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.

CMing

Going to take a quick break from studying physio to write a little bit about CMing at EHHOP today. It was my first experience being clinic manager, and I definitely felt unprepared for it when I got the phone on Thursday from Matt and Jeff. They explained to me all the things I had to do prior to the start of clinic on Saturday, and then what the day was generally going to be like. I called all the patients and got a little worried when I got in touch with less than half of them, but there wasn't much I could do about that. On Saturday morning, the two second-year CMs that were keeping an eye on me were really nice and did a great job of letting me run everything while making sure that I did all the things that I needed to do. There were a bunch of odd things that happened right off the bat (us having to use the Geri area instead of Medicine cause it was being painted, we couldn't find any of the files we needed because they were stored somewhere else, the websites were all down...) but we kind of went with the flow, and the teaching seniors were extremely helpful. I really enjoyed setting up the clinical teams and having them ask me questions about procedure or telling me about how they thought their cases were interesting. We had a little backup of patients around noon because we were waiting for Spanish-speaking seniors, but in the end I think it all worked out. Everyone got to see a patient, and most of the interviews went off without a hitch. I checked everyone out and closed up shop by 4:45, and was back by 5. It was also cool to spend some time with upperclassmen as they talked about second year, what sites to choose for third year, etc... It's good to get perspective from people outside of our first-year class once in a while. Now I have the EHHOP phone for the next two weeks because next weekend is the community health fair, but hopefully I won't run into any difficult cases. I think the next time I'm CMing I'll have a much better idea of how to direct people's questions (as opposed to having to confer with the teaching senior all the time to make sure I wasn't any wrong decisions).

Lack of Communication

In an effort to make this blog more intellectual (and less a recounting of everything I do during the day), I thought I'd start responding to articles and news that are medically pertinent. The first one I want to talk about is a actually a blog entry by a Dr. Brent Ridge, who happens to be a geriatrician at Sinai. Here is the link to the blog itself, but in case it gets taken down at some point, I am including the text here (it's not too long):

*********************************

Do you ever leave the doctor's office feeling a little unsatisfied with the visit? Are you ever frustrated by a conversation you've just had with the doctor? Do you ever think the doctor was outright rude? You're not alone. In this blog, I thought I'd try to convey the doctor's perspective. Being a caregiver for a sick relative or loved one is a difficult and often thankless and unrewarding job. More and more, physicians are feeling the same way.

To our discredit, doctors do have the habit of doing more talking than listening. Unfortunately, this has only become worse as managed care has strictly curtailed the amount of time each patient has with his/her doctor. While doctors do try to spend as much time with their patients, this time pressure constantly forces doctors to ignore the patient's own emotional health. Truthfully, if the doctor actually spends any amount of time at all addressing issues of the caregiver's sanity and emotional well-being, you should count yourself as very lucky.

However, I can't place the blame for the lack of communication solely on the doctor. Let's face it-- we are all human. Patients (and their caregivers) are not perfect, and also contribute to the lack of communication. In one survey doctors rated 15% of their patients as "difficult." Disagreements involve everything from expecting an instant cure to demanding prescriptions.

Patient and caregiver qualities described as "frustrating" by doctors:

• Do not trust or agree with the doctor. (You need to at least give your doctor the benefit of the doubt. After all, you are there for his/her advice.)
• Present too many problems for one visit. (I understand you are trying to make the most out of your visit; however, please remember, there are 15 more patients waiting right behind you.)
  
• Do not follow instructions (Again, you asking for your doctor's advice. What's the point if you don't follow his/her advice and instructions?)
  
• Are demanding or controlling. (Doctors are there to work with you to stay healthy--- not work for you.)
  
• Present themselves as overly helpless (You have to give your doctor some guidance in order for him/her to help you)
  
• Make a melodrama out of every symptom (Yes, it is important to let your doctor know every symptom. However, over dramatizing each one can be counterproductive. If you do so, your doctor will not be able to gauge which symptom is more relevant in determining your illness)

Despite the common saying that the "squeaky wheel gets the grease", that's not how it tends to work with the doctor. Studies have shown that patients or families who make too many demands on the physician's time ultimately get less attention.

