Random Thoughts

I. After not being able to observe a thyroidectomy this morning (the patient was in a hypertensive crisis), I took a nap and then woke up thinking, "Well, I might as well go to the beach." My grandmother heard my plan and said, "I think I'll go too." So we ate lunch, my grandfather packed a cooler, my grandmother grabbed towels and we headed to the beach, where Abuela and I sat with our legs in the water and we talked, among other things, about how my grandmother's brothers and sisters are living a routine, they go to church, go home, sleep, eat, and do it all again, never finding time to go the beach or anything like that. And I thought to myself, "That's the way to be 87," Not that my grandparents don't have their routines-- on a usual weekday morning my grandfather is napping in the patio and my grandmother is sitting in her rocking chair, listening to some radio show. But every once in a while, they do something I don't expect, like invite themselves to the beach, bathing suits and all, or travel to Europe, Texas or wherever my mom happens to be, or take 4 days to stay at a parador out on the west coast of the island. That's one of the many things I love about them.

II. At Seven Seas in Fajardo (towards the Cabezas de San Juan side), you can find many things:
1. dried up seaweed that washes up onto your legs
2. mangrove trees
3. water that barely forms waves, but instead gently rolls in
4. plastic cups
5. pieces of broken bottles
6. bottle caps
7. grape-like fruit (?) that fall from the mangrove trees (we think)
8. on a good day, my granparents
9. about 10 big trash bins by the entry, lined up, and not very full

And any Puerto Rican will not take offense when I say that that's the problem with us as a people. We have beautiful, beautiful nature all around us. Places that people pay a lot of money to be able to come enjoy, and we just leave our trash everywhere to come in and out with the tide, even though the trash cans are about 10 feet away.

III. It's scary (or a little sad) when you've let so much time go by, that all of a sudden, your little sister is 6 inches taller than you, and looking like a woman.

home, sweet, home

I got back to Puerto Rico on Thursday night at 10 p.m. local time, on a flight that was supposed to arrive at 8:30 p.m. Once, around 45 minutes later, I had my bag in hand and got on the shuttle that was going to take me to where I rented my car, I was told that due to the rain, Enterprise (the place I made my reservation at) wasn't able to take credit cards, but they were taking us to National/Alamo so we could rent there and they'd cover the difference... About an hour later, I'm told the difference would be around $200. $200 I'd have to track down the Enterprise people to get... Home, sweet, home.
I finally started out for Fajardo close to midnight and was immediately reminded of just how much of Puerto Rican taxes go towards keeping the roads driveable (about 2 cents I'd guess).
1 a.m. ish I made it to my grandparents who were still up, worried. I passed out about 1:30ish knowing I'd have to go back to the airport the next day to return the car I rented to get me here...
Throughout the next morning, the rooster my cousin bought for cockfighting woke me up at regular intervals. I snoozed my ears, woke up again, snooze, up again, until finally hearing a little boy crying at 11 a.m. I decided no more sleep for me. I left the bedroom, kissed my cousin on the cheek and met her 2 year old, who immediately learned my name. Considering how many adults can't ever pronounce my name, I'm confident Pedrito is a child genius.
The sky was blue, the air was warm, my grandmother had already started on making pastelillos for me (yum!), and I thought, "home, sweet, home!"

Today was much the same. I saw an old friend who I hadn't seen in about 4 years and he was still the same little person inside. But unfortunately much of what he's doing is still exactly the same as he was in late high school and college, things which make the med student in me cringe. But I promised to turn a blind eye and not scold, because I was his friend before knowing how cigarettes make your lungs look and how daily copius alcohol makes your liver feel.

Oh! I'm being called inside for dinner. Pasteles! Not pies for those of you who might google it but something far more delicious.

