ADCOM Q&A: Reading a Book (for Pleasure?!)

One theme I have noticed in admissions interview questions for medical school is that they want to see that applicants are well rounded, and do things other than study, work in a lab, or volunteer. I.e., that they involve themselves in activities that don't necessarily strengthen their med school applications. That they know how to decompress and relax. Because these are skills that are so important, especially in such a high-pressure field. So, one of the ADCOM questions I want to answer is this: Discuss a book that you have recently read for pleasure. Why does this book interest you?

And here was my answer, as of a few days ago: Uhhhh ... pleasure? I don't have TIME to read for pleasure!

Thankfully, I do have a little more time now, as I am not in school (and inundated with the requirement of reading textbooks). So I picked up a of book a few days ago, and started reading for "pleasure" again. And it's felt absolutely wonderful. While I haven't finished it, I will tell you a little bit about it, and what I have learned thus far. I will also share my reading list, books that I hope to read throughout the next months (when I will still have more time, before the insanity of medical school starts).

What I'm Currently Reading:

Nature's Robots: A History of Proteins

(Charles Tanford and Jacqueline Reynolds, 2004)

I downloaded this Kindle book (to read on my iPad) on Dec. 25, 2011, according to my Amazon.com account. And honestly, I totally forgot I had it. But I was looking at my Kindle books a few days ago, and there it was! I was thrilled, it was like Christmas (even though I bought it for myself). I started reading it that evening. And was pleasantly surprised. It's definitely a history book, at least thus far. But there's a lot of science - especially chemistry and biochemistry - in there, which makes me happy. And the authors detail a lot of the theories, and arguments over theories, that were proposed in the past regarding proteins. I've made it through chapter 5, and am quite pleased with how the book is going. Proteins were my first "love" in science, and they continue to fascinate me. They are such an important part of our lives, and anyone who is in the biological sciences needs to have a good understanding of them. Learning about their history, in terms of scientific advances, is a way for me to understand where we have been, as a scientific community, and also to be inspired about where we are going in the future.

My Future Reading List:

Fiction:

 

The Life All Around Me by Ellen Foster
(Kaye Gibbons, 2011)

One of my favorite authors is Flannery O'Connor, and Kaye Gibbons reminds me of O'Connor (very high praise, in my book - pun intended). This book is a follow-up to the book Ellen Foster, which I read several years ago. After reading that, I flew through several other Gibbons novels. I look forward to reading more about this lonely girl, and the struggles she goes through.

A Wizard of Earthsea
(Ursula Le Guin, 1970)

I was first exposed to Ursula Le Guin when I was a textbook editor, and worked on the American Literature lesson for the hilarious but disturbing short story SQ. "SQ" stands for "sanity quotient," and the story is a wonderful parody. I highly recommend it, even if you are not a huge short story lover (I am not). I immediately checked out Le Guin's Earthsea series, and this book is the first of that series. I have read it before, but I want to read it again. And I rarely read books twice, simply because there are so many books I want to sample.
On your Facebook info page, you can list favorite quotations. I have only one listed, and it's from this book, from the creation story that is entwined throughout. I find it beautiful, poignant, and enigmatic, something to ponder:

Only in silence the word,
only in dark the light,
only in dying life:
bright the hawk's flight
on the empty sky.

- The Creation of Éa

 Memoirs:


Genetic Rounds: A Doctor's Encounters in the Field That Revolutionized Medicine
(Robert Marion, 2009)

This book, which I found rather randomly while searching my library's online catalog, looks fascinating to me. I don't know much about it, don't know whether it's well written, but the topic is definitely something that interests me. I enjoy a good medical memoir for sure, because it gives me a glimpse into the field I will be entering soon. And this one piqued my curiosity in particular because it marries medicine and genetics, which is something I am interested in doing myself in the future.


The Spirit Catches You and You Fall Down
(Anne Fadiman, 2012)

This was recommended to me by a physician I highly respect as "must read" for any physician, or physician-to-be. According to Amazon, its "explores the clash between a small county hospital in California and a refugee family from Laos over the care of Lia Lee, a Hmong child diagnosed with severe epilepsy. Lia’s parents and her doctors both wanted what was best for Lia, but the lack of understanding between them led to tragedy." Given my interest in multicultural issues, and health literacy, it seems a poignant book to read right now.

