MIA (aka: winter break!)

I've been frolicking around the snowy northeast for the past few days. Mostly catching up with friends, but also visiting BREAKTHROUGH: THE DRAMATIC STORY OF THE DISCOVERY OF INSULIN exhibit in New York City (if you're in the city, go! even knowing the story before hand, all the documents and relics they have makes it pretty cool), and meeting with my PI from this summer to discuss my research. We also discussed how I should spend the next two years of medical school, as I received my official acceptance for the smaller program in the state capital yesterday. His two cents, to which I agree, is that I should go. 3rd year is about throwing yourself into the medicine and experiencing all that you can. He strongly suggests I go to the place that will give me the most experience and will also encourage the advocacy work that I'm drawn to. He also talked to me about the taking a year off for research, about choosing 4th year electives, and about residency applications. I'm so lucky to have such a grounded mentor.

With that, tomorrow I leave for the UK. This is assuming that the airport does not fall victim to awful weather yet again and that my flight actually takes off (and lands). I'm going to spend the rest of break NOT thinking about medicine. Not thinking about the impending move . Not thinking about Step 1. Not thinking about all the research I'm involved in. Instead, hanging out with lots of Jews, many of which will have cute accents! Okay, so maybe, that is a bit of a lie. I am bringing some work to do and study material with me. But I refuse to beat myself up if I don't get much, or any, of it done. See you on the flip side! Happy holidays ya'll!

Humbling reminder

A beautifully written article from The Washington Post, "A mother's joys and a family's anguish shared via Facebook", is a humbling reminder of exactly what I am getting myself into. Read it, but have Kleenex near by. It highlights the limitations of modern day medicine in such a highly technologically savvy world. More importantly, it is a potent reminder that every patient is a person: a mother, a child, a friend, a sibling, a unique and valuable entity in this world. I pray that I never forget this; that I never see a person as a just a medical case. Also, that I never forget how fine the balance is. That in a brief moment things can change from completely joyous to utterly devastating.

choices, part 2

In an update to this post last month, I just sent in an application for the program. Still not completely sure it is what I want to do, but I am also not ready to give up on it. The sticking point is the possibility to work with state officials on improving health care. To work on health policy reform in the state capital! Or at least working within the hospital to make policy changes. That'd be SOOOOO cool and so up my alley. I figure that by applying I'm allowing someone else to decide for me &/or buying myself more time to decide on my own. Only time will tell how this all pans out!

pitty me, I'm a medical student

I'm currently having a bit of a pity party. Tonight there is a rather large benefit concert at a local bar, a holiday party with my Jewish community, and a bar take-over with the city's queer community.... yet it is not even 10pm and I am sitting on my couch with Lulav, watching TV.

It isn't that I'm totally unsocial, I just can't seem to handle big group gatherings. Last night I hung out with a classmate instead of going to an upperclassman's holiday party. I then spent all of today studying. Right after shabbat ended, I met up with a classmate to get manicures and then grab dinner at a local thai restaurant. Tomorrow will also be spent studying, followed by an abortion movie screening and dinner with another friend.

The self pity stems from frustration in lack of a work-life balance. Also in the realization that this balancing act will never get easier. I can tell myself that life will ease up post-step 1, or post-3rd year rotations, or post-internship year, or post-residency, or post-fellowship, or, or, or... I simply wonder if medical school is causing me to be less of an extrovert. Instead, turning me into an unsocial, exhausted, isolated, single minded, socially awkward monster. If I can't rally myself to hang out in the bigger world now, how am I going to maintain a large (and non-medically based) social community? How am I going to have conversations about real world topics? Or worse, how am ever going to meet people to date?

Conclusion: my pity parties always seem to fast track me to crazy cat lady status.

Living in the south is bad for women's health...

The National Women's Law Center in conjunction with Oregon Health and Science University published the "2010 health report card for women" today. This report card looks at all factors important to women's healthcare: access, family planning, abortion, wellness & prevention, policy, etc.

The first thing I did was to look up the state I currently live in: F. Then I looked up the states that surround me: F, F, F, F... The south (TN, KY, LA, AB, MS) = fail. While not at all surprising, it is beyond frustrating. We theoretically live in a rich country with access to some of the best healthcare in the world; except clearly not. Women should not be receiving inferior care based on their gender. Southern's should be at a disadvantage based on their geographic location. Aren't we all US citizens?

My very liberal view is that we need some serious healthcare care reform NOW. Bring on the universal care with a single payer plan! Bring on preventative medicine. Bring on health education. Better incorporate other professionals into a person's care plan: social workers, nutritionists, and the such. Integrate more reproductive health care into primary care. OR, I should just move to Canada, or England...

What is my role in all of this? How can I help to improve healthcare as a medical student? Should I be getting more involved in health policy? How can I better prepare myself to provider comprehensive healthcare in such a broken system?

Words of Choice

“What is a good and RATIONAL reason to have a baby?"

This question was posed to us at a really wonderful “Words of Choice” workshop, which I had the opportunity to attend at this weekend’s conference. The workshop was facilitated by Joan; a well spoken, spunky, experienced, and passionate activist who shared insightful wisdom. With her blessing, I’d like to pass on a brief cliff-notes version of some of the thoughts and practical ideas that were presented. Please note that my writing cannot actually give this workshop justice.

The follow-up to the above question: It is pretty difficult to determine rational reasons to have babies. So, why do we expect such reasons from those choosing to not be pregnant?

General advice we were given about responding to anti-abortion rhetoric:

-Take a deep breath and then speak on the out-breath; this will lower your voice, giving you more authority. It will also help to keep you calm.

-Give a fact and move on

-Briefly state personal opinion

-Offer a generalized statement to recognize the complex philosophy

-Agree to disagree

Drum roll for my favorite piece of advice….

–Instead of holding tension in your back, shoulders & neck during these interactions, do kegels! Improving your sex life totally beats a life of stressed induced back pain.

Specific ideas that were suggested to respond to rhetoric with:

-“Women regret abortions” --> “Any major life decision has the possibility of regret -why should this one be different?”

-“You’re going to hell” --> “I’ll see you there”

-Someone making a threat on you/your family -->“What I am doing is legal, threatening me is not”

-“What if your mother had aborted you?” --> “Then I wouldn’t be standing here dealing with you”

-“Baby killer” --> “I’m proud to offer this service, babies are too important to be an accident”

-“Why is the mother more important?” --> “The mother already exists, and a child needs a strong & ready mother.”

Some other comments:

-"My concern is for the living children in this world who aren't getting their needs met. That’s where I would rather focus my energy.”

-“I didn’t go into this [providing abortions] to become a judge, therefore woman’s well thought out choices are all valid to me”

-“If one believes that the soul is immortal...then for the soul, having an abortion is like missing the bus - the soul will wait around for the right woman to carry it when the time is right.”

-“Human life is too important for there to not be choice present.”

One of the best parts of this workshop, which I can’t sum up here, was the opportunity to think/talk through my own ideology in a safe space. I recognize that my opinions, experiences, and beliefs will develop as I continue on this path to becoming a provider. (They already have shifted a bit over my past year and a half in medical school.) I recognize that in order to allow for this growth and ensure that I don’t burnout, having these safe spaces are so important. Besides being grateful for the overall session, I’m super excited about all the kegels in my future!

Where is the line?

I've been thinking and talking a lot about abortion today. Day dreaming about women's reproductive health isn't totally uncommon for me, but because of the Med Students for Choice national conference I was at this weekend, it is especially on my mind. The conference was such a high. A total reminder of why I was drawn to medicine in the first place, what I hope to accomplish in my career, and that there is a world of like minded peers out there (even if I am separated from the majority of them by the Mason-Dixon line).

I have so much I want to tell you about the conference. I took notes during the workshops which include many ideas for blog posts scribbled in the margins. These posts will (hopefully) come in due time. Once I have finished processing, caught up on sleep, and no longer feel like I am drowning in renal pathology. Okay, okay, maybe I wont wait that long; but I am not yet ready to post about it all tonight.

