Perspective

I’ve been working on a database for my research project, and it involves pulling data out of medical records for cancer patients. Most of this is fairly mindless but a few things continually catch my eye. Like how I am jolted and feel slightly uncomfortable every time EPIC tells me I’m accessing the record of a deceased patient. Or when I see a particularly young patient.

Today I was most bothered by seeing how many patients had various events on my birthday (April 7, a rather nondescript date). The most distressing was when I saw a date of diagnosis that happened to be on my 18th birthday. Even though I should’ve been mainly happy that I was even well enough to be out of the hospital, celebrate my birthday with some friends, and be able to eat a cake, I was mainly upset because I had wanted the boy I was seeing at that time to come to my birthday party but he wasn’t able to. Yet somewhere out there, there was someone who was receiving his/her diagnosis of cancer and that s/he’d have to go through chemo and radiation. How upsetting that must’ve been for both the patient and the family. Here I was belaboring over my insignificant and ultimately short-lived relationship while someone else out there was probably getting among the worst news of his/her life. Way to put my problems in perspective.

Intro to Anatomy thoughts

Before we first went into anatomy, we were asked to describe our feelings for a word bubble. I chose “epinephrine”, probably because I’m a dork, but also because it was accurate — I wasn’t really just anxious/nervous/excited, I was a bit of both, and all I felt was my heart rate speeding up and slight sweating and just adrenaline. I wasn’t sure how to feel. In the past, I’ve shadowed many surgeries, and I was never nervous around operations on open bodies. Something about the fact that we’d be with dead bodies, however, made me feel… eerie? I didn’t know what to expect. All I knew was that I wasn’t alone in my feeling in the room.

As we changed into our scrubs, I felt the rush more. I frustratingly tried different combinations to get into our lab until I finally got in, and I was the first girl. The minute I saw the body bags, all I wanted to do was find my body. Immediately, I adjusted. I didn’t even notice a smell, although I’m sure there was one. When I found my body, the bag was partially cracked open, and it was all I could do to keep my hands away from the bag so I could open it all the way.

I wanted to wait until after our first true lab and dissection to see how I felt, and I suppose intuition always wins — I love it. Before the class, we watched a video about what it meant to donors, and many talked about how they wanted to be more beyond their deaths, how they wanted to keep teaching, etc. As desensitized as I am to the whole “OMG, there’s a dead body in front of me that I’m cutting into” feeling, I haven’t stopped forgetting what a gift it is for us to be able to have these cadavers. Even in my fury of excitement as we reflect muscles and palpate structures, I still think about how lucky I am that someone was so kind enough to donate her body to me to let me learn and further my education. I have never had any anatomy — I’m not even kidding. I never even had to memorize the bones or the muscles of the body when I was in elementary school. I’ve literally had no anatomy. So in addition to learning this whole new language of terminology, I’ve also had to learn about where things are, what they are, how they are, etc. I won’t lie, it’s been tough. I spend hours on the pre-lab readings hoping to identify as many things as I can on various forms of art/pictures. In the end, there’s nothing like learning from touching the muscle in my hand or feeling the bumps of the spinous processes. I’m so thankful to the donors in our program that they are able to help me learn anatomy.

One of the cooler things to me too is how everyone’s body is so different. My friend and I were discussing how something that you’d even think you’d take for granted, like the number of vertebra, can vary between human to human! What does that mean for evolution? Who knows. I think it’s fascinating that you can try to extract someone’s life and story from their body postmortem. My program doesn’t let us know about details of death (or life) until maybe later, so it’s truly all a mystery to me. But I know that even the basics we’ve seen already reveal much. For example, I now know that if I were a cadaver, I’d be a pretty boring dissection since I’m probably all bone and fat with very little muscle. That sucks. I really need to work out more. I may not have exciting skin lesions on me, but I have had enough sun exposure that I may have some macules worth checking out. Is my story cool? What would future students know about me? Here’s a girl who either goes outside a lot or is extremely sensitive to sunlight or doesn’t wear sunblock (middle is true). Here’s a girl who clearly avoids the gym (true). Here’s a girl who is really frail — why? What happened to her? (kidney failure) I just think that’s so great that you can guess at all these stories about someone.

