Sunday, May 29, 2011

Shower Periodically

One thing I forgot to mention in my post about moving in: I found the most incredible shower curtain for my new bathroom. Yes, I'm excited about my shower curtain. Take one look and you'll understand why:

Yes, this shower curtain has the periodic table of elements on it, complete with a conversion chart (Fahrenheit to Celsius and all that good stuff) at the bottom. Perfect for a doctor/researcher-to-be, don't you think?

All Moved In (well, almost)

It's been a blur, these last couple of weeks. I'm still a little hazy (partially because I have a nasty cold and am sore all over from moving last Thursday), but things are starting to clear. And the moving boxes are slowly starting to disappear.

That apartment in Forest Park I mentioned in my previous post about needing to move out? I didn't get that place. The landlord gave it to someone else. I was heartbroken, because I loved it - it seemed perfect and nothing else I had seen came close. But I gritted my teeth, and the next day started looking again. And a couple of days later, I found an even better place in Oak Park (a suburb next door). I paid my security deposit and first month's lease immediately - I didn't want anyone else getting this place - got my keys the next day and started planning my move.

From the day I got my keys, I had about a week and a half before my moving day to buy everything I needed (which was a lot, considering we only had one set of pots and pans, one knife block, etc.) and to pack everything up. I managed, just barely, literally finishing the packing process 10 minutes before I had to go pick up the U-Haul truck.

As U-Haul's old slogan says, it was definitely an "Adventure in Moving." (The DIY moving company apparently no longer uses this slogan ... wonder why.) It was cloudy, chilly, and on-and-off rainy - yep, that's late May in Chicago for you. It wasn't bad moving things out of my old house; the challenge was moving things into my new apartment, which is on the third floor. (Of course I would get a third-floor apartment.) That's a lot of stairs to climb with about a zillion boxes and random pieces of furniture. But I had good help - my little sister, my dad, and a fellow post-bac friend all lent their muscle power. I also encountered some good neighborliness (my new first floor neighbor helped us with several things), as well as some maintenance workers who were willing to move the heavy furniture (two couches and a corner hutch) for a small fee. All in all, it worked out. Well, for the most part. My "new" (from Craigslist) couch didn't fit through my living room doorway, so I've had to turn my dining room (which was going to be my office/study) into the living room and vice versa. But that's OK. I'm flexible. Or at least, learning to be.

I'm still missing a few things - my desk hasn't arrived yet, and I still need to go buy a toaster. My dresser and wicker furniture for my balcony (yes, I have a little balcony!) are still at my old house. This is an old, OLD building, so there are probably a half-dozen outlets in the place (I'm not exaggerating), which means I need multiple power strips and extension cords, which I don't have yet. Neither have I made a full grocery run - all I've got in my refrigerator are the bare essentials (which include, of course, real half-and-half for my morning coffee).

While some things are lacking, others are in excess. I'm referring to cardboard boxes here, which are still stacked throughout my apartment. I've put most of the kitchen together, as well as the living room and bathroom, but the bedroom and my office/study could pretty much qualify for federal disaster relief at this point. I'm working on being patient with myself, and with this process. Doing what I can, and not getting too frustrated with what I can't.

The biggest adjustment is an emotional one, obviously: not living with another person, specifically with my spouse. It's odd to be in my apartment, all by myself all the time (well, most of the time). I find myself calling friends and family more frequently than I used to. Thank heavens for rollover minutes.

This has been a difficult, sad transition in many ways. But it's been a good one, too. And I know it will get easier as time goes on.

Matters of Life and Death: A Day With an Oncologist

When many people think of cancer, they think two words: "death sentence." Hence, the prospect of treating people with cancer could be summed up in one word: "depressing." And it's true that some of Dr. Park's* patients were dying. There was the woman whose lung cancer had metastasized to her brain. Her whole family - husband and three children - had accompanied her to her appointment to get an update, and the news wasn't good. They could do chemotherapy, and it could prolong her life, but chemo could not cure the cancer. And chemo would cause many toxic effects, including hair loss and nausea, Dr. Park said. You could tell the family had grabbed onto that little bit of hope and was clinging to it. Dr. Park had to bring them around to reality. He explained that without treatment, the average survival time for a person with her condition was four months. With treatment, the average was a year. And those were only averages. Chemotherapy was no silver bullet. One of the daughters was sobbing at this point. I reached to hand her a Kleenex box, but she had found some tissues in her purse. The woman with cancer, sitting on the exam table, said she thought she wanted to try the chemo and see how it went. Dr. Park agreed, and said that they could always stop if it became too much to bear. The woman, who had remained calm, collected, and still throughout the whole appointment, then spoke. Her voice broke ever so slightly, and she twisted her hands together. "I just want to go fishing," she said softly. 

