Mile 2740: Roadgeek Alert

Above: I am appalled to see so many signs about Dix on the road.
(SB I-57, Illinois Mile Marker 103)

I LIKE YOUR SUNGLASSES...
BECAUSE OF THE GREEN TINT.
Attendant at an Effingham, IL Gas Station

Even with long shifts, eating crappy fast-food, not looking debonair, sleeping on beds that aren't mine, and seeing my eyes dyed a crimson red at the end of the day, I still feel like I'm enjoying where my life has taken me. No, I'm not describing what residency is like: It's how to experience Americana through a road trip.

Whew. 1438 miles done and set.

I've actually made it to my Family Medicine core rotation, which takes place at the Miami Jewish Home & Hospitals in Miami, FL. With only a weekend from the end of my last pediatrics rotation and my family medicine rotation, I've been on a rush to make it from one part of the country to another. However, its good the route is actually not foreign territory, so 2 days went by no sweat.

Our family has visited the state multiple times and are yearly visitors to the legendary Disney World. My mom and dad have accompanied me on these trips, and even when as I was just 6 years old, I was the navigator of the trip, looking through road maps to keep us en route. In 2003, just after getting my drivers license, I added onto my duties, taking over my dad at the helm of our van for my first trip. To me, that drive to Daytona Beach in 18 hours from Chicago was one of my rites of passage.

I ended up loving road trips, and not only for the sights at my destination. I discovered a few years ago that the best way to describe my love for the road is with the term "roadgeek." I'm not alone either. There's many other people who are amused when an expressway comes to a stoplight, a 5-level stack carries cars in multiple directions, or trying to explain how poor designs of interchanges leads to traffic jams. I'm also the type of person when, if I have the time, would stop at every hole-in-the-wall restaurant, and little point-of-interest along the way. And finally, but not least, I love road trips because of the people I meet. On the way down to Miami, I chatted with one of the cashiers at a Wendy's in Georgia, a clerk at a gas station in the middle of Illinois, and another clerk at a Winn-Dixie here in Miami. Learning about how other people communicate and their respective culture can be done most of the time with a simple hello. Just keep the attitude that being on the road isn't just a long car ride. With an open mind, you find out its an awesome experience.

Anyway, tomorrow at 8:30 AM, I begin my next six weeks of the journey... Provided nobody blasts through a red light here and hits me, I should make it to May.

Mile 1201: Constantly Judged

Above: A wikipedia image of a "Kiss and Cry" featuring Michelle Kwan.

SKATERS GET THEIR SCORES
IN A "KISS AND CRY"

The passion for perfection can be seen in something my mom has our family watching for dinner every day: figure skating. I know, not a manly sport, but let me make a point here. We were watching one of the post-olympics championships, and I watched one skater prep-up for a triple axle, one of the significant jumps needed to be completed for a significant score in his program.

The anticipation was felt. The crowds eyes were on the skates. The skater's eyes were focused. His leg goes up... and he singles the jump.

Okay, so skaters make mistakes once in a while. The skater sets up once again, this time a triple-triple combination, according to the announcer.

The anticipation was felt. The crowds eyes were on the skates. The skater's eyes were focused. His leg goes up... and he singles the jump.

I'm glad the skater couldn't hear what the announcer was saying. All the talk about disappointment, not matching a highly expected performance, and how the failed jumps marked the end of his program. "A disaster," was the way they had put it. I could see the negative comments discouraging the skater from completing his performance. So, I give him kudos for the strength that he pulled off in putting that disappointment behind and finishing off his program, even though he knew he could no longer make up for his mistakes.

The skater was definitely not a slacker, as he had to work hard to get to this stage. However, I could feel the pain that he had as he was up on the "kiss & cry" waiting for his scores. After hours and hours of practicing to get to perfection (like many other figure skaters), I could see the skater's face in deep, deep disappointment. It seemed that he was feeling like nothing paid off: the judges gave him a score that was only a fraction of his average marks.

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I feel that becoming a doctor is the same. We go through hours and hours trying to dig deep into our profession, either by putting our heads into books or spending long hours at the hospital or the office for experience. And just like figure skating, one can read all about medicine and know about the in's and out's of a hospital, but without that practical real-life practice, the information is useless.

As I'm beginning this new leg of this journey, I'll admit it is tough to take 2 years of basic sciences, and now add on clinical thought to make sure as a doctor I can think on my feet and do things right. But yet I feel that with every patient, I'm not exactly there. And its kinda disheartening as I believe the essence of perfection is needed to take care of every patient and their needs. Either, I'm missing a question here or there when taking a history or I'll miss a couple differential diagnoses on a patient. My body keeps telling me, I can't miss details.

The patients and the doctors are there judging me with every move. The former for trust, the latter for grades & marks.

