My · Invincible · Summer

Say I want to close this livejournal account, b/c I'm just not that into it anymore. Nothing exciting is going on in my life. I just study all day. On occasion, something will come up, like tomorrow I'm learning how to do the female's pelvic exam and the male's genitorectal exam. What a crappy Friday afternoon.

But I digress. Say I want to keep all the stuff I wrote about China and England, but close this account. What would be the most efficient way of doing that?

I am still waiting to hear back from the CDC about me doing Tuberculosis Outbreak and Surveillance work this summer. I know they've got everything. It's been two weeks now. My contact there said just wait and let the bureaucracy take its course. And I certainly need to make some money. I also need to start looking for a place to live in Atlanta fairly soon.

I haven't heard anything with the Carter Center that would allow me to work with trachoma in Africa. That could be largely due to the fact that my school in London didn't send off the transcript by the time they said they would. Everything had to be postmarked by March 1st, which they assured me could be done. When did it get sent off? March 6th. Slightly diappointed.

A few weeks ago, we had an assignment to go do a nearly complete history and physical on a real patient at the Veteran's Administration. Before this, we haven't done a complete exam, and we've only done them on actors pretending to be patients. They've all been healthy. So today, after we got finished listening to the Neurology Grand Rounds, I was supposed to go with a friend to the VA and find a patient.

Well, the friend didn't come today. I jumped on board with two other guys I know, instead. We head over to the VA, and we finally figure out where the list of patients are. It took a while. Then we go through the list of patients, write them all down, and then start knocking on doors. We started off with wing 6D. Right. Everyone is either asleep or saying no. No big deal, there's still three more floors of patients left. Two more floors: asleep or not in the mood. We have one more floor left, and all three of us are starting to get nervous. This thing is due next Wednesday, and we have a test on Monday. That leaves us today or Tuesday to do it.

Finally, on floor 4E, we find our awesome, friendly, weak but funny patient. He was super-personable, understanding, and willing to bear with us. I can't tell you much about him because of HIPAA, but let's just say that I'm going to write him a thank-you note.

And on to "My Interests and Values"...

We did an exercise in class the other day to help us evaluate what kind of doctor we want to be when we grow up. We had these things called "Values Cards." They had all sorts of things listed on them, such as "harmonious relationships" or "having lots of independence" or "being well-respected." Our task was to sort through them, one by one, putting stuff in three piles of increasing importance. Then the most important pile required another sifting, where we isolated the top 10 values. Then we had to put them in order. So, here were my values.

1) working internationally
2) doing something meaningful
3) feeling my work really counts
4) having advenutre and excitement
5) having cultural opportunities
6) doing what I enjoy
7) being respected
8) having an active lifestyle
9) working for important causes
10) taking risks

Then, we had to take a Self-Direct Search, which is an interest inventory designed for career planning. It gives a Holland Code which tells you what your interest pattern is and what careers apply to that.

My Holland Code was Investigative, Social, and then a tie between Artistic and Enterprising. Careers that matched my Holland Code, as provided by Wikipedia.

Investigative:
* Computer science
* Economist
* Engineer
* Mathematics
* Pharmacy
* Physician/Medical school
* Professor (all fields)
* Psychologist
* Psychiatrist
* Science
* Surgeon

Social: Cooperative environments, supporting, helping, healing/nurturing:

* Art therapy
* Counselor
* Dance therapy
* Education
* Instructional technology
* Martial arts
* Music therapy
* Nurse
* Physician
* Professor
* Psychologist
* Psychiatrist
* Social Work
* Teacher
* Theology
* Trainer (Industry)

Artistic:
Non-conforming, original, independent, chaotic, creative:

* Actor/Performance
* Art therapy
* Artist
* Author/ Poet
* Dance therapy
* Music therapy
* Musician
* Painter

Enterprising:
Competitive environments, leading, persuading, selling, dominating, promoting, status:

* Administration
* Academic administration
* Communications
* Journalism
* Law / Politics
* Management
* Management Consultant
* Public Health
* Publishing
* Public relations
* Public policy


So yeah, I think it pegged me. I probably would have scored higher on the artistic thing if they didn't ask so many questions about music or art capabilities. If they asked more about film or writing or music/art appreciation, I'd have scored higher. Perhaps they have their reasons.

