I Published a Children’s Book!

February 26, 2010

During my freshman year at college, I made a list of general life goals.  At the time, I thought I could accomplish them all before I hit 30 (which seemed a world away at the time)!  Reduce suffering in the world.  Become a mom.  Visit every continent, including Antarctica.  Live in another culture.  Watch a sea turtle nest hatch.  Grow my own garden.  Publish a book.  Now that 30 is just around the corner, my time frame must expand.  However, this week I can check off one surprising goal.  I became a published author of a children’s book, Karen’s Epilepsy.

As a second year medical student, publishing a book was not the first thing on my mind.  However, I had already written the story with black and white illustrations as a combined high school project for an art class and my Girl Scout Gold Award.  As a child with epilepsy (which I discussed in a previous blog entry here), I had noticed the lack of children’s books about seizures.  I also noted whenever epilepsy was mentioned, it usually was in the context of generalized seizures (somebody falling and shaking).  I had complex partial seizures, which are more common but less recognized.  Thus, the idea for an educational and entertaining children’s book emerged.

As a high school student, I got a small grant from Parke Davis drug company to fund a limited self-publication.  My “self-publication” consisted of photo-copying pages on thick white paper and binding them in a plastic coil!  In hindsight, I do feel a bit mixed for allowing the owners of several brand name epilepsy drugs to sponsor my book.  Yet I am still grateful, and hope my feelings will not lead me to become a biased physician in the future.

I distributed my plastic-bound “ghetto” version of Karen’s Epilepsy to local schools and libraries in my town.  Still, my dream was to make it available to children with epilepsy through the Epilepsy Foundation of America’s bookstore.  I hoped that it would be inspiring for children to know that somebody with epilepsy wrote a book from their own experiences.  Additionally, I felt the shame and stigma associated with epilepsy in our culture, and I wanted to help promote the idea that people with seizures often are normal.

Now, skip ahead 10 years.  Several children’s books have been published recently about epilepsy, but to my knowledge none are about complex partial seizures, or written by a person with epilepsy.  Through personal connections I got an e-mail from WriteLife, a non-profit publisher, about my book project.  Perhaps it was still not too late to make Karen’s Epilepsy a real book.

I met with Cindy, the managing director, last May, and was surprised by the friendly encouragement she provided from WriteLife.  This would be their first full-color children’s book, and as a mother herself, she thought it would be great.  She was understanding of my being in medical school, and was willing to work on the project without giving me any deadlines.  All I needed to do was change the illustrations to color, which was a task that ended up taking me until November!  When I sent the drawings at last, I thought it would still take AT LEAST half a year to become published, and probably more.  So, you can imagine my surprise when I got the proofs in January!

Since then, I’ve been e-mailing back and forth with WriteLife to edit the layout, which included a long internal debate about whether to add that I was a medical student to my biography (my dad convinced me to do it in the end).  While nothing is perfect, especially looking back on a book I made when I was 17, I am thrilled that I can hold the story – now a real and charming little book- in my hands.  I hope this will not be my only publication, nor my greatest publication for that matter.  But, I am excited to imagine my book in the hands of another child who can relate to Karen’s emotions.

The story itself is a bit autobiographical.  Karen is unhappy when her family moves to a new town until something unexpected happens at school.  My family moved many times, and it was always hard to move to a new place where nobody would be familiar with my epilepsy. Despite the challenges, there were many interesting coincidences.  I learned that my first grade teacher had epilepsy, and a middle school classmate who made fun of me later had a seizure himself at school!

Karen’s Epilepsy is available on Amazon, Barnes & Nobles, and the Epilepsy Foundation of America‘s online bookstore.  I’m not sure how this book will influence my medical training, but there is an obvious medical connection in the story, and I hope it will be a positive asset.


Breast and Pelvic Session

February 10, 2010

My hospital day was cancelled today due to a impending snowstorm.  I don’t have time to be disappointed since I have a final exam on the lungs, a.k.a. “pulmonary,” Friday morning.  I’m home studying in my favorite spot (the couch), and it’s time for an update about something exciting… pelvic and breast exams!

Last week we had a special 4-hour evening session for Physical Diagnosis entitled “Breast and Pelvic.”  Like many PD sessions, we weren’t given a lot of information ahead of time.  We were asked to sign-up in groups, and then sent a reminder e-mail with two bullet points.

*Professional dress, white coat and name tag are required.  You will be given a syllabus at the orientation…

*Personal appearance and demeanor are important.  A pleasant appearance and polite approach demonstrate respect for the patient and encourage trust.  Careful consideration should be given to grooming, with special attention to hands and nails… Examine hand jewelry for risk of injury to the patient or risk of exposure to the examiner through puncture of a protective glove.

Needless to say, my classmates and I were wondering what would happen.  I did not feel nervous since I already assisted with many papanicolaou smears and three male GU (genito-urinary) exams.  Also, I have experience as patient, having received annual pelvic and breast exams.  These exams are not only important, but they are especially sensitive for women, so learning warranted a specialized session.

I was surprised to discover that the male exam was not covered in this session, and we will not have a dedicated session for males.  This means that I will have to learn on the plastic models or by following doctors’ examples, and reading texts.  While the male exam is supposedly “easier,” I have reservations about my first attempt at any procedure being in an exam room with a real patient.