Nonfiction:

The Immortal Life of Henrietta Lacks
(Rebecca Skloot, 2011)

One of my dear friends - who is most definitely not a science person - read this book and told me it was amazing. Here is a portion of the summary posted on Amazon: "Her name was Henrietta Lacks, but scientists know her as HeLa. She was a poor Southern tobacco farmer who worked the same land as her slave ancestors, yet her cells—taken without her knowledge—became one of the most important tools in medicine. The first “immortal” human cells grown in culture, they are still alive today, though she has been dead for more than sixty years. If you could pile all HeLa cells ever grown onto a scale, they’d weigh more than 50 million metric tons—as much as a hundred Empire State Buildings. HeLa cells were vital for developing the polio vaccine; uncovered secrets of cancer, viruses, and the atom bomb’s effects; helped lead to important advances like in vitro fertilization, cloning, and gene mapping; and have been bought and sold by the billions."
If you read any scientific literature, you are bound to come across HeLa cells as a subject of study. Reading the story of their "birth," so to speak, and such a controversial and heartbreaking one, seems like a natural thing to do for a budding scientist such as myself.

The Disappearing Spoon: And Other True Tales of Madness, Love, and the History of the World from the Periodic Table of the Elements
(Sam Kean, 2011)

It was my chemistry major friend who recommended this one to me. And as you know from some of my previous posts, chemistry - and the periodic table - have piqued my interest of late. I look forward to reading the history of this seminal scientific tool. This is what the Amazon summary says about the book: "The Periodic Table is a crowning scientific achievement, but it's also a treasure trove of adventure, betrayal, and obsession. These fascinating tales follow every element on the table as they play out their parts in human history, and in the lives of the (frequently) mad scientists who discovered them. THE DISAPPEARING SPOON masterfully fuses science with the classic lore of invention, investigation, and discovery--from the Big Bang through the end of time." Sounds pretty cool, eh?

Conclusion:

Clearly, I have plenty to keep myself busy. The wonderful thing is, I'm not afraid to use my local library (or the wonderful library loan system). So reading all of these amazing books won't cost me anything. In addition, a couple of these books are available through my library's digital lending center, which will allow me to read them on my iPad. As I read these treasures, I will definitely post about them. So stay tuned ...

Periodic Tables: One more (for the writer and editor in me)

I know, I know - I posted a boatload of periodic tables in my last blog post. But I came across this one in a recent Google search, and I just HAD to post it here. It represents a confluence of my interests in science and writing/editing. Plus, it makes me laugh. And as we future physicians know, laughter is the best medicine, right?

Thinking Outside the Box, er, Table

There are some things that we just take for granted, it seems. The sky is blue, the grass is green, and the chemistry periodic table of elements looks something like this (see photo at right):

But, as is the case with so many things, there are multiple ways of representing the information on the periodic table. There is a Web site called The Internet Database of Periodic Tables that I recently discovered, thanks to a dear friend who is a chemistry major, which has images of literally hundreds of periodic table representations. It fascinates me that there are so many ways of showing what we take for granted in chemistry class. Some of them are, perhaps, not so accurate anymore based on current information and data. Others are not really very scientific, and are more novelty items. Regardless, how amazing that people have taken the time (and you will see that many of these have REALLY taken time) to develop different ways of thinking about what our world is made of. Here are a few of my favorites. But I really encourage you, if you like any of what you see here, to visit the Web site and peruse the photos. You will laugh, scratch your head, and laugh again, I guarantee it.

Alternate views of the periodic table of elements:

Étienne François Geoffroy’s 1718 Affinity Table.
At the head of the column is a substance with
which all the substances below can combine.

