There is only so much you cram into one day. Only so much you can do in a week. And when the year is over, only so much you can be proud to say you have accomplished and learned. Time constraints are the true enemy. We must all account for time in order to set realistic expectations. Or so I thought…

They say “time stops for no man,” but it certainly does for medical students, just check the fine print. Orientation week was when I first realized medical students expect to be exempt from mortal time limitations. For us, each day is 36 hours long, each week disguised as a month, and a year feels like a minute.  When I first heard that in addition to our core classes, weekly preceptorship with a community physician, and weekly principles of clinical medicine course, there are also mandated electives to be completed within the first 2 years — my face fell into the expression of accepted defeat (I call it the eye-pop-smirk). Apparently, super-human memory and a B.S. in time travel are the only two pre-requisites for success.

On the other side of 10 months of medical education, I am awed by what has transpired in this seemingly short time frame. And all the while I am still a human, not just a robot with accelerated eye movements for exhaustive reading. I have utilized all the allotted hours of the day for class, extracurricular involvements, brute force memorization, and even found time to spare for, you know, maintaining sanity. Every minute has been accounted for. How I made time for everything is beyond me.  And again, I’m not just talking about class. In fact, some of my major learning moments have been during the completion of those seemingly impossible elective credits, which I have blurbed about below.

1. History of medicine – Lecture series from Hippocrates to the discovery of Penicillin, understanding the foundations of modern medicine.

2. Medical Spanish- 3 hours a week for 10 weeks, todo en español!

3. Diagnostic Imaging and Medical Uncertainties – Medicine from an analytic perspective via primary literature review and basic radiograph reading (for dummies).

4. Leadership Elective – Mentorship and leadership skills training from successful OHSU faculty and round table discussions about how to improve personal strengths and weaknesses in order to reach career goals.

5. Introduction to Surgery Elective – Buffet table of requirements including weekly suture lab, OR scrub lab, required OR observation, morbidity and mortality conference (M&M), and trauma conference.

As mere MS1′s my classmates have been able to accomplish so much. Their determination to squeeze the potential out of every day has been inspirational. From integrating new electives into our curriculum, proactively working with the administration to improve the foundation of our medical education, planning national conferences, training for marathons, starting a rock band called Bushmeat, putting together cultural enhancement seminars, and donating time to community health improvement – each person has gone above and beyond even our own realistic expectations. This short list does not do justice to what each person has been able to contribute to our community’s education.

As I reflect on my own year and the year for my entire class, I look forward to a future of super-heroic ambitions and accomplishments. The trick is to never let a minute go to waste. Days can be taken for granted because you always expect tomorrow. But remember this: Your days account for your years, which account for your life. Carpe Diem.

I can’t believe we have one week left of our first year! I had such high hopes for writing these blog posts as a record of my medical school experience. Somewhere around February, though, when the weather was at its worst and I was caught in the doldrums of staying on top of my work and laundry, it occurred to me that much of this experience is intensely personal… and hard to talk about.

When people ask me how medical school is going, my answer is never simple—I try to condense the whirlwind down to a sentence or two, but they never quite do it justice. It occurs to me that the practice of explaining my experience to friends and family is an exercise in empathy. In the way we ask our patients to tell us how to they feel, where they hurt, how it’s affecting their lives, so should we practice trying to explain ourselves…

It’s been wonderful, intense, challenging, inspiring, heartbreaking, astounding, nuts. This year has been anything but middle-of-the-road—the most exhilarating learning moments (say, the first time I watched a ventilator adjustment correct a patient’s acidosis) snuggle next to days so steeped in doubt, I question my most fundamental understanding of myself. Recently, in one of our OSCE exams (where we interact with standardized actor patients to practice clinical skills), I was told that I needed to intersperse more empathy into my encounters. The standardized patient/actor gave me a couple buzz phrases to use in the future, and I found myself bucking against this recommendation. I don’t want to be told what to say to make myself sound empathetic; I want to continue to grow into what I feel is my most empathetic self, to be able to share this in a natural way, and I am up for the challenge of discovering it. In some ways, much of this year has been about that discovery—learning to be gentle with myself when I need a concept explained multiple times, learning to step back and watch myself conceptualize or frame a problem or conversation, listening intensely to my incredible classmates as role models and counterpoints. It’s an understatement to say that I’ve grown this year; it’s also an understatement to say that it’s been an honor. I’m still in awe of this small corner of the medical world I am allowed to inhabit, and I can’t wait to get more comfortable in it next year, and the next, and the next… and all those yet to come. I’m working on putting words to this experience, and I’m grateful for this space to share it… Happy summer!