In the meantime, I received a gchat message from a classmate today. A classmate that is very much a friend. This was the message: "http://www.makearightchoice.com/index.htm
that's an interesting website i found in my research. thought you might want to take a look. "

I can't tell what his intentions were for sharing with this me. Was this in response to my attending the conference? Or did he really just want to bring it to my attention that such websites exist? I am (pretty) sure he didn't mean it to be threatening or an intervention, but regardless of the intentions, it still stung a little. This is someone who I deeply respect, conservative views and all. We dialogue about our opinions, we agree to disagree, and we normally are very respectful of the other's perspective and ideology when interacting. However, intentional or subconscious, I feel that this crosses a line. This plays into my fears about the path that I am on. Regardless of my fear of overt or subtle harassment, I WILL NOT stop being an advocate for abortion and I WILL continue on my path to becoming a provider.

post conference blues

I spent the weekend in a hotel filled with activist medical students. It was insightful, inspiring, and empowering. It also gave me a glimpse of what my future career as a doctor might actually look like. I bonded with classmates, reconnected with old friends, and made new ones. I will be blogging much more about it in the days to come.

The plane landed back home an hour and a half ago, returning me to my reality. I leave these conferences empowered yet also impatient and discouraged. I already miss being around so many like minded peers. I am back in the conservative south and back to the demanding life of medical school. I am also overwhelmed with all that I have to accomplish in the next 2 weeks before winter break, and needing to start my step 1 studying. Most importantly right now is my mph paper that is due at 12pm tomorrow. High-ho, high-ho, it is off to writing I go!

p.s. This weekend also reminded me how happy snow makes me! Yes, I know, this (along with many other things) makes me weird.

forced cultural competency

This post is a place holder. In our "fluffy" class (the class that every school has to teach med students how to "doctor", though these courses never share the same name), we broke into small groups for cultural competency standardized patients. My group went this afternoon. The activity was poorly planned. Actually, it was even worse than that. That said, it was by far one of the more powerful experiences I have had thus far in med school. It is an experience I hope to carry with me throughout my training and future career. More then ever I feel strongly that my duty and responsibility is to my future patient(s), who I must not judge or underestimate, yet I also need to remain true to my own values and experience. The feedback I received from today included: "You are golden", "make sure you don't change", and "don't let the institution of medicine ruin you". It is the most proud of myself I have been in a long time, and yet, I nearly threw a few temper tantrums (and punches) during the exercise.

That said, until the last group goes next week, I can not openly write about the experience. I can't give too much away to my classmates who haven't yet done it (though I doubt they read my blog). Plus/more importantly, I really need to be reading for class tomorrow morning.

Number Games

I love numbers. I always have loved numbers. I find them to be immensely useful and surprisingly therapeutic. When I was a very small child, my parents used to give me strings of numbers to add. This was how we filled long car rides. They would yell out numbers, and I would add them to the growing sum filling my head. As I grew up, the number games grew increasingly complicated. My favorite game was a version of math bingo... it was amazing. Even now, number games often make their way into my thoughts and daydreams. I still count, add, or find numerical patters in the world around me as a way of distracting myself.

This evening when I was driving home from school I started thinking about the start of chanukah tomorrow night. (How did we get here already?! Where has the year gone?!) This was my thought process: 8. 8 are the nights of chanukah. 8 are the days between birth and circumcision. 8 are the years of training: high school + college, college + med school, or med school + residency (if I go into OB/GYN). We have 8 system blocks of pathology in our second year of medical school. 8 years ago I was just beginning college, not even thinking about medical school. Dear reader, what does the number 8 signify for you?

This led to me doing a quick google search of the "significance of 8 in judisiam". At www.faqs.org I found the following answer, which I really like: " The idea that eight represents "an octave higher" can be seen in the form of the letter ches. Its shape as written in the Ashkenazi variant of Assyrian Script, the script used in Sifrei Torah, is that of two zayin's connected by a bridge. Zayin is seven in gematria. Ches is eight. Ches shows the bridge between one seven, one complete world, and the next."

The moral of the story is that I hope that this chanukah/ holiday season bridges us all to family, friends, love, peace, and holiness. Happy chanukah!









(This picture was from my chanukah party in 2008)

Coming out as a future abortion provider

I recently told my 92 year old grandma that I plan to provide abortions as part of my future career. While my grandma is fairly liberal, she rarely talks about her feelings on political issues. She is highly critical of the world she lives in yet she remains very tight lipped about her opinions. Our family seems to have a "don't ask don't tell" policy when it comes to conversations with depth.

As one of the most important people in my life, and as someone who brags that her granddaughter is becoming a doctor, I felt it was really important for her to know the whole story. I want her to be proud of this too. I want her to know that I'm going through this all in hopes of providing comprehensive care to my future patients. I really want to know how she feels about abortion. I also really want to know what she's seen and experienced in her life: pre & post the 2nd wave feminist movement, pre & post roe v. wade, pre & post having children of her own.

Since I didn't have the guts to tell her out of the blue, I sent her a copy of "This Common Secret" with a long note from me. We have yet to really talk about it in depth but she did thank me for sending it to her and did say enough for me to know that she supports me.

In response to all of this, a friend sent me the following card from someecards. I feel thankful for family & friends.

psuedo-science: update

My A1C came down 0.4 points from 3 weeks of wearing my CGM sensor. That is a pretty convincing argument to wear the sensor more often. Especially as life gets a whole lot crazier with the start of clinical rotations in the near(ish) future.

Now if only I could figure out how to not have an allergic reaction from the tape used to hold the sensor on...

What a difference a year makes

The following was my facebook status a year ago today: "DONE with gross anatomy, though far from done with anatomy as I assume it will follow me throughout my education and career."

So thankful that I am no longer a first year medical student for so many reasons.

positive mentorship

One of the many reasons I love my PI from this summer was highlighted in the e-mail I just got from him: "Remind me the official name of the award you won to spend your summer working your ass off rather than hanging out on the beach... ;)"

...he has an excellent sense of work/life balance.

choices

For 3 & 4th year clinical rotations, I have a choice to make: stay in the city I live in, or move our schools satellite site in the state capitol. In hopes of making the decision easier I went up there today to check it out. However, I'm now just more confused about what I should do.

The advantages of going: way more hands on experience (as in getting to be first assist in all surgeries, delivering babies myself, etc.), working directly with attendings, a special focus on leadership, nice on-call rooms, tuition incentives, cheaper housing, free meals & parking, and getting to be in a small close knit cohort of students with administrations who deeply care about us and our experience. Plus, it is only an hour drive away so coming back is an option. Oh! And we found a gluten free bakery/restaurant.

The disadvantages: The satellite site is new, small, and clam. It is not an official academic hospital, and the ER is a level 2 rather than the level 1 here. They see a little less trauma and don't seem as busy overall. We also wont have the formal lectures, though they do teleconference or make us come in to the main campus for some of them. The city has a lot less unique funk; there is also a smaller young activist community and basically no Jewish or queer community. With so few student there, no residents and interns, and no already established outside community, it seems somewhat isolating. Also, not all the doctors know what to do with students, but that has already improved a lot since this first class started last May. I will have to do a 4 week elective in non-clinical leadership on top of the 4 weeks I already have to do for my MPH, reducing my elective time to 16 weeks total.

Students at both sites seem generally happy with their experience and are learning a lot. Either location will afford me solid training and the chance to become a good doctor. It is unclear whether one will be more advantageous than the other for residency applications. Seemingly, both decisions are good which makes it even more difficult to choose.

April 14th 2011

I just scheduled the date. 5 months from tomorrow I will be taking the USMLE step 1. (Unless I decide to change the date.) As much as I don't buy into the whole "one test will determine the rest of your life", this test will significantly impact the rest of my life. One's step 1 score is the most distinguishing characteristic on residency applications. While scoring high doesn't guarantee anything, scoring low will close doors to competitive specialties as well as competitive cities. So if you see me freaking out, or disappearing, over the next 5 months, you now know why.

Side note: My exciting Saturday night plans? Preparing an MPH presentation, completing an abstract proposal, cuddling with my kitty, and maybe watching a bad movie. The joy of being a medical student!

election day 2010

I voted! Did you? If you didn't, why the hell not?! How can you rationalize silencing your own voice? I don't care if you're apathetic, too busy, confused as to who to vote for, etc... it is your damn civic duty! While one little vote doesn't seem like a lot, what would happen if EVERYONE decided that their vote was worthy enough to be cast? So get over yourself and step up to the challenge. Vote. VOTE! Vote as if your life depends on it. In fact, your life (or at least the way you live in this country) may in fact depend on it.