Yes, I know, perhaps I am complaining too early (6 weeks into my 78 weeks of clinical rotations), but I believe that to do well in medicine, I believe I have to earn the trust of my patients. And that can't be done without proper personal relationships, a good medical knowledge base, and an ability to think clinically (what I now call "across the board thinking", I'll explain in a later entry). I feel that with each mistake I make it harder for a patient to trust me. Well, I'll need to be patient with myself, because perfection can be achieved through the beneficial lesson that each mistake teaches me.

I think I need to strive for perfection more. It's the only way I can be an asset to my patients and to my field. I'm just thankful the doctors and patients don't put us through the "kiss and cry."

Mile 1125: Writer's Block

Above: The Robert Ross Parkway that runs in front of Ross University in Dominica.

"EASY READING IS
DAMN HARD WRITING."
Nathaniel Hawthorne

One of the reasons I started up this blog is I wanted to get used to writing about myself. And a year later, I feel that I've definitely opened up to the web with my experiences (it's still a work in progress, however). I'm not perfect though, and I'll be the first one to admit it. Here are several bad writing/proofreading habits I'm prone to:

1. The pothole - Some entries I type a lot of stuff, without thinking. Then I'll have a great idea, and think that putting a whole bunch of ideas somewhere else would be better. Ctrl+C... Click cursor in appropriate place... Ctrl+V. Then, my mind will have another great idea... and soon I'll forget I just forgot to fill the hole I just made with something. Well, now you know what happened when I started talking about medicine and probably ended up jumping to talk about potato chips, without a transition.

2. Circumlocution - A strategy I had in trying to talk Spanish rears its ugly head with writing. The concept is that if I can't find a word, I try to word around it. For instance, if for odd reason I couldn't come up with the words "potato chip", I'd probably end up saying "thin-sliced potatoes that are fried." So, if you see some unbearably long parenthetical expression or phrase (that could be defined as one word), this is why.

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With a whole slew of students starting to write their personal statements for residency, I decided to put my pen to paper (or in the digital world today, more like my hand to the keys), just to see what would come out. Even after months to write about myself, I found it hard to start something. I had many ideas, so many, that I wanted to put them all together. But nothing still came out.

Some people have mastered the art to writing about themselves. To me the challenges are, making sure I can present myself in a concise manner (okay, circumlocution is something I need to work on), selecting the right qualities of myself to present in that short essay, and writing something that doesn't seem like another "personal statement." It's tough to write, but fortunately in the digital age I only need to click and delete, making writing better a much faster process. I won't be killing trees by free-throwing my failed drafts one-by-one into a wastebasket.

At least I know I'm doing the environment a favor. Awesome!

Starting next week, I'll be starting my drive down to Miami, FL for my next rotation for Family Medicine. More on that soon...

Mile 1036: Games People Play

Above: My high score at Buzz Lightyear's Space Ranger Spin at Walt Disney World, FL. May 2009.

"SEEING IT FROM WHERE I STAND
NOTHING COMES EASY."
From the theme song to the 1990s sitcom Just the Ten of Us.

2008. A group of 10 of us students sits in a small room on our first day of the Behavioral Sciences Lab. There's a huge table in the middle of the room which we all are sitting around. We're staring at each other, probably making small talk... but we're waiting. A Dominican lady walks in, along with one of our faculty, and they sit at the table. I find myself in the chair directly to the right of them, as they prepare the class. And when they asked for a volunteer to interview the Dominican lady (a patient, standardized most of the time, if not always), I had raised my hand. A form with questions to ask was handed to me, and soon I found myself going through the form to take the Dominican's history.

However, I knew that soon enough - just like the training wheels on the bicycle - I needed to be free of support to know I could really do this on my own.

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We're finished with the babies, at least in terms of a full-time sense. As I've crossed the 1000 mile mark on this part of the adventure, we've moved from the hospital setting to a private practice in Buffalo Grove. Here's the dilemma I'm facing - how to take a history from a pediatric patient. Even though I've been through many experiences with history taking - starting with standardized days of yore - it feels different when I'm in with real patients with real health issues. I just don't want to mess up.

I'll admit during my first few days, I've felt nervous about taking histories and physical exams, but when I had talked to my attending doctor, he said that experience comes with practice. From what I've seen so far, I think there's three hoops to leap through to get an accurate history and physical exam in pediatrics:
1. The Kid's Trust
2. The Parents Trust
3. The Kid's Communication

One of my group mates brought up an excellent idea on why I might be having trouble: why don't I try playing a few games to start to earn some of the kid's trust. No, I didn't pull any of the following things on 19-year-olds but I did try them on some of my younger patients. For instance, with an infant, I soon made my hand into an airplane to try to make the kid smile. The benefits were enormous though as the kid showed teeth! I knew I had made the little one comfortable for the ride.