*********************************

I thought this was an interesting point that Dr. Ridge makes. We often hear reports of how doctors don't listen to their patients, about how doctors don't make decisions with the patient in mind, and how in general a visit to a doctor is an unpleasant experience. Dr. Ridge remnds us that the visit is really a two-way conversation between two people, each who has his or her own thoughts, ideas, prejudices, and expectations. It's only by really opening this dialogue that you are able to really have an effective doctor's visit. This, unfortunately, often gets lost, especially when physicians are under pressure to see as many patients as possible.

Saying goodbye

I'm sitting at DT-UT having a cappuccino, taking it easy and enjoying the end of Histo. Stacey's in Uganda this week working on an AIDS orphan project, and I don't really have a lot of work to do for tomorrow, so this is the perfect chance for me to get out of the Mt. Sinai area and do something different (and yes, going down to 2nd Ave and 84th St IS doing something different, since it seems that whenever exam time comes, I don't ever leave the 3 block radius around Sinai). I would probably be up to doing something even more exciting tonight, except that I'm recovering from a cold that I've had for the last few days, and fifteen blocks is about as much as I can muster right now.

Tonight we had a closure ceremony of sorts for our Anatomy class... even though Anatomy ended three months ago, this was the first time that was available for us to reflect on the experience we had in Anatomy and say goodbye to the cadavers we worked on all last semester. About half the class showed up for it, and it was a very solemn experience, with a number of people having some very sincere words to say about what the experience meant to them. Some people read poems or read things they had written about the experience, and others just spoke about what came to them. I hadn't planned on speaking, but when we were asked if anyone had anything to say, I decided to make a few comments about what I thought Anatomy had meant to me. I spoke about a conversation that I had had with Eric towards the end of the Anatomy class, where he had said that throughout his life, he had always been alright with being ignorant about the things that were inside the human body. After Anatomy, though, I think we all have a different appreciation for what makes up the human body, and may never see a person in the same way again, which in itself is pretty significant. After everyone who wanted to speak had spoken, we went into the Anatomy Lab and lit some candles while Patrick played a piece on his clarinet. It was a rather emotional moment, and a number of people were crying, or at least trying to hold back tears. I thought it was a very fitting end to a course that was a very significant part of the medical school experience. Truth be told, I think I might not have thought enough about the whole cadaveric donation process and what it all meant to the people who donated their bodies and their families, but in the end I am very glad that we learned Anatomy in the way we did. Anything less "hands-on" would have taken away from the full experience.

Tomorrow is the last day at our first set of ASM clinical sites, which have been been a really enlightening experience. I think the things that we are attempting to learn in ASM are only truly learned through the experience of interacting with patients, and so I've really appreciated the time that we're spent with Dr. Serlin. I know that we'll have plenty of time to do all of this ad nauseum in future years, but I think it's really important to get a sense of why we are all going through this process, even at this point.

I am also meeting with Dr. Zier tomorrow, the person in charge of medical student research projects. I'm trying to work something out with a professor who is doing health disparity work in the ER, but she hasn't gotten back to me yet, and I am hoping that Dr. Zier can help me out with setting something up. At this point, I'm starting to feel like I don't want to deal with the stress of setting up some grandiose summer project; instead, I'd just like it all to be figured out already. There have been too many extraneous things to think about so far this semester.

Tomorrow night I'm having a conference call for the AMSA program with Stephen Lewis, the UN envoy on HIV/AIDS. He worked at the Earth Institute while I was there, and I saw him speak a number of times. He's an absolutely phenomenal speaker, and I'm excited about getting the chance to speak with him. The topic is on women's health and HIV, and I think he'll have a lot of interesting things to say.