The short answer is yes, you do. Your mission, should you choose to be a great clinician or scientist, is to recognize your biases and not allow them to color your daily decisions or affect your ability to assess the evidence.

Bias is, to put it simply, a preference for something over another. There is a more complicated definition but that’s the gist. As humans, there is evidence that we are all biased. If you prefer the color blue over red or are a dog person rather than a cat person, you are biased. Likewise are our thought processes and decision making. Everything that happens in our lives colors our world view, and within that world view lie our biases. Therefore, cognitive biases are part of life, everyone has them. They color our personal interactions and impressions of other people. They also affect our ability to accept new concepts and change our mind on topics when new data is presented.

Bias is an important consideration in medical and basic science research because of its subconscious impact on rejection or acceptance of new concepts or theories. There are many examples of times that scientists had a belief that an experiment would turn out a certain way, and lo and behold, it did so. This is sometimes because they were right. We hope so! However, there is always the possibility that subconscious action on the part of the scientist influenced the results of their experiments.

In one of my favorite fictional book series is a gem of truth which has stuck with me since I first read it many years ago. Terry Goodkind said in his book Wizard’s first Rule: “People can be made to believe any lie because they want to believe it is true, or because they are afraid that it is true.” At the time, I thought this an exaggeration. Then I began to pay attention. There is substantial evidence in the events of the past decades that if you play to people’s preferences or fears some will believe almost anything, regardless of the lack of or weakness of the evidence. This concept seems especially true of the general public when it comes to medical research. One published paper covered by the New York Times can and has sent people into a panic and changed the behavior of millions, potentially endangering society. On the other hand, this response could be to the benefit of society, it all depends on the quality and accuracy of the research that lead to said panic.

There are many ways bias can show up in your experimental design and data analysis which make for poor quality research. Due to an emerging understanding of the large impact bias can have on the quality of the data produced, researchers are working to eliminate the opportunity for bias as much as possible in medical and clinical research. Randomization, blinding, and dual analysis of subjective outcomes are some ways in which bias can be controlled.

Bias is not only present in the performance of the research, but also in our digestion of the literature. We all have theories about the way things are, and would prefer to believe our own theories over those of others. This leads us to a situation where we will view evidence for a theory we dislike through a different lens than evidence for a theory we hold in high esteem. For this reason, in the systematic review process, before looking at the results of a study or group of studies on a topic of interest, researchers first perform an assessment of risk of bias in the experimental design, data collection and analysis of the relevant studies. This allows a measure of whether a researcher could have influenced their results. Because of the subjective nature of this assessment, it is often performed by a group of people or two people independently. Any disagreements are resolved in a way that is outlined in a protocol written before the analysis begins. This protocol is incredibly detailed, and should discuss methods for the database search including keywords, methods for choosing relevant studies which included a sufficient number of human subjects, studies that included the outcome of interest as a primary outcome, etc. Publication of these protocols allows for researchers reading the end product, the systematic review, to be sure that the authors were thorough and discriminating in their review process and allows for understanding of why certain studies were not included in the final analysis. Any studies that don’t pass muster are eliminated in a systematic way. These methods work together to ideally create the strongest possible evidence base for that topic. Systematic reviews are currently the pinnacle of medical evidence, and the assessment of the quality of the evidence is often more relevant than the data summarized within.

To further explain the importance of the criteria assessed in a systematic review, let’s take an example of a hypothetical clinical research study performed in the ER. Credit where due, I didn’t make up this example but heard a version of it in the Evidence Based Medicine course offered through the Human Investigations Program. Shameless plug to follow: this is a great course that I think should be required of all clinicians and scientists.

For this hypothetical study, a specialist has to be called in if the person presenting with a condition or event is to be enrolled. Rather than call the specialist in at night, study personnel choose to skip the potential subjects that come in at night. This selects for the subjects who come to the ER with said event or condition only in the day time. We can’t eliminate the possibility that there is something different about the people who come in at night vs. come in during the day with said condition, because we didn’t collect information about the people who come in at night. This introduces an unmeasurable potential bias to the study. Unmeasurable is the kicker here; it means there is no way to mathematically control for this confounder, and the resulting data is suspect. There is no way to extrapolate the data to everyone with said condition or event because there may be differences within the population that weren’t captured within the study. This detail may not seem all that important by itself but because this is only one of the many ways an investigator or study personnel can bias the results, the confounders that weren’t measured may compound in an unknown manner. If for example, study personnel who measured outcomes weren’t blinded, subjects were selected based upon convenience, and the randomization wasn’t random, now there are three unmeasurable confounders which bring the results into question. The researchers who performed this study may choose not to mention in their methods how they selected subjects for their study, or may tell you directly that they eliminated people who came in at night. The latter is preferable of course, but both indicate bias in the selection of subjects.

