Humble Beginnings

Above: A doctor making a quiet appearance in Robert McCall's mural Reaching for the Stars, 1982.

"EGO IS THE BIGGEST
ENEMY OF HUMANS."
-- The Rig Veda, a collection of over 1,000 hymns, which contain the mythology of the Hindu gods.

I don't know if it was truly planned this way, but I think that Ross gave me a neccesary humbling view of the medical profession...

A few weeks ago... During COMP studying, I was sitting in my typical spot at one of the public libraries. While working on questions, I look up and there was one of the people I went to high school with (keep in mind, long story, but high school wasn't exactly a Cinderella story for me). When I looked up she was about to head in another direction when our eyes linked, and the first thing that came out of my mouth was, "Hey!" She walks over and says "I see you're studying for the Step too." I knew that she went to a U.S. Medical School, so I told her about how Ross gives us the COMP, how I'm away from Dominica now, and the nine-yards about coming from a Caribbean Medical School. The whole time I could tell she had one of those smiles that kinda was put there for kicks. When I finished, all she could say was "Good luck." I wished her the same, and she walked away.

I turned around back to my computer screen, thinking, "Wow, she seemed really snotty."

For those of you unfamiliar with the medical school stories, in short there's definitely discrimination of us Caribbean students pitted against the traditional US student. Our programs are virtually the same in many manners, from organization, to class structure, to topics taught. There's not enough space to fit all of us future doctors in the states, so Caribbean schools were opened, one of the first for this purpose was Ross University in 1978. Although there are many similarities, that "I'm better than you" sentiment has been felt and seen with many of my friends interacting with US Medical Students at residencies and rotations. However, the feedback has been good for us Ross students, with many of our rotation sites saying that our performance has been equivalent or better than U.S. students.

So there :P. But I'm not here to get egotistical about our performance, for a reason.

Going to Ross has made me think retrospectively: had I gone to a med school in the states would I be acting the same way to someone who hasn't made it into med school? Would I be acting the same to my friends who went to a Caribbean med school? I'll be honest, I don't know. But what I can say is that being in this position has really taught me that, no matter who you are, Caribbean or US Medical Student, we're all in the same boat right now: about to take one of the most important exams of our lives, the Step.

Yes, going to a US Medical School is quite an accomplishment, as getting in over thousands of students is no easy job, but in truth, wearing that ego may do more damage to the profession than one may think. We're all going to become doctors, we all have the goal to help the health of the human race. Who cares what school one went to: a respectful sharing of knowledge, fighting for the patient, and effective teamwork is what us doctors need to do to carry medicine forward. When working separately, and not sharing knowledge appropriately, who knows if our decisions are the best ones made or if we overlooked a detail or two? How about encouraging other doctors to perform their best, even if it may seem bettering others than ourselves? Our pride as doctors should, in the end, benefit our patients not our ego.

To me, an ego can only stand in the way of taking care of our focus: patients. An ego won't get any of us closer to our goals as doctors, will it?

Being Positive about Thinking Negatively

Above: Atul Gawande in surgical scrubs (From the Harvard University Gazette archives).

"NEGATIVE THINKING MAY BE EXACTLY WHAT WE NEED."

In the eyes of a positive thinker... that quote shocked the hell out of me!

Atul Gawande, one of my inspirations behind starting up this blog, is one of my favorite medical authors. I've read two of his books, Complications and Better. They deal with the essence of medicine's imperfections and how doctors maximize their own performance, respectively. Through the books, Gawande's excellent narration guides the reader to feel like he/she is in the action, actually holding the surgical instruments and under those huge, bright surgical lamps in the operating room. Also via adding appropriate detail, he also sets the aura and emotion (for both doctors and patients) that makes every medical situation exciting and unique. I read his books to remind me of the excitement the medical field whenever studying pages of raw material in my review books starts to make me feel all punchy in the ole' noggin.

As I was scanning through Gawande's site a few nights ago, one link caught my eye. In a 2007 New York Times article called The Power of Negative Thinking, Gawande describes the need for antagonistic-like thinking. He uses the then-current controversial situation at Walter Reed Hospital to describe two-sides of hospital care there: how staff before and during medical treatment were taught to negatively think, while post-treatment, staff kept their positive thinking. The results: deep analysis of problems that patients had resulted in better treatment, while all who thought that everything was "A-ok" in the rehabilitation process ended up harming the patients down the road.