Alright, I think it's time for me to be heading home. I've got some Belize emails to send, and I want to get ready for my meeting with Dr. Zier tomorrow.

What renal physiology, the global TB epidemic, and esophageal varices have in common

Stumped? Well, I won't keep you in suspense any longer: renal physiology, the global TB epidemic, and esophageal varices are all related in that I spent a very long day yesterday dealing with them. I started off with two hours of Dr. Hanss' physio lectures, and then rushed over to Columbia for the TB Alliance Reversing the Tide of Tuberculosis symposium. The symposium was held in Low Library, which was kind of exciting since I had never actually been inside the building while I was studying at Columbia. Jeff Sachs opened the conference, and then a host of familiar faces were either involved in the presentations (i.e. Josh Ruxin, one of my readers for my Master's Thesis, was a moderator) or as audience members. There were talks from drug and diagnostic development companies, the Vice-Minister of Health for Mexico, as well as many others. On the whole the presentations were interesting, though the symposium was running late so they constantly had to cut people short, and there wasn't as much discussion and I would have liked. Still, the TB Alliance is a group I am interested in working with, so this was a good look at what the group does. I had wanted to stick around after the symposium to try and talk to some of the people who work there, but I had to run off to the train so I could get across town to Elmhurst.

I got to the ER at Elmhurst around 6pm, and things were relatively slow. There was a patient dying of COPD with a DNR in the trauma room, and the whole family was around and emotional. The wife actually was making suicidal comments, and wouldn't let go of a bottle of morphine that she threatened to drink, so psych had to be called down to evaluate her state. The husband was sent off to hospice care upstairs so he could be more comfortable. Dr. Okuda was extremely helpful and willing to talk through some of the cases, and offer a perspective of what life is like in the ER. I really enjoyed the time we had to just talk about how things are run down there. I also got a chance to spend some time with Dr. Clint Masterson, who is an ER resident that is coming on the Belize trip to OrangeWalk. He was also extremely nice, and let me hang around while he was taking care of some patients. When the ER finally got busy around 7:30pm, we saw a woman with a GI bleed (probably from esophageal varices), a 98 year old man who fell down 15 steps (he was called in as a red trauma, but ultimately he ended up being perfectly fine, not a single bone broken), another man who was drunk and fell down a flight of stairs (and was massively bleeding from his scalp-- I had to apply pressure to try to stop the bleeding), a 27 year old man who dislocated his shoulder playing soccer, a elderly woman with COPD who got excited when her son was in an argument with his neighbor, and stopped breathing, and a 80 year old man who was suspected of having a stroke. Dr. Okuda said that there wasn't any case that was tremendously spectacular, but I thought on the whole there was a lot of excitement. Truthfully, when I left at 11pm, it had felt more like 15 minutes had gone by, not 5 hours.

So today is the 8th of March, which means that we are leaving for Belize in less than a month. This is really starting to stress me out, because I really don't think we are where we need to be in the planning stages of the trip-- at least I don't feel comfortable with all the information I have from Peacework to feel that the trip would run smoothly at this point. And there is so much that still needs to happen in the next four weeks that I'm sure is going to go by in a blur: I have to finish preparing for Belize, we have to take 3 exams (two finals and a midterm), I have to take my trip to Chicago for the AMSA Convention, I'm going to have a number of phone calls for the Global Scholars Program, I have to be clinic manager at EHHOP, we are starting two new courses, and I have to pretty much figure out my plans for the summer, since the funding deadline is while I'm going to be away. All of this is quite depressing, actually, because I know I'm not ready for any of it. I guess it has to happen though.

Also, not sure how long it'll be on the web, but the AMSA Global Health Scholars website for this year is up. There is something satisfying to having your life summarized in approximately 200 words.

