Sunday, December 11, 2016

An update and some late autumn hiking

I am neck deep in our neuroscience module now and have two exams on Friday, after which I will go directly to the airport and fly back to San Francisco. Where did this semester even go?

I have a few updates I'd like to mention in this post, some important and some not. This post, of course, is also to share some photos I took of a recent hike in Middlesex Fells Reservation, which I visited in the early autumn. Taking pictures of the outdoors and fiddling around on VSCO is one of my favorite hobbies nowadays.

I also realize that I've included a potentially graphic story of a surgery I saw, so be warned.

I lost my LL Bean flannel on this very hike, actually. It was a bit warm so I put it in my backpack and fell out somewhere along the way. When I realized it was gone, we had already gone seven labyrinthine miles through the park and I was certain I could not find it again. I usually take pretty good care of my things so I was very annoyed and disappointed at myself, but I eventually did repurchase the same shirt. I liked it quite a lot and have realized that there is no way I can survive a Boston winter short on long sleeves. That's how I justified it.

School is going pretty well. I realized that I never wrote a summary or reflection post about gross anatomy, which is probably one of the most unique aspects of medical school, and one of the oldest and most arcane parts of medicine. I have time during winter break and should really do that. I also recently went to two talks: one about the history of surgery as told through advances in anatomy, anesthesia, and antisepsis; the other about the ethical transgressions in medicine and anatomy during the Third Reich. I have more research to do in both those topics.

My actual research is going well. I have a plan, a good mentor, a pile of work to do, and an abstract to revise. The project is something very important to me, and is in orthopedics, a specialty that I have long wanted to enter. I have shadowed the residents on call a few times and like the culture, like the work they do, and like their perspective. Of course, the surgery itself is cool beyond my wildest dreams.

I wrote back in the springtime about being utterly starstruck and sick with dreams after attending an orthopedics conference. I felt similarly after observing a trauma case that went to the OR. Long story short, a man in his 30s presented with a proximal and open distal femur fracture, a proximal tibia fracture, and lateral compartment syndrome. I'll spare the details for another post, but I was completely absorbed into the scene, the jagged ends of the femur sticking out of his bloody thigh, bits of plastic and glass removed, the red and yawning gash in his calf from the fasciotomy, the methodical placement of all the rods and pins and spacers to externally fix the limb...if this is bread and butter orthopedic surgery, I am all in. I've retold the story a dozen times and still go over the details. It was some parts carpentry, some parts butchery, all surgery. I want to see more.

For next semester's clinical skills class, I was placed with a general surgeon at our hospital. General surgery is second on my list for specialties and I am very excited to meet my preceptor.

Last week, some friends and I won a prize in our school's gingerbread house contest. A few hours later, some of more of us began our first Dungeons & Dragons campaign of medical school. We spent the week reading the player's handbook, building our characters, and telling each other how excited we were. Having a regular board game group has been great fun, but D&D will be even better.

Lastly, good luck on exams if you are taking them, and have safe travels if you are going somewhere.

Saturday, December 3, 2016

Three documentaries, two books, Fantastic Beasts and Where to Find Them

Now for a break from your regular Lord of Three Realms programming...a smattering of reviews of some recent brain food.

Three Documentaries

Staying Woke 101: watch a documentary and find discourse

Before the Flood - highly recommend

Leonardo DiCaprio's documentary about climate change is a sincere and ethos-laden warning siren about climate change. While Before the Flood does not cover much new ground, it brings the discussion of climate change once again to the mainstream, complete with interviews with heads of state, diplomats, scientists, and laypeople who recognize the dire consequences of the anthropocene. Indeed, it updates the narrative and turns the lens towards many aspects of the global ecological crisis, not just rising temperatures and sea levels, melting ice caps, or the ozone hole. This is a somber and comprehensive documentary with footage from Leo's UN appearance and the Paris Conference. Leo begins with a comparison to Hieronymous Bosch's The Garden of Earthly Delights and delivers through it a bleak message: capitalism and overconsumption will lay waste to the planet, and we must mobilize as a society to confront these systemic evils.

The True Cost - recommend

This one's been out for awhile and I feel that a lot of folks have heard of it. Fast fashion is one arm of global capitalism that has had tremendous ecological, economic, and mortal consequences. The Rana Plaza collapse, King Cotton abroad, pollution and emissions, and the ethical murkiness of sweat shop labor are all covered. I don't have much psychology or sociology book learning so some of the consumer behavior stuff was new to me, but I suppose this film will prompt many people to seriously consider their own consumption and relationship with objects. The documentary got the message out, but at times it does seem naively optimistic. I preferred Before the Flood much more.

Escape Fire - recommend

We watched this documentary for our public health class and it essentially lays out the status of health care in the United States today, and how unsustainable and costly it is. A few key points are how lack of primary care, exploitative private insurers and pharmaceutical executives, and the fee for service model is contributing to high-cost, poor-outcome care. I liked this film, though the narratives were fairly scattered and generally glossed over many structural flaws in American society that directly influence health care, but are not immediately obvious. I highly recommend this documentary as an introduction to medicine in the USA, with the caveat that there is much, much more to read and see.

Two books

All Souls - recommend; highly recommend for Bostonians and those interested in urban health, poverty and crime, and community activism

Before medical school, my knowledge of Southie predominantly came from Good Will Hunting, The Depahted, that one Anthony Bourdain episode, and Black Mass; I knew of Whitey and Billy Bulger, the desegregation riots, the Irish Mafia, etc. All Souls is one man's personal tragedy, and the community's long tragedy, that resulted from poverty and crime Bulger's drug trade. It is a story of the people of South Boston and their identity, and how it loved and feared, protected and was harmed by organized crime. All Souls is deeply moving memoir of growing up poor in South Boston, tragic and difficult to read, but an important perspective. One of the first patients I interviewed was an old lady who lived her entire life in Southie who, thinking back now, had been referencing some of the messages All Souls was trying to convey. South Boston has changed now, but All Souls was still an important read, especially for a newcomer who must learn a thing or two about Boston.

Also, our hospital features a few times in this book; if violent crime happens in Boston, chances are it will come through this trauma bay.

Hot Lights, Cold Steel - highly recommend

This is probably one of my favorite memoirs of all time. Dr. Collins write with great humor and thoughtfulness about his four years as an orthopedic surgery resident at the Mayo Clinic. From an impostor syndrome-afflicted intern to an admirable chief resident, Dr. Collins shows the highs and lows of surgery, the work ethic and discipline demanded of a resident at the Mayo at a time before the 80-hr/week cap. The graphic descriptions of surgeries are intense, gory, and left this wannabe future orthopod starry-eyed. Some cases are tremendously sad, and generally, I felt exhausted and overwhelmed reading about his life...orthopedic surgery resident, rural ER moonlighter, and father to one, then two, three, four, and more children during residency. I read this book in two sittings and didn't want it to end.

Fantastic Beasts and Where to Find Them - recommend, but watch Moana or Arrival in theaters instead

This movie was a pretty indulgent visual feast with a perplexing lack of direction. I loved this movie, am confused by the direction of the Harry Potter franchise, and will probably throw money at the wizarding world for the sake of nostalgia. Eddie Redmayne plays a charmingly eccentric Newt Scamander, who I hope will star in the next movies instead of Johnny Depp. It was a fun romp through the wizarding world and roaring 20s New York, but had a loose plot with flat characters and poor sense of mood. However, I liked it quite a bit and will probably not watch the next one in theaters.