Orientation

Today is the start of orientation for the new class of first-years at Mt. Sinai, and so an extra 120 well-dressed students are running around Annenberg today trying to fill out all their paperwork and get ready for classes to start. I think this officially makes me a second-year, because like it or not, I can no longer be a first-year student. For some reason I am not all that thrilled to have a younger group of students at Sinai-- I think I was finally getting used to my role here (as the bottom of the barrel), and faces had started to all look familiar. It's not so much that I look at the new students as competition, per se, but it's more of a realization that things are changing. I think I am also concerned that once second-year starts, things really won't slow down until after the match in 2009, which seems like an unbelievably daunting task.

The days getting shorter and shorter...

I (*hopefully*) finished the data collecting phase of my summer research project, so today I'm able to stay at home and do some of the data analysis on my laptop. I just picked up an Orson Welles film, so that is playing in the background. It's definitely not as hot today as it was last week, but in my living room it's still on the warm side.

I have a meeting with Dr. Richardson tomorrow, I'm hoping that we'll get somewhere with the data analysis part of the project. I'm around for another two weeks before leaving for Toronto, and it would be great to be working on the manuscript by then. We'll see what happens-- while it's been a bit nice to work at my own pace, the project started slowly and now I have to play a bit of catch-up.

I was looking through the latest Time Out New York, and for some reason there didn't seem to be too many exciting things happening these days in New York. The SummerStage schedule wasn't very good this year and there weren't too many free events that caught my interest. I don't know, maybe I just didn't take advantage of all the things the city has to offer. I did get a chance to see Corteo and Macbeth at Shakespeare in the Park, and of course I took those trips to Brazil and to Germany for the World Cup (which was amazing). And I did move to my new apartment and started going to the gym regularly (we'll see how long that lasts) , but that's been about it. Over the last few weeks I have been spending some time with old Columbia friends, mainly because Anu is leaving for graduate school in Dallas in a few days, and we've been trying to catch up before she left.

Last Friday I shadowed Sigrid Hahn in the Sinai Emergency Department for a number of hours. She is great to shadow, because she explains things really well. I had the chance to take a few histories and present the patients to her. There was a lady having an acute stroke, two guys with heroin overdoses, and a few elderly patients with heat-related complaints. I had a really good time there; I wasn't used to juggling all the different patients at once, but I felt that I could do a reasonable job obtaining histories under those circumstances, and think about potential plans of action. I'm hoping to shadow a bit more during the year, but it'll all depend on how much time I will have to do that.

We got an email from Mt. Sinai today saying that our schedule for next semester is on Web-Ed already. That coupled with the fact that I just ordered all the textbooks I'm going to need (a paltry $600), these summer days seem to be drawing quickly to an end. On the one hand I'm a bit excited about moving on to the next step (first-year is only good enough to get your feet wet), but on the other hand... I am worried about what happens when the ball starts rolling-- it'll never stop.

Heat Wave

I guess the time around final exams in not very conducive to finding time to write on this blog-- this semester in particular, with so many things going on at the same time: exams, birthday, moving to my new apartment, going to Brazil, starting my summer project... I'm in the East Building right now, trying to stay cool during this summer heat waver that we are having. I'm working on this health disparty project in the Emergency Dept. with Dr. Lynne Richardson, which began with a slow start, but is finally starting to pick up speed. I don't know how much will actually be done by the time unofficial deadline of August 13 (the day the project abstract is due), but we'll have to see. I know that at this point, I'm just going to have to put in some long hours to get the dataset completed on time.