Nothing compares to election day 2008. I spent the day on a med school interview in the Northeast. The interview went well, and I was excited by the political buzz surrounding me on the very liberal campus. The interview ended, I changed out of my suit in the parking lot, and began the long drive home all the while listening to NPR. I drove through small town after small town, each sporting a very different set of political propaganda. Driving across New Hampshire I counted signs to see if I could discern which way the state would swing. I arrived home to a house full of people anxiously awaiting results to come in. We were having an election night party. My housemate directed me to the stack of mail, where I found my first acceptance waiting for me. Getting into med school was the first victory of the night. A night of many small victories communally experienced in my cozy community. My high was grounded the next morning with the announcement of prop 8, but for one night I really believed we had the power to conquer the world.

I'm pretty sure I'm not going to be happy with the results of this election. I'm not yet sure what exactly I'll be unhappy about, but it isn't looking so good. It is looking even worse from my vantage point way down South in conservative land. I miss my cozy and loving community. I wish I were with them tonight. Such is life. You win some, you loose some.

psuedo-science

Since the beginning of this school year I've been on-and-off sick. Swollen lymph nodes, sore throat, exhaustion, bruising, and a sporadic low fever. Nothing too significant, just mostly a mild generalized malaise. Being the second year med student that I am I have subsequently created quiet an impressive differential diagnosis: lymphoma, leukemia, pericarditis, GI cancer, malaria, etc... but really, it's none of these. I am sure of that. Likely it is just stress and a reoccurance of anemia (which I have a long history with).

I was at health services for something else this week and in talking with the doctor, we decided to draw some labs to see if we could find the culprit. I'm not entierly sure what she ordered but I think it included a CBC, mono titer, and maybe something else. For kicks, and because she was definitive that this is all because I'm a type 1 diabetic (don't get me started on how frustrating this encounter was), she also drew a hba1c.

My blood work came back without any significant findings. So still no explanation for the generalized annoyance my body is dealing with. I'm relieved it isn't mono and really not all that concerned. It is possible that the malaise is cause by simple seasonal allergies, for which I just began taking Claritin. I also expect my endocrinologist (who is also my PCP) will want a full iron panel when I see him in a few weeks.

The point of this post? To acknowledge that 2nd year med students are crazy. It isn't fully our fault; pathology is enough to make anyone into a hypochondriac. However, more important, I'm now running a sort of psuedo-science experiment. My a1c was 8.1. It's definitely not ideal but also not horrible... My experiment is to see if 1 month of wearing my continuous glucose monitoring sensor will have an impact on my blood sugar control. Since it's only a month, and an hba1c measures a 3 month average, the change probably wont be too significant either way. Results will be determined through comparison between this 8.1 and my a1c when I see my endo later this month. I'm hoping that thinking of it as an experiment will motivate me to continue wearing the sensor through the month (which I tend to find annoying and a little painful) and that it will prove helpful with my control. I need to start developing a better relationship with the CGMS as I expect that it will be my saving grace for clinical rotations.

specialty apptitude test

While procrastinating this week I took a specialty aptitude test. While I find the results to be interesting, and a good reminder that I have to excel on STEP 1* so that all options are open to me, I don't know how accurate it is. For one, I'm partially going into medicine to be trained as an abortion provider and only some of the specialties (highlighted below) will allow for that. It'll be interesting to see what clinical rotations bring and what I actually decide to go into....

Rank Specialty Score
1 thoracic surgery 42
2 occupational med 42
3 aerospace med 41
4 obstetrics/gynecology 41
5 pulmonology 41
6 nephrology 40
7 orthopaedic surgery 40
8 cardiology 40
9 physical med & rehabilitation 40
10 pathology 39
11 otolaryngology 39
12 preventive med 39
13 general surgery 39
14 rheumatology 39
15 hematology 39
16 infectious disease 38
17 urology 38
18 plastic surgery 38
19 pediatrics 37
20 nuclear med 37
21 neurology 37
22 neurosurgery 37
23 ophthalmology 37
24 med oncology 37
25 general internal med 37
26 family practice 37
27 endocrinology 37
28 radiation oncology 37
29 emergency med 36
30 radiology 36
31 psychiatry 35
32 dermatology 35
33 colon & rectal surgery 35
34 allergy & immunology 35
35 gastroenterology 35
36 anesthesiology 33

*STEP 1 is the big scary test that I have to take at the end of this year. The results will significantly impact my residency options. Reminders of how important the exam is are not necessary... it is something every medical student is well aware of.

marriage & chronic illness

At 16 years old, I was dumped by a girl I cared a lot about. Her reason for dumping me? She was scared of my insulin pump. This was the impetus for many hours of therapy sent mulling over how my chronic illness(es) effect my sexual attractiveness & hopes for future relationships.

In some ways I understand her apprehension, especially while a reckless teenager. I'd rather find out sooner rather than latter that someone can't handle my baggage. I also understand how my diseases play into a relationship: effecting what restaurants we can eat at, decreasing my ability to be spontaneous, low blood sugar and pulling out pump sites at the most inopportune of times, etc.... But the thing is, it's MY baggage. Sure, what diabetic doesn't love a significant other who will occasionally gets up in the middle of the night fetch juice for a low blood sugar? But I don't expect it.

Anyhow, today a friend sent me an article posted in The New York Jewish Week. Her e-mail was short and sweet:
"seems like something you would write.
http://www.thejewishweek.com/editorial_opinion/last_word/ms_mrs_hiding_plain_sight
love,---"
And the friend is right. The author's points are things that I agree with, and her fear of chronic disease sentencing her to a life of single-hood hits close to home. Pessimistically though, this is not something I imagine changing (in or out of the superstitious observant Jewish community) anytime soon. So instead I just hope that someday I will meet someone who wants to build a life with me regardless of my diabetes & celiac.

In which I become a...

cat owner/parent/stereotype/lesbian/[insert something else].


Meet Lulav!

I adopted him this past week and am already so in love! While I am by nature much more of a dog person than a cat person, my life is currently not compatible with being a dog owner. I spend way too many hours at school. My apartment is small. My clinical hours next year will be way too unpredictable. (Side note: a bunch of my classmates have adopted dogs. While I am in no place to judge their decision, I would love to know HOW they are doing it.) So anyhow I compromised my needs to become a parent, or at least get over my fear of commitment, and decided that I can offer a loving home to a kitty.

It is strange to think about how much Lulav will likely see me through. Becoming an MD, going through residency, likely moving houses/cities/states a few different times, and possibly even becoming a wife and having children. It has only been a few days, but I already have such love for a such a small little creature! Plus, he helps me study:

Checking things off the bucket list...

I can now check "selling myself" off of my bucket list. Maybe, if being generous, I can also check off "sex work"... but that would be pushing it.

Last night was the annual date auction fundraiser; a night that involves medical students and professors selling themselves in order to send a small group of students on a humanitarian medical mission. Turns out that I'm worth $80! Well, me and one of my friends (a fellow 2nd year med student) are worth that much. We got sold as a package deal: one-on-one sex ed from me and home backed cookies from her. Not too bad considering that most everyone went for between $40 and $100, though there were a few outliers going for $120 or so. I'm just REALLY relived that we sold at all as it would have been really embarrassing to stand up on stage and not be bid on.

In general, last night was not a night I will soon forget. The date auction was preceded by a madmen themed birthday party with good people and fun costumes. It isn't that common that I go to events with large amounts of drunk med students. It also isn't common that I get all femmed up to go out... and feel confident that I look hot. I always feel like it wont be my thing: too much alcohol and bad decision making, too late of a night out, too much photographic evidence to be posted on facebook, and too much drama that I would rather avoid. However, last night was actually fun. I was reminded that a lot of my classmates are genuinely good people and enjoyable to hang out with.

Plus there was a friend visiting one of the first years who also wears a pump. We totally geeked out on and flirted about the diabetes! We got into a pretty intense conversation about diabetes & drinking as well as about pump sites & body image issues. Both of which are conversations I will probably have with you, blog, in the future. Even tipsy, I can't escape my reality...

It gets better, part 2

This National Coming Out Day my heart hurts, a lot. It is 2010, why do we still tolerate hate and discrimination? It is time to seriously start changing this world. Watch this video. Sign this pledge. To all of you allies out there: start standing up for those of us who are LGBTQ; it gets lonely fighting this battle all on our own.

