Let It Burn

One thing I learned from my ex-husband was how to make a good music mix. So when "Ticket To Ride" popped into my head (see my previous post), I decided to make an MCAT inspirational mix. I would like to share those songs on my blog, in the hopes that they might inspire others.

The next song on my playlist, after "Ticket To Ride," is "The Fire," by The Roots:



The music is catchy as heck, and the lyrics are phenomenal. The chorus alone makes this song an amazing inspiration:

There's something in your heart

and it's in your eyes

It's the fire, inside you

Let it burn

You don't say good luck

You say don't give up

It's the fire, inside you

Let it burn

It's all about keeping that fire burning, not giving up, achieving your goals, even in the face of hardship. That's a good perspective to keep in mind when facing something as daunting as the MCAT, or anything else for that matter.

Here are the rest of the lyrics, for those who are interested:

"The Fire"

(feat. John Legend)

[John Legend]

Ohhhh, the fire, the fire

Ohhhh, the fire, the fire

[Chorus: John Legend]

There's something in your heart

and it's in your eyes

It's the fire, inside you

Let it burn

You don't say good luck

You say don't give up

It's the fire, inside you

Let it burn

[Black Thought]

Yeah, and if I'm ever at the crossroads

and start feeling mixed signals like Morse code

My soul start to grow colder than the North Pole

I try to focus on the hole of where the torch goes

In the tradition of these legendary sports pros

As far as I can see, I've made it to the threshold

Lord knows I've waited for this a lifetime

And I'm an icon when I let my light shine

Shine bright as an example of a champion

Taking the advantage, never copping out or cancelling

Burn like a chariot, learn how to carry it

Maverick, always above and beyond average

Fuel to the flame that I train with and travel with

Something in my eyes say I'm so close to having the prize

I realise I'm supposed to reach for the skies

Never let somebody try to tell you otherwise

[Chorus]

[Black Thought]

One love, one game, one desire

One flame, one bonfire, let it burn higher

I never show signs of fatigue or turn tired

cause I'm the definition of tragedy turned triumph

It's David and Goliath, I made it to the eye of

the storm, feeling torn like they fed me to the lions

Before my time start to wind down like the Mayans

I show 'em how I got the grind down like a science

It sounds like a riot on hush, it's so quiet

The only thing I hear is my heart, I'm inspired

by the challenge that I find myself standing eye to eye with

Then move like a wise warrior and not a coward

You can't escape the history that you was meant to make

That's why the highest victory is what I'm meant to take

You came to celebrate, I came to cerebrate

I hate losing, I refuse to make the same mistake

[John Legend]

Ohhhh, the fire, the fire

Ohhhh, the fire, the fire

[Chorus]

[John Legend]

Ohhhh, the fire inside you

The fire inside you

The fire inside you

The fire inside you

The MCAT: My Ticket

Exactly three months from tomorrow, on May 23, I take the MCAT. It's the equivalent of D-Day, a potential turning point in my long pre-med journey. Hopefully a positive turning point, with a "victory" (a good score). Given that I want to do an MD/PhD, a victory for me means scoring at least a 35, out of a possible 45. That might not sound difficult, but the national average in 2011 was about a 28. Most people are happy if they get a 30. So naturally, I've been a bit nervous about the whole thing.

But about two weeks ago, I had an epiphany. I realized that I could look at the MCAT in one of two ways: either as standing in the way of my getting into medical school, or as my ticket to getting into medical school. Regardless of which way I view this exam, I need to study my butt off. But having a more positive outlook, I think, will help me be more confident. And confidence, when it comes to standardized test taking (or to anything for that matter), can make a huge difference. Self-doubt, on the other hand, is most certainly not a recipe for success.

Being a musical person, as I pondered the word "ticket," a song popped into my head: The Beatles' "Ticket To Ride." Granted, the majority of the song's lyrics have nothing to do with my situation (thank goodness). But one memorable chorus line definitely does:

She's got a ticket to ride

But she don't care

The MCAT is my ticket. And I don't care what else is going on, what distractions may come my way. I will focus on my ticket. Because one way or another, I am going to ride.

Health Care: A Risky Business

There are, clearly, risks associated with becoming any health care practitioner, including a physician. One potential risk that comes to mind is an accidental needle stick. This can transmit bloodborne pathogens such as HIV or hepatitis. Obviously not good. Thankfully, I have never experienced that. However, this weekend I did experience the dangers of the health care profession firsthand.

A classic scabies rash.

I likely have scabies.

My mom is a hospice nurse, and one of her patients was recently diagnosed with this skin condition, which causes extreme itching and skin lesions. I have been itchy the last couple of days but attributed it to the cold Chicago winters and dry skin. But this morning, I was literally scratching head to toe - not normal. My mom put two and two together (and she has a couple of the classic scabies lesions on her arm) so we both went to urgent care. The physician there said she couldn't make a definitive diagnosis, but she said we needed to be treated regardless. This involves literally putting a cream on your entire body, leaving it for 8 to 14 hours, and then washing it off. Like with a lice infestation, you also have to wash all your sheets, clothing, etc. A big hassle.

An image of the mite the burrows
into your skin (and lays eggs
there), causing scabies

My mom was at first so embarrassed and upset. But I just laughed. What else could we do? It happened, there was nothing to do about it now. It was nobody's fault. It's an adventure, a learning experience. And I will definitely now know the signs of scabies should I ever treat someone with it!

