I Took Step 2

August 10, 2011

The days before my exam passed slowly, and I had trouble staying focussed.  Finally my exam day arrived, and those 9-hours went by quickly.  I’m having a hard time believing that I indeed took my second national Board exam yesterday.  It’s done – finito!

In comparison with my first Board exam, I did not feel as anxious.  The Step 2 exam was still hard.  In a way, I felt even more challenged than I did for Step 1 because I wanted to answer all of the clinical questions with ease.  Step 2 was more relevent to my future career, and I wanted to do well to show I can be a good doctor.

I did 2 hour-long blocks, took a break, 2 more blocks, lunch, 2 blocks, break, 2 blocks, survey… and done!  It’s hard for me to gauge how it went.  As always, I came out remembering the questions that puzzled me most, and easily forgetting the ones that I answered quickly and confidently.

So it will be a long 5-8 weeks waiting for my score, and there is no point thinking too much about it now that it’s done.  Fortunately I have exciting vacation plans to distract me, including a much anticipated family wedding this weekend!  So… now it’s time to pack and get on to enjoying life.


Countdown to Step 2

August 2, 2011

My Step 2 CK is exactly a week away.  In fact, at this time next week I will probably already be finished with my first of eight hour-long blocks (plus hour of break-time).  Next Tuesday will no doubt be a loooong day, but I’m ready for it to get here and be done.

Overall I’m proud of myself.  A month ago I was feeling grumpy about studying for my second Board exam.  Somehow, I managed to get out of my “funk.”  I owe my success primarily to my decision to get out of my apartment and explore new study spots.

Ok, so actually it was my husband’s idea for me to get out of the house – and it may or may not have had  to do with an argument we had about something absolutely trivial and ridiculous.  If you must know, it was about the dangers of ground beef vs. foraging for wild mushrooms.  It’s laughable, but we got pretty heated at the time.

There’s nothing like the stress of a big exam and career change to put stress on a relationship. But don’t worry, I was not kicked out of the house or anything like that.  I realized he was right, so I decided to break my pattern of studying in the same place at home.

After all, summer is all about being outside (even if just for a few minutes while I’m walking to a new place) and having some adventures.   So, I made a new rule to never study in the same place twice and plan more breaks and rewards.  This has resulted in feeling more productive, happier, drinking significantly more caffeine… and no more silly arguments.

I’m not sure if I am actually more productive than I was studying for my first Board exam, but I feel much happier.  Up to this final week, I was also working 8-hour days at the hospital, so that didn’t leave me much time to study at night.  Yet, I feel like I’ve made a lot of progress.  I’ve managed to work my way through my practice Q-bank with only about 300 questions remaining at this point.

Do I feel ready for the test?  No.  But these Board exams are huge, and I don’t think anyone feels ready.  I wish I were more confident in my test-taking abilities, but I am the type of person who feels like I never perform as well as I’d like to.  I’ve been working hard, however and will do my best.  I do think I am feeling better than I did before my first Board exam.

And on top of studying, I’ve been working on my ERAS profile, written and re-written my personal statement and CV (still in progress) and attended a national residency fair.  I think it’s been a pretty productive month.

I am both anxious and excited because this exam is my LAST written test as a medical student… hard to believe.  Then I’ll have a much anticipated and well-deserved two-week vacation for my brother-in-law’s wedding and camping.  Stay tuned, my next entry will be to tell you how my Step 2 went.


3 Days of WHOA!

July 31, 2011

When I told my advisor I was going into family medicine, she told me, “Be sure to go to the AAFP National Conference!”  So I just returned from the annual American Academy of Family Physicians (AAFP) National Conference (and residency fair).  The T-shirt I received best described my experience with the phrase, “3 days of WHOA!”

First of all, it was invigorating to be with so many family physicians and those in training.  I attended workshops and speakers, and it reminded me why I love family physicians.  We are caring, unintimidating individuals who care about medicine in the context of a bigger picture.  I had a lot of fun, although it was exhausting.