Angular Form of the Periodic Table by Kamal Akhtar:
"The complete periodic table is consists of two circles,
principal circle and auxiliary circle. The principal circle
is consist of seven tracks (periods) and eighteen sectors
(groups). The auxiliary circle is consist of only two tracks,
inner track and outer track. There is no division of sectors
in auxiliary circle." (2008)

By Alexander Makeyev – integrated
interdisciplinary researcher, inventor, poet (2011)

From Protege Publishing comes the Progressive Periodic Table:
"The PPTE allows you to observe and learn the periodicity of the elements
in a more aesthetically pleasing form. It removes confusion
from the growth pattern between shell pairs, and solves the problem
of keeping the lanthanides and actinides in sequence with the rest of the table."

Bydgoszcz's Periodic Table (2008).

Harrington Projection for The 270 AMU Structure (2010).

Normal vs Correction Shell "Pi Paradox" for 1-270 AMUs

Origionally developed in 1933, the colour version of
Clark's arrangement is from Life Magazine, May 1949.
This was the model for Longman's 1951 mural.

Rafael Poza's Elements and the Magnetosphere (2008).

In 1944 Müller produced a formulation
based on Darwin's tree of life.

A 1970 periodic table by Prof. Wm. F. Sheehan
of the University of Santa Clara that claims
to show the elements according to
relative abundance at the Earth's surface.

Walter Russell's Periodic Chart of The Elements 1 (1926).

Walter Russell's Periodic Chart of The Elements 2 (1926).

Stedman's conic system of 1947.

The Wheel of Motion (WoM) representation of the periodic
table of elements shows the periodic nature of the elements,
as developed in the Reciprocal System of Physical Theory (RST).

Note: Photos and caption text taken from The Internet Database of Periodic Tables

A Kind Word Turns Away Wrath ...

Words we've all heard:
"What do you think you're doing?"
"What is wrong with you?"
"Don't you know any better?"

We've all been there: borne the brunt of whatever the woman in the photo to the right is saying. Had fingers pointed at us. Been yelled at. Criticized for something that wasn't our fault. That's a given, in life. What differentiates people is not whether that happens, but how one responds.

I'm headed into a world - medical school, and eventually a career in medicine itself - where the people around me will not always be nice, no matter how nice I am to them. Another fact of life.

I was reminded of this fact recently as I talked with a friend who is currently in medical school, and doing her hospital rotations. She recently started in general surgery, and BOOM. Another med student, who wants to go into a surgical specialty, immediately showed himself to be a know-it-all, and a pretty nasty person all around in terms of making my friend feel incompetent and useless (even though this was her first week on the rotation). My friend, thankfully, maintained decorum and professionalism all the way through. (I'm so proud of you!) When this other med student was breathing down her neck about her not being able to figure out a charting issue, she told him that she understood that it was taking her longer than it might take him, but in a few days, she would have the system figured out. When he responded that he was just trying to help, she told him, basically, that she appreciated that fact, but that his standing right behind her and raising his voice was actually more distracting than helpful.

My friend could have easily gone off on this guy, yelled back, and from some people's viewpoints, she would have been justified in doing so. But in the world of medicine, where there will be people like this, you have to learn to deal with them in an appropriate, healthy way (albeit not letting them walk all over you). Because if you let them get to you, it hurts only you, not them.

My mom, who is a hospice nurse, and I talked about this topic this morning. She reminded me of a biblical proverb:

A kind word turns away wrath, but a harsh word stirs up anger.

While I'm not a religious person, I do believe in this sentiment. If you respond in kind to harsh words, things tend to escalate and get worse. That's not to say you let yourself be a doormat - you can have a backbone but still be respectful and professional.

That's how I want to handle such situations when I'm in medical school, and when I am a physician. And now is a great time to start doing just that.

Health Literacy: My New Mission

In my last blog post, I wrote, in general terms, about the freelance work I am doing for Joint Commission Resources. I mentioned that not only am I getting paid, I feel that I am getting paid to learn. In this post, I want to share some of the things I have been learning.