The above example is extreme and a study wouldn’t be performed in this manner today. In the past however, researchers weren’t aware of the impact of potential confounders. When assessing literature that is from decades past, if you can get the full text of the article at all, you will find that rarely are concerns like selection of subjects addressed in the methods of the publication. Today, it is standard to include these details in the methods for any clinical study, improving the quality of the results therein.

In an evidence-based medicine approach, always assess the quality of the results first, then ask what do the results say and what does it mean.

Ultimately, if the quality of the reporting is poor it is impossible to know the quality of the data presented, and such data should be taken with a grain of salt. Personally, I think there are at least a few public health initiatives that began in decades past and continue today that should be revisited for this reason; the evidence for said initiative is incredibly poor.

Another example of a type of bias that is not often considered is publication bias. Guess what, editors and reviewers for journals are people. This means they have inherent biases for or against certain scientific concepts, as well as personal biases that may lead them to review papers differently based upon who wrote the paper. If your collaborator wrote a paper, would you be more or less likely to skim rather than read the whole thing? Would you be more or less likely to believe their interpretation of their data? We are also all aware that some studies are simply more fundable than others because of the nature of the hypothesis. Essentially, if you aim to test a hypothesis that is accepted by the scientific community, you are more likely to get your study funded than someone who aims to test a contradictory hypothesis. These are all important considerations, and in my opinion the holes in the literature are often as telling as the rich areas.

If you’re interested in your social biases there is a fun research study, Project Implicit, going on at Harvard. They have created an online tool to measure a few different biases. I took the racial bias test twice because I didn’t believe them, but the results were the same the second time; this white girl is biased against white people!  I can’t really explain this other than to say there have been a few white people I didn’t care much for in my past, and not so many of other races. Regardless of the reason, I found it interesting and relevant to my daily life. Better understanding of your own mind is never bad.

Controlling for bias in every way possible makes for better quality research, and ultimately better decision making. We can all benefit from remembering that everyone has them, and from recognizing our own biases in all aspects of our lives.

1. A three day weekend = catch-up lab time.

2. You  reason against showering because no one outside of lab will see you that day.

3. You get up at 5:30 AM to get out of lab by 8:00 PM.

4. Your calendar is planned around all the free food activities on campus.

5. You got really excited about new data and a week later saw all of it in a newly published journal article, i.e. YOU GOT SCOOPED!

6. Bleach spots dot your clothing.

7. There are even more holes than bleach spots in your clothing.

8. You hear the word “cell” on the street and have flashbacks to every graduate class you’ve taken.

9. The instructor specifically said there would be no derivations on the exam. Then you get to #3.

10. Pandora is your bff.

11. When someone on the street asks you what you do, you freak out and don’t know how to answer.

12. When someone in science asks you what you do, you recite your lab-life-story to them, complete with figures and interpretive dance.

13. Mentor = Darth Vader, both as the parental figure and as the dark lord.

DISCLAIMER – does not apply to me personally

14. No one outside of science gets your jokes.

15. You still wear clothes from high school.

16. You never used to drink this often….

17. The barista at Starbucks knows you on a first name/project topic basis.

18. You hide the fact you frequent Starbucks from the coffee-snob post-doc in your lab.

19. You get to use sexual innuendos as actual lab procedures. For example: Sex larva, collect virgins, detect binding promiscuity, breeding….the list really does go on and on.

20. [Experimental] Failure is, in fact, an option. But still has meaning.

21. Watching CSI, NCIS, and any other TV show that uses “science” makes you simultaneously angry and jealous at the speed at which their assays are completed.

22. Someone says poster and you immediately ask “Oh, what conference did you go to?”

23. You watch Big Bang Theory and relate to every single character.

24. When someone makes you mad, you wish antibacterial resistant tuberculosis upon them. (This could just be me, though)

25. Your family doesn’t quite get that you won’t be a “real” doctor and therefore can’t diagnose:

a. The strange discoloration on your sister’s cheek.

b. Your mother’s hip pain.

c. The fact that your aunt’s dog is sneezing.