I’ve so long wanted to donate my body to future patients that I never thought about another purpose for it. But as someone said in our video, what if your organs aren’t the best organs? (e.g. cancer/other diseases, you’re old, you’re missing some, etc.?) Is there any other way I could give back? Probably. I think it would be pretty great to donate my body to medical education if I couldn’t put it toward live patients. I’d hope that they would respect me as much as I respect my cadaver, but even so, I’d be dead, and the best I could hope for was that these future students would get something out of my body.

2013 Resolutions and the first steps!

The year I got into medical school (2011), something happened. I’ve been grappling with this issue ever since someone asked me once, what do you want AFTER medical school? And I didn’t have a good answer. After I got sick, even the thought of going to medical school seemed so far away and unlikely that that’s as far as I aspired, and I didn’t think about what I wanted after that. When I got my acceptance, the truth loomed over me — what next? What do I want now? It may also have just happened to coincide with the first year I’ve ever been independent, but when I was sitting down to make my 2012 resolutions, I was at a loss. What else did I really need?

So one of my resolutions ended up being the 20 books challenge, which I did complete, along with a few other resolutions that worked for me. I focused more on building myself as a person and culturing my hobbies.

This year was even harder to make resolutions, especially since I did so well with last year’s. But I finally scrounged around and made nine. I’ve actually finished 1/20 books for this year already, which I’m proud of. Here’s the one I will be talking about today as it’s a huge step for me! 3) Gain weight (5-10lbs) / start exercising. Seriously. (yes, I actually wrote it like that)

After the hospital experience, I lost so much weight. I don’t think I ever fully regained my muscle mass because I just haven’t been as diligent about working out compared to before (for example, when I used to swim). I mostly regained leg muscle because, really, it’s not like I can just not walk around or go up/down stairs. But working on my arms has been a lot harder, probably because I am lazy but also because it’s really hard to face just how weak I became. I don’t know where the 5-10lbs that I’m missing (compared to my base weight) went but I’m guessing it’s somewhere there. It’s been an uphill battle for me to regain my weight, but this year, I’m determined. I’m finally off of most of my medications, and this is the time.

Today I went to the school gym with my best girl friend here at school C. We were careful to eat lunch first upon her advice and one of my other “body builder type” friends’ advice. The gym was calming but filled with confusing machines. I’m so glad I had someone with me. She asked me what muscle groups I wanted to focus on, and I said arms and back. Arms because of what I said above, and back because I’m scared I’ll get osteoporosis. We started with back. OMG! First, I didn’t even know back muscles could ache or be tight. I guess I was just used to sitting and orienting my body in one way. I think the longest/hardest part was when we were trying to fix my form for something, and I learned how uncomfortable it was to arch my back after hours of sitting straight.

The arm weights were the worst. I truly learned how much I had lost. I think the strangest sensation was feeling the crackling down in my forearms every time I tried lifting something.

We finished off with a bit of cardio. I think in the future, I want to go swimming, although I heard rumors that the pool isn’t heated, which doesn’t sound pleasant given the current weather conditions. I also noticed the rowing machines, which I miss from my random crew conditioning days. Right now, I feel sore and light at the same time. I’m also still hungry even though I ate a whole meal after. If I’m to follow my diet, I’m supposed to eat whatever I want whenever, so I think I’m going to go grab some cookies and peanut butter. I weighed myself on the machine at the gym to gauge my baseline. Good luck to myself for this coming year!

Five Years Ago

About five years ago on Thanksgiving, I had one of the worst fevers in my life. Temperature-wise, it wasn’t that high. In fact, I’m positive I felt worse when about two years later, I got swine flu. But I remember shivering no matter how many layers I covered myself in, crying because everything hurt so much, and not being able to breathe.

Three days later, I wrote in my journal: “Last night, I couldn’t sleep because I kept thinking about what it would be like if I literally died tomorrow.” Noteworthy because in my clinical development class a few weeks back, we discussed this weird phenomenon in which people seem to be strangely aware of their bodies and futures in a way that is completely medically unpredictable. Like when someone’s experiencing the worst pain in her life and feels a sense of doom, she’s probably having a heart attack.