One of the projects I am working on is continuing education PowerPoint presentations for nurses. My role is to write quiz questions (which is really fun, but challenging as well), develop new lesson objectives, and adapt the lessons as needed to meet updated Joint Commission standards. Which, of course, requires me to closely read (scrutinize, really) every single slide of every single lesson. Originally I thought this task would be tedious and boring. On the contrary. I have learned some very interesting things about health care, things that I honestly am interested in incorporating into my future career as a physician-scientist.

The lessons I have been working on lately have dealt with health literacy and patient communication. As a Spanish medical translator, I know how critical it is to have trained translators, and to ensure that medical information is presented in a manner that every patient can understand. Quite often that means that the physician needs to tailor his or her explanations and demonstrations to a person's level of education, for example.

But the concept of "health literacy," at least in those specific terms, was new to me. The definition of "health literacy" on the U.S. Department of Health and Human Services Health Resources and Services Administration's Web site is:

"The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions."

OK. We all know that doctors sometimes present complex information that doesn't seem to make much sense unless you've been to medical school. But even basic health information isn't so basic if you don't speak English, don't read, or have some cognitive impairment, for example. Or if you are under stress (which happens a lot if you are sick!). That's where it becomes necessary for health care practitioners to engage with patients in a way that the patients can understand what is going on. That might mean using a translator (which is what I do), using visual aids, or other methods. There are many tools and strategies that I didn't know about - tools I found very interesting, and potentially useful for me in the future.

One of those strategies is called Ask Me 3™, a campaign developed by the National Patient Safety Foundation. This is what the NPSF's Web site says about the program:

"Ask Me 3™ is a patient education program designed to promote communication between health care providers and patients in order to improve health outcomes. The program encourages patients to understand the answers to three questions:

1. What is my main problem?

2. What do I need to do?

3. Why is it important for me to do this?

Patients should be encouraged to ask their providers these three simple but essential questions in every health care interaction. Likewise, providers should always encourage their patients to understand the answers to these three questions.

Studies show that people who understand health instructions make fewer mistakes when they take their medicine or prepare for a medical procedure. They may also get well sooner or be able to better manage a chronic health condition."

Encouraging patients to focus on these three basic - but key - questions engages patients in their care in a way that strips things down, removes some of the unnecessary complexity, from the situation and hopefully empowers them to make those "appropriate health decisions."

On the Ask Me 3™ Web site, there are also links to resources to help in other ways. One way in which patient encounters can get out of hand - from a complexity standpoint - is through word choice. So the NPSF has a PDF document entitled Words To Watch (in both English and Spanish) which lists difficult words - and then simpler, but appropriate, alternatives. For example, rather than ask whether someone's pain is "intermittent," you could ask whether the pain is "off and on." Definitely something to think about as I venture into the health care field myself, eventually.

But this information is not just for my future. As a Spanish medical translator, I hope to bring some of these tools and techniques into the free clinic where I work. Because really, nearly, if not all, the patient population at the clinic has low health literacy. And that can reduce the effectiveness of medical intervention.

But it is not only "LEP" - limited English proficiency - patients who struggle with health literacy. It is important to remember that there are many groups of people who are at risk for low health literacy, and also that even people who have high incomes and are educated can have low health literacy. In other words, health literacy can be an issue for anyone. 

Here are some interesting, perhaps frightening, statistics about health literacy from the NPSF:

- The health of 90 million people in the U.S. may be at risk because of the difficulty some patients experience in understanding and acting upon health information.

- Literacy skills are a stronger predictor of an individual’s health status than age, income, employment status, education level, or racial/ethnic group.

- One out of five American adults reads at the 5th grade level or below, and the average American reads at the 8th to 9th grade level, yet most health care materials are written above the 10th grade level.

- Limited health literacy increases the disparity in health care access among exceptionally vulnerable populations (such as racial/ethnic minorities and the elderly).

- According to the Center for Health Care Strategies, a disproportionate number of minorities and immigrants are estimated to have literacy problems:

• 50% of Hispanics 

• 40% of Blacks

• 33% of Asians

- More than 66% of US adults age 60 and over have either inadequate or marginal literacy skills.

