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!
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!
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!
Somehow the gravity of the words was diminished when translated into a second-language. “Tienes diabetes” (You have diabetes). It wasn’t until after I had said them, and after I saw the empty stare of the words’ recipient, that I realized the weight of the information I had just relayed. The make-shift office of felt walls and PVC pipes in the underground parking garage felt like an odd place to give someone a diagnosis of a potentially chronic illness. In that moment, the reality of health inequity was made clear to me.
Health Care Equality Week 2013
Though an organizer for this year’s Health Care Equality Week screening fair, I had a bit of patient interaction on the day of the event when I stepped in to interpret for Spanish speakers a few times that day. The annual event, held in downtown PDX, brought in nearly 300 patrons from the surrounding area. When I arrived for set-up at 7:30 that morning, many had already started forming a line, waiting for the gates to open an hour and a half later. As a multi-disciplinary and multi-university event, the screening fair featured a variety of services including oral exams, visual acuity screenings, diabetic foot care, immunizations, veterinary care, medical consult, blood glucose checks, and hair cuts among other things. Throughout the day, a steady stream of people seeking medical attention ventured into the damp, cold underground parking garage where the fair has traditionally taken place. Held in conjunction with Potluck in the Park, patrons could head above ground in the afternoon for a meal after the fair.
I used to write just to write, for no particular reason – it was just something I liked to do. I had one of those way-too-popular black Moleskine journals that are about the size of a back pocket, and I would sit on a bench of my undergraduate campus and write a poem or a paragraph or anything that came to mind. I don’t do that anymore. Instead, I learn. I learn all the time. And when I’m not learning, I think about learning; I plan out when and how I’m going to learn, and think about all of the things that I want and need to learn.
As a first year medical student, much of what we’re responsible for learning is hard, biological science. Our core classes are meant to teach us the background information we must understand in order to eventually treat patients. Sometimes, in the midst of all the biomedical science, as ironic as it may seem, I forget what I’m really doing here. I spend so much energy trying to master the material at hand, I forget how it fits into the big picture of what I’m trying to accomplish in medical school and beyond. When there’s a test around the corner and 200 pages of information to learn, many first-years might agree that it’s easy to miss the forest for the trees. Luckily, OHSU has found a way to attenuate the tunnel vision so many of us find ourselves slipping into by cycling our focus between our books and the clinic.
“I am slow to learn and slow to forget that which I have learned. My mind is like a piece of steel,
very hard to scratch anything on it and almost impossible after you get it there to rub it out.”
- Abraham Lincoln
Despite his demonstrated capacity for significant life accomplishments, I’m not sure how well our 16th president would have liked being a medical student in the 21st century. Modern medicine is an expanding body of knowledge, but the brain is a relatively static piece of biomachinery. The amount of knowledge that a medical student must acquire in order to pass the first step of the licensing exam is considerable and seems to grow daily. The reality is that there’s not enough time to learn it to the point where one can consider the knowledge etched in steel in one’s mind. I can’t tell you how many times I’ve talked to upperclassmen, residents, and even practicing physicians who report that the learning in their careers has been matched by an equal amount of forgetting. Like Lincoln would, most of us have to cram knowledge into our brains in order to pass exams, only to later find that our brain’s hold on it is ephemeral.
How do most students deal with the rising tide of knowledge? Study harder, dose themselves with stimulants, sleep less: these are some popular strategies. They’re popular because they more or less work – almost all students pass classes and exams using a combination of these three methods. But is this the best way to learn? What about retaining those details that might not be useful on a day to day basis, but incredibly important to treat that rare disease only encountered once in one’s career?
What does spring equinox mean to you? For many it conjures the image of flowers, bees, bunnies and sun (unfortunately more like rain in Portland). The season that arrives right before the much awaited summer. For Persians, spring equinox is the start of a new year and the time for celebration, family and traditions. Persian New Year, known as Norouz (meaning new day), is based on the ancient Iranian religion of Zoroastrianism. The holiday has since lost its religious connotation but is still celebrated throughout the world each Spring and is deeply rooted in symbolic traditions.
MS1 classmates celebrating Persian New Year
This year Norouz fell on March 20 at 4:01 a.m. here in Portland, which marks the start of the year 1392 on the Iranian calendar. In preparation to welcome a new year of health and happiness, Iranian families begin spring cleaning of the home and prepare the traditional Haft-seen (7 S’s) table setting. In the minutes before 4:01 a.m. PST families worldwide would be taking pictures, hugging and kissing, and calling elders in their new Spring clothes. On the Tuesday night before Norouz, families welcome the new year in part by jumping over a bonfire while saying a chant translated as “I give you my disease and illness, and get your beauty and health.” Unfortunately for me as a first year medical student, I was studying for an exam during this first part of the holiday. While studying in the library, I decided that this new year was an opportunity to teach others about Norouz traditions. After hearing interest and wonderful support from my new classmates, I invited a few of them over for the traditional fish and rice dinner on the eve of the new year.