Life, love, and the pursuit of happiness

This morning I was reading an article in The New York Times called “Love in the times of dementia”. It talked about Sandra Day O’Connor rejoicing in the fact that her husband of 55 years, who suffers from Alzheimer’s, formed a relationship with another woman. She even visits them because it’s the happiest she has seen him be in years. And thus, the concept of “old love” versus “young love” is introduced.
We all know young love—it’s modeled after romantic comedies and Disney movies, and it requires extremes of emotion, sacrifices, tears, and grand gestures. Old love, however, is the one that values positive times over negative times, the one that derives happiness from seeing the person you love be happy. It completely goes against our western culture.
Since we are young our society has taught us that we have a personal right to “the pursuit of happiness” and we have somehow come to equate that happiness with things that will bring us personal gain—I’ll be happy if I live here, I’ll be happy if I have this job, and so on with the I’s. But it seems like somewhere throughout our lives, our social nature we have ignored somehow takes over. Maybe it’s having kids—I’ll be happy if my children are happy and safe. And ultimately, it reshapes the way we love, and maybe (according to studies) maybe even makes for better more stable love.

Since living in Bangladesh, I’ve been reshaping the way I think about love. In Bangladesh there is a natural tendency to include the family in your own personal pursuit of happiness. Many people still live in extended families so your actions affect a much wider range of people than yourself. Hence the support many of my students felt for arranged marriage—your family is going to live with your spouse too, why shouldn’t they have a say in who that person is? And, as Indian literature teaches us, love that lasts is learned much more than it is there immediately. And now this idea today, “young love” and “old love”, I first understood it recently, that drive to put someone’ happiness before your own—in trying to maintain a friendship I wasn’t yet ready to have because I knew it’d make another person happy. I wasn’t able to succeed at that, but I have years to get to the old love stage…

My final definition of love comes from my grandparents, who have been married 57 years. Love is taking out the sweets your diabetic husband puts in the shopping cart while he’s looking away and always reaching out your hand for your wife while she’s going down stairs, because you know she’s prone to falling.

Other people's pictures.

I got sucked into facebook purely for facebook stalking (as me and my friends call it) reasons. What kept me going, though, was refinding all the people who meant so much to me in elementary, middle, and high school. Those people I’d swore I’d be friends with forever, who I wrote international mail to, who I haven’t spoken to in years. Though, in defense of childhood friendships, it isn’t so much because I don’t want to as I am missing the e-mail/phone gene. E-mail tends to be purely business to me (though I love receiving them) and phones are for weekly conversations with my mom and brother.
Anyhow, facebook quickly lost me, as have all those other similar things—myspace, friendster, etc. It’s exactly like e-mail but with pictures and lots more people to keep up with. What I still find interesting about facebook though is that people can post pictures of you and tag them. So I open my e-mail and it says H has posted 3 pictures of you. I go to check them and they are pictures of me, yet not. Seeing myself in other people’s pictures is kinda like seeing myself in other people’s eyes lately. Facebook shows a girl who lets monkeys play with her hair, who hugs children in Bangladesh, and who looks extremely happy to be 26 in a red dress. I don’t feel like that girl, though I wish I knew her—she seems far more self-confident than I and I would even say she has together.
The real me, the me in the mirror, who wear purple sweatshirts and pajama pants at home and sits in front of a book or a computer ¾ of her life is usually frazzled, she runs late all the time (and excuses herself by saying things never start on time), she almost puts milk in the cupboard and cereal in the refrigerator, she abandons her vacuum cleaner at another person’s house for months, she writes blogs instead of studying for a final, etc, etc, etc. Not together, but kinda spread out all over the place—even in that little crack of space under the refrigerator where lost things never reappear from…
Anyhow, maybe I should look at other’s people’s pictures some more. Being overconfident isn’t good but not recognizing your good traits isn’t either, and I haven’t quite grown out of judging me from how other people perceive rather than from the virtue of my actions…
So that’s it, back to studying. Congenital heart disease—usually not a good thing.

Art

I've been drinking sangria... For my heart originally and then later because I was drawing and usually when I'm in artist mode I drink something or another. Call me Julia de Burgos...


Anyhow, I was drawing and noticing how med school makes it into my art someway or another lately-- poems with lines about scar tissue in them, and (look towards the bottom)
this... My broken heart is anatomically perfect... Aorta, pulmonary artery, and all.
I like it-- it's like I'm finally learning how to tie the two sides of me together.

To Community

Well, first off, thanks to my Midwest following for commenting on my blog. I love it! I've laughed, scratched my head, and just had much fun reading the comments. I even learned something about pig latin via Wikipedia because of the comments (In Puerto Rico we used "chi"). Chiyo chime chilla chimo chixa chivi chie chira...

