Saturday, February 18, 2017

Scenes from a blizzard in Boston

Weather report: we've had a mild winter. Most days from December until now have hovered in the high 20s-low 40s F range, with several days of rain, sleet, and snow. Last week, we had a blizzard that really showed me what New England is capable of -- the snow from that Thursday is still hanging around.

I guess the point of this post is to share some pictures I took from a foolhardy trek from school to the Charles River during this very blizzard, but also to share a few thoughts that have stuck with me recently. Read on for thoughts on winter gear and medicine so far.


All season, I've been waiting for the perfect time to photograph our charming campus under snowfall, but this was not what I expected. This particular day was not terribly cold, but windy, which can be worse. The only way to navigate this kind of weather successfully is with ski goggles, wool socks, base layers, and snow boots.

We walked about two miles in total to the river and back, buffeted by wind and taking pictures along the way. The pain of revascularizing frost-nipped fingers is no joke! We helped push a car that got stuck, which was pretty fun.

Oh, yes. The Sunday before was Super Bowl Sunday, and later that week (and before the blizzard), Tom Brady took to social media to proclaim a day of rest in Boston. Well, Mayor Marty Walsh declared a snow emergency when it became clear that this nor'easter was going to be a rough one, all the public schools closed, and finally on the morning of, our classes were cancelled as well.

I shadowed orthopedics call on the Saturday after the blizzard and got some startling facts: on the very icy blizzard-eve (Wednesday), there were 70 ortho consults from the emergency department for ice-related injuries. While I was there, we saw five patients with fractures (four related to ice, one related to ice hockey).

School and research

After a disastrous exam in January, things are looking up. I did very well on my last set of exams, but my academic counselor warned me not to be complacent, but also not to take on too many other things. Those other things are research things, and after a stumble regarding authorship order on an abstract I wrote, I think things are looking up. I will be continuing my project through this summer, working on a manuscript and another conference abstract, and starting two other projects with the same attending surgeon. Research and research acquisition are still mysteries to me, and I fully recognize that I got what I have by emailing the right person at the right time, and by leveling up in "networking" and playing a game whose rules I'm just learning. And, of course, the importance of a paper trail.

I'm pretty lucky to have a mentor who has my back and introduces me favorably to faculty. My next steps are to get funding for the summer, work on the manuscript, and crunch more numbers.

A good surgeon

We have begun our second semester of our clinical medicine class, which now places us under individual mentorship of a doctor affiliated with the school. My preceptor is exactly the kind of surgeon I hope to become, and though I have been practicing my physical exam skills at his clinic, the true value of my time there is in watching him and learning how he interacts with patients.

His patients trust and like him, for one. For those who have been his patients for a long time, he remembers their kids' names and asks how the spouses are doing. When a patient is self-deprecating or despairing, he knows what to say to make them smile. He was able to recognize far before I could that a new patient with many tics and anxieties and worries was not a "difficult" patient, but one with a long history of physical abuse that he needed to (and successfully) gained the trust of. He knew what to say to a family whose patriarch was going to die. He only speaks English, but knows just enough phrases in Spanish or French to make patients laugh. He sketches out surgeries and knows what questions patients have but won't outright ask.

To be fair, I think a lot of his demeanor has to do with the fact that he is older, white, tall, wears a sharp suit to clinic, and looks like a politician. But I've learned a lot so far and know that he is exactly the kind of doctor I want to be.

And, of course, he makes me want to be a surgeon.

Strong women

Earlier this week, we had a dinner panel talk with several female doctors, mostly surgeons. It's too much to describe, but the energy was great, the speakers were all engaging and hilarious, and I felt very empowered. The night eventually became a call to arms for women supporting women in surgery, fighting the patriarchy, and becoming good doctors.

Anyhow, this is something one of the speakers, our favorite trauma surgeon said:
Keep fighting the fight. Fight it in yourself. Fight it in others. Fight it any place you can. Fight it in every place you can.
 Will do.

Dr. Samuel Shem

Consider me starstruck -- Samuel Shem came to speak at surgical grand rounds! The lecture was open to medical students as well and I got there early to make sure I got a seat.