It gets better

Tomorrow is National Coming Out Day. It is a day that has never had meaning for me. I don't really understand having a single day with the mission of coming out, nor am I someone that revisits my own coming out story. However, in light of recent events, this year I feel a little different about it all. I walk a fine line with this blog in differentiating between professional and personal; I feel that it is important to be an advocate who leaves details of my own life out of the equation. After A LOT of thought, I have decided that this post is going to cross the line though. I'm going to share my personal coming out story in hopes of getting the message across to others, and to further propagate the amazing "It gets better" project started by Dan Savage and his husband Terry.

It gets better was started in response to the recent media coverage of a string of gay youth committing suicide across the country. In quoting Jay Michaelson, executive director of Nehirim, "I’m writing to you this month in the wake of six gay-related teen suicides reported in one week. At such times, all of us who are LGBT or allies ask ourselves what we can do... let’s remember that last week was not an epidemic of gay teen suicide. What was new was not the number of suicides, but the way they were reported in national media. Those of us who have been active in the LGBT struggle for equality knows that gay teens kill themselves every week, all over the country. Studies tell us that 42% of GLBT youth have suicidal thoughts, and that GLBT youth are nearly four times more likely to attempt suicide than straight ones." He's right, though some data states gay youth are actually up to 6 times more likely to attempt suicide.

Additionally, an article was printed in the New York Times this week regarding the disturbing realities of medical student/doctor suicides. The article, written by Pauline Chen M.D., stated that "...the culture of medical school makes these students also feel like they can't be vulnerable or less than perfect." These events and articles have acutely reminded me of my own past and have made me feel incredibly vulnerable. The more I think about it, I realize that I don't share my coming out story anymore because of the shame I carry with it, and because of fear of appearing "less than perfect." But by not sharing my story, a story that is way too common amongst the queer youth that I know (and don't know), I am further propagating the shame and guilt. My silence is not helping anyone; it is not raising awareness or helping queer youth feel less isolated; it is not acknowledging that medical professionals have past (and current) mental health struggles nor bring light to the copious resources to help one move forward; and it isn't honoring the experiences, good and bad, that have shaped me into who I currently am.

A week after my 16th birthday, just over 10 years ago, I attempted suicide. My attempt landed me in the ICU under a 72 hour hold, followed by 2 weeks in a psych hospital. This "event" (as my parents referred to it) was very much out of character for the 16 year old me. I was an honors student and athlete, I came from a close knit loving family, I was a "good girl" with a solid group of friends, I had just gotten my drivers license, etc... However, while I presented to the world as a put together young woman, I was completely shattered on the inside. At the time, I didn't have the words to explain why. I knew that the me I felt internally was not the same person as the world assumed me to be. My first attempts to rectify this discrepancy came in the form of experimentation with boys; numbing myself with the fantasies of teenage lust. These encounters only made things worse. They made me feel used and rotten, completely taken advantage of. One thing led to another and I found myself at the bottom of a dark well; there was no light to be seen and an urgent need to end the pain of brokenness. I was clearly an angsty and depressed teenager, but I had no understanding of what was causing these emotions and that it could get better. I felt that I had no where to turn and no other options to help me find myself. 10 years later I still thank G!d that my attempt failed, and that I was blessed with a second chance at life.

That summer, at a youth leadership camp for high school students, I met 3 young queer college students who were working as RAs. These women were the first queers I had (knowingly) ever met. Through getting to know them, asking questions about their lives, and shedding countless tears on their shoulders, it all began to make sense. I realized that a huge impetus for my angst was my sexual orientation, for not having an understanding of what it was or what it meant, and for having no clear vision of what it would mean for my future. I had no comprehension of a future life with a women and so feared that it would mean a life of pain and loneliness. Two pivotal things happened that summer though: I had my first girlfriend, and one of my RAs explicitly explained to me that "it will get better" in a tangible way that I could understand. She also exposed me to resources so that I could proactively make it better. Thank G!d for that summer. I came home and began to come out to close friends, followed by coming out to my therapist. Some were easier than others, but with each encounter I began to feel a little less shattered.

It wasn't always easy. I was outed to my parents by my therapist, without my consent. I was physically threatened by a group of boys in high school and harassed by others. I was told time and time again that coming out to my extended family wasn't an option. I feared holding hands with a lover publicly and had to seek out communities that were safe to be out in. I dealt with crushes on straight girls and learned to navigate finding other queer women to date. I shaved my head and wore combat boots in order to convince others that I was in fact queer, because it turned out simply dating women wasn't enough (and looked really stupid while doing it). I experimented with gender and challenged the notion of binary. Time and time again I ran up against my parents who's theory has always been to not show weakness, stand out, or make yourself vulnerable; and who were convinced that "it was just a phase". But, over time, it did get better in a lot of ways; which became especially true after my freshman year of college. By that time I had developed my own identity and a close group of friends to support me and as time went by, the wounds became less raw. For the first time in my life, at 24, living in a city that I love, surrounded by a family that I choose, personally accepting and encouraging my constantly evolving identity, and dating other good Jewish girls with strong queer identities: I felt like I was being true to myself, coming into my own, and paving my own path to change the world.

However, everything turned on its head with the start of med school last year. Moving south, putting myself into this ideal world of perfect superhero doctors, and living so far away from so many that I love reverted me to my 16 year old self. More often than not, I felt totally alone, raw, and vulnerable. Regardless of the soapbox I stood on, being somewhat fem and very Jewish, I was invisible queer. I lacked community and people to turn to. I had no shoulders to cry on, people to hug or cuddle with, friends within the same zip code to kick me in the butt. Once again though, it is slowly getting better. I am working on creating community here, getting better at asking friends (near and far) for the things I need, and working to make changes in myself and in the system that I can be proud of. While it is not yet totally better, I have faith that it will continue to get better as well as a shifting understanding of what better even means; and I continue to be grateful every day for the second chance I was given.

p.s. If you are an LGBTQ youth struggling about your identity, know that there are so many people out here who care about you. Also, know about The Trevor Project. Even if you don't believe me right now, your life is valuable enough to warrant reaching out to them, I promise.

Insulin is my friend, but not a cure

I've been forwarded a few articles on diabetes in the past few days. There was a feature in the New York Times on the discovery of Insulin. If you don't know the history of how insulin was discovered, you should learn! It is considered to be one of the great advancements in medicine and is a fascinating adventure of making of what was perceived to be impossible into reality. It is a story of resurrecting the (nearly) dead. In all fairness, part of my fascination may come from the fact that Insulin keeps me alive on a daily basis; but still, it is a pretty cool page in the history of scientific advancement. It won a Nobel prize. This article is a good place to start learning. This book is an even better resource to learn from. The article was published because of a new exhibit opening in New York on the history of diabetes. I want to go! If anyone is in NY and goes, let me know how it is!

Another article was on an innovative design contest held at Harvard. It makes me happy to know that "out of the box" thinking is being publicly funded and gaining growing attention. As a child, I use to constantly doodle up plans for diabetes management improvement and far fetched ideas for ways to cure it. In college, by attending an extremely progressive and integrative institution, I learned that inter-disciplinary approaches of critical analysis give rise to true innovation. I have to believe it is competition like the one in this article and the DiabetesMine annual contest will continue to revolutionize management of the disease. It is important to remember that while we have come so far with diabetes treatment in such a short period of time, insulin is not a cure.

Forgivness

So this essay kind of sucks. The month of (Jewish) holidays which just ended means that everything I've been doing has been somewhat half-assed. However, I still thought I'd post my second personal development essay of the year:

Being an observant Jew, my religious doctrine requires that I take an annual visit to the land of forgiveness. Our rabbi’s suggest that we spend the month before Rosh Hashanah preparing to ask for forgiveness from our peers, and then actually engage in the process during the10 days between Rosh Hashanah and Yom Kippur. After weeks of thinking about and asking from forgiveness from others, Yom Kippur, the day of repentance, is spent in synagogue asking for forgiveness from God. Having engaged in this religious practice since the age of 13, I have grown familiar with asking for forgiveness from peers.

The same Jewish doctrine requires that if you are not forgiven the first time you ask, you must ask for forgiveness twice more before you are let off the hook. This illuminates two different points about the process. The first that it is important to sincerely ask for forgiveness sincerely, and with enough to commitment to give your peer time to actually forgive you. Secondly, it is the others person obligation to forgive you. A process that is not always quick and easy. Though even if they don’t, you are still eventually able to move on with your life.