Given I am a 4th-year starting my residency “match” process, I spent a majority of my time in the “Expo Hall,” a huge “Disney World” of Family Medicine with program booth in place of rides. When I first entered, I had my first “WHOA!”

I visited a LOT of residency programs and although I’ve never tried “speed-dating,” I think my experience was similar.  I spoke with residents and program directors about their residencies.  I love conversations with people and I enjoyed the process, but WHOA!  By the end of the day, my mouth was extremely dry.

The conference really helped me articulate what I am looking for, and has given me a lot to think about.  I am excited that interview season is getting closer, but after visiting so many booths, I realize it’s time to narrow down my options before I begin.

Things that appealed to me:

friendly, happy people with families

people who do cool stuff outside of work like cook, garden, camp

docs who call each other by first-name

support/ funding for international rotations

working to serve the underserved

knowledge of community disparities in health

multi-lingual

doctors who are activists for change in health care

exposure to reproductive options

exposure to gay/lesbian/transgender friendly health care

excellent resources for addiction medicine and psycho-social support

access to alternative medicine such as spinal manipulation and acupuncture

adolescent medicine and rotating at school clinics

strong EMR system

OB with midwives, flexibility on C-section training

ability to take call from home

having clinic/ hospital in a condensed region

being able to bike/ walk to work

more elective time, more flexibility after 1st year

climate, location (ability to grow a fig tree, visit mountains and oceans/ lakes)

creative schwag:


Pedi Neuro Block 3: NICU

July 22, 2011

Many of the overnight patients I visit daily during my pediatric neurology rotation are in the NICU (Neonatal Intensive Care Unit).  I begin most mornings with the secret NICU entry code, rolling up my white sleeves and scrubbing my hands.  Then I perform my neurological exam – the mini version for the tiniest patients in the hospital.

Adapting physical exam maneuvers for infants was an acquired skill.  Even though I’m comfortable with examining newborns now, I was hesitant on this rotation.  The first time I tried to elicit a reflex, I barely touched the dime-sized knee cap with my hammer.  I was assigned to babies who weren’t simply newborn babies – they were premature, and they were sick.

As I saw their tiny bodies connected to feeding tubes, IVs and small breathing masks, I thought of the NICU nurses I know (Melissa and Aunt Sharon).  They must be some of the most talented nurses I know to find those piddling veins and perform miniscule procedures.

And NICU nurses are tough because their lives are full of sad stories.  Babies withdraw from drug-intoxication.  Babies stop breathing.  Babies live inside plastic bubbles.  Babies have genetic or metabolic syndromes that have challenging, predictable outcomes.  Or worse, they have mysterious symptoms that doctors can’t place.

My patients* were particularly sad because their parents had done everything right to have a healthy baby.  Parents held one another, grieving the loss of college graduation, football games and all that could have been.  The stress and sadness were apparent.  Later my attending exclaimed the divorce rate of parents with NICU babies is over 90%.  This was staggering, and I couldn’t find data to back it up, although according to one paper I found (“Effects of Child Health on Parents’ Relationship Status” by Reichman et. al. in Demography, August 2004), parents are 10% less likely to be living together after 18 months.

One of my patients was a baby born early who weighed less than 4 pounds.  She suffered an unexpected injury during birth, which had deprived her of oxygen and caused irreversible brain damage. I was in the room when the neurologists explained the devastating news – she had visible brain damage on her MRI.  She would certainly not develop normally, but it was impossible to predict how.

Another baby I saw was missing a part of her brain.  Her parents had discovered this during an ultrasound, and then the baby had a  prenatal brain MRI.  Her parents had to make the difficult decision whether to end the pregnancy.  They chose not to, and now mom told me the most difficult part was “not knowing what to expect.”

Yet a third baby was a twin who had meningitis, a brain infection that affected his brain stem and stopped his breathing.  When I first met him, his arms, legs and face were twitching.  He was having spasms and seizures, and could barely cry.