Gawande's right. It is discouraging to think negatively for ourselves; most of us want to think positively to get through things (sometimes to even avoid them, I think). It's easy to avoid wanting to think that there's imperfections within us... I could see how for a perfectionist that thinking negatively could lead to what Gawande calls "a state of perpetual dissatisfaction." (Just imagine every moment of the day leading to some type of criticism... disturbing!) However, let's spin this idea positively: how do situations improve if one doesn't know the imperfections to look at? Progress of humanity doesn't come without changing a few things around, especially obstacles that block getting to goals. It seemed like Gawande's ultimate point was this: without thinking negatively in business or humanitarian situations, loopholes can be missed, resulting in failures.

After reading this article, I can see how the two opposites work best hand-in-hand. Through negative thinking, issues that need to be addressed can be identified, but I believe it is through a positive (and forward) attitude that they'll be actually be addressed (and addressed well).

Put the yin and the yang together... and there's one of man's greatest gifts: critical thinking.

What's Next?

Above: A Med Student's Bible, First Aid (2006, 7, 8, or 9). I have the odd -numbered years in that aforementioned set :P.

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

-- From EPCOT Center's Horizons (1982-1999)

I really enjoyed that I took some time off for R&R after the COMP. Spending some time at Epcot to refresh myself on the promises of the future, and now on the shores of Daytona Beach to relax, I'm back to get into the grind of studying (I miss my coffeehouses).

I talked a few entries ago about where I want to go as a doctor. Well, it's time to take that issue head on. For every medical student, the boards (a more lax term for the three "steps" of the United States Medical Licensing Exams - USMLE) are fate-determining for medical students. Many studies show that the First Board Exam will almost absolutely determine what type of doctor I'll become. So, I'm about to head onto the fog once again, and its time to start thinking who, or what I want to go with medicine. And, here's three prospects...

1. Pediatrics. I have always loved kids... they're the hope of the future. Hence, I've always dreamed of working in a pediatric hospital, treating some of the worse of diseases. Sometimes it may seem that diseases are simply spontaneous, but for many kids they're born with them. Chromosomal abnormalities, physical deformations, immune system and even tumors present at birth plague these kids. And for some odd reason that pulls me that some of the pride of the future is affected from the beginning.

On my flight to take the COMP, I had an opportunity to meet a Canadian resident currently doing pediatrics. She caught me carrying two of my step books with me. However, as we were talking about our medical experiences, she mentioned one thing that stoked me... pediatrics encompassess a lot of embryology. I see embryology as one of the most intriguing parts of medicine, and it focuses a lot on the origins of the different parts of the body from the start of the merging of a male sperm and female egg cell. I'll be honest, that with the complexity of the way cells develop in a baby during pregnancy, I feel that embryology albeit interesting, is neglected in today's medical education: I felt it was something we had to simply memorize instead of understand.

2. Pathologist and potentially as an educator. I bet you're thinking: You're crazy... from kids to dead people. I'm not. Pathology was one of my favorite subjects in medical school. Opening up bodies, with the pursuit of mystery and problem solving, in addition to mastering the visual art to realize minute differences in the appearance of pathologic organs, makes pathology a quite interesting field (if you don't believe me, watch Dr. G: Medical Examiner on Discovery Health). Yes, interacting with people isn't involved, but I figured I would make that up if I would become a medical educator. With inspiration from my favorite(and in my opinion best) professor, Dr. C, back in dominica, along with my aspirations to teach others, this has appeared as a great option. Because pathology is a subject in medical school, my clinical and educational aspirations have found a great partnership.

3. Anthropologic medicine. I have always been interested in behaviors and culture. And we know that both of these options affect the ways that people treat themselves. Looking at the Wikipedia entry on Medical Anthropology:

In general, we may consider the following five basic fields:

• the development of systems of medical knowledge and medical care
• the doctor and patient relationship
• the integration of alternative medical systems in culturally diverse environments
• the interaction of social, environmental and biological factors which influence health and illness both in the individual and the community as a whole
• the impact of biomedicine and biomedical technologies in non-Western settings

I honestly believe that understanding patient behaviors and the rationale behind them can improve healthcare. And, with my likening for research, I can see how this might be a field for me in the future. Along with the pathology field, I can see how this may get me re-involved with becoming an educator (via academia), along with participating as a clinician. The disadvantage is that this may involve additional education: a PhD may be in the works here, perhaps in Anthropology or Psychology, but those are definitely other interests down my alley.