This list is not inclusive, exhaustive, or in any way accurate. I would argue, however, that if you can relate to at least three of these examples, you might just be a grad student. Cheers!

It’s been such a pleasure to write for the Student Speak blog this year. I am incredibly impressed by the innovative and inspiring words my colleagues present. I thought I’d make my final post one that hopefully seeks to inspire as well, through the unparalleled opportunity I had in addressing students during my own graduation ceremony. Thank you so much…

Commencement Speech by Nathaniel Warren, MPH Candidate

 There must be some irony in that I’m speechless for this incomparable honor…thank you all so very much for the opportunity to share my thoughts.  I am so grateful to have had such a supportive group of friends, family and faculty leading to this culminating event of graduation.

Sports announcers sometimes talk about “Cinderella stories” – athletes that advance much further than anyone would give them credit. I want to draw comparison through one such story, about a man who did the impossible. Despite childhood abandonment, a brother lost to violence, homelessness and constant poverty, at 62 years old, Charles Bradley landed a deal with the famous Daptone Records, top bookings at music fests like SXSW and Bonnaroo and an international tour spanning 17 countries and three continents. How was this possible? Pushing forward against all obstacles, Bradley’s talent, heart and perseverance won the war for survival and ultimately, success.

Never before has the need for talent, heart and perseverance to rise amongst health professionals been more critical. And, like Bradley questions through his track “Where Do We Go From Here,” as new graduates, we enter our careers into a brave new world. Healthcare is transforming. We’re seeing an unprecedented, fundamental paradigm shift from graduates of the past…and we get to lead the way. Here in Oregon, our state represents the point source of efforts to improve health access, cost, care and equity.

The New York Times recently promoted these efforts, stating that “grass-roots leadership holds the key to fixing health care in America.” Governor Kitzhaber described in the article Oregon’s bold experiment: “Local, interventionist, hands-on attention — reducing health problems before care is warranted or billed — means breaking deep tradition in a system that thinks mostly about treatment and response.” Kitzhaber went on to say, “We’re building something that’s never been built before.” By creating a culture of self-sufficiency in patients, promoting health literacy and disease prevention, and enacting community resilience, this objective is already underway.  An integrated approach to care that incorporates aspects of education, physical activity, nutrition and other “upstream” interventions represent our new common cause. The role of the health professional must influence both on the micro and macro level and, like Bradley’s unlikely success, we must recognize an appreciation of circumstance for each patient if our state’s own Cinderella story is to be achieved.

It would seem that few universities value the power of grass-roots, interdisciplinary leadership more than OHSU. From nursing to medicine to public health to dentistry, through partnerships on campus, with community agencies and through advocacy in our legislature, our voices and actions are strong. Even through my practicum at a local community health clinic, I’ve met other OHSU students who’ve brought their compassion and expertise to those most vulnerable, advancing an inspirationally collaborative model for healthcare delivery.

The challenges of this transformation are great; requiring the same level of determination, innovation and insight as our degree programs have demanded of us, perhaps even more. I believe we are able to meet the challenge. Numerous examples provide evidence for this, through OHSU projects like I-CAN (an acronym for Interprofessional Care Access Network), a School of Nursing grant to improve access to health care services for the uninsured, isolated or medically vulnerable. Through free health screenings put on by OHSU nurses, physicians, dentists and other health professionals, community members have been able to receive medical check-ups, personal hygiene items, dental, vision and hearing exams, as well as educational materials and resources for social services, mental healthcare, housing, job assistance and much more. Even in fostering a sustainable grass-roots model for future leaders, OHSU has proposed the Scholars for a Healthy Oregon initiative, which pays the entire cost of tuition and fees for selected medical, dental, nurse practitioner, certified registered nurse anesthetist and physician assistant students in exchange for their commitment to working after graduation in Oregon’s underserved or rural communities. Through these and other examples, our collective compassion shines through.

“If you feel that you’ve got something good to give to the world to make this planet a greater place, don’t just hold it back,” said the now 64-year-old Bradley in a documentary chronicling his story, titled The Soul of America. “At my age now, I just want to give, give, give, give, because I don’t want to hold nothing back.”

Giving back isn’t just about altruism – it defines the future of healthcare, through collaboration across disciplines and through the support of transformative, lifesaving institutes like those for heart and cancer care at OHSU. Bradley’s story is a metaphor which holds tight to the notion that our future lies in strengthening our community. When we build up our country’s most vulnerable, we prove that by pushing forward despite barriers, empowering our collective strength and remaining grateful for our opportunities, anyone can rise.