'Cause in my head there's a Greyhound station

So I spent most of the day reorganizing my life by finding a place to put most of the clutter that was taking over my room (and thereby my life), listening to Death Cab for Cutie, mourning Duke's loss to UNC last night, and hiding from old man Wheater's Histology. By the looks of it, i's a nice day outside, and I'd like to get out into the sunshine at least for part of it. I'd also like to make it to the gym downstairs as well, but that's contingent on me finishing the Physio quix before dinnertime. Even so, it feels good to be about to walk around my room again (and not trip on cardboard boxes, shoes strewn around the floor, and other equally random objects) and be able to actually find things when I'm looking for them.

I've got a bit of a rough week coming up, since it's the week before the Histo exam (which I absolutely can't get excited about, even though it means that we'll actually be finished with the worst "real" class in med school so far). Tuesday is a wash in terms of studying because I'm going to be running around the city, first for lecture here and then the TB symposium at Columbia (Jeff Sachs is doing the keynote), and afterwards I'm heading to Elmhurst to shadow Dr. Okuda in the ER until 11pm. It should be a very long, but hopefully good day.

All I have to do now is get excited about renal phys.

Children = evil.

It seems that I do the bulk of my posting after days at EHHOP. Today I was working there as a Junior Clinician, and I was able to see one Mexican patient who came in for a routine physical exam. She was a nice lady-- 23 years old with two children, ages 3 and 5. Her mother is 38 years old, which means that by the age of 33 she was already a grandmother, which I think is pretty crazy. Anyway, she needed a PPD and a tetanus shot, so the Senior gave her all that-- all the while her two children were absolutely reaking havoc on the examination room: throwing latex gloves in the air, opening every drawer and playing with the otoscopes, etc. They just could not sit still for a minute, which made it incredibly difficult to try to translate a history and do a physical exam. In just the hour or so that we were with the patient, I got absolutely exhausted by having to constantly tell the kids not to run around the room. I can't even imagine trying to treat children on a daily basis. It would be a nightmare.

Since immunology/allergy is a field that deals mainly with infants and children, it's starting to fall a few rungs in my list. To be honest, the only thing I could really see myself doing right now is EM, and possibly Med/ID. Possibly. I'm not thrilled with the idea that ID's main job is consults from other physicians, though. All I do know though is that children are evil, and I can't imagine taking care of them.

MICU

So today I met with Dr. Thomas Kalb, a Pulmonology/Critical Care physician who works at Mount Sinai's Medical ICU. I didn't get a chance to shadow him because he had some family matters to take care of, it was great to get a chance to talk to him for a while. He was a really nice guy to talk to, and was really interested in hearing about what I want to do and telling me about pulmonology. He thought my decision to do the MPH before medical school was a great idea, and it would be very beneficial during the learning process in medical school. He also really supported my interests in global health, and gave me some advice as far as what I can do with that. He said that in general, critical care is a technology-dependant field, and is really not relevant to situations in the developing world. If I wanted to have skills that could be used in other parts of the world, I should either look into general surgery or ID. Those are the two fields, he said, that have the most in common with global health work. Not to say that pulmonology is not important, but there is only a limited amount of work that I would be able to accomplish with it. I thought that what he said held a lot of truth-- and I think this is where my interest in global health comes into conflict with my desire to be grounded in one place and be financially stable. I genuinely think that is is possible to do both, but I'm not sure if I have found out the right way to do that yet. Still Dr. Kalb was extremely nice to me, and offered me a chance to round with him after his teaching duties are over for the year, some time in early June. I'm not sure how I'll feel by that point, but I think I'll take him up on that offer.

After thinking about what he had to say, I don't think I would count pulmonology out, but it certainly has moved a little further down my list. Walking through the ward on my way out made me realize that all the patients in the MICU are generally elderly, and are all attached to a machine of some sort. It was remarkably quiet on the floor, and there was just this sense of keeping people alive using machines.