Anyhow, I've been reading "The Alchemist" over the past week for the third or fourth time in my life. The first time I came across "The Alchemist" was in twelth grade when my friend Michael told me he picked it up and didn't stop reading until he was done. Michael never read unless forced to so I was curious. Since then "The Alchemist" has been the book I turn too when I need to be reminded that things happen for a reason. Now I concede that Coelho is not a great writer as far as literature goes. His language is simple, his message is obvious-- his writing is more parable than fiction. But that said, I like his message, and I like that he made it simple enough to be understandable to a majority of people. So I am a Coelho fan (people either love him or hate him I think).

Ok, that's the background you need for my story this week.

This morning I got on the wrong bus. It was the right route but it was just a bit to late to make it to class on time. To top it off, I got off on the wrong stop thinking, "It's gonna be one of those days". I knew I still had frantic studying to do for my final yet I had made lunch plans already, and then I was going to be late to the first day of my elective. But, then I saw red Doc Marten boots and short dark hair. I called out a name, and H, a person who's e-mail I had been frantically trying to find a few weeks back turned around. We had a quick conversation and I got her e-mail again, then I headed to class, happy to be late because when I met H, she seemed like someone I could be friends with so I was happy to see I still have the chance to make that happen.

The rest of the day actually went excellent from there. I had a nice lunch, the final, well, the final seemed passable, and then I spoke about the Global Health Pathway for a group of first year students. (I really get to toot my own horn here because, struggling with anxiety, it's very hard for me to do public speaking but it went pretty well). After speaking, Dr. Acosta introduced me to a student who is interested in the Global Health Pathway. We talked a mile a minute, the way people do when they know they've met someone who fits right in with them.

And then I took the bus home and thought. I've lost an individual for the moment. I might get him back as a friend in the long run. But in trying to get through it, I've gained a community: I've gotten closer to my roomates who, I now know, will come home if I say, "I just can't be alone right now." I've met a pastor and his amazing partner who walks for AIDS, does craft projects, and accomplishes the amazing feat of being upbeat and healthy after 26 years of living with HIV. I've made friends with a displaced Indianan (other than Sarah). I found a person I thought I'd never see again and I met a potential friend. Community-- I love it.

And best of all, my very best friend arrives in 2 days to spend my birthday weekend with me. Yey!!!

Disclaimer: The above image was taken post-final and thus cannot be taken as a true represetation of what Sage Cottage house-members look like. It is only intended to portray the idea of community.

This weeks assignment: Write your own question. And I will answer. Unless I can't for HIPAA compliance issues...

Tooting my own... Kazoo!

I just finished my standardized patient session for ICM II. Basically, I had a few basic stats on a patient and in 20 minutes I had to interview them and perform a focused physical. It was kind of nerve wracking for me-- I haven't practiced my physical exam skills or interview techniques in a while and I'm a bit scared of people, but it ended up going great. Oh, of course I missed tons of questions and wasn't the best physical examiner in the world but... My 2 SP's said that my interviewing was excellent. I was called warm, was told I have a great smile, and was told, "Your patients are going to love you!" Yey, Xavi!!!
It means a lot to me because I might struggle through basic sciences, I might be a physics dummy, but I am determined to be a good clinician. It's what drives me. I love the patients. I love hearing their stories and their lives (even if they are scripted) and I am glad that that is getting across to them. I figure at the end of the day, I myself would prefer a friendly doctor than one who scored the highest in his/her exams. That's just me. So I am especially happy today-- I have things to work on, but I was told to keep my warmth.

On another note, Sarah and I were joking about how to encourage people to leave comments on our blogs, which we love reading, we should post discussion questions-- so here you go:
1. Exactly what makes a good doctor?
2. Is it ok to toot my kazoo, or should I work on my humility?
3. If Xavi blogs, and nobody reads it, did she really blog?
4. If Sarah and Xavi blog, is it really all just one big blog since they live together?
5. What might be some possible reasons that Ananda, the bunny, chooses not to blog?

Alright, that's enough for now. You may answer one, none, or all of these questions. Answers written in binary will be credited (though not understood). Extra credit for answers written in Spanish.
Ok, back to school life.