The pediatric neurologists have a difficult job.  I watched them explain to parents that talking or walking might be unreachable milestones.  Eating and smiling would be huge accomplishments.  And the worst part would be raising a child without expectations.

I came home and proceeded to think about a question that only a medical student would ask herself.  What if I had a sick baby like this?  Would I want to put a feeding tube in her stomach?  Would I want the doctors to save her life?  I feel like the possibility is real, and the endurance of these babies and their parents is an inspirational feat.

*Please note all patient identifying information has been intentionally changed or omitted.  The details are modified, but the overall experience remains true.


Pedi Neuro Block 3: Memories

July 11, 2011

Wounding and healing are not opposites. They’re part of the same thing. It is our wounds that enable us to be compassionate with the wounds of others. It is our limitations that make us kind to the limitations of other people. It is our loneliness that helps us to to find other people or to even know they’re alone with an illness. I think I have served people perfectly with parts of myself I used to be ashamed of. 
-Rachel Naomi Remen

This week I started Pediatric Neurology.  This rotation called for an expedition into my desk drawers for my ophthalmoscope, otoscope and tuning fork.  I’ve rarely touched these tools, or performed the full-blown neurological exam since 2nd-year physical diagnosis class.  Little did I realize, this rotation also called for an expedition into my past.

I felt excited.  My husband is a neuroscience Ph.D. student, and I had epilepsy when I was 9-16 years-old.  Therefore, Neurology  - especially Pediatric Neurology – is something near and dear to my heart.  At several points, I thought about becoming a Pediatric Neurologist.

This rotation has a much different pace from my Block 2 sub-internship.  First of all, I have fairly regular work hours 8:30am to 4-5pm. Additionally there are no on-call or weekend shifts.

The Pediatric Neurology team is made up of an attending, a “fellow” in post-residency training, and 3 other medical students like myself.  We are not overwhelmed with patients during the day.  This means there is plenty of time for individual patients and for teaching.

I saw several kids being evaluated for seizures, and these patient encounters were both fulfilling and difficult for me.  I was surprised by resurfacing of my own memories, many of which I had forgotten.  And many of which made me feel surprisingly ashamed.

Perhaps my feelings are best characterized by the first day of the rotation.  The fellow said, “You are going love this rotation… you will see so many cool seizures…”  As soon as I heard the words “cool seizures,” my heart pounded Seizures are not cool.  

Yet, I too refer to unusual medical findings as “cool.”  When doctors say “cool,” it means “interesting,” something that makes us think and learn.  ”Cool” is not meant to be a positive remark about disease or the patient experience.  I knew that, but it was hard to hear.

At first I wondered if I had made a mistake choosing Pediatric Neurology.  This rotation felt a little “TOO close to home.”  For example, as I watched a child get an EEG, I was taken back to my own experiences and frustrations.

I remembered sleepless nights, lying motionless in a dark room while watchful eyes waited for me to sleep, and hours later pulling the hard rubbery knots of adhesive out off my head (along with the hair). I remember the disappointment when the EEG was “normal,” like it had all been for nothing.  And both the fear and excitement when one of my seizures was finally caught on EEG!  A painful triumph.

Now, EEGs are much more advanced.  The kids get wired-up and march out the office door with a gauze-turban and small backpack.  The in-patient EEG’s are computerized with constant video monitoring that can be replayed in sync with brain waves.

When I previously thought of Pediatric Neurology, I mainly remembered my deep admiration for the Pediatric Neurologist who eventually helped me find a medication to control my seizures, and my pride of overcoming the disease.  My doctor was a calm physician and compassionate listener who navigated through choices with me.  He led my family and I down the path to control seizures while avoiding undesirable side-effects.

This task is much easier with medications available today.  Just fifteen years later, I learn the medications I was given to control my seizures are now considered sub-optimal treatment for my seizure type.  This demonstrates how quickly medicine is changing!  I selfishly found myself frustrated that the newer medications weren’t available when I needed them.