OHSU medical and nursing students participate at the 2012 Health Care Equality Week
Madeline is one of the sickest patients I have met in three years of medical school. Homeless, she came by ambulance to the hospital for malnutrition and frostbite after days sleeping out in a Portland area park this winter. She was resourceful: She made drinking water by melting snow in plastic bottles with her own body heat. And her physical health was surprisingly good. Her mental health was not. She thought she had magic powers, had pockets inserted in her body, that people were chasing her across country.
Madeline (not her real name) was either too addled or too afraid to give any information about her past, using a fake name and claiming she could not remember any phone numbers or any other cities where she had lived. She denied being sick, saying she was only the psych ward for “R&R” and taking her antipsychotic to gain some weight. I think her psychiatrists and I did almost nothing that helped her: her mental health was not a whit different on leaving than on coming in. But the hospital’s social workers helped her immensely. They found her a place to live and outpatient clinics for physical and mental health care.
[As you read by the title, this is Part One in another of my lucky-to-be-nominated-award-winning series of two-part Mega Posts. Sorry, guys. Hopefully, this duology will be less like a continuation of one story and more like two meditations on a single topic. In this post, I’ll talk about the importance of good science communication, and in the next one, I’ll provide some of my favorite examples. Hopefully it’ll be fun for the whole family.]
One of the greatest things about science, in my opinion, is its almost neurotic obsession with exactness. (Please excuse me for anthropomorphizing the entirety of our practice, but since science is impartial and, you know, not alive, it probably won’t mind.)
Science—or scientists, rather— aren’t satisfied with vague approximations or educated guesses: they want the truth (and yes, Tom Cruise, they can handle the truth). They want to unwind everything, to shine flashlights around corners, to behave like mechanics and dismantle and rebuild the engines of nature until they can better understand how they work.
I know my metaphors are somewhat muddled—my writing has gotten a little flabby since college—but my point still stands: science is a precise discipline. And often, when communicating science to other people, that precision becomes an obstacle.
Let this be known as The Low Point.
I wasn’t prepared for it, much as I thought I was getting used to the feeling of never being 100% prepared and settling for a decent-enough understanding or grade. This weekend, despite all my kicking and screaming, I hit a serious low point in balancing school and the rest of life.
A snapshot: I can’t tell which basket is clean or dirty and there are no clothes hanging in my closet; I cleaned a spoon from the sink of dishes to eat frozen leftovers I don’t remember cooking (there were tomatoes involved, so I think it was summer then); I have emailed my PI without an attachment more than once today. We have one quiz, one block exam, one final, one practical exam in the next 7 days.
4 exams in 7 days. Not to mention the friend we have visiting on Thursday, the two afternoon labs this week, and a summer research proposal I have due tomorrow. I really don’t like the sound of my own whining, but it’s what I feel like doing most of all at the end of these days.
My sister, a fourth-year awaiting her match results, remembers The Low Point of her first year, and I’m watching my colleagues slump further down in their seats as the weeks go on (or begin to not come to lectures at all). I know I’m not alone in it. But what to do about it? I’ve tried giving myself a day off (the guilt turned quickly to tears and panic), buying new pens, cooking dinner. Nothing bypasses the truth of my life right now: I have more work than I can possibly swallow and nothing is going to be exemplary, from the dishes to my hair to my exam results to calling my friends when I say I will (sorry, guys!).
I know it’ll get better. Until then, I’m hanging on, and the knowledge that these low points (I know there will be more) are worth it makes my grip even stronger.
Unless your workplace is having a snow day or you brought an incredible lunch to look forward to – Mondays tend to be a bit of a bummer. As we all push through the daily grind – I try to revitalize my afternoon with a reminder of how often public health touches our lives each and every day…
Graphic courtesy of here
(Adopted from www.whatispublichealth.org)
BUZZ. Wake up and brush my teeth, take a shower and get that coffee brewing! Luckily, my water is potable and I don’t think twice about turning on a faucet.
My stomach is rumbling as I head to the kitchen to scarf down anything convenient and edible. Thankfully, in a more awake state of mind I was paying attention at this year’s American Public Health Association conference, which showed research on the country’s rising obesity epidemic and thus I’m opting for organic milk, oatmeal and OJ over pop tarts and energy drinks.
Cursing an insane driver who sped through a red light while texting, my seatbelt tugs at my shoulder and prevents whiplash, my brakes screech to a halt. Injury prevention is a silent lifesaver quietly involved in the mechanics and design of countless aspects of our lives.