Scar Tissue

Sometimes I forget who I am. Especially lately. Since starting medical school little pieces of me have fallen into cracks or been hidden away in the back of a drawer until I became-- a medical student, a girlfriend, a halfway decent family member, and friend who was more absent than not. These past few weeks I've been missing those other lost pieces of me. I keep thinking that if I can put them all together, I can somehow find my smile again... and feel a little stronger. I keep thinking that if I put myself together again into the person I once was, I can be more lovable again (because the child in me still sometimes says that maybe if I had just been more lovable...)
Anyhow, regardless of the purpose, it's kind of comforting to look at myself again and think about who I've been, what I haven't given myself credit for, and the talents I've forgotten I had. As Sarah reminded me this past Sunday (when I wouldn't claim one of the apples being given out to the teachers in church) I am a teacher-- I taught English to a group of wonderful students, I taught the teachers who now teach my 48 children, I taught pre-meds who were ansiously preparing for their MCATs. I'm also an artist, a sister, a daughter, a grandaughter, a sort-of mother of 48 beautiful Bangladeshi children, a mentor, a medical student (still, yes), a writer, and hopefully more.

So a long intro to say, I've been getting reacquainted with writing again. Here you go:

9-16-07

I find pieces of myself
scattered,
around the bed, in long hallways,
on the rim of a beer glass perhaps.
In the places you've recently left
the me pieces that flaked off your skin now carpet wooden floors.
9 a.m. me, stretching and rolling over,
laid half-forgotten under the bed.
Mischievous smile me
was still wrapped up in your sleeping bag.
Pumpkin pie baking me got
crusted onto a dirty pie pan.
I find pieces of myself and I
sew them--
interweave them like collagen.
Scar tissue to keep me from falling apart.

No hay mal que dure cien años, ni cuerpo que lo resista

The hard part about having classmates in your same class is that you feel selfish asking them to cater to your distraction. I am recently going through a break-up, greatly timed to go with the beginning of classes, and my attention span is roughly about the same as that of Soso (golden retriever who outshines me in pictures). So as I try to read about calcium and find that I've read the same sentence 5 times, I realize that I have to give up for awhile, but I have no one to give up with me. My East Coasters are 3 hours ahead, meaning that at the hardest times (at night, usually after 8 p.m.) they are in bed, and my roomates are getting through what I should also be getting through. So the start of the year feels lonesome. And frustrating. And confusing...
I do have one thing to look forward to though-- a visit from my best friend on my birthday.

Where to draw the line

This one is actually from today.
Unless you are watching Gray’s Anatomy, doctors on TV are presented as calm, cool, and collected. They don’t have outbursts. They discuss issues with their patients quietly behind closed doors. They mask their emotions. But they are just doctors on TV.
At the end of last quarter our ICM small group leader, a real doctor, told us a very funny story about how after much time, she finally let a problem patient have it saying, “I can’t stand you!” While she was saying it, she couldn’t believe she was doing so but, amazingly enough, it was all for the good—it put her in a better position to negotiate with the problem patient who continued to come to see her after all that.
Today I had my first outburst. The clinic in general was a little crazy. Dr. Salvatierra seemed moody and was sending Rosa (the nurse) off for things he could easily do himself. Rosa was mad at Dr. Salvatierra because he told her she couldn’t go to a staff meeting (because there was no replacement for her) so she was slamming doors. They had an argument in front of a patient. Etcetera, etcera…
And after all that, as I was walking to the lab to see if there was anything interesting to see, I started hearing catcalls. “Hola guapa.” I looked over and saw a boy with his arm folded up at the elbow (he had just had blood drawn apparently), smiling, and I wondered if I knew him because surely that must’ve been a joke. There was nothing to see at the lab except the completely overwhelmed lab tech who was left behind while the other 2 were at the meeting so I went back down to Dr. Salvatierra’s office. “Ey guapa,” I heard again, but this time from a different boy, sitting next to the original catcaller, arm folded at the elbow and smiling as well.
I was still processing the fact that I was getting catcalls. At the clinic. While wearing my white coat that identified me as a medical student and, therefore, someone who was obviously at the clinic for educational or work purposes. And I decided that that just was not okay. So I went back out and asked the boys if I knew them. Their jaws dropped. “Oh, you didn’t know that I speak Spanish?” I asked and then went on to tell them, “Well do me the favor of treating me with a little respect while I am working. It is one thing to deal with catcalls while I am walking down the street but to have to deal with that while I’m at work?! It’s people like you who make Peru look bad.”
After my little diatribe and the boys’ immediate apologies, I looked over at the sex workers who I had just examined sitting a little ways down. They looked a little in awe at the unexpected outburst and seeing them made me wonder whether I should’ve asked the boys into the office and let them have without the other patients being present. But then I decided that that is the nice thing about my still being a young and naïve medical student—maybe it was wrong to lose my cool, maybe a bit unprofessional, but it felt damn good.

