Reflections on the first 1/8 of Medical School

Hi there, it's been awhile since I checked in but better late than never! Life has been good in Madison. One semester down I feel I made the right decision. This is due to many factors but key ones are:

1) Finding several caring mentors amongst the faculty and a plethora of inspiring and kind peers.
2) A schedule that while quite busy has allowed sufficient time for me to keep up to some degree several activities that I most enjoy (exercise, cooking, and a little reading and journaling)
3) The opportunity to get away from the books and actually help people! Highlights include working at several student run clinics for the uninsured and helping provide vaccinations at a mass H1N1 clinic.

Bonus items: Harvesting apples from the copious apple trees in my neighborhood, great biking and skiing, and being able to use my truck for more freezer space because it is so cold!

For the Holidays we had two weeks off and I spent all of it back in WA with family and friends. My brothers and I had a blast climbing trees, making and throwing spears, trail running, damming a small stream with sticks and leaves, and shooting lego launchers. The highlight was a trip to the WA coast where we constructed a huge log fort to "resist" the ocean! See pics below:




(Our builder team minus me. Yes, with only 5 people we lifted all those logs into position:)




(The three brothers and the sea.)


Now I am back in Madison. We just started up the second semester and from what I've seen so far it looks to be another action-packed round of learning. The big news this time around is we started anatomy and today I was introduced to my team's cadaver. Let's just say it's probably best you're not sitting next to me right now as the smell just wouldn't come off in the shower... Just kidding, the odor isn't that bad as they use different chemicals than in the past and the room is very well ventilated.

Wishing you all the best in 2010,

Michael

Milwaukee Vaccine Clinic + more

After finishing up round two of exams last week I was facing a weekend free of studying and no plans - awesome! But what to do?

As fortune would have it I had received an email calling for volunteers to help with a mass vaccine clinic in Milwaukee that was to be held on Saturday. That sounded like just the kind of thing I was looking for! A great mix of service and learning. I recruited several like-minded classmates and we drove the 1.5 hours to Webster Middle School in Milwaukee yesterday morning to help vaccinate people against H1N1.




(Our team at lunch, L-R Anst, Anna, myself, and Tramanh)


Now, I must confess that I had never actually vaccinated anyone before arriving to supposedly do just that. I had done a little blood drawing in Ecuador but that was a quite a while ago and didn't involve screaming needle-mortified young children. So, you could say I was a bit nervous. Then, the very first patient that came to the vaccinator (a local EMT) who had agreed to teach me turned out to be a screaming needle-mortified young boy. Kinda reminded me of myself actually (I had a deathly fear of needles stage during childhood for those who don't know). His cries of terror reverberated across the school gym and it took two grown women to hold him semi-still. The EMT somehow succeeded on his still moving target and I found myself hoping I would get more tranquil patients to start with...

And then it was my turn. Luckily my first patient was a calm adult and there were no problems but my third patient was a terrified young girl who although she didn't really physically flail about, she did cry and scream a fair bit. However, I got her vaccinated without messing up or hurting her and from that point on my confidence started to grow.

An hour later a father and his two adolescent kids approached my station. The father seemed quite nervous. "So, is this going to hurt a lot? You're a pro right, you know what you're doing?" I responded with a, "I've been at this for a bit, don't you worry; the last lady said she didn't even feel it." Luckily he didn't ask me to clarify what a "little bit" meant and all went smoothly:) The rest of our time helping was a blur of constant and exciting work. I met one older gentleman who was a fighter jet pilot in WWII and even flew escort missions for B-24 bombers (the plane my grandfather was a radio operator in during the war!) Small world moment for sure.




(Our team including Dr. Cindy Haq, an amazing person and doctor who supervised us for the day with me holding up an example of the signs we used to bring the next person in line to our station.)


After a late lunch Dr. Haq noted that the crowds had wound down and suggested we go explore the lake-shore of Milwaukee as things were well under control. We took her up on the offer and headed for downtown.

During our wanderings we came across a new science center/museum/aquarium that was having a free admissions day. We had fun pretending to be kids again with my favorite highlight being the sturgeon touch tank!