I am reminded of a family friend whose daughter had brain surgery as a toddler, and the surgeon allowed a rotating medical student to do part of the suturing.  When she lifted up her hair to show me the scar, I immediately knew which side the medical student sutured.  It makes me cringe to think that I could be that medical student whose first attempts could figuratively or literally leave patients scarred for life.  I would rather have good practice before I’m asked to do something, so I can proceed without as much fear and worry.

Therefore, I was thrilled with the woman who helped us learn the pelvic exam.  I’ll never forget her.  She was bubbly, talkative, and natural about the entire process. She was a good teacher who knew how to keep the atmosphere relaxed while giving us straight-forward instructions and feedback.  I also appreciated that she had us help and observe one another since team-work is such an important, and often overlooked, lesson of medical training.

The breast and pelvic exam we were taught included more than I have witnessed or experienced before.  Step 1 was the vaginal exam with a speculum.  This included going slowly, using proper draping, helping the patient get into the right position, and explaining my movements.  “You will feel my hand on your thigh.  Now I’m examining the mons, labia… everything looks healthy.  Now I’m going to insert the speculum.”  It’s important to know how to hold the speculum, so it won’t pinch the skin, and insert it at a downward angle away from the urethra and clitoris.  Then, once inside it hits resistance, and then is pulled back a little before opening slowly.  Ideally, I would open it and the cervix, like a little mini-donut, would be right there, but often the cervix is at a different angle or to the left/ right.  Then, on the way out the walls of the vagina are observed.

Step 2 was the bi-manual exam.  This is where you put one or two fingers inside the vagina, then twist and press up on the bottom of the cervix.  With your other hand, you feel the abdomen to locate the uterus and ovaries.  For me, this was the trickiest part of the entire exam.

Step 3 was the vaginal-rectal exam.  This is the part that I have never seen or experienced before.  Apparently it is part of the “normal” exam, but it seems not many doctors actually do it unless they suspect a problem with the rectal wall.  In this exam, the index finger is inserted in the vagina and the middle finger in the rectum.  Those two fingers are swept left and right to feel for polyps or prolapses.

Then there is the breast exam.  Like many physical exams, I was taught to observe first.   We were told to ask the patient to raise their arms, then put them on their hips and move their shoulders forward.  Then the patient lies down and we have to properly place a pillow to make them comfortable.  With one arm raised, we palpate all the breast tissue using the preferred “lawn-mower” (I’d rather say “ zig-zag”) technique.  And for bonus points, we should ask the patient about self breast exams.

When my group was almost complete with the session, one male classmate was left to finish the breast exam.  He gave our standardized patient instructions to raise her hands, and then without thinking he said “Awesome.”  She immediately told him that one should never say “awesome” during the breast exam.   We all had a good laugh!  Additionally we were told to stay away from phrases including “touch,” “feel,” “rub,” “stick” and “put.”

One of my favorite parts of medical school training has been working with standardized patients.  I was astounded by how well this patient knew her body.  Equipped with only a small mirror, she told us detailed information about where to look and what to see.   I also have access to a skills center with large “life-like,” anatomical, blinking, and talking manikins, but nothing is more helpful for practicing procedures than a real human being.  And nothing is better than an educated standardized patient who can make an awkward situation seem relaxed and even, dare I say it, “awesome.”


Thoughts After a Weekend Skiing

February 2, 2010

It’s late Sunday night, and I’ve spent the weekend in a cabin with a group of 30ish folk on a ski trip. The skiing wasn’t that great this year because it didn’t snow as much so the paths were icy. Yet I still enjoyed being in the woods, and having a mini-retreat with people my age (none of whom are studying medicine). This trip reminded me of the contrast between the life of a med-student and the lives of most people my age.

A few years ago before I started medical school, one of my husband’s friends was dating a girl who was in her second year at medical school. At the time I was taking post-bac classes and involved in the application process, so I enjoyed hearing about her experiences. But there was one night when we were together with several friends in a hot tub. Clearly the other people in the hot tub were not as interested in her classes or the stresses of medical school life, but she couldn’t seem to steer away from that topic.

I am afraid that I am becoming that girl. Or at least I am a lot more like her than the other people on our ski trip. I observed that I was one of the first people to go to bed this year, and I was certainly the first person awake. Only one other person brought a stack of reading (she’s a PhD student in a lab that works with cholera), but admittedly she didn’t read most of it. I read my entire stack of papers about the lungs (my new organ of focus). Many of my conversations revolved around medical topics with people, including questions about individual health concerns. I also enjoyed fielding questions about school- of course. And I even dreamed about school and let my mind wonder about the patients I saw this week.

Most people in the house played video games, or board games. Some people read pleasure books, People magazine, and watched movies or sports on TV. Those who didn’t ski were happy to say they were busy “doing nothing” or “holding down the couches.” Surrounded by these voices, I felt different. I managed to have many conversations filled with depth and laughter- that I enjoy as much as anything in the world. I still played some games, and even tried “Beatles Rock Band” (a new Wii game). But, I recognized that I don’t get that much enjoyment from these activities which satisfy so many people I know.  Rather than spending my time with a screen, I would rather study my lecture notes.

Does this make me officially lame and boring? Am I that girl?! I hope I am keeping a balance of both a studious and fun. I wish there was some type of external meter to let me know for sure. At the same time, I see that I must love the path I’m on to be so excited about learning and talking about the body- even more than playing Wii. And the truth is I do– I do love the knowledge, the conversations, the new ideas, and even the challenges. Maybe I am that girl, but I hope that at least sometimes I let people forget that I’m a medical student, including myself.


Follow

Get every new post delivered to your Inbox.