What I can give

Monday, July 9, 2007

Another entry from my journal. This one is from July 6th. And the experience I wrote about just made me reflect on how nice it is that across cultures we have some commonalities that allow us to do small acts of kindness. In this case, as a woman, I was able to put myself in my patient's shoes...
Today Hollie and I were taking care of the vaginal fluid specimens again. The doctor, slightly distracted, was in and out of the room and Rosita, the nurse, supervised and instructed us. During one of my turns doing taking vaginal fluid samples, I began to look around the patient’s labia and anal sphincter for any lesions, warts, or ulcers as I do with every exam. Although I’ve seen several ulcers and warts already, for the most part they are usually under control. However on this patient, I found warts on her vaginal walls, one huge one on her labia as well as several other smaller ones, and some around her anus. I showed them to the doctor and then began inserting speculum, which (of course) hurt since the patient was a community person who was not used to these exams and so was not relaxed and because the lubricant-less speculum was rubbing against her warts.
I completed my exam as delicately as possible and as I was withdrawing the speculum, the nurse and I noticed that the patient had some bleeding around her labia. We decided to call the doctor to make sure it wasn’t an ulcer, but the doctor was nowhere to be found. So for several minutes my patient waited, laying on an examining table, with her legs in stirrups, and her body exposed to Hollie, the nurse, and myself who kept coming in and out of the curtained area. At one point I looked over at the patient and she looked as though she was going to cry and I felt for her. I pictured myself in her shoes, just being told I have an STI I know nothing about, laying in an uncomfortable position exposed to everyone who walks past, and I desperately wished that we used drapes at Barton. In the absence of that, I closed the curtain more and asked Hollie to come out from the curtained area. Then I decided to tell the patient that she could sit up until the doctor returned if she wished to.
The doctor was finally found and he determined that the bleeding was from abrasion to one of the warts, not an ulcer, and the patient was sent on her way. And I was left with a lot to reflect on. On the one hand, I had the initial excitement today of feeling like a medical professional. I saw a patient, I diagnosed her, and I gave her treatment (I put ointment on her warts). But on the other hand, I think the best service I did to that young woman today was just putting myself in her place and helping her to be comfortable.In my travels before and now I have always been very aware that I will be taking much much more from my experience than what I am able to give. But today it felt really nice to be able to give through such a simple act.

About a little old woman

Monday, June 25, 2007

The following is the most recent of my required journal entries for IHOP:
On Friday, we packed our bags, sadly said goodbye to Iquitos, and boarded a plane to Lima or the big dirty city as I like to call it. In Lima, we had arranged to rent an apartment in the Miraflores area, considered to be one of the safest areas in Lima and therefore recommended to us foreigners. Normally I don’t get to wound up about what the US Embassy and other expats recommend as far as safety but this time I decided that since I need to have my computer with me and since it’s my summer, I might as well live it up in the opulence of Miraflores.
Our apartment is small but beautiful by anyone’s standards. It is on the main avenue of Miraflores, a couple of blocks from the supermarket and from a gym that rivals many gyms in the US and where we will be exercising during the week. All these newfound comforts suddenly hit me yesterday in a taxi after a long day of walking and shopping (because “it’s so cheap!” as we often exclaim) when I was mentally calculating how much I’ve spent in the last few weeks and how much that same money might mean to some of the patients that we saw back in Iquitos. One patient that continues returning to my mind was an elderly woman that we saw at the hospital who had a melanoma that was gradually taking over her nose. “You need to go to Lima,” the doctor told her, while explaining to us that there are no oncologists in Iquitos. “You need to go to Lima to get care,” he repeated several times.
A cheap roundtrip to Lima can cost as little as 116 US dollars. The care the woman needed, who knows? Regardless, anyone who looked at this woman would be able to tell that she did not have 116 dollars to spend on a trip to Lima. I had 116 dollars. Much more than that in fact. And I’ve used it to buy shoes, clothes, earrings, phone cards, and other things that I suddenly want, but not much I actually need.Being in Peru puts me in a same state of mind as being in Bangladesh often put me. It makes me very aware of the hundreds of privileges I have that the majority of the world does not have. And this is an uncomfortable realization because even if I did give all my privileges up, how much of a dent does it actually make? If I paid the woman’s trip to Lima, can she afford hospital care? If I pay for that too, can the next woman who comes in with a melanoma afford care? Do I pay for her too? I know that it makes much more sense to try to work on what is at the root of the problem—lack of access to healthcare, poverty, unemployment, lack of education, etcetera, but what do we do in the meantime?