My teachers on this rotation still reinforce my positive image of Pediatric Neurology – they are calm, caring role models.   Yet, I find myself in an awkward position, as both former patient and “doctor.”  I thought I was in a better place to deal with my past.  My anger and sadness surprise me.  I am challenged to suppress these emotions to focus on my responsibilities with patients.  I thought the personal experience would help me, but I didn’t anticipate it would simultaneously be more difficult.


Step 2

July 10, 2011

After a weekend of camping, I moved back home last Sunday.  And to “celebrate” my homecoming and July 4th, I took a practice board exam ($45, 4 blocks, 4 hours).  Today marks exactly one month to August 9th, my Step 2 Clinical Knowledge (CK) USMLE Board Exam date.

Step 2 CK = $525, 8 blocks of questions, 9 hours, passing score of 188. *

*Note: DO NOT confuse Step 2 CK with Step 2 Clinical Skills (CS).  Step 2 CS= $1120+ flight/ hotel to destination city, 1 day of patient-actors, pass or fail.  I’ll take this exam in November.

There are 3 Steps of National Boards.  Step 2 CK is styled like Step 1, but supposedly easier.  Step 3 is generally taken at the end of intern year (the first year of residency), so it’s not even on my radar screen yet.

Mainly Step 2 is easier than Step 1 because it has less basic-science questions (i.e. “name the enzyme that…”) and more clinical reasoning (i.e. “what is the next step for a patient who…”).  After 3rd-year of medical school, I have more patient and “national exam” experience, so clinical reasoning questions seem more intuitive.

BUT UG (insert squinty look with tongue out), I dislike Board Exams!  I am reluctant to take another standardized test that costs >$500, study in the summertime when it is gorgeous, and feel stressed.

I was trying to avoid the study torture that was my Step 1 Board Exam – 4 weeks of solitary sofa confinement, which turned me into a “factoid-zombie” who could not have a normal conversation with her own husband!  I thought I could avoid this by studying twice as long (8 weeks) while seeing patients daily on clinical rotations (where I learn more and feel happier).

The problem is that after a full day of work I can hardly focus on Board Exam studying for >1 hour.  I feel way behind, and was contemplating postponing my exam until September,  rearranging my schedule, and taking a block off this fall for “4-week solitary sofa confinement.”

BUT… my 4th of July practice test was good enough to convince me to stay on track for my August 9th exam date, and get this thing over with.  This time around there are no colorful sticky-note charts -just practice questions and readings. More stuff to study than I have time for.

I have the rewarding, engaging job of 4th year medical student by day, and the dreaded task of study machine by night. Unfortunately, I am still feeling pretty grumpy.  I think the irritability might be compounded with the added stress of residency applications and big life decisions looming ahead.  The Electronic Residency Application System (ERAS) also opened recently on July 1st, and will be due by August 31st.  No shortage of things to elevate my blood pressure these days, but nobody said becoming a doctor would be easy.


Medicine Block 2: Internship Preview

June 26, 2011

This is my first of two “acting ward internship” blocks which I must complete in my 4th year.  I am supposed to be acting like an intern, a first-year resident.  The experience makes me realize that I’m not too far away from actually being an intern.

July 1st is approaching, the date when residency programs begin, current residents “fly-up” or advance to the next year-level and older residents graduate as full-fledged physicians.  It’s been great to be here during this time because many of the resident teaching sessions focus on how to help the interns.  In about 1 year I’ll be fitted into a long white coat, getting ready to dive into my first job as “doctor.”   This rotation has not only made my intern year feel closer, but its helped me to see my job as intern as an attainable role.

Less than a year ago I started my medicine rotation as a third-year.  I was working on a large team with 3rd and 4th year medical students, an intern, a senior resident and an attending doctor.  I admitted patients, “rounded” (checked on) my patients every morning and reported to the medical “team.” I wrote daily progress notes, followed some of my patients to their procedures, helped with discharge paperwork and attended student conferences.