After arriving back in Madison Anst, Tramanh and I all spent the evening cooking, eating, talking - it was great! Anst made a Haitian inspired fish dish while I cooked up a bunch of veggies in a soysauce/brown sugar/cornstarch/ginger sauce which we had over rice. I also made an apple crisp from the huge store of apples I still have from harvesting a few weeks pack. Tramanh was blown away that young males such as ourselves could cook things that tasted so good! (Thanks mom for the instruction:)




(The cooks)




(The food)




(Enjoying the meal!)

Today was spent on chores/errands as well as a couple of hours with my young mentee Steven. For those of you that don't remember (or never knew) I am part of a youth mentorship program through the med school and this was the first time Steven and I hung out just the two of us. We cooked up chocolate milk french toast with strawberries (and of course ate copious amounts of it) and then went mountain biking. I think (and hope) he had a good time and noted he seemed much more talkative on the drive back versus when we came to my house. I look forward to more adventures with him in the future.

So that about wraps it up. I hope you are well - keep me posted on what's up in your lives if you can!

MedWAR

Two weekends back I had the opportunity to participate in what I can only describe as an amazing event. Before I go any further I must put out the disclaimer that i do not have time to edit this much and thus I am sure errors will abound. please forgive me:)

anyhow, medwar. the short version is i participated in an all day adventure race with medical scenarios. and it rocked. for the longer version, read on.

after a 6+ hour car ride to central michigan and a night spent at sub-freezing temperatures in a tent (i know see why my tent is called a three season tent because i found the 4th season) we got up and assembled at the start line. being the midwest medwar there were over 30 teams of three from all over ohio, wisconsin, michigan, and more.

at the go command we all raced helter-skelter to the lake shore where the teams jumped in canoes and headed out onto the lake in the cold early morning light. or tried to. one team, close by our boat, capsized and almost took us out as well! we were then rammed by another boat which almost tipped both teams. clearly there were few skilled canoeists in the competition. the starting canoe portion took us over 2 miles through a series of lakes connected by small passages until we arrived in "asia." i say asia as the theme of this year's competition was "around the world."

we were handed a slip of paper explaining we had just arrived after a tsunami had hit and needed to help as many people as we could. before us were three dummies and an event coordinator who narrated to us/answered our questions as if he was a victim. we had to initiate CPR on a baby (plastic life size doll), splint the arm of an inflatable dummy and insert a tube (we used part of a pen we disassembled) in the throat of a third dummy to restore breathing after massize facial trauma. when we cut through into the "throat" (plastic tubing under fake skin) red goo went everywhere - they had inserted ketchup packets in the dummy! for failing to assess the scene for safety we were penalized by having to clean the babies diaper which had been fouled with chocolate goo.

From there we were told to navigate any way we saw fit to the next point on our map. heading off at a medium jog we started passing several teams who had gotten ahead of us by whipping through the medical scenario. Arriving at the top of a hill (mt. everest) one of our teammates was whisked (alex) and myself and Luke were handed a scenario detailing that he had become disorientated, wandered off, and fallen. assessing alex's condition we found a fractured femur and possible spinal cord injury. we had to immobilize his neck, splint his leg, and then construct a stretcher to carry him down a very steep hill covered in low trees and brush. this proved to be the most physically demanding of all the scenarios. we splinted his leg with the canoe paddle we were required to carry, immobilized his neck with card board and duct tape, put him on a tarp we had, and started to haul him down the hill. this sort of worked but the trees were so low and the slope so steep we went very slowly. if alex really had the injuries we was pretending i imagine we would have severely aggravated his condition. we eventually made it to the checkpoint and received no penalties - nice!

We ran on until the next point in which i had become "too cold to continue." my teammates had to warm me up and build a fire of adequate size. to pass each team had to burn through a pencil. alex had read about rubbing cotton balls with vaseline and those babies worked like a charm - we were through that pencil in no time!

at the point luke and i became "snow blind" and had to put on goggles with that essentially left us with no vision. alex led us through a mile of trail in this condition and with his careful guidance we had no falls.