I go back and forth as far as staying in New York is concerned. On the one hand I like being able to slowly put my new apartment together and lead a relatively relaxed lifestyle for a few weeks. Plus, it's not like I'm spending every moment in NYC this summer-- I spent a week in Brazil, a week in Germany for the World Cup (which was amazing, in spite of the fact that Brazil didn't make it to the semifinals), and I will be ging to Toronto/Montreal/Detroit at the end of August. Still, I get this sinking feeling that it would have been better to get away for a longer period so I could be a little more refreshed by the time school starts up again in September. It promises to be a tough year-- and a tough three years for that matter-- that I wish that I was spending a little less time inputting data into a computer and a little more time doing fun things. There are so many things happening in the city this summer, and I sort of regret not taking more advantage of them. I did go see the Shakespeare in the Park production of Macbeth with Liev Schreiber a few weeks ago, and last night I went to see the Philharmonic in the Park with a bunch of people from Sinai. It was nice, especially the fireworks at the end, but on the way home we got caught in a torrential summer downpour that left me drenched to the bone. I want to make sure I do more things like that though.

I also had all these big plans for finally putting together my photography website, which has been many years in the making. I don't know if it will actually make it off the ground since I'm still in the research phase, but I don't know when I might get a better chance. I've got about 4 weeks to figure all those things out.

I'm CMing this Saturday for the time time in months; I know I'm going to be rusty but I'm just hoping that I will remember all the things that I have to do. It'll be nice to get back into a clinical setting, since I haven't really had that chance with my summer project.

Farmer and the Pathologies of Power

Yesterday I took part in a conference call with Dr. Paul Farmer through the AMSA Global Health Scholar Program. Just as he was when when we met last Friday, Paul was extremely warm and receptive to to us and our questions. Or conversation ran the gamut of global health issues, from his projects in Haiti and Rwanda, to the best ways to develop global health interventions, to how to galvanize national governments and multinational organizations, to questions surrounding human rights and morality, and much more. It was a wonderful conversation and it was such a priviledge that I had the opportunity to take part in it. I am debating on whether to contact him at some point, but I'm not sure if I would have the opportunity to work with him.

I have another interview next Wednesday with the TB Alliance. Hopefully I will be able to finalize some type of project with them for this summer. I am not sure how I'm going to juggle all the plans I have, but I would really like to have a global health component to my summer.

In other news, we just found out that one of the students in my medical school class passed away last week. We don't know what she had exactly, but we know there was a congenital disease that also took her mother's life. When her health problems worsened, Sarah took ths Spring semester off in order to rest. She passed away at her grandmother's house in Massachussetts. There was a memorial service for her yesterday at Mount Sinai, and a number of students and faculty who knew her spoke.

Yesterday we also found out that one of my roommates contracted tuberculosis. He had a positive PPD and so they did a chest xray, which also came back positive. Now they have to culture his sputum to see what strain it is, and then he will most likely be put on isoniazid and rifampin. It's pretty wild that something like that would happen, especially since he had a negative PPD last July. He's worried about it, and let his family know that they should also get a PPD test done.

A YEAR?!?!

I just took my midterm exam in Pathogenesis and Mechanisms of Host Defense, which means that only three final exams stand between me and second-year (those being Path, ASM, and PMHD). As the end of first-year is quickly coming into sight and I can count the last assignments I still have to do on my fingers, I thought this would be a reasonable time to think about what has happened in the last 11 months. About a year ago I was putting the finishing touches on my Master's Thesis (I think it was due a year ago this Friday), and I was getting ready for graduation. That was such a crazy time, when I still didn't know where I would be going to medical school (NY... Miami... anywhere...). Soon after I accepted the spot at Sinai, I started the SEP program. While that program was a great practice for the actualy courses we'd be taking in the Fall, it was all still surreal to me. When classes actually started and we met all the rest of the students, things started to move really quickly. I remember the first time I volunteered at EHHOP I was scared to even touch the patient... now I almost feel like I could do the whole history/physical on my own (as I did countless times in Belize). This year I dissected two cadavers, got the opportunity to be an AMSA Global Health Scholar, spoke with Stephen Lewis, met Jeff Sachs and Paul Farmer, saw Bill Clinton speak, went to Belize, and am closing to having a paper published. It has truthfully been a roller-coaster ride, and I definitely would not have thought so much would happen in this year.