My actions that require asking and giving forgiveness have matured as I have aged. Actions of talking back to my parents and hitting my brother have evolved into spiteful break-ups with significant others and prioritizing myself before my family. While maturation is a good thing, the increased stakes of life’s decisions means that there is more room to seriously hurt people and to hold grudges. Misjudged actions now seem to have more significant consequences. I also realize how cathartic the process is. Holding grudges is never healthy and tends to drag me down emotionally. It prevents me from fully moving forward from the actions of my past and from becoming a better and more mature person.

One of the areas of forgiveness that I have yet to acknowledge in my life is forgiving myself. It used to be that I could use my past mistakes and self-frustrations as motivation to push forward. However, the longer that I hold onto these past experiences and negative memories, the more they weigh on my sense of self. As I am growing older, I realize that holding onto mistakes that I have made previously is airing more on destructive than productive. These memories can help fuel the fire of self-criticism. I am now realizing that I need to learn how to forgive myself, and embrace my past mistakes, through concentrating on the personal growth they have catalyzed.

The other area that I need to work on, or at least start to consider, is forgiving the mistakes of my classmates. Over the past year I have realized that I hold myself, and my classmates, to a very high standard. While we are full time students, we are also already out in the world playing doctor and interactive with many members of the community. As such I expect us to present ourselves as professionals. When a classmate does something that presents them self as less than professional, whether it be disrespecting a professor, blowing off a service learning commitment, or getting drunk and proudly posting pictures of the experience on facebook, I loose respect. These are grudges and opinions that for better or worse, I hold onto. I am just starting to realize how much I (internally) criticize such behavior. While it motivates me to present myself in a different manner, it also requires a lot of energy. I am starting to consider what I should do about these emotions and how to forgive behavior that I don’t really have a right to judge in the first place. Maybe it needs a mixture of forgiving their behavior and forgiving my own judgment.

saying no

One of my biggest challenges is saying "no" to things, especially to things that I sincerely want to do. Last week I was accepted into a scholars program focused on a topic that is my favorite to learn about. It is a program that I was rejected from last year, making this year's acceptance that much more exciting. The course includes 20 weeks of weekly online learning, small group sessions, and a final project. I had until today to make a decision about whether to participate in the program.... and after much strife about it, I decided to say no.

I'm super bummed. I really wish I had the time and energy to participate. If I had known I would be accepted this year, I would have not taken on other commitments.... commitments I am very much already committed to. At the end of the day, school needs to be my #1 priority along with staying sane and setting myself up to get into a good residency.

Saying "no" is an art. An art that I very much suck at. However, I also realize that if i want to succeed at what I am already doing, I need to say "no" in order to stay focused. There are hundreds of good options and potential activities to engage in but part of growing up is realizing that I simply don't have time to do everything I want to do; especially if I want to do these things well.

So here is to learning to say "no", to being at peace with these decisions, and to trusting that an occasional "no" (to maintain sanity) will not completely obstruct my personal development or cause my world to implode.

Med School Burnout

Tonight marks the start of succos, my absolute favorite Jewish holiday. Who doesn't love a holiday that commands you to build something, gather with friends outside, dwell in a shelter that lets you see the stars, eat yummy fall food, and shake branches while praying for a rain in a totally pagen way?! Last year I spent the first days of the holiday at one of my favorite places in the world: lost in the mountains of New York, in sukkah built for 150 of my closest (and newest) friends, overlooking a beautiful lake while watching the leaves change color. Plus there was really awesome learning, and very cute goats!

What am I doing this year to top last year's experience? I am spending it at home, very much inside, studying for Friday's exam. I had some lovely offers for meals in the community, in lovely sukkahs that my friends, the local synagogues, and chabad have put up; but a) I need to study and b) it isn't the same (mostly because the weather in the South is still 100 degrees out and the farmers here are praying for the rain to stop, not start).

While I know this sacrificing of identities is not good for me, today was the first time I realized that it might be detrimental for my future patients. By sacrificing social time and religious practices I'm setting myself up for burnout. I justify it by saying that something I learn, or don't learn, now might be the difference between life and death for one of my future patients. An article published today by the Mayo clinic in the Journal of the AMA on med school burnout though makes me think twice. A synopses on the article can be found here. These types of articles reinforce my belief that medical school is one of the least healthy endeavors one could engage in. Ironic, right?

The conundrum remains that there simply are not enough hours in the day. How can I learn everything I am supposed to know, while still doing all the things I need to do to stay sane and avoid burnout? It is undoubtedly a juggling act; one without a simple solution. My guess is that I'll learn to master it just in time to graduate medical school and start residency... just in time to face a new conundrum on time management and burnout avoidance.

I promise, er suspect, that once the fall chagim (Jewish holidays) are over, there will be a little less discussion on finding balance between Jewish and medical student identities. This just tends to be the season for such guilt.

Yom Kippur 5771

The Jewish community in this small southern city is fragmented. I live within walking distance to the chabad, but have to go stay out in the suburbs for the conservative and orthodox communities. I have spent multiple holidays and many a shabbos out in the 'burbs and have been well adopted into the community.

Last year, for Yom Kippur, I decided to stay home and go to chabad. Because I can't fully fast due to my diabetes, I don't like spending it away from home. Also, we had an anatomy exam right after the holiday and I was too stressed to go out to the suburbs. As much as I love the chabad community, it felt totally unfulfilled and decided to spend this year in the suburbs. However, at the last minute I changed my mind and stayed home.

I have mixed feelings about having stayed here. "Yom Kippur 1984" By Adrienne Rich speaks to some of these feelings. The alienation between identities and isolation from the community/ies I want to be in. I spent it at one of the local Reform temples with many if my classmates, professors and the dean of student affairs. While it became clear that I am no longer a reform Jew, it mirrored so many of my holidays growing up; it also magically made my classmates and professors feel like family. There was also an AMAZING drash about gay marriage- and how it is our duty to use Jewish doctrine to embrace it. Overall, a mix of blessings and frustration.

Hope ya'll had a meaningful holiday & gmar chatima tova!
---------
"Yom Kippur 1984" By Adrienne Rich

What is a Jew in solitude?
What would it mean not to feel lonely or afraid
far from your own or those you have called your own?
What is a woman in solitude: a queer woman or man?
In the empty street, on the empty beach, in the desert
what in this world as it is can solitude mean?

The glassy, concrete octagon suspended from the cliffs
with its electric gate, its perfected privacy
is not what I mean
the pick-up with a gun parked at a turn-out in Utah or the Golan Heights
is not what I mean
the poet's tower facing the western ocean, acres of forest planted to the east,
the woman reading in the cabin, her attack dog suddenly risen
is not what I mean

Three thousand miles from what I once called home
I open a book searching for some lines I remember
about flowers, something to bind me to this coast as lilacs in the dooryard once
bound me back there--yes, lupines on a burnt mountainside,
something that bloomed and faded and was written down
in the poet's book, forever:
Opening the poet's book
I find the hatred in the poet's heart: . . . the hateful-eyed
and human-bodied are all about me: you that love multitude may have them

Robinson Jeffers, multitude
is the blur flung by distinct forms against these landward valleys
and the farms that run down to the sea; the lupines
are multitude, and the torched poppies, the grey Pacific unrolling its scrolls of
surf,
and the separate persons, stooped
over sewing machines in denim dust, ben under the shattering skies of harvest
who sleep by shifts in never-empty beds have their various dreams
Hands that pick, pack, steam, stitch, strip, stuff, shell, scrape, scour, belong to a
brain like no other
Must I argue the love of multitude in the blur or defend
a solitude of barbed-wire and searchlights, the survivalist's final solution, have I
a choice?

To wander far from your own or those you have called your own
to hear strangers calling you from far away
and walk in that direction, long and far, not calculating risk
to go to meet the Stranger without fear or weapon, protection nowhere on your mind
(the Jew on the icy, rutted road on Christmas Eve prays for another Jew
the woman in the ungainly twisting shadows of the street: Make those be a woman's footsteps; as if she could believe in a woman's god)

Find someone like yourself. Find others.
Agree you will never desert each other.
Understand that any rift among you
means power to those who want to do you in.
Close to the center, safety; toward the edges, danger.
But I have a nightmare to tell: I am trying to say
that to be with my people is my dearest wish
but that I also love strangers
that I crave separateness
I hear myself stuttering these words
to my worst frineds and my best enemies
who watch for my mistakes in grammar
my mistakes in love.
This is the day of atonement; but do my people forgive me?
If a cloud knew loneliness and fear, I would be that cloud.