A recent AMSA The New Physician article is what started me on this idea. These people do cool things, see great places, and get to interact with people the average clinician won't see on a daily basis. A little adventure to make things exciting, right?

---

SO...With these options: Perhaps there'll be a research component? Like I said, I love the clinician aspect, but i always wanted to do more with the job. Perhaps I'll need extra education? I love academia, so I wouldn't mind. Perhaps I need to do more research on my future? Yes. Perhaps I need to have a back-up plan in case things don't work out? Obviously. Perhaps I'll change my mind? Who knows.

My options are open... the higher my score on the boards, the more options I can keep. Well, all of us med students value options... Therefore, we value this exam. Along with my friends who have/will take(n) this exam too, this is a time we all need to put our best foot forward. Good words from the king, Elvis, put our situation well: It's now or never.

However, I prefer to look at the situation using the words that started this entry... :D

Edutainment

Above: The Wonders of Life Pavilion in Walt Disney World, Florida, August 2007.

EXPERIENCE THE JOY OF LIFE.

August 2007. I'm here at EPCOT staring at a huge golden geodesic dome. Unlike the pavilion to my left that is shaped like a mirrored box (Universe of Energy) and the granite colored space-themed pavilion to my right (Mission: Space), there's something different about this dome.

NOBODY'S WALKING INTO IT.

Nope, instead a sign saying "Wonders of Life is Currently Closed" is placed in front of the entry walkway, with bushes surrounding the sign to prevent curious people (such as myself) from entering the closed pavilion.

If you know me well enough, you'll know that one of my great hobbies is the Disney theme park EPCOT Center (now known as Epcot). However, the common misconception that's made along with that hobby is that I'm in it simply to feel like a kid. The truth actually encompasses Epcot's original vision, a center standing for world diversity and peace (through the showcase of nations in the World Showcase) and a display of progress through our scientific discoveries (Future World) to millions every year.

Wonders of Life was not one of the original pavilions of Epcot when it opened in 1982. With the sponsor Metropolitan Life (most of you know it as MetLife, the snoopy sponsored insurance company), the golden geodesic dome, featuring the words listed above, in FutureWorld West opened in 1989. The outside mounted a tall DNA spire (not shown in picture above, as it was removed by this time). To demonstrate the progress and technology of medicine that was to be approaching in the 21st century in addition to spreading good words about medicine, various instruments from interactive exhibits to a serous simulator ride were erected. In 2007, the health pavilion in epcot closed after years of sponsorship under MetLife came to an end.

At Wonders, one of the attractions that struck home with me was an experience called "Cranium Command."In my opinion, the brain is one of the most complex parts of the body. It is the control center of the human, the centers of our thoughts, the processor our senses, and even unconscious actions of the body, heartbeat, breathing, and reproductive cycles. But yet, with Disney magic with imagineers (the guys who create the experience for us in an engineering standpoint) and the actors provided (stars like Charles Grodin, Dana Carvey, Jon Lovitz, Charles Wendt, and more), the general gist of the functions of the most critical parts of the brain (right side, left side, hypothalamus, etc.) can be made sensible to even someone in 2nd grade.

The other significant exhibit of the Wonders of Life pavilion was the Frontiers exhibit, oddly placed at the rear of the building for introducing to everyone the forward-thinking that was going on with engineering & health. You'd walk up to a station with a picture and a short description of that technology, and if you wanted to learn more, you'd pick up the handset and listen for more. If you think it sounds very 80s, I definitely agree with you (Handsets... come on!).

AND it is for this I call medicine an art... One of the most important devices to being in the profession is an essence of educating the patient to understand his/her condition. In this day and age, information is one of the best ways to arm the patient to win against what might be plaguing them. And to me, through creativity, doctors can avoid that medical "scientific lingo" to teach the common person effectively, potentially help their patients strive to do better to improve their health, and make that information reach as many people as possible.

Taking the Dive

Above: Jumping at Chadiere Falls in Dominica. Fall 2008.

"COME ON...
1, 2, 3... JUMP!"

In 2008, my group of Rossies decided to go to this place called Chadiere Pool in Dominica. I've seen beautiful rock cliffs like the ones at Chadiere in films, TV, and movies, and it looks quite easy to take the jump on the screen. From my personal experience, I have to say differently.