Any time that I'm at a function that requires small talk, such as the keg party I attended on Friday night, I'm constantly asked what kind of doctor I want to be. I tell my inquisitors that I want to do infectious disease. They typically respond with, "aren't you scared that you might get ebola, smallpox, SARS, sleeping sickness, or some other nastiness and die from it?" or "Aren't you scared that while you're in Africa chasing these diseases, you might get caught up in some civil war and be killed?"

And then I'm left saying this following: I have options in how I live my life, and options for how I die.

I could chose to live like most of my inquisitors in the suburban US for all my life, eating greasy McDonalds, not exercising, and growing fat and atherosclerotic. I could then die in my 60s, as a diabetic stroke and heart attack victim. But I don't want to, so I don't eat McDonalds and I exercise. That's not how I want to die.

I could die one day after being hit by a drunk driver. I can't really do much to control it, and I'd be pissed as hell if it happened. That's not how I want to die.

I'd much rather die doing what I like to do. I like to chase diseases in exotic places, having adventures and seeing new things. If I'm in an environment where I'm likely to be exposed to a disease, there are protective measures I can take to keep from getting the disease. I'd wear the yellow suit that the movie Outbreak made famous. I'd take my malaria pills. I'd wear gloves. And if, despite all my best efforts, I still manage to contract the disease and die, I'd be okay with it. I'd die in the middle of the life that I have always dreamed of.

And if civil war broke out, and I got caught in the middle of it, I'd do my best to get myself out of the situation. I don't really relish the thought of being hacked to death by machete, accidentally stepping on a land mine, or being targeted by someone with an AK-47. I'd rather clear town until the whole thing boils over. And if I didn't make it, at least I died doing something worthwhile, instead of perpetuating society in a cubicle somewhere.

In the long and short of it all, as long as I am doing what I want to do, I don't care if I die. I have no current dependents. No one really needs me to show up in their life everyday, so what I do is my business. One day, if a husband and kids popped into the picture, I'm sure my priorities will change. However, none of those cards are on the table. They may not even be in the deck. If someone were to call me up today and say, "hey, there's a malaria outbreak in Afghanistan, we need you to take care of it," the only thing that would hold me back right now is if it would interfere with medical school. After medical school...the hell with it all. I'm going.

All right, so I've got this club going again...Physician's for Human Rights. This week is HIV/AIDS Awareness week. Yesterday, we handed out ribbons. Today, we showed part of a movie called "A Closer Walk" and had the Christian Medical Association (CMA) co-sponsor it by serving pizza.

Well, shock and awe if very few people actually stayed to watch the movie. Granted, we get out of class at noon now, so I can understand people wanting to leave but I really hate it when people are just in your face about not going to it. As in, a good friend of yours saying "I feel like Vietnamese food..." and as they leave "Good luck with your thing today!" I couldn't hold back a retort: "Thanks for staying!"

Then, the pizza is late. One of our classmates who keeps posting notes on Facebook on how good and wonderful God has been to him and thanking Jesus for saving his eternal soul snottily grumbles "where's this pizza?" I couldn't hold back that retort either: "CMA is providing it." That's right, buddy. You're beloved Christian Medical Association is the one flaking out on us. He immediately looked aghast and his entire demeanor changed. As a one time conservative Christian, I can understand that behavior, but I can also say that said behavior is one reason why I wouldn't jump back on the Jesus bandwagon anytime soon.

Finally, the pizza comes while the movie is focused on an emaciated Ugandan child with full-blown AIDS, a TB infection, and complications from a second respiratory infection. I felt so guilty as I went up to get my pizza.

Tomorrow, one of our professors, the amazing Dr. Tariq, is going to give a presentation on women and HIV. Then Thursday, we're going to finish the movie. Thing is, we're supposed to have more pizza for the movie, but Papa John's has flaked out on us. Now I'm scrambling to find any restaurant in the Little Rock area that'd be willing to donate food for 50 already well-fed med students so that they can become aware of HIV/AIDS, because it is certain that they will see HIV positive patients one day.

On an upnote, it's spring. For some reason, the astronomers and calendar buffs that be have decided that for 2007, March 20th is the first day of spring. See http://www.msnbc.msn.com/id/7231497/. And I have to say, since coming back from New York, I've decided that it is indeed spring in Arkansas, with trees budding and tulips and iris blooming in Hillcrest. Yes, it's spring. And thank God for Daylight Savings Time starting early so that the sun sets later!