Welcome to the Jungle

Saturday, June 9, 2007

Today, Hollie and I climbed aboard a little plane with bags full of yummy fish and fried chinese food and proceeded to fall promptly asleep. When I next woke up, we were in the air, 1/4 of the way to our destination of Iquitos, Peru. We made it to Iquitos and managed to wake up, get our bags, and go outside where our driver Don Marcial was wating for us with a sign that was not quite as big as Omar's sign (our taxi driver in Lima), but we'll forgive him. As we travelled through central Iquitos to the house where we will be staying, Don Marcial serenaded me with verses from "En Mi Viejo San Juan"-- Javier Solis joined me as a little girl growing up in Puerto Rico to Don Marcial, a driver in Iquitos who has never left his city.
Don Marcial also recited verses of poetry praising the Amazon as he pointed it out at the distance, obscured in the evening darkness. "Wow, that's beautiful!" I exclaimed, thinking about how being this close to the Amazons might be the best part of the trip to Iquitos (sorry Van Voorhis!).
But the best suprise came later, when Hollie and I met our housemate who gave us the key... to the wireless internet... We have the internet? Awesome! We came close to surviving ten whole hours without it...

An explanation & Arriving in Lima

I've decided to transfer all the blogging I've done in my group blog to my regular blog so that everyone can see what I've been up to, so althought these will appear to be written on the same date, they are from different dates.

Thursday, June 7, 2007
I am the big spoon... For anyone who has met my "amiguito" that probably conjures up a funny image-- 5'1" me wrapped around a 6'1" body. But I am the big spoon and it works for us.
Last night, after arriving my hostel in the big, dirty city of Lima at around 1 a.m. (so actually, this morning). I tried to wrap myself around a little stuffed mycobacterium (www.giantmicrobes.com if you need a reference), I tried to wrap myself around myself, I tried to wrap myself up in the sheets, but it wasn't working. For the longest time I lay awake in bed hearing the random cars drive by. When I finally drifted off to sleep it was a fitful sleep, I'd wake up every so often, switch sides and go back to sleep again, until the knock on our door at 9 in the morning that meant breakfast was here.It's morning now, not much brighter in the southern hemisphere winter time, but I'm a little more excited. In a few minutes Omar will pick us up so that we can go meet Silvia, our local contact person here and we can figure out what we will be doing over the next few weeks. So far the few people I've met have been nice and helpful and at least I speak the language this time around. So, maybe tonight I will try wrapping myself around a pillow, who knows... I'm sure I'll figure it out.

A Poem for my Pocket

What happens when you get a group of 4 socially anxious women and two counselors who have battled with social anxiety in the past together in a room?

Talking.

A social anxiety group does seem like a strange idea at first, what are people just going to sit around, be nervous about talking to each other, and blush the whole time? But so far it's turned out to be a comfortable space where things that seem nerve-wracking at times become something that can be laughed at.
Anyhow, today I was given a copy of this poem at the group and I really appreciated what it says so I figured I'd share it-- copyright laws be damned, in the hopes that someone else can appreciate it too.

Wild Geese

by Mary Oliver

You do not have to be good.

You do not have to walk on your knees

for a hundred miles through the desert repenting.

