surprising, but still...shocking

Have you seen this? Getting chronic disease management/prevention under control are essential to any plan overhauling health care in this country. It's one area in which "ObamaCare" got it right. We'll see how the pilot projects play out and whether they are fed into mainstream (i.e. medicare/medicaid) health care delivery.

Monday, April 25, 2011

Remembering a photo-journalist

No one life is more valuable than another. Yet people have talked extensively about two photo-journalists who recently died while covering the fight for Libya. Indeed, there is something haunting, deeply saddening about someone dying while trying to cover the horrors of war. In an effort to bring the carnage to light, photo-journalists are not immune to the dangers of their work. Although this is off the topic of medicine, it is certainly a reminder of our mortality and the sacrifices involved in dangerous work; this moving tribute to Tim Hetherington struck me especially hard.

Wednesday, April 20, 2011

Is sugar toxic?

A perspective on sugar - refined cane sugar (sucrose) or high-fructose corn syrup - and some of the current research into the havoc it wreaks on the body. Worth a read. The research isn't entirely convincing, but again, why take the chance by eating simple sugars in excess? Regardless of whether everyone who eats large quantities of sugar or not gets diabetes, it's not healthy to binge on the sweet stuff. So again, it's worth a read.

Monday, April 18, 2011

"New Normal"

It has been some time since the tragic Tuscon shootings of January, 2011, and much of what needs to be said was covered elsewhere -- the tragedy, coming together, partisan bickering, blood libels, etc., etc. -- but I am interested specifically in Congresswoman Gabrielle Giffords' remarkable recovery progress. Anyone who has followed the news since January has seen the numerous news reports on a rapid recovery: holding her husband's hand, following commands, breathing on her own, opening her eyes and tracking movements, speaking, asking questions. It all sounds very good, heartwarming, and promising. Gabby may even be back to work in the House of Representatives one day, and she may run for the Senate seat, soon-to-be vacant due to John Kyl's retirement.

But what is her recovery really like? What happens when the rhetoric (101% chance of survival, remarkable progress, determined, brave, courageous) is replaced by realism? What is Gabby's "new normal"? Though difficult to read, this piece in Newsweek attempts to paint a realistic image of what a life of intense rehabilitation is like. There's no discussion of the Senate seat, and, I think most importantly, there's been little discussion of what happened on 8 Jan, 2011.

And it makes sense not to force the discussion on someone who probably has many, many questions but who, because of the ongoing rehabilitation, lacks the full capacity to ask these questions. But this is nonetheless important, because it speaks to the magnitude of the change in Gabby's life. The New Normal is very different from 7 Jan, 2011.

Although Gabby Giffords' story is one of the most high profile post-traumatic recoveries in recent history, her New Normal is similar to that of a war veteran, accident victim, or anyone recovering from a catastrophic injury or illness, regardless of the cause.

Update: 4/25/2011 -- another piece, from the Arizona Republic.

Offer stands

People considering UCLA's MSTP, feel free to comment, email (MSTPLA at gmail dot com), or get in touch w/ us through the UCLA MSTP's official website.

Friday, March 04, 2011

Man, this sucks

High school basketball player makes game winning basket. Then collapses and dies.  It's a cruel world.

Update (4:42 PM): this wasn't unexpected, but still sad - the deceased player had dilated cardiomyopathy.  Although hypertrophic cardiomyopathy has a greater prevalence and is more often a cause of sudden death in young athletes, DCM can also lead to untimely deaths.

Thursday, March 03, 2011

Monday, February 21, 2011

This week in Chronic Traumatic Encephalopathy

Dave Duerson committed suicide last week. That he was a successful NFL safety and businessman in retirement alone justifies the reverberations felt throughout the sports world.

Then there's this: Dave shot himself in the heart, not the head. He suspected the depression with which he suffered mightily in the final years of his life was connected to a career filled with jarring head trauma. So he wanted a post-mortem examination of his brain, believing that he was afflicted with chronic traumatic encephalopathy (CTE). Although the results have not yet been revealed, I suspect they may show the hallmarks of CTE.

Until the results are released, and no doubt in spite of whatever the diagnosis, the NFL remains big business. But what happens in the wake of successful careers is nothing short of astonishing; not to mention tragic.

YOU try the individual market

NYTimes linking begins again.  This time, one well-off, healthy family of three tries to get insurance in the individual marketplace and BOOM, epicfail.

Look, I'm not saying I think ObamaCare is the panacea to our problems with health care. Many of the criticisms (other than "socialized medicine", "death panels", "bankrupt our country", etc) are valid. But have YOU tried recently to get healthcare? Any congressmen/women trying?

Crickets.

Thursday, February 17, 2011

Last symposium as a PhD student

Holy crap, tomorrow is the last MSTP symposium I will attend as a PhD student.  Next year, I'll be a third year medical student.

In some ways, time has flown by quickly; in other ways, it's gone by very slowly.  ~5 1/2 years at UCLA, and still ~2 1/2 to go.

I have a boat-load of work to finish in the next few months for this all to be realized, and according to some of the powers-that-be, "productivity" has "declined" over the past few months.  So be it; point taken.  Finishing is indeed a challenge, and in many ways since I turned in the "return from leave of absence" form to the medical school, I'm psychologically had one foot out the door w/r/t being a graduate student.

All that said, I can't complain.

Oh and I get a chance to talk about my research at the symposium tomorrow as one symposium speakers, which is both exciting and daunting: it's challenging to convince people what you do is interesting and very important.  In reality, it's all just another variation on the same theme of nitty-gritty, slow-and-steady work-- character building.

Wednesday, January 19, 2011

Batshit crazy

Amy Chua confirms what some people have told me about Chinese mothers.  I'm not rendering an opinion about all Chinese mothers, but Chua is clearly, by her own admission, batshit crazy.

And I'm not the only one who thinks this.