Two days later (I was off by one day), I was hospitalized.

But now this year in 2012 a day before Thanksgiving, my doctor told me it was time to finally start taking me off all of my medications. Yes, all. I had been taken off most of them before and prednisone at one point (before getting put back on it) but CellCept too? Yep.

You’d think that for something as big as kidney failure and hospitalization and missing out on school, you’d remember it forever. I do, somewhat, but it’s so easy these days to not think about it anymore. I don’t really have dietary restrictions, I can pretty much do what most people do, and I’m studying to be a doctor myself now, prancing around the hospital in my white coat as if I were completely healthy and not a patient. It’s so easy to forget, especially since almost none of my peers for the past few years ever saw me sick. But about two weeks ago, it just hit me again out of nowhere. And I felt so bad for my poor little sick self. She didn’t know at the time that she was going to get better, get to graduate, get to go to college, get into medical school. Whenever I do remember, I also recognize why I don’t think I’m ready (and may never be) to be a pediatrician or go into nephrology/rheumatology. So I guess what I’ve learned is that time heals some wounds, but you could always be left with scars. And scars, well, they certainly take quite the time to heal.

20/20: A Feast for Crows by George RR Martin

A Feast for Crows by George RR Martin
Category: F
Rating: 3/5
Date finished: November 25, 2012

Summary: Continuation (book 4) of the A Song of Ice and Fire series. (can’t come up with a better description)

My thoughts: So GRRM decided to split the same time interval into two books to give more room for character perspectives. This book mainly seemed to focus on Sam leaving the Wall, all the politics going on at King’s Landing and with the Lannister family (except Tyrion), the Stark sisters (both of whom took on new names), and some other random stories (like about the House Greyjoy and Arianne at Dorne). I’m not sure if this was the best decision on his part because it seems that most people disapproved of this book and the next one. I can see why, because I often found myself wonder what was happening to everyone else, especially Dany and Tyrion, among my favorite characters of the series. Also, with the time lapse until the next book comes out, I think we will have forgotten a lot of what went down in this timeline, especially since I have to read yet another 1000 pages on the other half of the cast of characters.

My overall thoughts are pretty boring. I was annoyed that Asha didn’t get the Iron Throne because I felt that was extremely sexist. I don’t care much for what Brienne is doing right now… or Jaime for that matter. Cersei’s chapters were interesting because she was clearly going more and more insane and paranoid throughout the book, and it was great to see that GRRM finally tied up a knot in that plotline in the ending. Let’s just say that she had it coming! And good on Jaime for sticking to his guns and not coming back to save her. Margaery is a BAMF, and I want to know more about her. I’m so sad Maester Aemon died!!! :O Sam’s involvement with Gilly is SO boring… she needs to become more interesting or he needs to drop her. I also like Arianne — go female power! I’m hoping she’ll play a bigger role in the upcoming books.

The Stark sisters were my favorite perspectives. I had always liked Arya, and it’s cool that she’s really off making her own existence. I promise somehow that GRRM’s going to find a way for her to come back and own everyone at King’s Landing because he’s kept her alive (no small feat for this author), she’s off doing really awesome things, and she’s the arguably the strongest Stark remaining (not counting Jon Snow, but he’s not really a Stark and his character didn’t have a POV this time around). I also used to despise Sansa, and then I started to pity her, but now I can see that she’s also growing into a stronger character, which I like. Although Littlefinger remains creepy as usual….

I thought it was funny how he ended by saying that since he had already written the chapters for Dance, GRRM was hoping the next book would be out in a year. Nope, try six years. Well, that gives me time to attempt to squeeze in book 5 during medical school before Winds of Winter comes out. (PS, I’m already excited for that book. He’s clearly paving the way for the big epic battle(s), potentially involving the Others at the Wall but also definitely a battle for King’s Landing. QUEEN DANY!!!)