You only have to let the soft animal of your body

love what it loves.

Tell me about despair, yours, and I will tell you mine.

Meanwhile the world goes on.

Meanwhile the sun and the clear pebbles of the rain

are moving across the landscapes,

over the prairies and the deep trees,

the mountains and the rivers.

Meanwhile the wild geese, high in the clean blue air,

are heading home again.

Whoever you are, no matter how lonely,

the world offers itself to your imagination,

calls to you like the wild geese, harsh and exciting —

over and over announcing your place

in the family of things.

Two in a day?!

although I must confess both were written earlier and just finished today...

“Baby Docs” one professor calls us, alluding to the fact that we are more human than doctor still. Differentials don’t immediately pop into our head as soon as we hear the words nausea and fever, and we still identify more with the fear of the unknown the patient has than with the confidence with which the doctor pronounces the patient well after listening to breaths, heartbeats, and palpating the body.

Today, though, a classmate did a Gram stain and successfully diagnosed a patient with gonorrhea. Another milked the parotid gland, a technique we were just told about yesterday in lecture. And I examined a deep tissue MRSA-infected lesion, and recited, “Gram-positive, methicelyne resistant, staphylocci,” in my head…

So I have to say, if we are baby docs, I call us nine-month olds—still curious, getting our hands into everything, learning to walk and learning to stand up again after we fall (with a few tears in between).

I know that as years go by and we’ve seen it all over and over again it won’t all seem as exciting, and shiny, and new. But hopefully then I’ll still have this little piece of writing to remind me that we get to do things that so many other people don’t get to do, that we get intimate knowledge and immediate trust from people just because of our titles—medical student, resident, doctor. And hopefully it will humble me a little and remind me to be appreciative and find joy in the small pieces of knowledge we are privileged to have.

Xavi's Magnificat

Wow, I can't believe I haven't written since February... I'm slacking...

So this past March, I went to NY with big plans of seeing all my college friends as well as introducing my "friend" (with that wink-wink stress on it) to all the wonderful things to see in NY. Needless to say, 4 days flew by and I saw Felicia and Mickie (which by itself made my trip worth it) and maybe a small percentage of those wonderful things I was planning on...
Although I didn't get to do everything I set out to do while I was in NY, I did bring something back with me-- having been in the envrionment I associate with my former more artistic part of life and around my friend who creates art everyday, I brought a small hole in my heart. It was hard to come back to pure science and to remember I rarely get to indulge in some of the things I once loved to, so much so that half the time I don't know where to start anymore. So after my first breakdown of the spring quarter (1 made it one week!), I asked my friend Sarah to give me a writing assignment and she said, "write a magnificat"
To which I said, "Is that some sort of famous poetry?" Sarah gave me the 'you poor infidel' look and explained that a magnificat was Mary's celebration of herself:

And Mary said: "My soul glorifies the Lord and my spirit rejoices in God my Savior, for he has been mindful of the humble state of his servant. From now on all generations will call me blessed, for the Mighty One has done great things for me--holy is his name. His mercy extends to those who fear him, from generation to generation. He has performed mighty deeds with his arm; he has scattered those who are proud in their inmost thoughts. He has brought down rulers from their thrones but has lifted up the humble. He has filled the hungry with good things but has sent the rich away empty. He has helped his servant Israel, remembering to be merciful to Abraham and his descendants for ever, even as he said to our fathers."
Luke 1:46-55

My magnificat is more self-centered than Mary's but hopefully still a nice read:

Sometimes

… I like the smell of stale cigarettes
it reminds me of where I want to be
the small jazz club with the saxophonist visible through the haze of smoke
dim lights and a couple kissing in the corner
my hand wrapped around the stem of a glass of red wine

… after a drink or two
I look in the bathroom mirror and say damn,
you’re hot

Always

…at night, once the lights are off
I trace the lines of my other’s face to see if my hands can memorize the lines
or at least the feel of skin a day old

…for at least a day, I fall in love with each of my friends and I wonder what it would be like
to live in their skin

…the feel of rough surfaces feels good against my skin

Never

…it won’t ever happen if I’m quiet

Boricua on Ice

As I sit here procrastinating on relearning all about HLA's (how quickly we forget!) by looking at my friend Sarah's blog, I was wondering if anyone ever reads my blog anymore since, predictably enough, my frequency of posting has been reduced to my frequency of e-mailing... So here it is, my renewed attempt at keeping people up to date on my life and hopefully a little entertained or interested. I'm going to reattempt to keep up with the posting...