after the blindness we arrived in south america and luke was instructed to split from us to go get water. i handed him my filter and we split ways. alex and i had been instructed to find the park headquarters to rest before luke would rejoin us but we could not find him. we headed to the other side of the parking lot and found a bunch of competitors with paper bags over their heads and a lady patrolling them with an airsoft gun - colombian hostage situation! i tried talking to her in spanish but i guess the scenario wasnt that realistic. we had to identify luke, and then escape with him without getting shot by the guard. running from the scene we came across several dummies. it turned out our interpreter had been injured in the flight and we had to take care of him. looking to dummy over we found a gun shot wound over his right lung and discovered it had caused his lung to collapse in. for this we had to create a one way valve for which we used the pen tube, tape and a piece of a latex glove. when i tested the device later at my house it really worked! you could blog through it but not suck much air back in. after rescuing Javier we had to describe how we would coordinate a helicopter extraction and alex's lucky guess of a 100 ft by 100 ft landing zone let us escape without a penalty.

after rocking through south america it was on to its northern counterpart. yes, things were going well. and then we got lost. badly. we thought we knew where we were on the map but this turned out to be incorrect and led us to run 2 miles down a county road outside the park. by the time we got back on track any hope of victory was pretty much gone but we were having fun so this wasnt too big a deal.

the north america challenge was three-fold: removing a giant fish hook from a chicken thigh (dead chicken) - we pushed it out through the flesh and then clipped the end with pliers that alex had somehow thought to bring, filtering water and then drinking it to prove it, and finally a gear check to make sure we had a change of clothes and water proof layers, a compass (should have been using it more:) etc.

We took off though the trails on the way to Europe and promptly got lost again. I blame it on our speed. we were running fast enough that we could get way off track before we thought "hey, maybe we shouldn't have been going south quite this long..." in the end we arrived at the first europe scenario from the opposite direction have run an extra 3 miles or so on a completely different trail. at least we were getting great exercise! the slow teams we had passed earlier all gave us funny looks as we passed them for the second time.

arriving in europe we were "exploring nazi caves on the coast of france" when alex screamed. we rushed to over to find him, according to the scenario, lying next to a broken bottle, pupils dilated, vomit and feces evident, and shallow breathing. we had to figure out what he had been exposed to and administer the proper medication. luke and i looked at each other. 6 weeks in and we certainly hadnt gotten to any like this yet. we both recognized signs that his parasympathetic "rest and digest" nervous system was out of wack and one of the meds from the pile (of which most i had never heard of) i knew had something to do with stimulating the heart (atropine). as we debated, the volunteer delivering the scenario got on us saying, "you gotta commit, he's gonna die, make a decision!" "ok, ok, um... we'll go with atropine" i replied

"you're right, he lives"

nice! turns out the substance was sarin nerve gas which is an irreversible cholinesterase inhibitor aka nasty.

At that point we had to get to the next point on the map without using any roads. this didnt turn out too bad as we found a good trail and didnt make any wrong turns. popping out from the forest we came upon... africa! the first challenge was a safari "hunting" expedition. each team member had to hit three separate targets using paintballs and a slingshot - super fun! from there we ran up the road a bit to find huge rubbery fake halloween feet that had a small hole with a cooked noodle sticking out. this was to simulate Guinea worm and we had to extract the noodle, er worm, without breaking it. in real life this process can take over a month!

another free for all navigation section led us back to the lake where we had to construct a shelter and have it tested by a guy with a squirtgun. at this point we could have canoed back or there was the optional orientering challenge. a number of questions had been scattered throughout the park and for each question found and answered correctly time would be subtracted from your total team time. losing so much time being lost we didnt have much of a chance on this portion but did manage to get 2/10 question zones.

from there it was back to base as fast as we could paddle. the pizza, chili and cidar feast that awaited us was heavenly after a hard 7+ hours on the move fueled by bagels and energy bars.

reflecting back on the event not only did i have a blast but i learned a fair amount too. we didnt finish very high (middle of the pack) but in the end none of us cared too much. i definitely plan to return next year.

White Coat

Yesterday was our white coat ceremony in which we donned the traditional garb of our profession and recited the oath our class had created.




(Me with my friends L-R Phat and Steve before the white coat ceremony. Phat is from Vietnam and has become a study partner of mine; we've been meeting up to quiz each other and find areas we are weak in/explain them to the other person. We're planning to hang out and cook some time soon as I want to learn how to cook Vietnamese and Phat wants to learn something that is not Vietnamese!)