The first full week of March was absolutely crazy at school. We took our last unit exam in Gross Anatomy over the Head and Neck, which is by far the craziest part of Gross Anatomy. Your head is one complicated place. Then, we had a week to study for our Gross Anatomy final, a national standardized test known as the NBME. Then we had a few days to study for our Neuroscience exam on Friday March 9th. The next day, I flew to New York for Spring Break.

The real story starts with flying out. My friend Anna was going to take me to the airport at 5:15 for my 6:00 am flight. Note, I hadn't really been sleeping all week, but studying. Anna calls me at 5:20 and wakes me up. It was a mad rush that got me to the airport at 5:40. The guy wasn't originally going to let me on the plane since it was less than 30 minutes to flight time. I begged. I pleaded. He throws me my boarding pass and says "run. your bag won't make it, but it'll follow you."

I ran. I made it, but oh just so barely. The guy at the counter said, "wow, you're a good runner." (Thanks, just ran a half marathon a week ago!)

All in all, I made it to New York just fine, without my baggage. That meant that I had 1) no pillow and 2) no blanket and 3) no towel. The bag finally came on Monday morning.

I'm not going to do a play by play. I'm just going to do some isolated commentary here. First of all, I like London a lot better than New York. London doesn't have as many oppressively tall skyscrapers that make you feel like a rat in a maze. It's more homey. You can see the sky, even if it is covered in clouds most of the time. The subways in London do not stink of urine 95% of the time. I also think the London mass transit system is easier to follow initially.

However, I did get to see some really cool stuff. I got to see a taping of the Daily Show with Jon Stewart, the UN building (hasn't been renovated since it was built in the 50s. very kitschy, with old-school ash trays between the seats in the press corps gallery), the Museum of Modern Art, the Metropolitan Museum of Art (could spend an eternity in there), the Natural History Museum, Rockefeller Center (ice-skating rink much smaller than one would think), the Brooklyn Bridge, the Staten Island Ferry, the Guggenheim, Central Park, Lincoln Center, Greenwich Village, Chinatown, Little Italy, etc. etc.

I basically did a whole lot of walking around and checking things out. That's my basic philosophy when checking out a new place. It turned out pretty well. I'm not sure if I ever really want to live in New York. I definitely wouldn't want to be raising kids there. I'd like to be able to have a backyard that I can send the kids to play in. In general, the place just feels a bit oppressive, even within the first week of being there. London never really felt that bad.

I don't know. Perhaps if I got a residency there, but I don't think I'd want to spend an extended amount of time there.

I also don't do the cold. I got up there and it was 60 degrees Fahrenheit. It was sunny, when the sun could peak out from between skyscrapers. Then on Thursday it rained in the morning. It started to get cold. By Thursday night, it was snowing. By Friday, there was a lot of snow falling and sleet pelting me in the face. I had to go buy new tennis shoes because my wimpy little flats weren't going to cut it. It was the kind of weather one should only have to face if you are going up Everest or traveling to a remote village in Siberia. It dumped 5.5 inches in Central Park, closed all the major metropolitan airports for Friday, and delayed my flight out on Saturday. I don't believe in cold weather.

Now I have a ton of crap to do before classes start tomorrow. I swear, I've forgotten what my purpose in life had been this past year while I've been away. I seriously have to start studying tomorrow. I think I've forgotten how. I also really need to clean my apartment and go grocery shopping.

Cholesterol (Lipid) results:

Cholestero: 198 03/08/2007

Triglyceri: 65 03/08/2007

LDL: 69 03/08/2007

HDL: 115.70 03/08/2007

Basically, with these results, I should never ever die of a heart attack. Especially with my HDL being astronomically high. An internist heard my HDL and he said, "WHOA! THAT'S REALLY HIGH!" over and over again.

That's a massive difference between fasting and nonfasting cholesterol. I guess there was a TON of cholesterol in the cookie I ate a half hour before going to the doctor.

I have high cholesterol. A couple of weeks ago, I went to my MD for a routine checkup. She felt it was necessary to have my cholesterol checked. I told her she could if she wanted, but I wasn't really concerned since I'm a vegetarian on a naturally low cholesterol diet anyway. However, she took a non-fasting blood sample. It was 3 in the afternoon and I'd just had a goat-cheese and hazelnut and greens salad for lunch. I got my lipid screening results after coming back from my Gross Anatomy final.