The Belize experience has made me think a little more about ER, because that seems to be a field that be highly involved with global health (at leave three or four of the physicians coming with us are ER docs), has reasonable hours and lifestyle (on a shift, so no phone calls in the middle of the night), is compensated quite well (avg. is $200,000) and has only a 3 year residency that isn't horribly competitive (according to this website, it's middle of the pack: a relative competativeness rating of 0.84, as opposed to derm which is 1.26 and medicine which is 0.53). I'm going to try to shadow an ER doc at Elmhurst sometime in the near future, as soon as I get a hold of him.

Late night thoughts on histo...

"Wet Seal"

Conference Call

I just finished a conference call with the other members of the AMSA Global Scholars Program, where we talked to Saranya Kurapati, the health action organizer for Physicians for Human Rights. It was great to listen, even for a brief amount of time, to someone who is very comfortable talking about issues surrounding human rights on a level that is far more sophisticated than the conversations that we have among medical students. It made me realize how different all of this is from the types of discussions we were having at Columbia. And I don't think it has anything to do with Sinai-- this is the nature of medical school. I was talking with my roommate about this kind of thing, and he was commenting that he feels that everyone has this nature of being so self-absorbed, only worried about how to pad their resumes and what subspecialty they are going to do. There is something about school that can be so all-consuming, so homogenous, that it is impossible to have outside beliefs or interests or plans. This may be a cynical thought, but I am still tired after that first round of midterms that we had, and the prospect of starting to think about the final exams in Histo and Physio is disheartening. Things with Belize are starting to pile up, and I find that summer plans are being pushed to the back burner. All that manages to do is get me more anxious.

The Global Health Scholars are going to have a conference call with Stephen Lewis in a few weeks, which I think is very exciting. He worked at the CGHED while I was there, and I saw his speak a number of times at Columbia, he's a wonderful speaker.

I went to an ID panel this past Tuesday which was really interesting. It felt very comfortable to talk to ID docs about the diseases that they work with on a daily basis, and I think that I could do something along the lines of what they do. Although, as far as doctors go, ID docs kind of get the shaft I think-- they are up there with peds as getting the least respect for what they do. It really bothers me that some surgery subspecialties do nothing more than the same hernia surgery every single day, day in and day out, and receive an enormous amount of compensation and respect, while subspecialties of medicine get none of that. I heard a pulmonologist talk on Thursday, and that was really cool I thought. I'm going to try to shadow him this coming week.

Here is a table from the WHO Global Burden of Disease Project that gives an estimate of diseases or injuries with the highest mortality rates in 2020. There is little I would be able to do about road traffic accidents, war and violence, and I really don't think I want to work with mental health issues (i.e. unipolar depression and self-inflicted injuries) or with obstetrics (i.e. perinatal conditions and congenital anomalies). That leaves CVD (HD and stroke), ID (diarrheal disease, pneumonia, TB and HIV) and lung diseases (COPD and lung cancer). Fully four of the fifteen diseases are related to the lungs (pneumonia, TB, COPD and lung cancer). Of course these are data from all over the world, and different parts of the world will have different rates of diseases. It is quite interesting that the major diseases of the world are still related to ID, heart disease, and lung disease.

Rank of diseases and injuries attributed to the highest mortality rates, 2020

1	Ischemic heart disease
2	Unipolar major depression
3	Road traffic accidents
4	Stroke
5	COPD
6	Pneumonia
7	TB
8	War
9	Diarrheal diseases
10	HIV
11	Perinatal conditions
12	Violence
13	Congenital anomalies
14	Self-inflicted injuries
15	Trachea, bronchus and lung cancer

Alright, renal physio calls, so I'd better be going.

Global Health Scholars Program

I got a phone call yesterday telling me that I had been accepted by the AMSA for the Global Health Scholars Program, which is a new certificate program for medical students interested in global health. It was a pretty competitive program-- out of about 100 people who applied around the country, they said, they interviewed 10 students, and accepted 4. One is from Yale, the other is from GW, and the third I can't remember. Anyway, it involves a 6 month curriculum of sorts and a couple of stipulations for things we have to do to finish the certificate. The first step is to read Paul Farmer's Pathologies of Power, and then in April we are going to have a conference call discussion with him about his work and the topics in the book. I think that is very exciting-- I saw Dr. Farmer give Grand Rounds at Columbia once while I was there, and he gave a very inspiring talk. On top of that, there is a chance that they are going to want the four of us to sit on a panel during the AMSA National Convention that is being held this April in Chicago. Again, also very exciting. Of course, all of this means more work, but it's still some great opportunities.