My heart broke for that family. For what they were going through, for what they would continue to go through as this woman's disease progressed and even after she was gone, dealing with the loss of their wife and mother. 

But there were survival stories too. Like the woman who had beaten breast cancer, even though it had cost her one of her breasts. She came in laughing and joking, obviously happy to be there for a routine check-up rather than for chemotherapy treatment. For her, cancer had not been a death sentence. And she was obviously resilient, having bounced back from a major surgery that would deeply affect anyone on so many levels - physical, emotional, psychological, sexual. I honestly don't know how I would handle such an intensely emotional situation. But here she was, offering to let me feel the difference between her reconstructed breast tissue and natural breast tissue. "Whatever you can learn from me, that's wonderful," she said. 

I am still in awe of that woman, and of every patient I met in Dr. Park's downtown Nashville office earlier this month. What was I doing in a Nashville oncologist's office, of all places? Isn't that what everyone does on their summer vacation? In all seriousness, that is what I did on my summer vacation. In early May, I was in Nashville, Tenn. visiting a dear friend (who is also a non-traditional pre-med student). Her husband is good friends with Dr. Park, a Nashville oncologist. And Dr. Park was more than happy for the two of us to hang out with him for a day at his office. And as I have already suggested, it was an amazing day.

From the beginning, Dr. Park told us that he wanted to make the experience as educational and beneficial as possible, and that he would try to walk the line between explanations that were way over our heads and explanations that were so simple they might insult our intelligence. He found that balance perfectly and effortlessly, it seemed; he was a natural teacher. Before each patient's appointment, he would pull up the patient's history on the computer (their office had completely gone to electronic medical records, or EMR), explain the person's disease, prognosis, treatment plan, and reason for that day's visit. We would also go over the patient's most recent labs together; these values often determined whether a cancer patient was well enough to get chemo that day, or whether a hematology patient needed an adjustment of his or her coumadin (a blood thinning medication). 

While so much of the oncology world was (obviously) new to me, I was able to make connections to what I already knew. And that is always a rewarding experience for me. Those lab results we looked at for each patient? They were the same types of results that we had gone over when I rounded with the ICU director in Chicago several weeks ago. So I was familiar with what some of the normal ranges were, and therefore also when something was amiss. One patient, who had myeloma, also had a kidney problem that had him on dialysis. Dr. Park told us that before they had started any cancer treatment, they had to make sure that he really had myeloma, not just an amyloid issue with his kidneys, because the two treatments were very different. Amyloid ... the word struck a chord in my brain. "Is that in any way similar to the beta-amyloid protein accumulations that are a feature of Alzheimer's disease?" I asked. Dr. Park looked surprised, and said yes, that they were both protein accumulations (although the histologies are very different). Another connection I made had to do with tissue structure, something we learned last fall in General Biology I. A woman came in as a new patient, having had a bilateral mastectomy (both breasts removed), and her physician wanted Dr. Park to evaluate her pathology and lab results to see whether she would benefit from any chemo treatment in addition to the surgery that had already been done. DCIS - ductal carcinoma in situ - was the type of cancer she had, meaning that it had not yet spread to the basement membrane (and this is a good thing), Dr. Park explained to my friend and me. I remembered learning about the basement membrane, and could picture exactly where it was in relation to the other types of cells in human tissue.   

But to the woman with the DCIS, it didn't really matter so much where the basement membrane is, or even what it is; what she cared about was that her surgery had most likely gotten all of her cancer, and that chemo was not needed. "Praise Jesus," she murmured as she listened to Dr. Park's good news. "Hallelujah."

That particular woman clearly had a faith that helped sustain her through her breast cancer. But another breast cancer patient we met seemed to be all alone, almost aimlessly so. Her cancer had metastasized to her bones - her skull, sternum, femurs. Yet she seemed not to be able to come to terms with the fact that she was dying; her main concern was that she had intense back pain. So Dr. Park worked out a plan with her to get her the immediate relief she needed, suggesting radiation treatment. I felt bad for the woman, because not only was she going through a torturous disease, she was doing it alone. That's something no one should have to do.