To love the Stranger, to love solitude--I am writing merely about privilege
about drifting from the center, drawn to edges,
a privilege we can't afford in the world that is,
who are hated as being of our kind: faggot kicked into the icy river, woman dragged
from her stalled car
into the mist-stuck mountains, used and hacked to death
young scholar shot at the university gates on a summer evening walk, his prizes and
studies nothing, nothing availing his Blackness
Jew deluded that she's escaped the tribe, the laws of her exclusion, the men too
holy to touch her hand; Jew who has turned her back
on midrash and mitzvah (yet wears the chai on a thong between her breasts) hiking alone
found with a swastika carved in her back at te foot of the cliffs (did she die as
queer or as Jew?)

Solitude, O taboo, endangered species
on the mist-stuck mountain, I want a gun to defend you
In the desert, on the deserted street, I want what I can't have:
your elder sister, Justice, her great peasant's hand outspread
her eye, half-hooded, sharp and true
And I ask myself, have I thrown courage away?
have I traded off something I don't name?
To what extreme will I go to meet the extremist?
What will I do to defend my want or anyone's want to search for her spirit-vision
far from the protection of those she has called her own?
Will I find O solitude
your plumes, your breasts, your hair
against my face, as in childhood, your voice like the mockingbird's
singing Yes, you are loved, why else this song?
in the old places, anywhere?

What is a Jew in solitude?
What is a woman in solitude, a queer woman or man?
When the winter flood-tides wrench the tower from the rock, crumble the prophet's
headland, and the farms slide into the sea
when leviathan is endangered and Jonah becomes revenger
when center and edges are crushed together, the extremities crushed together on
which the world was founded
when our souls crash together, Arab and Jew, howling our loneliness within the tribes
when the refugee child and the exile's child re-open the blasted and forbidden city
when we who refuse to be women and men as women and men are chartered, tell our
stories of solitude spent in multitude
in that world as it may be, newborn and haunted, what will solitude mean?

1984-1985

A picture is worth a thousand words

This is from "Stirrups and Stories", an amazing attempt for patients to reclaim the OB/GYN experience. Looking through the site I am very much reminded of what brought me to medical school in the first place and why I want to be an OB/GYN. I want to empower women to reclaim their own bodies.

It reminds me of my college thesis. I spent a year examining elements of power and agency in pregnancy that lead to a woman being educated about her pregnancy and birth options. Using anthropology and photography, I created a multi-dimensional ethnography with a corresponding photography gallery exhibit. I was blessed to spend my year engaging with women who opened up to me, sharing their stories, families, homes and images of their bodies with me.

On a similar note, here is a pretty awesome article on home birth. The article illuminates the reason that I choose medical school over nurse midwifery: the desire to advocate for reversing the over-medicalization of births from the top. Additionally, I want to empower ALL women to embrace their health and trust their bodies, instead of just working with women who choose midwifery care. I strongly agree with a lot of what the article is saying, especially the following paragraph: "In anthropology, we say that "normal is simply what you are used to." The power of socialization and the dominance of biomedicine have kept us from systematically examining a variety of birthing environments and providers as viable alternatives to the expensive and interventive hospital delivery that has become the norm in the U.S."

Here is to hoping that we can start listening to women's voices and remembering that birth happened long before western medicine came along; and that I don't forget my background as an anthropologist and a labor doula as I progress through my medical training.

conflicting identities

Since starting college, every fall brings with it a little bit of dread. The chagim (Jewish holidays) which are supposed to be filled with meaningful contemplation, community, and celebration seem to instead be filled with stress, guilt and juggling. I hate the fact that for a solid month, I feel like neither a good Jew nor a good medical student. By trying to find a compromise between my identities, I simply fail at being either. The saddest part is my disconnection from sukkot as it is totally my favorite holiday but seems to get overlooked by the post Rosh HaShana & Yom Kippur catch up games.

Since it is very apparent that I'm no longer on the professional Jew track (there was a period of time where I seriously considered becoming a Rabbi), it seems to be time to re-conceptualize my religious identity. What does being observant mean to me now? Now that I am without my progressive-trans denominational-intellectual Jewish community, now that chabad is my only walk-able option, now that I am a busy med student who never has enough time, and now that my kavinah (spiritual intention) seems to be elusive at best. Now, what is meaningful for me?

Goals for 5771: (0) Spend some time reconnecting with and reformatting my spiritual identity. (1) Work on broadening my Jewish community in this southern town that I now call home; especially by expanding my circle of liberal-queer-intellectual Jews. While I already know most of the people that fall into the above category, I need to put more energy into really making these people part of my community. (2) Revisit what being shomer shabbos means to me. (3) Make more of an effort to connect with my inner Jewish mother. I miss having people over for shabbos and holidays. I miss taking care of others in my community. (4) Follow through on my plan to volunteer with the local chevra kadisha (people that do burial preparations) as a means of connecting my conflicting identities. (5) More text study! I miss text study.

Broken

I subscribe "Pulse", a weekly internet-based literary journal. Some of the pieces are so-so but others are absolutely wonderful; this week being one of the later. The story was titled "Broken" and tells of a pivotal moment all medical professional go through, the point where our idealistic nature gives way to jaded frustration. Besides being a good read, it hit close to home as the shifting mindset of budding physicians is something I've been thinking (and talking) about a lot recently.

Last week I had my first official meet up with my "first-year buddy" where I passed along a piece of advice I had been given by a doctor-friend. Before I began this doctor-friend told me that her biggest reget was not keeping a paper journal throughout her med school journey, as she knew she was profoundly changed, but lacked documentation of the evolution. I was already keeping a journal at the time (having started during the interview trail) but have used her words as motivation to keep up the practice. When I passed these words on to my buddy, she immediately asked what, if any, changes I had noticed so far? To which I responded with a simple "yes". It is not easy to express how an experience changes you. It is even harder to do when you don't view all these changes as positive. And harder still is to present this information in a way that it wont bias the experience of my first-year buddy.

While I have not yet "broken", what are some of the things that have changed over the past year? The top 3, or at least the 3 I feel like mentioning right now, are:
1) I have become more impatient with people and with bull shit. Because my time is overly structured and because I can't take a break from studying without feeling guilty, I find myself inpatient to anything or anyone that slows down my productivity.
2) My vocabulary has changed. I now use words like "acute", "lateral", and "pathological" in every day, non-medical, conversation. I also triage my conversations with friends in order to extract the most important information first. I blame this on being impatient .(see #1)
3) Having yet to see a really successful model of personal life for career driven physicians, I have been making peace with the idea of potentially not getting married and having children. (see previous entries with "family" labels)

I am sure that I will continue to change over the course of medical school and my career, and am hopefully that these changes will be chronicled in my paper journal and maybe also on this here blog. I sincerely hope that I never significantly change or break to the point of being driven away from medicine and the idealistic desire to do good in this world. If I do, I hope that I, like the author of the article, can find ways to be reminded of my goals and be made whole again.

Normality

This article titled "Are You Sexually Normal -- and Does That Matter?" by Dr. Marty Klein may just equate a literary orgasm. I think I'm in love with it, or at least significantly lusting. I want (all) my potential future partner(s) to read it, assuming that I, G!d willing, have future partners. If society as a whole could just take the message to heart, we might be able to create a utopia, or at least a much less anxious and more sexually satisfied community.

silly traditions

Right before the first anatomy exam of our first year of medical school my classmates and I were all freaking out. Between the sheer quantity of information we were excepted to know, the uncertainty of what to expect from the exam, and the fear that doing poorly would alert the admissions office to their mistake of accepting us... we were anxious to say the least.

Two days before the exam we were sitting in the main lecture hall for a review session which we had been informed was "extremely high yield". About 15 minutes into the 2 hour review a noise began to grow louder outside the doors to the auditorium. Out of no where a large amount of the second year class came storming into the lecture hall, hurling candy, mardi gras beads and plush toys at us. Looking around, none of my classmates appeared to know what was happening as we laughed and ducked. Before leaving, the second years sang to us and explained that this "review session storming" was simply an annual tradition with no explanation. They left us with a noticeably more relaxed attitude and a huge mess to clean up in the auditorium.

I look back on the experience as one of my founder memories from last year. It was the moment I realized that everything really was going to be okay. If the upper classmen could take a break from their studying (as they also had an exam to cram for), and if our professor could allow for this to happen during his review time (and then continue to teach while wearing beads and eating candy), and my classmates could see the humor in oddity of the situation: I too could learn to relax and enjoy the experience.