While I’ve done many of the same jobs, this rotation has felt different.  First of all, the “teams” are structured so they are smaller.  There are “teaching teams” with 3rd year med students, interns, senior residents and an attending.  And there are “managing teams” with a 4th year student, a senior resident and an attending.  So I have been working with one resident, just the two of us, and our attending.  I had to act like an intern because there was no intern.

My third-year medicine rotation doesn’t seem so long ago, but as I started this rotation it felt distant.  I’m not the same girl who started internal medicine last September.  I had an easier time adjusting to the task patterns of last year (writing notes, interacting with nurses and patients) but for the first time I felt ready to “jump in” and help with plans and orders (as much as allowed – I’m still restricted as a student).

My knowledge base, while still lacking in significant ways, is much broader than last year.  I can actually begin to see a difference. I remember one specific day during my 3rd-year medicine rotation when I got tongue-tied talking about Coumadin/ Warfarin and Heparin (blood-thinners).   I mixed up the names, and felt frustrated with myself.  Now, I am able to talk about them at length, their mechanisms, decide which patients should be on them, when to order the INR (one of the several tests to check clotting time), when to give Vitamin K (to reverse Coumadin/ Warfarin) and when to worry about HIT (heparin induced thrombocytopenia).  I can’t tell you when or how this change occurred.

I’ve completed three of four weeks, and the job has been more rewarding than last year’s hospital rotations. It helps that I was working with a DO resident who was in the “community medicine track” (to be a primary care physician), and who was caring, holistic and spoke fluent Spanish. She was the first resident who seemed pleased with my choice of Family Medicine, and she showed me that becoming a primary care physician demands excellence. Tomorrow I’ll be working with a new resident, but I was promised I would like her too.

I worked with different attending physicians each week and weekend. They surprised me by going over every note I wrote, sentence-by-sentence.  Last year my notes were mostly critiqued by residents, not the attending.  My attending last week was the director of the medical residency program, who was an exceptional teacher, excited by each patient’s “puzzle” and asking me to explain my reasoning  out-loud.

During this rotation I’ve kept the same schedule as my resident, although I have less patients to follow.  I thought the schedule would seem easier since I’m living away from home this month.  However, combined with trying to start studying for my Step 2 (Board exam) and start my residency applications, I’ve felt exhausted and overwhelmed.  But mainly because of the exam and residency applications, not the daily work of the rotation.

In fact, I’ve been having a lot of fun at work this month.  My patients have all had complex issues, not only severe pneumonia, but severe pneumonia with end stage liver disease, asthma and hepatorenal syndrome.  Not just tumors, but tumor with tumor lysis syndrome.  Not just cellulitis, but cellulitis with HIV and Hodgkins lymphoma. I’ve had memorable experiences with osteopathic joint manipulation, drawing arterial blood gasses (successfully), training for codes and thoracentesis (taking fluid from the lung cavities).

And while I’m still terrified of the responsibilities that will come with my intern year, I can imagine it.  I make mistakes daily, but at least my learning curve feels steeper.  If I’m a different person now than last November, next August I ought to be new and improved too. Even though I probably won’t feel ready for internship in a year, I can see myself doing and even enjoying the job.


Medicine Block 2: Code Blue

June 17, 2011

Until last week I had never been to a code where somebody died.  In fact, during my entire third year I was only called to three “Code Blues,” and a “Rapid Response” (which is an emergency, but not as serious as a Code Blue).  All those people ended up doing alright, and being transfered to the ICU.  In the past 7 days of my medicine rotation, I have been called to two codes (coincidentally both during lunch) and both patients died.

Medical school didn’t prepare me well for these emergencies.  We had Basic Life Support training each year of medical school, but it consisted of a meager online tutorial and 30 minutes of pumping on adult/ baby manikins.  I think I learned more about CPR when I took a day-long Red Cross training as a camp counselor in my teens.