With my (somewhat) impulsive personality, the first thing I wanted to do when I approached those falls was jump right off like on the silver screen. When I got to the top of the cliff, I felt things were different. I looked down and I started to worry about multiple bugs that might run into my plan, most of them life-threatening (i.e. not pushing off the cliff hard enough and swiping along the rock-lined sides of the pool, me crashing into the bottom of the pool because it was too shallow, etc. etc.). My friend Karyll was at my back telling me just to do it, coaching my legs to finally react to nerve impulses the way that they should.

... And yes, after a time, I did it. It was so awesome that I elected to do the jump again.

With my exams being more critical than ever, I've had to take some time off to write this entry, as I've felt like I've had to redevelop my "Mission in Medicine." I've always felt that a defined mission of what I'm going into helps to motivate me with clear goals and outlooks. Here, spinning a more positive entry against my Overcast entry several weeks ago, I need to set come clear visions for myself. It should be good motivation for the steps for the future.

To me, being in the profession doesn't mean just becoming a doctor... I want to do so much more with the job. And as non-relevant as a bunch of pencil and paper exams (or even a "240" on Step 1) seem towards one's own physical ability to becoming a doctor, its a part of that leap I need to make in order to get to achieve these goals. Think of it as a Future Doctor's Christmas List... except I'm the Santa to myself :P. However, it should be noted that this is scheduled to change. I'll probably look back and laugh at this years later, because I did take the leap.

This is a leap that I really want to make: No more holding back.

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MY FIVE POINT MISSION STATEMENT
Revised May 2009

1. Do more than just be a clinician.
I've always had the idea of doing more than I'm called to do. I like applying things that I know to new procedures, perhaps new demographics, perhaps new cases. Staying flexible, looking for open opportunities, striving for not just "acceptable" and keeping an open mind should help me achieve this goal.

2. Act humble and professionally.
Like my Overast entry had brought forward weeks ago, I've never liked the cockiness factor that people wear in such a distinguished profession. I want to treat everyone from the patient struggling to understand my dialogue on diabetes to the medical student wanting to earn that degree. I want to treat the black, the white, the asian, the American-Indian, and all races in the same manner. I want to treat all socioeconomic classes equally. Everyone is entitled to the best possible care.

3. Enjoy every moment in my job.
There's going to be stress... it's characteristic of the job, and something I'll enjoy. There'll be even drama, awkward cases, weird patients, and potentially losses of life, but the twists and turns are things I'm looking forward to doing. Keeping it positive, I say.

4. Be willing to teach others and patients the wonders of medicine.
I see that as part of my job... to extend the effects of helping to heal others, I have to be more than willing to be receptive to questions, communicate answers appropriately, and admit when I really don't know things (and look them up too). In the information age, facts and figures mean power. By simply spreading them, we're empowering others to do good for themselves and others.

5. To become a leader in the progress of medicine in many of its aspects.
I think creating progress is just one of my favorite hobbies. Like myself, I want medicine to do more, for patients, for doctors, for healthcare management, and for medical students like myself. I'm not just looking for change, I want to be out there to create it. And this in itself can branch out to another mission statement of its own...

The Terminal

Above: Passengers in the O'Hare International Airport Concourse C just coming off their flight arrival. Try to count how many places disease can spread in this picture.

IN THE PICTURE ABOVE...
A BATTLE IS TAKING PLACE

I'm about to head out on my flight to MIA for a second shot at this thing they call the COMP. Last time around, Jo brought me a Chicken Dinner right before I took it. This time, I'm sitting in the terminal, to take the exam at the Test Administration Site in Miami, potentially to grab Mickey D's from my friend Zubin who's picking me up at the Miami International Airport.

[And not to mention listening to the over the air advertisement for Chicago's 2016 Candidacy for the Olympic Games.]

However, as I'm waiting, I'm just looking out and watching people walking up and down the walkways, some buying magazines, others listening to the James Taylor sampler playing back at the music kiosk about halfway down the terminal. All of a sudden, over the loud PA system, it is echoed:

"Please take precautions by washing your hands after you cough or sneeze."

[Right now, I'm totally amazed that nobody is taking the oh-so-convenient moving walkway.]

And that's when it all makes sense how a little action can make a difference at preventing spread of a disease. First let's test you: Where do you think you'll find more bacteria? A public computer or a public toilet seat. Think about it: A recent report (sorry I forgot what news network) said that there's ACTUALLY more bugs stuck on...

...........

A public computer. Yes, when you're at your dorm or university computer lab, or even a public terminal offered to you at an international airport, there's a exposure to loads of bugs everytime someone is just typing away at their e-mails. And then (follow me here) each and every one of those people who type on the computer go out, and do exactly what I was describing before (touching the handlebars on the moving walkway, punching buttons on the music jukebox, or picking up the latest issue of Maxim) have just spread the bug to even more people. It's like a pyramid scheme, well where everyone loses, except the bug.