** And with that, I’ve finished my reading new year’s resolution for 2012. :)

A Glimpse into Oncology

(NOTE: all identifying patient information is excluded and/or has been changed. also these are patients from different locations, different doctors, different departments, and different times in which I’ve seen them… I’m truly trying to minimize ability to identify them. If anyone thinks these are too personal, please tell me so I can remove it. Thanks!)

[1] We’re called up to the hospital because the doctor’s patient was recently admitted. First we look over her scans again. Although I have close to no experience reading images, even I can see the abundance of round balls in the brain that probably shouldn’t be there. It looks bad. Doctor sighs. The resident thinks she’s done for. Doctor agrees; the patient has at most two weeks left. We rush up to the room just to let her know that we’re here for her if she needs anything. She’s frail and old but she’s smiling. Does she know why she’s been hospitalized? Maybe she does, and maybe she’s made peace with it? Or is this a coping mechanism?

[2] A team of us load her onto the apparatus. The doctor and resident place the scary-looking metal devices into the patient. She’s on her last round of radiation for her cancer, and she’s clenching her teeth and gripping my hand. I don’t feel the pressure of her grasp because all I can think about is how brave she is and how much this must hurt. After, she’s crying. We tell her she’s so strong, and she’s so happy because she’s done for the foreseeable future.

[3] We walk into a cold room where a man is being strapped into a glass frame. He’s on harnesses and chains and velcro, and I can’t help but think that it looks oddly like someone in a Houdini water torture cell chamber. Still, he’s grinning. He’s about to get blasted with full-body radiation in preparation for a transplant that might save his life. I could see that being something to smile over.

[4] I see a survivor. He wears his hair long, perhaps proving his success and how he no longer needs chemo. He was diagnosed with his cancer decades ago. Genetic analysis showed that he had lost p53, a critical tumor suppressor gene that is implicated in many cancers. Doctor said, it didn’t look too great for him. He took his drugs and got his stem cell transplant. With the transplant, there’s risk for another blood disorder that could develop into cancer (myelodysplasia). They’ve been following up on him, but he’s well beyond the time frame in which post patients develop the side effect. Doctor thinks he’s “cured” (I hear that word is never used in oncology). It makes me wonder — when I’m ten years out from my disease remission, am I “cured” at last too? Or will I keep having to make routine visits to my nephrologist? When do we get “cured” from chronic diseases? (Is that even possible?)

[5] I’m so impressed by how positive she is. She has papers with questions and appointments, and she’s so on top of her disease management. She’s also curious about her imaging and asks us to teach her about what’s going on. In a way, it reminds me of me. It also reminds me of previous patients I’ve seen; isn’t it so intriguing how some patients end up learning so much about their disease that they could almost be specialists in that field? I was so in awe of her energy that it took me by surprise when she asked about her eyesight. It had been growing worse since her treatment, and she wanted to know the prognosis. She wanted to go back to her normal life. I looked at the doctor. He told her it was unlikely she’d regain her vision. She started crying. In those few minutes I saw everything about what we’d been learning in the past few weeks about “breaking the bad news”. It makes me wonder what happens when you are at the crossroads of quality vs. sanctity of life. I can’t imagine ever losing my eyesight and how distraught I’d be. But when you’re fighting a disease as aggressive as cancer, there are casualties. When do you draw the line? I really don’t know what I’d do if I had to choose.

Wisdom from class

Ugh, I should really write my Berlin post. It feels like at this point, it’d be a waste, but I do have it all written out in my Moleskine, so the only thing that’s holding me back is pure lack of time (or perhaps laziness).

We’ve been learning about cancer this past week (and this coming week). Thankfully, I still think it’s a field I’m open to (as in I haven’t been grossly proven wrong, whereas with some other fields, I definitely feel a huge aversion to [esp. embryology... *shudder*]). Last Friday, we had this talk about end of life care. I thought it was going to be really depressing, boring (it was an out of class lecture), and/or stuff that I already knew. Somehow, it was a great lecture, probably the best of the ones we’ve had out of class and definitely better than some of the ones we get in class. The professor had this one GREAT quote that just shook me, which was “You cannot feel guilty about not being able to cure an incurable disease“. I don’t even know why this impacted me so much since I’m not doing any curing of any sort right now, but it just felt so revelatory that I had to share it here.