I felt embarrassed when my sister-in-law recently asked me about  Pulseless Electrical Activity (a type of cardiac arrest).  I had no clue what she was talking about.  Shouldn’t I know more about emergencies as a medical student?  I’m terrified that one day soon I’ll be on an airplane or walking down the street, and somebody will expect me to know what I’m doing when they collapse.

Maybe I actually will.  Finally I feel like I’m getting some real training.  On this rotation, I participate in weekly trainings in a simulation center.  There is a manikin who has simulated codes, and the residents “run” the codes.  As a 4th year medical student, I participate too.

When there is an emergency in a teaching hospital, the residents are called, and along with them come their medical students.  There is nothing quite like tagging along to a “Code Blue” or “Rapid Response.”  The pager/ hospital intercom blares, and the next thing I know I am bolting up flights of stairs trying not to lose my resident – or all the contents of my white coat pockets!  Sweaty and short-of-breath, I arrive to a patient’s bedside where a crowd is gathered.

Codes are organized chaos, but it’s easy to miss the organization at first.  People are screaming things: Gloves! Epi (short for epinephrine)! “We need an airway!” “Does anybody know the patient’s code status?” “Has the family been notified?!” “Has the attending been called?”  I try to keep out of the way, but observe everything that is happening (which is tough for a short person like myself).  Usually I am seeing the code through a small window between people’s moving bodies, like I’m peaking through a moving keyhole.

I also see lots of flushed faces, sweating, trembling hands and people getting agitated.  I think everybody’s heart rate and blood pressure skyrocket during a code, no matter how “calm” we’re attempting to be.  There is a person who is dying in front of us.

In the simulation center, I am participating during the mock codes.  My heart rate still goes up, even while I’m trying to “bag” (breathe for) the manikin.  However, I noticed a change this week because I began to make sense of the chaos during the real codes.  I feel ready to take a little more initiative too, and maybe eventually I will even be ready to “run” a code.

It came as a surprise (especially after seeing 4 patients recover from unresponsiveness last year) to watch 2 people die this week.  I kept waiting to see the patients start to moan or move.  And all the residents kept going, pumping the chest and breathing, for minutes that felt like hours.  When the leader finally asked if anybody had any objections to “calling it” (ending it), there was silence.  And then, everybody left the scene just as quickly as we came. Later in the hallway, another resident asked us what happened, the answer was a thumbs down and frown face.

In the midst of the code, I found everything fascinating.  Yet, as soon as I realized the patients had DIED last week, it became painful – for the first time.  I didn’t feel emotion for either patient because I had no connection to them.  Mainly I felt sad for their deaths.  After all, who wants to die naked surrounded by chaos and screaming, sweaty strangers, with tubes and needles getting shoved into orifices?

After I left the second code, I ran to my lunch meeting, washing any sadness away with a squirt of hand sanitizer and brisk steps down the hallway.  Ironically my lunch meeting was about palliative care, how to discuss death with patients.  Until the talk, I was able to easily forget about the patients I had seen die.  As I listened I felt a choking feeling in the back of my throat and an extra glisten in my eyes.  But after a few seconds, it was gone.

And suddenly I remembered words I read a few years ago in Pauline Chen’s Final Exam: A Surgeon’s Reflection on Mortality.  She discussed being exposed to death in medical training, and she felt “it was okay.”  Then, when she came home, and her goldfish died, “it was not okay,” and she sobbed for hours.  At the time, I didn’t understand it, but now I think I do.  There must be some better way for medical professionals to express what happens- to grieve.


Family Med Block 1: Fourth Year

June 8, 2011

Confession: I have been bad since 3rd year ended.  My 3rd year culminated in a much-anticipated and longed-for 3-week vacation.  During which I mentally (and physically) distanced myself from my previously “normal” life.  The further away I got, the harder it became to overcome the hurdle of how much time had passed since my last post.  Now the time has of course accumulated into a big pile of events that I can’t hope to explain. But let’s start with the basics.