Total Cholesterol: 305 (over 240 is considered high)
Triglycerides: 93 (less than 150 is normal)
LDL: 170 (less than 100 is optimal. 160-189 is high)
HDL: 116.40 (good = above 40)

So, total cholesterol is high. My triglycerides are low. My LDL is pretty high, and it's the kind of cholesterol that clogs arteries. HDL is really, really good. It's the good kind of cholesterol that picks up the LDL from the cells and takes it to the liver to be excreted in bile. So, bad cholesterol should be doing a really good job of being eliminated.

I do have a prescription for simvastatin, which prevents you from making your own cholesterol. Apparently, I might be making more than I need (if you don't consider the fact that it was nonfasting. They do recommend that LDL cholesterol levels be taken 8-10 hours after having eaten. For HDL and Total Cholesterol, it's perfectly acceptable according to British NHS, "William's Textbook of Endocrinology" and "Clinics in Laboratory Medicine" for the sample to come from a nonfasting blood sample.

I did just do a check around my kitchen. Olive oil, SmartPlus margarine, Ezekiel bread, boca burgers, soy milk, edamame, vegetables, fruit, luna bars, Kashi go lean crunch, peanut butter, and coffee creamer = 0 grams of cholesterol. The only cholesterol containing food in my kitchen: the omega fatty acid enhanced free range eggs and the parmesan cheese I sometimes sprinkle on my veggies. Oh, and when was the last time I ate fast food? I was coming back from hiking in Cornwall on May Bank holiday. All I had was an order of onion rings.

I need to email my doctor and tell her that I want to redo the lipid profile screening after a legitimate fast.

Job #1 = pretty much guaranteed. Dr. Bates, my mentor at the health department, has got his buddy at the CDC to set up a job for me as an Epidemiological Assistant in the Tuberculosis program. I would get a stipend. Application is submitted, and I just need to get my transcripts forwarded. I'd be in Atlanta for the summer.

Job #2 = pipe dream. The Carter Center would send me to one of three locations in Africa where I would do work for their Trachoma Control Program. It includes a stipend. They only accept one or two students a year. I don't know if my transcript from London will get there in time.

We also have our LAST EVER gross anatomy practical on Monday, over the head and neck. And I'm so tired of the head and neck.

Last weekend was a three day weekend, which I spent studying Respiratory Physiology. I had two breaks: dinner with friends at a Vietnamese place (where one of my friends got food poisoning) and lunch with mentor from the Health Department. I spent the rest of those three days with my nose in several physiology books. Then Tuesday morning at 9 comes the exam. It's all on computer. Well, the entire class tries to log on and nothing happens. The computer won't give us our personalized passwords.

They have to delay the test in order to get the computers back online and recognizing our info. What a way to let the test anxiety build up. We finally get to take the test, which has to have been the hardest test I've ever taken in my entire life. We had 39 questions to do in 1 hour. We needed one and a half hours. The questions aren't ones where I can go through, ruling out A because it's backwards, ruling out B because that doesn't happen in those circumstances, and then it's between C and D, and I know it's got to be D because I remember hearing that in lecture.

It's more like:

A. Why can't it be A? Well, it can't be A because when the lungs take in oxygen they expand, which implies...blah blah

B. Why can't it be B? B's saying that if the patient's hypoventilating at high altitude...but this pattern's commonly seen if they're at sea level.

C. Why can't it be C? Okay, if ventilation is this, and perfusion is this, that means it's a physiologic shunt, which is just like hypoventilation...now what effect does that have on CO2?

D. Why can't it be D? Because...OH NO! I'VE GOT 1O MINUTES LEFT BEFORE TIME IS UP AND I'VE GOT 12 MORE QUESTIONS TO ANSWER!

I have never ever studied so hard for an exam and done so poorly. I wasn't the only one who had problems. The entire class was upset. Some girls left the room crying. I didn't cry, but I did make a grade worth crying over. One of my classmates emailed the professor, saying that she didn't feel like the test was a representative assessment of the knowledge that we had learned, and the time limit was too strict. His response: we'll look into the time issue. however, 2 people made a 100%, so it couldn't have been that bad of an exam.

I previously liked this professor.

If I go to class every day and pay attention and take good notes, and then go home and study and make that kind of grade, then I'm going to stop attending class. It's not as productive for me as my independent studying. I've kept going out of guilt. No more. The powerpoint slides, the syllabus, and my 7 textbooks ought to be enough that I can teach this to myself and email professors with questions.

Then that day, we had our last day of gross anatomy class. We dissected the larynx. Now, we no longer have to go down there, except to study our cadavers for our exam on Monday. I'm going to be so happy when I no longer have gross anatomy to worry about.