I don't want my patients to ever leave the exam room not fully understanding the answers to the three questions that the Ask Me 3™ campaign promotes. And knowing that now, before I even get into medical school, is pretty amazing. Like I said, I'm getting paid to learn. It's a pretty sweet deal, if you ask me.

Getting Paid (and paid to learn)

My Facebook post Thursday afternoon was as follows:

I'd almost forgotten the great satisfaction of successfully making a deadline, and knowing that I'll actually get *paid* for the work I've just completed. Key word: PAID.

In the last two years, I have worked insanely hard in school. Exams, lab reports, homework assignments ... a flurry of academic activity. It was very rewarding, to be sure, to be learning new and fascinating material (and to receive stellar marks for my efforts). But there is something about the work world, about completing a task and receiving monetary compensation for it. I'm not saying that it is more rewarding, just rewarding in a different sense. While in school, your efforts lead to greater understanding and knowledge (definitely a good thing); with paid work your efforts lead to financial independence and an ability to afford what you need (and sometimes what you want).

As I said, I am not touting one over the other, just that they are different. And I am enjoying feeling the sense of satisfaction that comes from earning money. Not that I believe that money is the key to happiness. However, right now I am in some debt - not terrible, but debt nonetheless - and doing some paid work will allow me to eventually pay back that debt, which will be a fantastic and freeing feeling.

It's been more than three years, since March of 2009, that I have had a paid job. At that time, I was a textbook editor for McGraw-Hill in downtown Chicago. Monday, March 2, 2009, more than 40 editors, including myself, were laid off. We had only hours to clean out the cubicles that we had decorated and nested in to make our homes for eight hours out of every day of the work week. It was a traumatic and terrible experience.

I went on unemployment and began looking for a job (a fruitless search). However, prior to being laid off, I had been thinking about returning to school to do a post-baccalaureate pre-medical program, and soon I decided that this would be the perfect time to do just that. So I did. And I never looked back.

Now that I have postponed my medical school application, though, I am back in the working world as a freelance writer and editor - back to my roots, so to speak. And honestly, I am enjoying it. Not that I want that as my lifetime career; I have already determined that. In fact, it is in part the content I am working with that has made this freelance work so interesting and engaging to me.

Serendipitously, I called a good friend a few weeks ago to chat. We hadn't talked in a few weeks, and I wanted to know how she was doing. She works as a senior editor for Joint Commission Resources, which is the publishing arm of the Joint Commission. The Joint Commission is the organization that develops standards to regulate, and then accredits, hospitals and other health care facilities. Part way into our conversation, out of the blue, she asked whether I wanted to do some freelance work for Joint Commission Resources. I was just about broke at the time, scrambling to make ends meet and searching (fruitlessly again) for jobs. Of course I jumped at the chance.

Really, I did it for the money. I'll be honest. But, serendipitously again, I have been learning a great deal through the revision work I am doing - in addition to gaining that feeling of satisfaction from doing work and getting paid for it. You can't get much better than that, can you?

The Way Out Is Through

If you recognized the title of this post, CONGRATULATIONS! You and I have more in common than a love of science and medicine - we also have in common a thorough knowledge of the Nine Inch Nails music catalogue.

Seriously, though, the title of this blog post is a meaningful one for me now. With all that has been going on in my life - serious upheaval and loss and decision-making - the song I reference in this blog post title (which is from NIN's double-album, "The Fragile"), and its lyrics (while simple) are quite poignant to me right now. I would like to share them:

"The Fragile" album cover

"The Way Out Is Through"

all I've undergone
I will keep on
underneath it all
we feel so small
the heavens fall
but still we crawl
all I've undergone
I will keep on


I know, I know ... Nine Inch Nails has a reputation for some serious negativity. That reputation is partly deserved (although only partly, if you know Trent Reznor's later music). But that's besides the point. The point is that when you are "underneath it all," the way really is through - through the difficulties, the pain. That's how you get past it. But even when "the heavens fall," perhaps when we feel like we can't stand up in the darkness, we can still crawl, and keep on. The opening and final lines, "all I've undergone / I will keep on" are so on-point as well - after going through so much, I don't want to give up. I refuse to.

I will keep on. No matter what.