Samuel Shem is the pen name of Dr. Stephen Bergman, the author of The House of God, which has provoked discussion and reflection within medicine for almost thirty years. Though considered satire, The House of God revealed the mistreatment and hardship that medical residents saw in training, and is practically required reading for medical students and interns.

It's rare that I get to hear the author's opinions on their own work. But really, this talk was about a great many things, with an overarching theme of retaining humanity in medicine. A few pearls from the talk:
  • The House of God is about:
    • the fight against injustice
    • the danger of isolation
    • the healing power of good connections
  • medicine is a hierarchy and the group in power is not doctors, but insurance executives and corporations
    • medical students are at the bottom of this hierarchy, but have strength in numbers
  • the only threat to the group in power in a hierarchy is the quality of connections of the subordinate group
  • the only sustainable model of health care delivery in a large, industrialized country is a national health care plan; a private market can only work if it is highly, highly regulated
  • relate to patients as people
  • the best thing about the Trump presidency is the incredible grassroots resistance against it
This was an exceedingly long post, but I had a lot on my mind

My friends demonstrating the depth of snow. It looks like they're holding hands, but I assure you they aren't

Tuesday, February 7, 2017

Assorted thoughts on diary writing

Volumes I to XIII, autumn 2007 to present

I write a daily diary. This is the first in a three-part series about diary writing.

After reading the Diary of Anne Frank at an early age, I thought it would be important to chronicle my life. In fifth grade, our teacher required each of us to keep a writer's notebook, and I distinctly remember one little proto-diary with a blue and brown cover. In it lives my larval political outrage at Bush v. Kerry 2004, a detailed account of a roadtrip to Yellowstone National Park and the wildlife I saw, and my goals for my Pokemon Sapphire progress.

Sometime around that, I received the volume with the blue cats on the cover for a birthday and abandoned my old notebook for it. I abandoned that one, too, when daily writing became a bore. I rediscovered the cat diary sometime in college, where it fell in line as Vol. VIII of my archived life. The first fifteen pages contain the imaginations and ramblings of a ten year-old who hated school, and the rest contains the long-winded agonies of a nineteen year-old studying for the MCAT. The last page contains my score.

I began writing in earnest in August 2007, and then daily in August 2008 at the start of high school. Every day has an entry, whether it was written before midnight, after midnight, the morning after, or in pieces over the subsequent week.

Materials and Methods

I am very fond of beautiful notebooks. Many of the more recent volumes have come from Paperblanks, which have beautiful covers, luxurious paper, and a shocking sticker price. However, it is important to me that these volumes last long, lay flat, and are a delight to write in. Hence, I can justify throwing money at expensive stationery, and am seriously considering buying a fountain pen for the next volume. I currently use any number of pens around my desk to write, but reserve my favorite pens for diary writing.

I write mostly about what happened to me on any given day, anything at all. I don't follow prompts and I don't describe this process as 'journalling,' which is becoming more popular nowadays. I have poured out my heart before, but have also written in exhaustive detail everything I could remember from surgeries that I have shadowed, complete with sketches. During gross anatomy, my entries read more like a dissection manual than anything else; when I was in Germany, it was an itinerary with as much sensory details I could fit in. Memorable patients, memorable places, etc. It varies. I could be more reflective, emotional, and introspective, but those entries are not common.

Rules and Rituals

Over the years, some rules and rituals have emerged. Exceptions are noted if ever applicable.
  • write in pen only
  • begin each entry with the date
  • end each entry with a signature
  • write at night immediately before going to bed, but fill in details the morning after in case I missed something (rarely) -- only under very specific circumstances will I revisit an entry after a day
  • if I am currently writing Vol. n, I am not allowed to read from Vol. n - 1 until I finish Vol. n
  • at the end of Vol. n, I write a postcard to myself to read when I begin writing Vol. n + 7. This began with the end of Vol. VIII
  • include ephemera (ticket stubs, stickers, etc) if they are important or beautiful
  • write legibly, but try not to waste space
  • note the Vol. number on the front page
  • copy a meaningful poem or quote on the back page
  • be HIPAA compliant
  • one entry each day, every day, ad infinitum
Next time: what I have learned from writing a diary, why you may want to consider it yourself, and how it has affected me