I went to Uganda between my 3rd and 4th year.  I promise to retroactively post about my Uganda trip soon.  Right now I’m am trying not to be overwhelmed, which entails sticking to the present…so most importantly…

I am a 4th year now.  This requires a new “category” for blog entries.  I am reluctant to believe that I’m in my last year, and now I have to REALLY make decisions about shaping my career, not to mention where I will be living next.  I’m really looking forward to the possibility of moving and starting residency (really I am), but I’d like to avoid all that comes with it– applications, job interviews and most of all this unknown uncontrollable future that feels like it’s looming over me.  Big stuff to think about.  Lots of work to do.

But back to the present… (deep breath)… 4th year is broken into thirteen 4-week blocks (electives, 2 mandatory “ward” or inpatient rotations, neurology, family medicine and a few vacation blocks for Boards/ interviews/ scary stuff etc.). I don’t expect you to keep track of all those things because I can hardly manage my schedule myself, so I won’t attempt to explain how I planned my year (yet).  We can just go along month-by-month together.  One step at a time… doesn’t that sound nice?

May was the first month of 4th year, so I just finished block #1, which was Family Medicine.  Awesome for multiple reasons.  First and foremost, Family Medicine affirmed that I think I DO indeed want to be a family doctor when I grow up.  Next, it was the first time where I really felt “on top of my game,” like I was doing a good job coming up with plans that matched my attending doctor’s.  And it was the first time that several patients gave me the best compliment I could ask for… “I wouldn’t have known you were a student if you hadn’t told me!”  and “You seemed like a real doctor.”   Yippee, a real doctor!

I was working at a clinic not far from my house with a preceptor who described herself one day as being “hippie-dippy.”  I think of her affectionately in this way because she did indeed fit many of my “hippie “stereotypes.  She wore no make-up, long flowing skirts and jewelry shaped like leaves.  She tried to persuade patients to avoid aluminum-containing deodorants and artificial sweeteners.  She got me to read Anticancer, a frighteningly fascinating book about how our Western diets and lifestyles promote cancer growth.  She mentioned the moon cycles. She was simultaneously medically brilliant, and had close relationships with her loyal patients.  I got excited to think people like her will be my colleagues if I go into Family Medicine (somewhat counter-culture, but so caring and patient-focused).

I kept meaning to post about Family Medicine because I was having a great time and seeing a bazillion patients per day (compared to # of inpatient hospitalized patients I saw). But, May whizzed by too quickly.  I would like to blame it on something.  Rain? Friends with adorable new babies? Graduation parties and visitors? Extra time with my husband after surviving 3rd year?  Cooking, art and movies… gasp… in the theatre!

May was grand, but it’s gone now.  June came too quickly, and I just moved away from home for my next rotation at a more rural hospital.  I finished my second day of internal medicine sub-internship.  I’m supposed to be acting like an intern, which is kind of thrilling but unlike Family Medicine  I do not feel “on top of my game” yet.  I’m repeating the humbling and exhausting pattern of  newness– computer-program plus hospital mazes, complete with an unfamiliar bed!  But I will save more for my “Block 2″ entry.

I promise not to leave you hanging in cyberspace for SO long before my next entry.  If I do, please badger me (I love saying that… badger me).  I keep this site so I’ll be accountable.


Uganda

May 8, 2011

Hujambo! This is the story of my trip to Uganda, which actually begins long before Uganda. About four years-ago, I returned from Peace Corps and my dad began traveling to accredit international laboratories as part of his work as a pathologist.  He invited me to join him again and again, and as the lives of two busy adults often interplay, we found no synchronicity.  That was… until my recent 3-week vacation between my 3rd and 4th year of medical school.