However, it's not over yet, as many kids come in with concerned parents. And I've seen them all, from the laid back, leave the son/daughter in control mom/dad to the stern, "I don't any students in the room" mom/dad. Parents are an important part of the health of the kid, and from what I've learned so far, as physicians, we're not here to override what parents are thinking, but to help and assist them with their children. The cool part is that pediatric histories may include a combination of information from the mom/dad and the patient himself/herself (both will answer your questions). It's up to the clinician on how to interpret any differences (which occur often!) between the two.

I also am learning how kids love to term how they feel. Some instances were an unending "stream" of yes's to a line of questions I asked one patient. Other times, I found myself trying to interpret what "weird" or "tickle" meant. The words are cute, but in order to help out the kid, I had to probe what exactly those words meant. I'd love it when a kid would clear up how "weird" something was by saying, it was just "weird." It's just another piece to try to put into the puzzle.

I guess jumping through hoops may be right up my alley.

Mile 768: The Learning-Teaching Pairing

Above: The Chicago skyline on the NB U.S. 41 Lake Shore Drive to SB Interstate 55 flyover. I love flyovers!

"SEE ONE, DO ONE,
TEACH ONE."

2007. I recall one of our professors in the anatomy lab at the campus in Dominica was talking to us about how things "roll" in the anatomy lab. After our class was split into three groups, one of the groups each day would go on in to the lab and dissect a part of the body. For the people who weren't dissecting on a given day, they had to come in and watch the group that was currently dissecting give a demo on what they found out on that day. And for the next day, we'd rotate a group, and the process was repeated over and over again throughout the semester.

Dr. Martin said this was his philosophy, to see one, do one, and teach one.

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There's truth to that statement, and I'm seeing how it works firsthand in the wards. For instance, this past week, our attending doctor had demonstrated to us how to perform a neonatal physical (see). As a group, we then spent time everyday to perform the physical exam (do). Finally, when a new group came in to work in the ward with us, we spent the time to teach them the procedure if the doctor wasn't available (teach).

And through doing all three, I would have gone through either a procedure or a nugget of information, three times (and the procedure amazingly stuck!). Most would agree that in order to teach one has to learn. However, for me (but not for everybody), to learn one has to teach. It is commonly said that becoming a physician is a career of lifelong learning.

Right now, at this stage as a medical student, this is how I see it:

Throughout our careers, we have to keep up with the continuous research that goes on, filter out what's appropriate, and pass that information to improve the care of our patients. When we teach them what we learned (one way is through a doctor visit), I think that we have to pay attention to our patients, such as if we are communicating our ideas effectively to the patient or how well the treatments we plan are working. If something's wrong with that, we have to go back to the drawing board and start learning about that issue from square one again.

So after all that, I'll have to say that teaching and learning go hand in hand, and for me, one can't go without the other. For me, being enthusiastic about medicine (or just about anything) can make the processes of learning and teaching exponentially addictive.

Mile 644: Robert McCall (1919-2010)

Above: Robert McCall's former mural at the now defunct Horizons attraction at Epcot Center in Florida. Click the picture for a close-up look. From Imagineering Disney.

"IF WE CAN DREAM IT,
WE CAN DO IT."

Robert McCall has been a part of my medical school journey... well, in a more indirect way. One of the most inspirational events was riding the Horizons ride at Epcot Center years ago. The ride was all about the future. During the 15-or-so minute ride in the cab, I saw how the future was imagined in the past, what trends were presently (think 1980s) were done to help us get to the future, and what the future (again, think 1980s) was visioned as in the present. At the end was the coolest part, you could select the manner to travel back to the present (sea, space, or desert), and your cab followed suit.

But the most inspirational parts of the ride occurred when walking in and walking out. When entering the Horizons building, one saw the above quote, "If we can dream it, we can do it." It's been one of my "optimistic" quotes I carry at the back of my head. At the end, I never got to experience it, but I learned that in the early days of the ride, Robert McCall had a mural, the one shown above, at the end of the ride. The Prologue and the Promise it was called, and the transition between the darkness of the past and the light of the future Mr. McCall portrayed in his painting is something that still gives me that "tingle" to this day.

However, it was removed, because according to the internet, GE, the sponsor of Horizons until 1994, wasn't satisfied that people were walking off the ride not knowing that it was the sponsor. So, by the time I rode it, they had replaced the room with the mural with hallways leading to a GE logo. I honestly think they should have stuck with the mural, as it was much more conducive to solidifying the message the ride gave, which to me was There is hope in the future.

I learned a few days ago through the NASA website that Mr. McCall passed away at 90 years old on February 26. He has inspired a lot of people through his interpretations of space and the future. He showed us that the future is quite a beautiful thing. He was one of the people who showed me that there is always reason to keep looking forward.

Thank you, Mr. McCall.

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Check out Mr. McCall's galleries here.