Thank you.

“9 is arrogant”, he calmly tells me as if we’re on the same page.

“Why do you think that?” I ask, trying to wrap my head around this alien concept.

“Obviously it has the right to be, but I don’t know the exact reason.”

“No, there’s nothing obvious about it, but what are some other examples?” I intriguingly prod this sophomore who has stayed around after class to discuss with me the recent discovery of his rare form of synesthesia. He quickly rattles them off.

The grades are in and my first solo teaching experience is complete. Starting back in January, I embarked on a 4 month teaching odyssey at Lewis & Clark, designing, organizing and delivering a PSY280 class called “Brain & Behavior”, which can essentially be thought of as an introduction to neuroscience. Even before beginning at OHSU, I knew that I wanted teaching to play a role in my future career in science. So why not get started now? Of course, OHSU doesn’t have the undergraduate population for which our mentors, on one knee (or whip), send us off to fend for ourselves teaching their intro courses or grading their exams. Instead, luck, motivation, and more luck enabled me to score mini teaching opportunities across Portland which culminated last fall in being accepted as a visiting adjunct course instructor in the L&C Psychology Department. Yep, it came with an office… that had a window! Note: both are rare luxuries in the graduate student world.

“7 is sinister… the kind of friend who would stab you in the back.”

It was a Friday in mid-November when I found out I had received the teaching position. To celebrate, I came home, opened a bottle of wine and went through my old neuroscience textbooks, skimmed through the pop-culture neuroscience books I’ve acquired over the years, and gathered any remaining Scientific American Minds that had somehow not been replaced by the countless issues of Science that are clogging my shelves. What grew was a list of topics, sub-topics, and well, just cool facts that I wanted to build my class around. Soon, this list would be cut in half, and then half again (yes, neuroscience is a HUGE field). Do I want to spend time talking about retinal implants? Yes! Do I have time? Probably not. It’s a good thing my wine-potentiated excitement carried me through topic generation, because there was no time to waste prepping for lectures. For the next two months, there wasn’t a day that I didn’t work, in some shape or form, on class lectures. I would be teaching twice per week (1.5 hours each class) from mid-January to early May, and I quickly learned that my efficiency was approximately 5-6 hours of prep for every one hour of presentation. And this was material I already knew! What did I get myself into?

Any concerns regarding my decision to embark down this unfamiliar road were alleviated immediately on day 1. I found the typical Lewis & Clark student to be highly intuitive and engaged. The degree of discussion generated within the classroom was like hitting a 300-yard drive straight down the fairway, it makes you eager to come back with the hope of doing it all over again. Despite class attendance being optional, rarely did I have more than 2/3/4 students absent for a given class period. While the class’s dedication as a whole built a solid foundation, it was the individual personalities that made teaching an immensely rewarding and unforgettable experience.

“6 is feminine, athletic.”

I’ll never forget Batman (that’s how he signed his name on all his exams and quizzes). Entering the weekend, I had just finished the second of two lectures on the neuroscience of consummatory behavior (i.e. feeding and thirst), and Batman seemed to be particularly intrigued (he remained awake through the entire class). The following class period, Batman approached me looking slightly disheveled, and being polite, I inquired about his weekend.

“I didn’t eat for 48 hours. It was rough.”

“Excuse me?” I alarmingly reply. “Why would you do that?” Now feeling guilty that there may be some religious reason behind this madness.

“I wanted to go through different stages of hunger and see how it affected my brain. You know, relate it to what we’ve been learning.” Okay, now I’m just impressed. To me, this would be hell. I can barely make it to lunch without completely forfeiting my attention to thoughts of the peanut butter and jelly sandwich in my backpack. Instead, Batman’s mind was on science, discovery, and experience. How could you not appreciate the dedication?

“So how do you feel now?” I asked.

“Hungry.” He rapidly replied. “I haven’t felt full in a while.”

“And why do you think that is?”

His eyes break their contact as he thinks silently for a few seconds. “My leptin levels are probably still low and my lateral hypothalamus is active.”

The guy deserves an A.