(The three neighbors, L-R Emily, myself, and Anst with our white coats and lake Mendota in the background. Neither Anst nor I had family that was able to make it so Emily's family took us on as surrogate children and even gave us a ride to the ceremony.)


I went in to the ceremony not too excited but ended up having a pretty good time. The two highlights were meeting several classmates' families and listening to Dr. Cynthia Haq, the main speaker for the event and also a UW professor of family medicine and head of the global health center. She talked of the excitement and challenges ahead as well as reminding us to take care of ourselves in the years to come so that we may continue to be of use to those we serve. Right on! As for the white coat, well, to be honest I hope to not wear it as much as possible. I tend to overheat with extra layers and in addition feel in some cases the coat can be a barrier between doctor and patient. We shall see; I know they want us in them when we are in the hospital but my preceptor physician told me right off the bat not to bring one and no tie either - fine with me!

Speaking of which, I've visited the family doctor I was assigned to twice twice now and just this last time (Friday) I was with the doctor for a kid's exploding abscess, frying off warts with liquid nitrogen, , general well exam, several substance abuse/depression cases (which are so tough - you can just see the potential in the person if only they could remove the yolk of their addiction), I felt a possible testicular cancer and, the highlight, I interviewed my first patient!

The patient was a young spanish speaking woman with a sore throat and got to ask her the questions we have been learning in our interview class: "where does it hurt, how long, fever?, tried any medications or home remedies?, etc." Then I reported bac to the doc before we both went in and he finished up the interview. Watching him I realized I missed some key questions but overall most of them! It may have been a pretty minor event/illness but for me it was pretty exciting - my first real patient interview - and it was in Spanish!

In other news we finished up our first round of exams last week and so far the 2/4 grades I have seen came out well. It's nice to know I haven't forgotten how to study after 2 years out! It's also getting colder - fast. My first month was a paradise like 70-80 degrees, sunny all but one day with low humidity. Then about two weeks ago it dropped an average of 30-40 degrees!

One final highlight. Right before exams I needed a study break and decided to head out for a short run. I was chugging along when all of a sudden I noticed apples at my feet! A quick scan of the tree above showed it loaded down but the tree was a big one (closest apples were a good 20 ft up) and it was smack in the middle of someone's yard. I decided to knock on the door and see if the owners were OK with my going for the apples. The man who answered seemed a bit perplexed - "they're pretty high up but go for it if you want." I returned home, grabbed my football and bag, ran back to the tree and began to chuck the football up into the branches. It worked great! The best times were when I would knock an apple down and then catch it and the football! After I was at this for a good half hour the wife came out, she had been watching me for some time, and commented she'd never seen anything quite like it but it sure looked like I was enjoying myself! I collected a good 30 of the most amazing tasting apples and proceeded to make a huge apple crisp which I just finished up yesterday. Awesome!

I hope you're all well.

Next - The Start

Hi all.

I debated once again, just as I did when I traveled to Ecuador, how best to stay in touch with those I care about. And once again I have come to the same conclusion. A blog will let me stay in touch with more of you, more easily, than any other way. I can't promise that I will post as often as my previous blog or that the same level of proofreading will be upheld but I do hope this helps us stay in better touch. So feel free to comment or send me an email! I promise to respond to any and all emails sent my way.

For those of you who I haven't communicated with in some time I have just started medical school at the University of Wisconsin School of Medicine and Public Health. The addition of the Public Health portion of the name reflects a push by the school to educate it's students to be able to care not just for individual patients but communities as well. It was one of the reason I came here and so far they have seemed very serious about this part of their mission.

But I am getting a bit ahead of myself.

How did I get to WI in the first place? By car, or rather my little truck. My brother Patrick accompanied me on the journey and many an adventure was had. Hiking Glacier National Park, running around in the Badlands of South Dakota, taking breaks to jump in random rivers, and sleeping in our tent at rest stops all come to mind. Some pictures from our travels follow.