Yesterday Caroline was asking me whether med school was what I expected, in terms of workload. I answered that it's not. Although everybody had warned me that it wasn't the level the information is at but rather the amount of it that is thrown at you at one time that kills you, I didn't really get it until now. It's a feeling of constant guilt whenever you keep up with your life because you know that you should be studying right now. It's an illusion that if you spend all the available hours in your day studying, you could, possibly, get through most of the material, and possibly understand about 75% of it. It's a wondering of will I really need to remember the medical term for the Adam's apple during my third year rotations (and realizing, damn, I already forgot it! let's get out the book for another random fact search). Balance, what they so often preach to us at our medical school, starts to seem like a guilty pleasure and I'm never quite sure what side I tip to on the balance / work tighrope but I constantly feel like I'm about to fall the wrong way...

So what keeps us sane? (Actually I'm not quite sure how close to sanity we all are to be honest so maybe it's more what keeps us from an overall breakdown)... Family-- 20 minute drives to Redmond for coffee or a big screen TV with my brother. Friends-- girls getting spruced up for med school prom with 20 dresses thrown on a bed and a passing of jewelry from hand to hand. And the special people in our lives who are willing to put up with grumpiness, tears for no reason, and flans that are made to redeem us for our madness.

My special Xavi-putter-upper took me to Leavenworth, WA about a week and a half ago so that this island person could experience all the wonders of snow. It was a fun weekend. I often had thoughts about my studies nagging at my brain, but I managed to ignore them and say I deserve a weekend of falling on my bootie in the snow. And so you all can share the moment with me-- some pictures:

Yes... I managed to fall a few times...

A Simple Solution

Ok so I'm cheating a little by just putting my class assignment for this week up rather than writing something original, but it's temporary, I'll write something original soon. Anyhow, this assignment was a reflection on several articles, including one titled "A Simple Solution" by Andrea Gerlin, which appeared in Time magazine in October of 2006. I encourage you all to look it up if you can. Anyhow-- this is my rant...

It was interesting to read this week’s articles from the perspective of someone who has lived in one of the places frequently mentioned in them, Bangladesh. I remember arriving to Bangladesh and receiving my medical kit containing, among other things, multiple packets of Oral Rehydration Salts, something I had never used before. When I first became ill (as we all did at some point or another) with diarrhea, my host mom kept telling me I needed “slime”. I eventually figured out she meant saline and I brought out my Oral Rehydration Salts, which she mixed with some Sprite-like soda for me to try to make it taste better.
Bangladesh made me very aware of how important public health measures and preventative health are in the context of the developing world. Having grown up in a place where every year we were warned not to collect water in open containers in order to avoid breeding the mosquito that carries dengue and not to swim in standing water to avoid the “bilarcia” parasite, I was exposed to some of this early on. But, as the Gerlin article says, in Bangladesh many children still die from diarrhea and this somehow shocked me more than acquiring an illness from a mosquito bite—perhaps because of exactly how preventable diarrhea related deaths could be.
In Bangladesh, most people don’t boil their water—some can’t afford to, many more don’t know to. Food is stored on a shelf at room temperature, which can be quite warm in the monsoon season. Many people don’t wash their hands with soap after using the toilet (again some can’t afford to and many more don’t know to) and subsequently don’t wash their hands again before handling food. All this leads to a country whose health risk section on their Lonely Planet guide reads like an infectious disease textbook- hepatitis, cholera, dysentery, giardia, amoebiasis, ring worm, tape worm, pin worm, etc, etc, etc. And the sad part is that educating people on hygienic practices, giving out water filters, giving out soap, deworming children, and all the other myriad of programs that could be done to significantly reduce diarrhea-related mortality in Bangladesh (and in the rest of the developing world) would probably not cost that much compared to other healthcare initiatives that we fund domestically and worldwide but, as Gerlin points out, diarrhea is just not that popular—and until the publicity is there, the funds will not appear.