My dad will tell it another way.  He’ll say that he took my brother to Kenya last year, so he had to take me to Uganda this year.  But truth be told, it had nothing to do with the destination or sibling equality.  It was pure chance of timing, but after four years of failed timing, I’m glad it finally came to be.  After all, didn’t I (his future physician child and returned Peace Corps Volunteer) deserve to share the family experience of international medical work?

The saddest part of our trip to Africa was the beginning.  My dad and I found out days before leaving the country that he had $3,000 stolen by an African internet scammer.  I won’t go into details, but this is the type of problem that Africa is well known for, unfortunately. And to make matters worse, the day before we left the country there were violent riots in our destination city. Five Ugandans were killed and flights were cancelled.

As we left the USA, I wasn’t sure what was awaiting me in Uganda. After a long 13-hour sleepless flight, I saw my first glimpse of Africa, the yellow, dusty landscape of Addis Ababba Ethiopia. Our second flight took us to Uganda, with contrasting lush green hills.  We flew down over Lake Victoria, and I had a wonderful view.  I was expecting clouds because it was “rainy season,” but all I saw was gorgeous sunshine with cool breeze.

There was no difficulty getting visas, or getting to the hotel.  And on our way into town I saw one of the most impressive things of my whole trip to Africa – a guy with about 50 live chickens driving a motorcycle!  The chickens were flapping, giving the impression that the “chicken-cycle” was a live creature, half human and half wings.

We hired a driver named Mousa (pronounced “Moose- ah”) to take us around Kampala.  We stopped at a craft market, supermarket, the parliament, Makarere University and “Old Kampala” with its impressive Gadaffi Mosque.  We didn’t go inside since Bin Laden had just been killed.  However, the atmosphere in Kampala seemed too caught up in its own political unrest to care much about Bin Laden.

The next day I accompanied my dad to the research laboratory. The political situation did not deter us from the trip’s purpose.  The lab was a research laboratory dedicated to HIV, and their biggest project was developing an HIV vaccine currently in stage 1 trial.  The director told me he feels in about 15 years we’ll probably have an effective HIV vaccine, at least for the African strain of HIV.

Amazing, isn’t it?  All the work that goes into developing a successful vaccine is astounding – freezers, energy to store specimens, all the specimens extracted by hands, volunteer patients, years of dedication, etc.  To respect all these efforts we ought to feel honored as patients able to get annual flu shots (and other vaccines).

Yet I know so many people who don’t even make the effort to get vaccinated.  Do it!  Vaccines are miraculous, in fact so miraculous that I might even overlook the cost of my recent vaccines for Uganda (which I recently discovered is not covered by my insurance).

I observed my dad while he did his work, and asked lots of questions about the research.  Then, I got my own personal tour of Makarere University medical school and public hospital. It felt similar to my experiences touring the public hospital in the Dominican Republic.  Room after room of patients overflowing onto the floors, warm spaces with scarce plumbing, doctors and medical supplies.  The main difference were individual specialty departments for diseases common in Africa like “Sickle-Cell Disease” and “Burkitt’s Lymphoma.”

Uganda met my expectations as a developing country in political turmoil, with very little tourism.  However, I didn’t expect to love the culture as much as I did, especially after having $3,000 stolen.  Yet my experience with Ugandans was friendly and polite, and I loved our conversations.  I felt it was easy to ask people about everything, and they seemed excited to tell me about their birds, politics, weddings, lack of cemeteries, etc.

Ugandan cuisine was delicious – soups, goat stew, mashed plantains, peanut butter sauce and tropical fruits.  I tried grasshoppers and even those were delicious.  Seriously- imagine buttery-cheesy pop corn.

And after the inspection was over, dad and I went on a safari to the national parks, overflowing with animals which are crowded into small confines by the growing population.  Villages shared fence-less borders with the land that was once all home to elephants and lions.  And chimpanzees watched me as intently as I watched them.

I found myself excited by the natural beauty, and the birth-land to humanity. I want to go back, and maybe somebody as a physician I will.  After all, it seemed like every American we met had some connection to health care or public health projects.


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