(A view of Glacier National Park)




(Gunsight Lake)




(Patrick and I on a Glacier)




(Patrick and I inside a Glacier - we went down a small ways into a crevasse)




(Patrick looking out over the way we had come in Badlands National Park)




(Sunset over the Badlands)


Upon arrival in Madison we were welcomed by our Aunt Linda and her family. The company, food, and rest were just what we needed. I am very lucky to have a family away from home here in Madison. In addition to welcoming us my Aunt and family had helped me located a place to live. It is amazing how difficult it can be to find a decent but affordable place when you can't go look at them in person! So my aunt was a saviour.

My apartment is located just a little over a mile from the medical center/school and in-between two parks (Madison is full of parks) one for running and one for mountain biking - awesome! The place was more or less fully furnished but on "move in day" we were able to acquire a number of additional items: a desk, two dressers, two desk extensions, and a coffee table - all for free! This was possible because all the undergrads have to move out August 13th, August 14th places are cleaned, and the 15th they can move in. As such people don't have a place to put their stuff and it gets set on the side of the road for the taking. What isn't taken in by someone gets tossed the next week.




(My room view one)




(My room view two - where I sit writing this!)


After a week of exploring the city and moving in (which by the way is bike crazy! more people on bikes, bike trails, bike shops, radio bike product ads and more than you'd believe!) it was time to start medical school.

Orientation started off in a unique manner. Instead of hearing from the dean or some other important figure we were all ushered into one of the main halls. After we were settled (all 168 incoming students) a number of individuals came down the aisles, one at a time. They stepped forward to a microphone and proceeded to describe the illness from which they suffer without naming it, including symptoms, cost to society, and other impacts, closing with "my name is ______, I have ________ (diabetes for example), today you will hear my story." After over a dozen patients related their illnesses we broke into small groups and were able to converse and ask questions of two individuals. I found it an inspiring and thoughtful way to begin medical school. The day closed just as memorably as all students, in groups of four, were invited to dinner with a faculty member or community physician. Our group was paired with Dapesh, a radiation oncologist, who took us to his home, introduced us to his wife and two young children, and then grilled up some amazing burgers and brats! Orientation lasted 4 days and then it was time to get down to business



(One of our main lecture halls where I spend a good amount of time.)


I forgot to mention that I have a roommate! Anst-Bidry Gelin is a fellow first year medical student. He called me from Haiti (where he is from) with 12 hours of my posting an ad for a roommate on the medical student website and it has turned out to be a great fit. He is into biking, triathlons, all kinds of sports and cooks a lot too. Anst moved to the states for high school (his dad has been here some time working as a physical therapist) and completed both HS and college in New York. His mother is still in Haiti and he was spending time with her when he originally called me. I hope to learn some creole but it isn't much like Spanish so we shall see. In all my free time:)


(My roommate, Anst, at our kitchen table)


Over labor day weekend Anst and I accompied several second years on a one night backpacking trip in the Kettle Moraine state forest. There certainly weren't any mountains but the terrain was new to me and beautiful. The entire area had been shaped by glaciers and consisted of kettles (deep bowl-shaped craters often with water/marsh land in the bottom) and moraines (high hills of rock and left over glacial debris).



(In the woods of Wisconsin. Kettle and moraine)

You may think I've just been biking around, hiking, and collecting free furniture but this is not actually true. Our classes consist of medical genetics, cell physiology, biomolecular chemistry, population health (epidemiology), and PDS or Patient Doctor and society. This last class is an interesting one indeed and teaches us how to take a history, basic exam skills, discusses the ethical aspects of medicine and is honestly the one class above all I will probably remember the most from in 5 years time. So they've kept us busy.

If that weren't enough I have been getting involved in a number of extracurricular pursuits. They haven't formally started yet but volunteering in a free medical clinic, becoming a mentor for an at-risk 7th grader, and going to Michigan for a wilderness medicine/outdoor adventure race are all on the agenda in the months to come.

Oh! As part of PDS we get paired with a primary care doctor somewhere near Madison and my placement is with a family physician based in Access Community Health Center. I have gone to meet my preceptor (who seems like a great person and teacher) and found out the clinic I will be at is much like the clinic I just left in Seattle - underserved populations with a majority Spanish speaking only. I am excited to start and will do so this coming Thursday.

That's all for now but I'd love to hear from anyone and hope you are all well.