My friend has an extensive family history of cancer, and she told me she didn't think oncology was something she could imagine herself doing. I completely understand that. But the other day when someone asked me what type of doctor I want to be, I found myself blurting out "oncologist." I was a little surprised at myself, honestly, but I ran with it in the context of the conversation. Clearly, I have plenty of time to make these decisions. But it doesn't hurt to try a professional hat on (in the most basic way) and see how it feels.

Thank you, Dr. Park.

*Name changed.

Monday, May 16, 2011

Moving Out, Moving On

For the last 10 minutes, I've been staring at my bedroom walls with an immense sadness. The kind of sadness that grips your gut and tightens your throat so that you feel claustrophobic within your own skin. That kind of sadness. These old walls are a deep-sea turquoise, dark and rich. I painted them myself shortly after we moved into this house. It was a Chicago winter, so cold out - I was impatient; I couldn't wait for spring - and I had to keep the windows open so I wouldn't pass out from the paint fumes. So I wore my old gray Nike sweatshirt, the one I'd had since high school, a Christmas gift from my grandparents. Funny the things you remember.

Memories ... I have made so many in this house. And almost seven years to the day after moving in with Geoff, I will be moving out. Alone.

It's not that I'm going to live in a dump. I found a lovely little one-bedroom apartment in Forest Park, not far from school, not far from my friends and family. Decent rent, garage parking, lots of windows and natural light, newly refinished hardwood floors, not one but two closets in the bedroom (if you've ever seen my clothing collection, you'll understand the importance of this amenity), the list goes on. I can see myself living there. And assuming my credit check goes through (which it should), the landlord told me it's mine whenever I want it.

No, it's what I'm leaving behind. And what those things represent. This house says "Lorien" all over it - I stripped wallpaper from the entire first floor, patched and sanded the walls, then primed and painted in a colorful palette of gold, sage, and raspberry. The upstairs I painted too, again in different colors. I wanted anything but white walls, and just about made it. (Only the kitchen, office, and Geoff's music room are white.) This house is where we had family birthday parties, barbecues, sister sleepovers. But most of all, this house is where Geoff and I were together. We inhabited this place as husband and wife. That is over. But as long as I'm here, it doesn't feel quite over. So as I sort through seven years' accumulation of stuff; through my clothes and papers and books and art supplies and dishes and everything else that hides in the nooks and crannies of this big house; as I sort things into the "keep," "throw away," and "give away" piles; as I begin to pack things in cardboard boxes; the evidence of my former life is gradually fading away. Until eventually, when this house is empty and bare, the evidence of that life will have evacuated to the recesses of my mind. What do I do with that?

I need to move out, to move on, I know that. I can't stay in this place anymore. But just because I need to do it doesn't make it any easier.

Monday, May 9, 2011

ADCOM Q&A (working amid diversity)

The western Chicago suburb where I went to high school prides itself on being one of the first "integrated" communities in the country, and on a continued history of diversity. However, if you take a deeper look, you'll quickly see that most of the African-American people live on one side of town, while the Caucasians live on another. And at the high school, African-American and Caucasian people rarely associate with each other. In fact, I caught nasty looks and insults for carpooling with a lovely girl originally from Nigeria (as did she). Maybe you can call this "diversity," but I certainly don't think you can call it "integration."

And so, if an admissions committee member asked me something to the effect of: "What experiences have you had working with diverse populations? What have you learned from those experiences?" the first thing I would do would be to differentiate between "diversity" and "integration." And then I would talk about the experiences I have had with integration - where diverse people really were mixed together and interacted with each other.

My first such experience came when I was a little girl. I grew up in a predominantly African-American church (and when I say predominantly, I mean there were three white families in the whole church) on Chicago's West Side. I still remember the magic of Keystone Baptist Church's amazing choir, how the songs those men and women sang would raise goosebumps on your skin. I remember the passion of the preacher, and the devotion with which deacons prayed. But most of all, I remember the people. We all loved each other deeply, like family, and that love overcame the boundaries of skin color. I remember my mom telling me once that for some of the people in the church, interacting with our family (and the other white families there) was the first and only positive experience they had ever had with white people. And it changed their perspective on skin color. 