Today it all came full circle. It was our day to storm the first year review session, which I did with 30 or so of my classmates. Seeing the same look of confused enjoyment on the faces of the first year class, I could sense that they too were getting it: the moment of clarity that medical school will be okay and maybe even a little bit enjoyable at times. The surprise though was realizing that not only did I help give this experience to the first years, I was able to take from it as well. As chaotic as this year gets with course work, step I preparation and extra curriculars, there is ALWAYS time for humor, to be silly, to carry on tradition, and to make someone else's day.

Though there really are never enough hours in the day. So, with that, back to studying for Friday's exam I go.

As much as I love microbiology, I was reminded today of why I will never go into infectious disease. Or ophthalmology. I did a google image search of roundworms (ascaris lumbricoides) in order to supplement our lecture. There was a picture of a roundworm in someone's eye. I'm not sure why but eyes REALLY freak me out. An eye + a parasite visibly swimming in it = enough to make me almost want to quiet med school.

Yet I know that I am a med student because as much as it freaks me out, it is kind of cool...

Dr. Harrison

Dear Dr. Harrison,

I was fortunate enough to hear you speak last fall when you visited my southern medical school. As a first year, I sat wide eyed listening as you eloquently explained your motivations to provide comprehensive women's health care, your drive to ensure that all women have access to safe abortions, and the factors you have had to overcome in order to offer these services. The stories you told of the patients you have encountered inspired me. I have no doubt that these patients, and so many more, are standing with you now in solidarity.

I spoke with you briefly after the presentation, asking if it is better to do the MSFC externship between first & second year vs. during 4th year electives. Along with replying that 4th year is preferable you also suggested that I should come to your clinic to do it. As someone struggling with the conservative nature of my school's OB/GYN department, that warm and welcoming invitation is something that I will always carry with me. It is a rose among the thorns of naysayers and hurdles trying to keep me from being trained as a provider. Just as you did not hesitate to offer yourself as a teacher and mentor, I promise to never hesitate in pursuing my education. In following your lead, I will not let obnoxious barriers keep me from providing safe and affordable care to women in need.

Thank you for all you have done. Thank you for believing in women's rights, and for letting these beliefs shape your actions. Thank you for being a warrior on the front lines. Thank you for inspiring all of us future providers. Thank you for paving the way for me and my peers to be abortion providers, to be guardians of women's rights, and for showing us that we can actively model our values and beliefs. You are leaving us with mighty big shoes to fill. While we might not be able to fit in them perfectly, I can promise you that we will continue to march on. Your patients need us to, the women of Arkansas need us to, the women of The United States need us to, as well as the rest of the women in this world.

While the words will never be big enough, they are the best I have:

THANK YOU FOR ALL THAT YOU HAVE DONE,

(just another MSFC member and future abortion provider who is inspired by you)

Listening

For one of our classes we have to write "personal development essays". While rushed and somewhat BSed it still provides some insight into my inner musings. Plus one of my classmates posted her's, leaving me to think "why not?". So, this is my first one of 2nd year:

As a child my parents made sure to teach my brother and I the difference between “listening” and “hearing”. According to them, listening was a passive act that held little meaning and respect. Instead of having us listen, they wanted us to hear what was being said. They wanted us to be actively engaged in dialogue and to put effort in to ensure mutual understanding. Their distinction introduced us to the value of not spacing out while listening to someone, not interrupting, or otherwise being inconsiderate in conversation.

Later on, through group facilitating experience I was introduced to the idea of active listening. While I have learned that there are many ways to do this, one of the most meaningful ways I have experienced involves having one person speak for a set period of time while the other(s) remains totally silence. When the speaker has said all that they have to say, they end their session by saying “I have spoken”; the other person(s) respond by saying “I had heard” and nothing else, never responding to what was said. Then it is the other partner’s turn to speak. This interaction tends to feel very unnatural and uncomfortable at first, but manages to create an extraordinary safe space for significant interactions to occur. There is a shared trust that a scared space has been created, and that you have as long as you need to process what you are saying while you are saying it. In theory listening to others should be an intrinsic ability yet activities such as these make me feel that it is much more of an acquired skill.

I guess that I should not be surprised that truly listening is a challenge. We live in a world where we are constantly on the go, constantly multi-tasking, and being completely self-consumed with our own lives. Our society appears to no longer values face-to-face conversation (at least outwardly), having instead replaced it with the instant gratification of e-mail, text messages, and cell phone conversations. The problem with these forms of communication is the difficulty in staying actively engaged, and the ability to misinterpret what the other is saying. I have more than one string of e-mails turn sour due to misinterpreted words, leading to more e-mails in order to rectify the situation.

The culture of medicine seems to add even more difficult to listening. From day one in medical school we begin learning a new language, one that is efficient, relatively exact, and completely foreign to the majority of our patients. We are also taught the importance of time management; learning early on that time is limited and valuable. While many of us have the best of intentions, these lessons can easily put distance between us and our patients. Leading us, their doctors, to ask questions without waiting for answers, correct their statements with authoritative-knowledge, and dismiss their concerns with our lack of time. While we many think that we are listening to our patients with the 15 minutes we have for a visit, we are never doing it for more than a few seconds at a time and we certainly are not hearing what they are telling us.

Through my work at the student clinic(s) I am already starting to sense how easy it is to feel rushed and inpatient during visits with our patients. When I ask a question such as “have you have a TB test before?” and get a long winded response, it takes effort to not interrupt to ask “yes or no?” However, the tiny bit of effort that it takes to bite my tongue produces valuable awards: the privilege of hearing personal stories and a better understanding of my patients. I hope that throughout my medical career, especially when feeling overwhelmed, I remember the value in active listening. The valuable lesson to strive beyond listening, to work to hear, is one I will carry with me throughout my career and will hopefully play into all my future.

Research

Research is a necessary evil of medical school. Yes, it is possible to go through the educational system without doing research. It is even possible to do well and match in a good residency without a publication. But as someone interested in academic medicine, research is basically a required optional activity. The process fascinates me. The ability to spend time questioning, exploring, and explaining speaks to my inner child. However, the process also creates an emotional roller coaster which drives me nuts. There are constantly ups and downs, with very little balance between the highs and lows.

Currently I feel overwhelmed by the lows of the process. My abstracts from this summer need to be submitted this week, yet are stuck in the in-box of my PI waiting for revisions. I can't imagine how he's going to edit them in time, and being 3000 miles away limits my ability to nag him about it. If he does get them back to me, will they still need work before submission? How does one even submit abstract proposals to a conference in the first place? (I am sure I will learn as I go, I'm just not sure that timing will allow me to learn with these abstracts). What will happen if they aren't ready? Will this be the end of everything I worked on this summer?

The second project I've been involved with is currently stuck in the IRB labyrinth. We submitted our application for exemption on Thursday, right before the Friday deadline. This was our last chance to submit and get a reply before our intended (and non-negotiable) project start date. Late Friday afternoon we were informed there is a snafu in our application, and it may be insurmountable. I may have thrown a temper tantrum yesterday morning when I found out about this. I may have acted immature and unprofessional by sending out a rather pungent e-mail to my adviser and co-researchers, an e-mail I now can't take back. I intellectually know why the IRB is necessary but am so frustrated that silly bureaucracy (relating to intellectual property rather than ethical concerns) may impede on interesting and important research, biased opinion of course. Not to mention that this is research I WANT to spend my time doing instead of just doing it for the sake of my future... but maybe that is the problem. Being so attached to the topic might be increasing the emotional weight of every set-back. I guess you can never win...

"Letting Go"

Here is another amazing article by Atul Gawande. He speaks of issues that make us Americans very uncomfortable: end of life care. It is not surprising to anyone that a disproportionate amount of our health care spending goes towards those facing death; is it worth it? When do we say that enough is enough? While drawing concrete lines that such and such a procedure under x circumstance is wasteful doesn't seem so hard; it all changes when talking about a specific person. How do we create a fair, finically responsible and sustainable medical system? How do we do it while valuing each individual life as priceless? Thoughts?

My inner-anthropologist thinks that we need to come to terms with death being a natural, and sometimes even desirable, end to life. As doctor's we need to stop seeing death as failure on our parts, and need to start seeing palliative care as an alternative option. We also need to really listen to our patients, identifying what their true desires about end of life care and encourage them to share this information with their loved ones.