[Okay, now they're taking the walkway.]

Those nice little microbes that they paint a color red on the news, really pack a punch, with mechanisms to attach to the outer membranes of your body, toxins that throw off your body's own molecular mechanisms, even with "shields" that throw your body's own defense mechanisms that throw your body off course.

And that's how a battle is taking place in the terminal of O'Hare International Airport. However, do yourself a favor and give your immune system and its various troops a rest. Prevent the battle before it happens by preventing the organism from entering yours and others bodies. Wash your hands, and you can give yourself (and others) the glory of a (temporary) win.

Media Pandemic

Above: The Center for Disease Control's Youtbe Page. Reliable information about the Swine or H1N1 Influenza A Flu.

"HEAR YE, HEAR YE, HEAR YE...."

I'VE HEARD ENOUGH.

At least now they're required to call it the science-jargon-filled name, "H1N1 Influenza A." The media has been set ablaze tracking this "newfound virus" in every way that it possibly can. They're everywhere: mayor's offices, on farms in Mexico, closed schools, and even local neighborhood supermarkets. No matter what channel I turn to, the media covers the virus like a crazy culprit. I can almost say that I can imagine their news copters are chasing this virus down a Los Angeles freeway in a 1994 Ford Bronco... To cover this sickness with this type of coverage, to me, is rather annoying.

To a medical student like me, there's nothing special about this virus in terms of its own characteristics. In our lectures, we've learned that the Influenza Virus has always been a killer - especially in the immunocompromised, the young, and the elderly - but with controls due to vaccinations and sanitation improvements, Influenza has been reduced to being known as the "common flu." The H1N1 influenza name comes from the variations of two different genes that encode for proteins that are important for the virus lifecycle (hemagglutinin and neuraminidase). However, other identified virus strains that have gone around also are named by the same system; searching up the wikipedia page on Influenza demonstrates the numerous strains that we have dealt with.

I'll admit though, that getting a pandemic like this one takes a concept that's pretty mind bizzaring. There's two pieces of medical jargon I'm going to run past you: genetic drift & genetic shift. Genetic drift is what keeps researchers on the ball with creating new vaccines for current influenza strains. When the virus is replicating, the machinery that creates protein necessary for its life cycle coughs up and makes and error. However, like many things in life, shit happens, but it works out; the new proteins produced don't disrupt the life cycle of the virus. As a result, current vaccines need to be tweaked to fit this cough up. The virus is still the same strain, but a different twist (Hypothetically, H3N7 would become an H3N7 - Version 2.0)

On the other hand, genetic shift is the backbone behind the current pandemic (an epidemic in terms of worldly proportions). In livestock, which can get infected by both avian and human strains of the Influenza virus, chromosomes from both strains may get "packed" into the box that makes up a virus, creating a new strain (like our good old friend H1N1). This mode of genetic shift is what leads to pandemics of the Influenza Virus. Unlike how the media portrays the new virus like its something we've never seen before, there have been many pandemics over the last century of Influenza (some even in the last decade).

And again, at least to the eyes of a medical student, such as myself, the symptoms of the "Swine" flu are none other than your typical chills, muscle aches/pains, fevers, cold-like symptoms, that are experienced like the common flu. Avoiding catching the "Swine" flu is exactly like the common flu: staying away from crowds, washing hands before meals, and of course, avoiding people who look infected by the flu. Yet, the media seems to treat the pandemic with such attention that it gives me the idea that we all we should be wearing masks outside here in the United States in order to slow school closings. Don't get me wrong, people should be aware of the new strain, but the knowledge of it should be painted in a way that says, "If you know the precautions, you're already battling the virus." instead of "Watch out, virus coming, no matter what you do, you're sunk!"

Yes, the results from Influenza can be deadly if the body is not prepared for an invasion of the virus. However, the media should not try to portray the virus and its spread around the world as a deadly chase. In my minds, while they're going on a joyride chasing this thing, I'm the bystander, starting to freak out, hoping the outcome of this pandemic isn't going to be the worst.

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Before you go, make sure you get the down low on the correct & unbiased information about the swine flu (Don't go solely on my information yet, I'm a medical student!). For you media-freaks, I'll give you a start page: the CDC's You Tube page. It's a great place to start.