My own perspective on skin color was that it was irrelevant in terms of status or value. In fact, I thought the dark skin was amazingly beautiful. My favorite babysitter at the time, Felicia, was African American. She was my heroine. One day, my mom found me, black permanent marker in hand, carefully and methodically coloring my skin. "What are you doing?!" she asked, shocked. "I want to look like Felicia," I told her, in a complete matter-of-fact tone, like it should be obvious. My mom was careful to explain that everyone's skin was different, and everyone's skin was beautiful, but that my skin couldn't be dark like Felicia's. She then shuttled a very disappointed daughter to the bath.

What did I learn from these experiences? First, how important it is to instill a sense of respect for diversity and integration into children at a young age, when they are impressionable and willing to learn those lessons. And how important it is to expose them to integrated experiences. Because you can talk all you want, but if you never experience integration, the talk is really meaningless. Second, how important it is to be an ambassador. Because you never know who is watching, and who might take what you say and do seriously.

In addition to my experiences at Keystone with the African-American community, I have spent significant time with the Hispanic community, especially now that I am a Spanish medical translator. Of course in this context, I don't get to know the people on a personal level. But it is an integrated experience nonetheless. Because I am right there, interacting with and speaking with these people in their native language. 

One of the most difficult things about my job at the clinic where I work is that medical vocabulary is something you don't use in everyday conversation, so those words have been like a new language I have had to learn on my own. For example, you generally don't talk about IUDs - dispositivos, in case you're wondering - on a daily basis. But you do talk about them when you're translating for a pap smear (papanicolau) appointment. 

The second most difficult thing is that the people with whom I work come from so many countries, regions, and backgrounds and hence have different colloquial words and expressions that they use. I remember one time working with a Mexican woman who had injured her shoulder. She kept using a word I had never heard before - I think it was estrellar - and I had no idea what she was saying. Finally, I asked her, "Se rompió el hombro?" - "Did you break your shoulder?" "Sí, sí, sí," she said, smiling and obviously relieved that I had figured out her meaning. 

From these experiences, I have learned that sometimes you have to invest a significant amount of time to really be able to integrate yourself into a community and situation, but that the effort is worth it in the end, because you are able to truly make a difference. At the same time, you're never going to get everything perfect - just like how I didn't know what the word estrellar meant at my first go. But when you do make that effort, no matter how imperfect it is, that effort truly is appreciated. So trying is worth it, even if you only know a few words of a language, or a little bit about a culture. Because in trying, you are demonstrating respect for the other person's world. And that makes all the difference.

I'm not trying to paint a rosy picture here. Working in situations where there is diversity (and hopefully integration) can be very difficult, full of misunderstandings, and sometimes even animosity. I only want to share my experiences, what I have learned, and what I hope to bring with me into my future as a physician. Because in that role, I will encounter all kinds of people. And all of them deserve the best of treatment, both medical and personal.

Sunday, May 8, 2011

I'm Not Old, I'm 'Refreshingly Contemporary'

Whenever my mom has to learn some new-fangled technological thing, like how to program the DVR or how to update her cell phone's bluetooth headset on her computer, she has a great sense of humor about it. She refuses to consider herself old or out of date. "I'm refreshingly contemporary," she always says - no matter how long it takes her to figure out the technology.

I'm not even 30, but I had my own "refreshingly contemporary" moment during finals week, one that gave my research biology class a good chuckle. (Glad you got a laugh on my behalf, guys!) Rather than have an exam, our "final" was to give a 15-minute PowerPoint presentation on our antibiotic resistance project. (I wrote about my own experiments in an earlier blog post, Caffeinated E. Coli. Click on the link to read that post.) The goal was to emulate a scientific conference, where we, as the presenters, demonstrated what we had done through slides showing our data, tables, figures, conclusions, etc. In addition, of course, we also had to explain everything to our audience in a clear, concise manner. So our grade was to be based both on our oral presentation and on our slides.