In other news, I took my Histo exam this past Monday, and it was overall a very frustrating endeavor. The questions were overly ambiquous I thought and I spent more time trying to figure out what they were asking than actually thinking about the correct answers. Sufficed to say I didn't do a stellar job-- enough to pass, but not enough so that I can coast through the final. Stupid practical. If there was any doubt about pathology before, I think I can safely say that it's definitely out of the running now.

I started my elective in Clinical Immunology today. It was kind of strange, to be honest, since it was just me and another student sitting in a room as this pediatric allergist gave us a talk that she have given that week to immunology residents. I must say that I think I understood a lot of it, but that was from an amalgam of personal experience and stuff I sort of remembered from the NIH. On the whole, it was somewhat interesting, but I kind of got a sense of it being dry and even a little boring. I don't know. We have another session next Monday and another one on Friday, maybe those will be more exciting. I mean, it doesn't have to be anything out of an ER episode, but I was just thinking about what Eric is doing for his elective (scrubbing in on ENT surgeries), and even though I don't think I'm going to end up doing something like that, it still sounds far more interesting. This week my specialty-of-choice is critical care. I'm not sure if I would be able to work in an ICU, but it seems to have a little bit of everything. I emailed a pulmonologist who works in the MICU to see what he has to say. I'll keep you posted.

Unusually warm day in January

And I'm at my desk.

Have midterms coming up: Histo a week from tomorrow, Physio the following Monday. Having a hard time getting motivated. I just don't love the material. Plus there are so many other distractions, like Belize, summer plans, apartment hunting, etc...

We had a couple of exciting things this week: on Wednesday we got our first experience with the human simulator program, and saw some pretty cool "real-life" situations. Later that day we had our first ASM clinical site rotation. I'm paired with Christian Garcia, and we're shadowing Dr. Michael Serlin, and ID attending at North General Hospital in East Harlem. We got to take histories and physicals on two patients, one with many infectious diseases (HIV, TB, syphillis, chyptococcal menningitis, etc) and the other with many chronic diseases (COPD, emphysema, hypertension, diabetes, etc). Then today was our first training session for the new EHHOP clinical managers. We have to come in two more times and shadow current clinical managers, and then by the beginning of May we'll be running it ourselves. That should be pretty exciting.

Keila left Sinai for the year. She's planning on coming back next Fall, but she'll have to start first-year again. It's sad to see another fellow SEP-er go.

By the way, the weather forecast is predicting snow tomorrow.

One semester down, seven more to go

I realize that I haven't written in a while, and I can't help but feel that as I sit here in Levy Library, all I'm managing to do is procrastinate.

I wanted to check in though. We're half way to the midterms of Histo and Physio, and I'm not loving the subject matter, I've got to be honest. It's been a bit boring, and I'm hoping it picks up. We are going to clinical sites this Wednesday with ASM, and I'm hoping that helps to pick things up.

I'm having a really hard time deciding what to do with my summer. No matter what idea I come up with, it seems to come to a dead end. There hasn't been a lot of support from faculty and administration (all my emails remain unanswered), and I'm starting to feel just as frustrated as I was before my trip to Mozambique two years. I know that if I end up volunteering somewhere on my own, I probably won't get a paper published, which should be a goal of mine. At the same time, I have absolutely no interest in sitting in a lab this summer, or working around the schedule of a Sinai professor.

So right now things like apartment decisions, summer plans, and Belize are much more stressful than class, which seems more like a distraction than the purpose of me being here.

I am just worried that things will things are going to get much more stressful when the classwork piles up.