The light-bulb moments that are obtained through hands-on discovery or through refocused examination of the material are like an intracranial self-stimulation of the mesolimbic dopamine pathway for a teacher. Once you see a student get one, you want it to happen again and again. But it’s just as good when you witness one’s mind being blown by the realization of some unknown concept or fact that could perhaps drastically change their view of the world. Teaching neuroscience lends sufficient opportunity to witness this phenomenon. However, if/when it was to occur, I really wanted to observe the massive physical visceral response I had built up in my head. Challenge accepted; I wasted little time getting started. I showed beautiful images of the brain (e.g. the “Brainbow,” which my students were quick to point out were taken by a recent faculty hire at L&C, drastically reducing the effect I had hoped it would have); I compared images of the neuronal landscape with images taken by Hubble telescope; I discussed case studies of trauma patients performing remarkable tasks, impressive feats of memory, neuralprosthetics, epigenetics, I even discussed the mindblown protein involved in synaptic plasticity. Did these blow minds? Maybe, but whatever effect it had was contained to the occasional “whoa.” Then came the lecture on neuronal communication and the action potential. As an electrophysiologist, I find this topic fascinating and its application can be an incredibly useful tool for understanding how the brain functions. With that being said, I didn’t give it great odds for being a mind-blowing lecture. But everyone loves an underdog. After my introduction, I dove into ionic gradients (potassium on the inside, sodium on the outside, etc.). That clearly wasn’t going to blow anyone’s mind that day (ever?). I then progressed to describing the stages of the action potential, beginning with the neuronal membrane reaching threshold and the opening of voltage-gated sodium channels. Sitting in the front of the class was a young man with a great mustache (truly, a great mustache). As I described this process, his forehead crinkled while he contemplated what I was telling him. Then, his eyes opened wide and his hand shot up.

“Whoa, whoa, whoa!” He started, looking quite alarmed. “So you’re telling me, that all the thoughts going through my head,” pausing for emphasis, “everything that makes us who we are, are really just due to the movement of a bunch of sodium ions?”

“Yep.” I responded, a smirk across my face. This is what I had been looking for.

“No way!” almost falling back off his chair. The class broke into hysterics.

Challenge complete.

“8 is the hero, the protagonist in any novel.”

Class ended as a celebration. Students gave their own presentations on a neuroscience topic of their choosing, utilizing the foundation that they had acquired throughout the term. Synesthesia, Greek for “together” and “sensation” where stimulation of one cognitive or sensory pathway automatically stimulates another (e.g. seeing a particular number makes you see it in a specific color [9 is red] or numbers take on human personalities [9 is sinister]) was presented by a young woman with grapheme-color synesthesia, autism spectrum disorder was presented by a young man with Asperger’s syndrome. The many topics were presented passionately and comprehensively, suggesting that they did indeed learn something during the term. The sense of accomplishment was warming; from my biased perspective, I like to believe that I aided in their growth as students, critical thinkers, and informed members of society who will use their knowledge to filter through the overwhelming media influence over our perspectives on health and science. But deep down, I realize that their growth was self-driven, for I learned that as a teacher, your role is to be merely a facilitator. You can talk until you’re blue and they may learn nothing, or you can talk little and they can learn greatly. Throughout this process, the most important thing I learned was what it means to “teach.” Teaching doesn’t equate to talking, or lecturing, but instead, directing someone to form connections and make their own “discoveries.” Because let’s face it, does it really matter if they don’t remember the thalamic nucleus where optic nerve fibers terminate before heading back towards V1 in the occipital lobe (it’s the lateral geniculate nucleus for those keeping score)? Of course not. However, through the critical assessment of material throughout the term, being able to detect inconsistencies, determination of experimental validity in primary literature, synthesizing large amounts of scientific information and presenting it back to an audience, that’s where the substantive growth develops and lasts. No doubt they taught me as much as I taught them.

Okay, now challenge complete.

This past weekend I took two hours off from writing and lab work, drove myself to the movie theater, and saw the breathtaking wonder that is Jurassic Park in 3D. JP holds a special place in my heart because, as a little girl, it enchanted me in much the same way as Willy Wonka and the Chocolate Factory. The power of what humanity can do and not do inspired me, even at 4 years old. In fact, I credit this movie as my very first exposure to science. You might laugh at this thought, looking now at the “science” presented in the movie, but such is the naivete of youth.

Like all classic films, there are themes in JP that transcend both the early 1990′s and the idea that we can isolate dinosaur DNA from fossilized mosquitoes, do some quick pipetting and virtual simulation, and wam-bam-boom have a baby dinosaur.  BIG questions are posed in this film. What are the limits of scientific discovery? Can we control the natural world? How responsible are scientists?  And of course there is also the famous line, “God created dinosaurs. God destroyed dinosaurs. God created man. Man destroys God. Man creates dinosaurs….Dinosaurs eat man. Woman inherits the earth;” quite the commentary on human progress……I doubt Spielberg meant this movie to be a specific commentary on the scientific community.  But the scientific community is nothing more than a microcosm of society, and these are certainly ethical questions scientists, including young investigators, are met with everyday. Sitting in the theater as a second year graduate student beginning to start drafting qualifying exam materials, there were some lines that particularly struck me:

“Life finds a way.”