The End of AIDS: the CNN Special Summit with President Bill Clinton

Saira and me with Paul Farmer

So last week Tina (the AMSA GAF) let us know about an opportunity to attend the CNN Presents Special Summit with Bill Clinton called The End of AIDS: A Global Summit (I'm not sure how long the website will be up, but for now it's here). It was being beld at the Mother Zion church in Harlem, and AMSA was given a bunch of seats in the audience. Since it was being held so close to where I live, I figured I couldn't pass up this opportunity. I skipped out of an Epi small group that I was supposed to run and went with a few other Sinai students. The show was set up as a conversation between Dr. Sanjay Gupta from CNN and Clinton, with thoughts from "panelists" interspersed in the conversation. The panelists included Dr. Helene Gayle of CARE, Bill Roedy of MTV International and the Global Media AIDS Alliance, activist and actor Richard Gere, Dr. Zeda Rosenberg of the International Campaign for Microbicides, Dr. Paul Farmer of Partners in Health, the Chairman of Pfizer drugs Hank McKinnell and the director of Doctors Without Borders. The focus of the program was the international span of the HIV/AIDS epidemic and it centered on a model of how to realize the goal of “a world without AIDS” in 20-30 years. It was very interesting to see how a show made for television is organized-- I haven't seen the final product on TV yet, but I'm really curious to see how they put it all together. At the end we had an opportunity to meet Paul Farmer and have our pictures taken (as you can see above). He was just the most friendly and approachable person... we're also going to be talking with him this coming Thursday. I am really excited.

What we learned in Belize

At the Clinic in August Pine Ridge, April 11, 2006

I really don't know where to start with this post. The problem with writing all of this down now is that it is all in retrospect, and I'm afraid of losing some of the emotion that was felt during the whole experience. Suffice it to say, going to Belize was an amazing and inspiring experience of self-reflection and personal growth, and really solidified some of my beliefs, desires, and understanding of myself.

On the one hand, I am fully aware that the one week trip cost up to $70,000 not to mention hundreds of hours of collective time and effort put in by the students who went on the trip, and in the end, very little was actually done on a tangible level for the people we saw and treated in Belize. What they need is far more than what a group of 50 students and doctors from the U.S. can give in a week's time-- they need what everyone living in apparent poverty in developing countries need: economic and human development, access to care, and the education to take care of themselves and their communities. Still, all the interactions that I had with patients while we were there makes me believe that we made a contribution, even if it is no more than just a dent: the 2000 patients we treated both in Orange Walk and in San Ignacio responded to us with nothing but appreciation and thanks, giving me the impression that a.) they are in desperate need of some coherent health care system, and b.) every little bit helps. I don't think I am wrong about that. I left the trip feeling optimistic not only because it came off more or less without a hitch, but because I felt like there was an exchange, albeit skewed heavily in our favor.

Working in the clinics in Belize was everything that I live about medicine. The medicine was simple, and the intention was clear: to provide some care to people that would normally have a much harder time obtaining it. We weren't curing anyone of anything-- in fact, in general all we could do was alleviate some of the pain with over-the-counter drugs. I think on some level though, they also wanted us to hear their stories and try to be sympathetic.

Last week was the first experience I had had where I felt like I was actually "taking care" of people. I know that what I did wasn't much, but there was something about the history taking, brief physical exam, presentation to the physician, and dispensing of the medication that made me feel like I was involved in the whole process of treating people. And by the end of the week, I actually felt like I was actually able to diagnose most of the patients I spoke with, and had an idea of what to prescribe. I think this is nothing short of amazing considering all of my exposure to medical treatment is from EHHOP and from my ASM clinical sites.

More importantly though, I think this trip has helped me to make my own interests a little bit clearer. My experience in medical school thus far has been by and large to decide I am not interested in the fields that we are exposed to rather than to really enjoy them. There was a moment on the first day of clinic in Belize when I was walking from lunch back over to the clinic that I realized that I was really enjoying what I was doing, and that it was something that I could actually see myself doing in the future. That has happened very few times in my life.

In the end, I know I didn't cure anyone of what really ails them. But I did learn a little bit about myself. And I got to know some great people a bit better too. The people on the trip are some of my favorite in my medical school class, and it was really great to spend that week getting to know them. I have a feeling that we all had a shared experience that will make us closer.