Lonely

"If your heart is bleeding make the best of it"

This video is absolutely beautiful and resonates with me on a personal level. Living in the South, I often find myself lonely in a way that I haven't since I was an uncomfortable middle schooler. I can be surrounded by people, knee deep in medical school text books, stressed about the 100s of different thoughts flying around in my head and yet feel totally and completely alone. It often happens when surrounded by people who don't understand (or know about) all the unique paradoxes that define me. The loneliest times are shabbat days that I stay home to study, feeling completely cut off from both my Jewish and non-Jewish communities.

I am starting to understand the naive idea of wanting children in order to have something that needs and loves you. I know that I am not ready for children, but I have been starting to contemplate getting an animal. With 12 to 15 hour days spent studying at school, and the reality that impending rotations will keep me away from home at random hours, a dog seems out of question. A cat might be a good fit though. However, I worry it will fast track me to "crazy cat lady" status. That if I get too comfortable with a cat at home to talk to and cuddle with, I'll have no motivation to ever leave home and/or look for a significant other. Also that it'll make me the stereotypical lesbian. Though the true stereotype involves 2 lesbians, multiple cats, and a Uhal. A friend responded to this fear by stating that one doesn't necessarily need a cat to become a crazy cat lady. Helpful, right?

going gay

My medical school went gay last week.

Okay, fine, let me try rephrasing that. After a lot of work, meetings, and jumping through hoops, we finally got an LGBT and allies student group approved at the medical school. While not as hard as I feared it would be (and with a lot less backlash) this was still a rather difficult task as we had to defeat the overwhelming amount of stress induced apathy. But advocacy and grassroots organizing paid off. We are now a guaranteed student group with all the rights and privileges such a status bestows... all $300 or so a year to put on events with, events we were already putting on. The money wasn't the point of creating a student group though; rather it was to create a visible and inclusive community fully supported by the administration.

To celebrate we had a gay happy hour outing Friday afternoon. There was an excellent turn out and people seemed to enjoy themselves. Meeting some of the first years was lovely. The surprise of the night? Learning there are nearly 15 openly (out) identified (L/G/Q/insert proper identity term) students in the first year class. That is as many as the other 3 years combined! While it still represents less than 10% of their class population, it is a HUGE number for a medical school class, especially medical schools in the South. I'm taking it as a positive sign for the ability to change the system and encouragement to keep fighting for LGBTQ visibility. I'm also really interested to see if this increase in population will have any effect on perceived community dynamics. Or for that matter, on my personal life (so doubtful)....

Broken, part 1

"Medicine used to be simple, ineffective and relatively safe; now it is complex, effective and potentially dangerous." -Cyril Chantler

This is the first part of what I am sure will be a many part saga; an epic about how broken the US health care system currently is. I say all of this with the caveat that a) I'm really not sure what would be better; b) if I did, I'm not sure I would know how to transform our current system to this new shiny, effective, and cost efficient system; and c) as imperfect as I know single payer systems to be, I support systems that acknowledge my belief that health care is a right. However, I am never really sure what to say when asked "how much health care is a right?"

Two things happened last week that made me think about how broken our system is. The first was a public health class on health care management. We spent 5 days sitting around a room, shooting for the moon with our ideas about what health care should offer. We then discussed authentic leaders, and how to use leadership to make these things happen. In 20 years it will not surprise me to see these classmates transforming the way health care is delivered; and with the ideas that were shared, I pray that these minds are able to make an impact much sooner than 2030.

Second, I received two e-mails. The first from a friend worrying that her birth control pills were fallible. This friend should have been educated about all the possible signs and symptoms that may present when put on the pill. The lack of premptive education caused needles worry, undue anxiety, and possible misstrust in the system. The fact that she came to me (a know-nothing medical student) instead of her clinician speaks to the inaccessibility of educational services. Second, another friend, with a history of asthma ended up with multiple time-consuming and stress-inducing specialists appointments because of follow-charts. She saw her clinician presenting with shortness of breath and heart palpitations which automatically sent up the red-flag for cardiac trouble. While this red-flag supports the effectivness of the system (along with the fear of malpractice litigation), no one took a time out to actually think about the situation. The fact that she's young, healthy, had a normal EKG in the office, and that her signs and symptoms were consistent with her asthma regiment. If this thought process had been followed, she would have been saved excess time, money, use of precious resources, risk of added interventions, and excess time before the necessary change in asthma medicine.

I may be a naive medical student. Maybe you don't agree that these examples illuminate some of the many issues with our medical system. But, even still, can you really say that our system isn't problematic? And should we settle for something so broken?

underachiever

"I'll be in the student lounge studying all week" is a common statement to hear from my classmates, especially the week before an exam. However, hearing it from a classmate today, TODAY which is still SUMMER vacation, a week before classes even begin for the year, was like a punch to the stomach. That's it, I am an underachiever. But I am not. I am just seizing the opportunity to spend the summer free of studying; though not free of: clinical research, shadowing physicians, planning extra curricular programing for the fall, and remembering what if feels like to be a real human being in the multidisciplinary outside world.

I WILL enjoy my last week of summer and I will not let my peers make me feel like an underachiever. My challenge this year is going to be finding a way not to compare myself to my classmates. I need to do the best I can for myself and my future patients. Spending hours agonizing over how much they are studying, the amount of details they seem to retain that I don't. and comparing exam scores will not help. In fact, I'm pretty sure such things would make me go insane. Me going insane? Well, that wouldn't be good for anyone involved.

All good things must come to an end

Today was my last day of work, wrapping up a summer spent researching in a city that I love. I was fortunate enough to spend the last 8 weeks surrounded by big brains in long white coats who happen to also have very big hearts. Half my time was spent in front of a computer screen: analyzing data, researching prior literature, writing, and rewriting. The other half of my time? That was a mixture of shadowing in clinic, getting into theoretical and hysterical conversations with my coworkers, and collecting mentors as if they were baseball cards.

After all, medicine still is an old boys network, with an emphasis on the network part. Being here, in the city that I love, surrounded by forward thinking and well established medical providers gave me an opportunity to begin forming my network. While my PI may be the only one that I keep in touch with, sitting across a table with so many fabulous physicians has given me the opportunity to begin envisioning MY future as a physician. Scary and exciting at the same time.

While only I time will tell if I get a publication of this summer, I am already aware that I gained so much from this experience. As I prepare to go back down south I am making sure to pack these moments of inspiration as I am sure going to need them getting through the forthcoming uphill journey. One such pearl of wisdom is the following quote "It is your job as a physician to take care of your patients and then pursue the things that interest you. It doesn't matter how many papers you write or how many awards you win." As school starts up again, and times get stressful, I need to remember why I am doing this: my future patients and my interests.

seems to be the summer of sex talk*

Through a conversation about Dr. Richardson & Dr. Schuster's book Everything you NEVER wanted your kids to know about SEX (but were afraid they'd ask), my coworker and I got into a very long discussion about sex, power, and knowledge. Somewhere in the conversation we derived that knowledge may in fact be what holds us captive. Without knowledge, we're able to enjoy inherent and simple pleasures: food, shelter, sex. When knowledge increases so do more complex emotions: stress, anxiety, worry, doubt, fear, etc.

In fact, we decided that as a species, an orgasm is the most intrinsic and intense emotion we can experience. It carries with it huge amounts of power for humans to realize what we are each individually capable of. Through knowledge, and through the learned experience of sex being shameful and secretive, that power is negated and control centralized to an outside authority. Here is where discussion turned to Adam & Eve, original sin, and religion as a whole. From there it continued to spiral into sociology, philosophy, and literature.

The conundrum: without knowledge, would we even enjoy sex (and all the other intrinsic simple pleasures) in the same way?

The point of all of this is simple that I am loving my summer. I miss this kind of liberal arts discourse that used to occupy my life pre-med school. Oh, and that EVERYONE needs to read the above mentioned book. Especially all of you parents and future-parents. I promise that it will screw with your thoughts some and make you question everything you thought you knew/believed.

*One of my research papers I have been working on this summer is about adolescents and sex. I blame it, and the necessary lit review, for fueling a lot of the conversations I have been having this summer.

"The New Abortion Providers"

This is an article from the New York Times Magazine, July 12 2010. The role of this "new" provider speaks to the model of a women's health physician I hope to be .