“God help us, we’re in the hands of engineers.”

“What’s so great about discovery? It’s a violent, penetrative act that scars what it explores. What you call discovery, I call the rape of the natural world.”

“…but your scientists were so preoccupied with whether or not they could that they didn’t stop to think if they should.”

Can we? Should we? Why? Big questions addressed in most grants and papers. But I think it is important to point out here, once and for all, that not all discovery is destructive, not all scientific endeavor bad. Responsibility and ethics are essential to science, of course, but scientists are some of the most serious people I know. They must be, because their reputations and the future of their disciplines demand it. Unfortunately, this film chooses to focus on the negative consequences of discovery rather than the positive, casting a disparaging light on the scientific community.

But of course, this film is fantasy and should be taken as such. Watching the creations overtake the creators, there is an intrinsic sense of inevitable powerlessness I sometimes feel about science. I have never doubted the necessity of scientific discovery to human progress. I have become increasingly convinced, however, that like the scientists in JP, we cannot know everything about anything. There is a dark line on the horizon I do not think is penetrable. But then again, I could be wrong. Hence the beauty of science.

In a “former life” as an emergency preparedness specialist with the Red Cross, part of my job was to educate community members on everyday practices that can support their preparedness for disasters. A suggestion I often cited was, in order to make the task of building a “bug out bag” (emergency items to help you survive) and the magnitude of facing disasters less daunting, creating a “culture of preparedness” is crucial. A few examples for this included: picking up extra cans of food during routine grocery shopping, creating a game out of identifying emergency meeting places (or practicing fire, earthquake and other drills) and justifying card game purchases as emergency items (to stave off boredom – an incredibly important aspect of survival). Essentially, those in the classes began to view preparedness not as a chore or an insurmountable achievement once they saw that they could work within their inherent interests, tastes and schedule.

Similarly, through work in various public health capacities as I navigate through my degree, I believe a “culture of public health” can make intervention strategies towards improved wellbeing achievable…and even fun! In attempting to become a healthier individual myself and possibly spread ideas a bit further, here are a few ideas I’ve tried to build a “culture of public health” for my own sake.

• On campus days, I take the bus then the tram to “Pill Hill.” Even if I can’t always afford the time on the way up, I’ve been making an effort to get off several stops early and walk the rest of the way home (and sometimes forgo the tram and bus completely). If that’s not possible (or for extra opportunities), opt for stairs over elevators, or better yet, get a dog so they’ll force you to walk daily!

• Every morning, I try to eat a fast yet nutritious breakfast (oatmeal with fruit and milk lately) and pack away healthy snacks to bring to campus to avoid succumbing to unhealthy vending machine urges later (although OHSU gets a free ride, as we are fortunate to have amazing healthy vending machines).

• Tax season isn’t quite over yet and as the idiom goes: “nothing is certain in life except death and taxes.” I use this guaranteed deadline as a conduit to integrate an annual visit to my physician. Other critical health checkups can correlate with scheduled activities as well, such as coordinating a routine dental visit and an oil change for my car.

• Along the same line, because I found myself skipping flossing with the style that required finger twisting and reaching, I started investing in the toothbrush-handle style and have never turned back!

• For vices, it can be a painful process to go “cold turkey” and quit without any latent urges. Therefore, I’ve tried to incentivize myself for slowly giving up a tough addiction one reward at a time (for instance: each shirked off box of cigarettes might allow you a new $6 prize, like an awesome autotune phone app).

• Instead of Twinkies (yes they’re back) I’ve switched over to dried fruit (apricots are my favorite) as a healthy snack. I’ve also found that pistachios, almonds and hazelnuts make easy grab-and-go food without the sugar coma to follow.

• Just like my wallet and keys, I never leave home without a refillable water bottle…and I fill it often. For that needed jumpstart, I’m also trying to forgo or substitute soda, mochas and other sugary beverages with caffeinated tea.