My Research Methods in Molecular Biology class,
the day we gave our PowerPoint presentations.
And now for my "refreshingly contemporary" moment: As an almost 30-year-old, I have never, I repeat never, given a PowerPoint presentation. When I told this to my class and my professor, my lack of PowerPoint experience did indeed elicit laughs. "Never?" someone asked. "What did you use for presentations?" I thought about it for a second. For starters, I realized that I hadn't given a presentation of any sort in a long time. And in school - way back in the day - I used posters and overhead projector transparencies. Yes, I'm old. In comparison to the undergrad youngsters I was talking to, at least. And there was another thing: "Well," I said, "as a former journalist, I'm used to being the one asking the questions, not the one doing the talking." My professor just smiled. "I guess the tables have turned then, haven't they?" he said.

One side note: I had used PowerPoint once, but not for an actual presentation. I had put together some graphs and text for a previous class assignment, and decided that the slide page orientation looked better than an 8.5 x 11 page. So I wasn't completely unfamiliar with the software. But I had most definitely never made anything for the "big screen."

I wasn't really worried, though. PowerPoint is Microsoft software, which I'm pretty good at using. And when I had used it the previous time, I quickly realized that all the same copying, pasting, and formatting skills from Word would apply. Sure, I didn't know how to make the presentation fancy - but I didn't really care. I would focus on substance rather than style. Which is the main point anyway.

So I approached the presentation in the same way I would a lab report. Look at the data, decide what kinds of figures and tables are necessary, and then put those together. Then work out the analysis of the data, and the conclusions that I could make from it - analogous to the "discussion" section of a written report. And last, put together an introduction and conclusion. I found that my writing skills - both having a good understanding of sequence and how to use transitions - came in very handy in both writing the presentation and designing the slides. When I was done, I was confident in my work.

The day of the presentations, Dr. Kreher brought us bagels, coffee, and juice - "It's not a conference without food," he told us. I went near the end, and despite some technical difficulties (related to creating my presentations on a Mac and trying to run it on a PC ... always an iffy proposition), felt really good about how things went.

The only downer of the morning was that after the last presentation, our class was officially over. My favorite class, the class that kept me going through this incredibly difficult semester. That thought saddened me. And then ...

"Wait everybody, don't leave!" shouted out one of my classmates. "I want to take a picture of the class." So we all lined up in front of the blackboard, and smiled for his iPhone camera. "This will be fun to look look back on in 20 years," he said.

Indeed. Fun to look back on a photo of the people with whom I truly got my feet wet in research. And fun to look back at the PowerPoint presentation I gave that same day, which, I hope, will be the first of many.

Pre-Med Year 1: Done

Well, it's official: I have finished year 1 of my pre-med courses. It's surreal. Two years ago, I was a laid-off textbook editor barely contemplating the road to medical school. One year ago, I was gearing up to work in a research lab and start classes in the fall, not having "done" any science since my sophomore year of college (back in 2000). And now I have a 4.0 for 29 credit hours of straight science courses. Things are looking good.

More importantly, I am loving this journey. Courses I knew I would enjoy (such as biology) have delivered. Classes I thought I would have to fight my way through (namely, physics) have piqued my interest in some way. Subjects I didn't even know would capture my attention (I'm referring to research here) have lured me in.

I have learned so much, but everything I have learned has only made me want to learn more. Case in point: I practically drooled when I looked at the list of upper-level science classes I was eligible to register for next year; the hardest part was that I obviously have limited time and can't take everything. With most of my requirements out of the way (physics, gen bio, and gen chem), all I have to take, in terms of pre-reqs, is organic chemistry. But since I'll be in school, I get to take so much more: anatomy, a cadaver dissection lab, genetics, and biochemistry. I absolutely can't wait to take what I have learned this year and add to and expand upon it. I feel like this year, I got a general outline of so many things; in the future I will be filling in a lot of the details of that outline. Being a former journalist (and still very much a writer), I understand the importance of an outline, but I also understand that the meat of a "story" lies in the details. And I am hungry for those details.

I look at some of my classmates who are so impatient to "get there" - to medical school, I guess. But I have a feeling that once they get to medical school, they will just want to, again, "get there" - to residency. And then to a fellowship, etc. If you are always focusing on the future, you miss what is in front of you. And that is the most beautiful, amazing part of life. Sure, I'm excited to go to medical school. But I am enjoying each day as I go. Because if I don't, this journey is empty. And I won't have absorbed all the lessons and knowledge I can gain along the way. And in many ways, that would make not only this journey empty, but my life empty as well. And in emptiness, I would certainly not be fulfilling my dream.