• As a fun preventative health measure, my friends and I take advantage of blood pressure machines by turning it into a wager. Also , in my former role as a “vampire” when working in Blood Services at the Red Cross, I’ve recruited friends to donate together, where I’m not only guaranteed a free mini physical to check blood pressure, pulse, body temperature and hemoglobin, but also help potentially save someone’s life with a transfusion.

• I tell myself that stress reduction is a legitimate excuse for a time-out from life’s craziness. Even though I initially worried in allowing myself to “take five” from school with a favorite album, book or film, I came to realize I was far more productive in classes by making room for these breaks.

• Speaking of breaks, I’ve found that zoning out to music on a treadmill works as a fantastic escape from stress, or, if my iPod dies on me, a guilty pleasure TV show at the gym will suffice (if only “Shark Week” was every week!).

• That said, as busy as most of us are, finding time for scheduled exercise can be intimidating in our calendars if we want a social life as well. I’ve noticed this reality during my graduate work and decided to make my exercise my entertainment: racquetball, salsa dancing, lazertag…even that Sky High Sports trampoline place (where you’re never too old) can prove to be both exciting and great cardio! Furthermore, social networking (no, not the internet kind) and a strong community of friends is critical to your health, as well as your sanity!

What strategies do you use? Feel free to comment below – I’d love to see other ideas for building towards a “culture of public health!”

I was honored to participate in the OHSU School of Nursing video.  I am passionate and committed to the nursing profession and I am overjoyed to be a part of the one of the best nursing programs in the country.  OHSU offers a strong didactic and clinical education, and I feel prepared and excited to enter the nursing field.  I have loved working with such a diverse and experienced group of colleagues, faculty and precepting nurses.  I am looking forward to a career in pediatric oncology nursing!

- Mary

Click here to view the embedded video.

When learning a massive amount of material, it helps to have pneumonics for rote memorization. The crazier the phrase the better. Of course sometimes you remember the wacky phrase but not what it stands for. In our neuroscience class last term, we were specifically told to NOT remember a pneumonic for brain MRI findings that related the age of an intra-parenchymal hemorrhage to the findings on a T1/T2 MRI.

But it was just so darn memorable: It Be Iddy Biddy Baby DooDoo

It also doesn’t help that I have babies on the brain because my wife gave birth to our first child just a few weeks ago! I am currently in the process of adjusting to a new normal in regards to my study schedule, recreational activities, and amount of sleep. Let’s go through an exercise in exploring the dichotomous nature of parenthood and just enough medical knowledge to be dangerous, all in the context of my favorite fancy pneumonic!

-It….

Medical knowledge (0-8 hrs old, Isodense, T1): Most neonates experience jaundice soon after they are born, but a blood level of 11 before 24 hours of life could indicate a high risk situation and potential kernicterus.

Parenthood: He is so perfect that there is no way there is something wrong, and is he even that yellow? Oh my gosh, what if it it’s Crigler-Najjer or Gilbert’s!

-Be….

Medical knowledge (0-8 hrs old, Bright, T2): Newborns have basic needs and communicate those basic needs via one of their only means: crying.

Parenthood: He won’t stop crying, and I don’t know why. I feel like I should intuitively know how to soothe my own child, maybe I’m a bad parent.

-Iddy….

Medical knowledge (8-72 hrs old, Isodense T1/Dark T2): Your overall percentage (i.e. grades) in the first 2 years of medical school can be used to predict potential issues with passing USMLE step 1.

Parenthood: Well, I almost failed an exam in medical school for the first time, but that’s what happens when you don’t study and spend all day staring at your kid. That’s not going to work forever, but it sure was worth it this time,

-Biddy….

Medical Knowledge (3 days-1 week, Bright T1/Dark T2): Newborns don’t start smiling until about 2 months of age, and it is often only in imitation.

Parenthood: He’s only 2 weeks old, but he’s already smiling! Or was it just gas?

-Baby….

Medical Knowledge (1 week-Months, Bright T1/T2): One theory behind the pathogenesis of SIDS is excessive rebreathing of CO2 without sufficient central drive to increase ventilation

Parenthood: I’m so worried that the blankety cover over his car seat is going to cause his PCO2 to rise! Should I open it more?

-Doodoo…  

Medical Knowledge (Months-years, Dark T1/T2): REM sleep is crucial for processing memories and for long-term retention of knowledge. Interrupted sleep often makes it more difficult to reach REM because you may have to restart your sleep cycle.

Parenthood: Not again.. This is the fourth time he’s been up tonight. But I can’t leave him in a dirty diaper, and I’m quite sure he wants to eat again. Good thing he’s worth it.