When you go into health care, you have to be prepared for such risks. It's easy to say you are. But less easy to deal with the consequences if it actually happens. I'm very glad this wasn't a serious issue, and it's one that is relatively easy to treat. At the same time, my reaction to it makes me aware that I seem prepared for health care-associated risks, not daunted by them. That is a good sign, I think.

New [Mouse] Surgeon on the Block

Until a couple of weeks ago, I had mainly been doing genotyping at my lab job. I've got it down to a "science" (pun intended). I've been getting great results, which is wonderful. But I was itching to learn some new techniques. Well, I've gotten my wish.

My supervisor is teaching me animal surgeries. She has dozens of these to perform in the coming weeks and months, and wants someone to help reduce her load. And of course, I'm thrilled to learn something so practical for my future career as a physician-scientist, especially given that the mouse is the most frequently used animal model for diabetes research, which is what I want to do.

The first technique I learned (and am now pretty good at) is called an ELW (Excess Lung Water) procedure. It involves nebulizing mice with LPS, which basically gives the mice a septic lung infection, and then measuring various aspects of their lungs and blood. The most difficult part is taking a blood sample from the inferior vena cava, which you can imagine is pretty tiny in a mouse. And given that I've never really handled a syringe before, getting that needle in and then pulling the plunger back (with the same hand) was at first a challenge. But Thursday I performed my first ELWs on experimental, as opposed to practice, mice, and all went relatively well. (Except for one thing, which I will talk about in another post.)

The other procedure I'm learning is much tricker, and I've only mastered the first half. The purpose of it is to clear the mouse's lungs of blood so they can be used for other experiments, such as histology, sectioning, etc. Cutting out the lungs is the easy part. The more difficult parts are putting the mouse on a ventilator (yep) and catheterizing the heart. Getting the mouse ventilated involves cutting part way through the trachea (again, quite small in a mouse), inserting a trach tube, and then hooking that up to a ventilator machine. The hard part is all the manipulations you have to do with your forceps prior to getting the trach tube in - for example, getting the 90-degree forceps under the trachea without causing the mouse to go into tracheal spasms (so you can pull through silk thread to eventually secure the trach tube). At first, I really struggled with getting that trach tube in. But I am quite good at it now, which is very exciting progress for me. 

After getting the mouse on the ventilator, I heparinize the mouse to prevent blood clots, again through the IVC. Not that bad, considering I now am pretty decent with the ELWs. Another challenge after heparinization is catheterizing the heart. A mouse's heart is literally the size of my pinky fingernail (and I have small hands). You have to get silk thread under the pulmonary artery, cut off half of the atrium, cut the aorta/IVC, and then slice slightly into the left ventricle to insert a small catheter. You then feed the catheter up the heart, into the pulmonary artery, so the fluid (PBS) going through the catheter will clear the lungs. This part of the procedure I am not so good with yet, but I am making progress. "Paso a paso," one step at a time.

It's slightly amusing to me that I am doing these procedures, and really enjoying learning them, given my past history with animal dissections. When I was a kid in homeschool, my mom would go to the butcher and get meat remnants (eyeballs, a pig head, various organs) for us to dissect. My sister would totally go to town with them, using a surgical kit that my dad, a physician, lent us. I wasn't afraid of the dissections, but neither was I interested in them, so I hung back, watching. Now I'm totally into it, and thrilled to be expanding my skill set, as well as becoming more useful in the lab.

Anatomically Correct HEELS?!

Google search terms: 
"inferior vena cava."
One result: 
See these photos of high-heeled shoes. 
Flickr caption: 
"Can you spot the inferior vena cava?"
My reaction: 
"Can I wear these when I take the MCAT?"

Patient Education: It Can Make All The Difference

I volunteered this week at the free clinic where I am a Spanish medical interpreter. I was reminded of a very important lesson: the need for patient education.

As I have mentioned previously, I am very interested in endocrinology and diabetes (both the research and clinical aspects). The Latino population in general is at a higher-than-average risk for diabetes, so a large proportion of the patients with whom I work have this disease.

A diabetic patient came in with high daily blood sugars as well as a high HbA1c (the test that monitors blood glucose over a 3-month period). The physician who patient saw was somewhat frustrated at the fact that his diabetes was uncontrolled, because the patient was on a high dose of NPH insulin.

So the doctor probed the patient. Did he ever skip doses of his meds (including the insulin)? Was he taking his insulin twice a day as prescribed, X units in the morning and Y units in the evening?

Turns out that the answer to the second question was "no." And not because the patient was trying to be noncompliant. He was taking all (X +Y) units of insulin once a day, because he had previously been on Lantus. He didn't understand that Lantus is a long-acting insulin, which means you can take it only once a day, while NPH is intermediate acting, which means you have to take it twice a day to appropriately control your sugar. (The reason he had been switched from Lantus to NPH was that the clinic pharmacy had run out of Lantus, an unfortunate occurrence which sometimes happens given that all the medications at this free clinic are donated.)

When the doctor explained this clearly, it was like a light bulb went off for the patient. He said he just didn't know, and thought that it was OK to keep taking the insulin the same way he had been taking it before. He agreed to make the change right away.

It is true that sometimes patients are just noncompliant, and that leads to uncontrolled conditions. But other times, they simply don't understand the (often very complicated) instructions they receive. Language and education barriers make this all the more difficult. And so it is the responsibility of the physician to make sure the patient does understand, so that he/she has the tools to control the disease, whatever it might be. A good lesson to remember as I make my way toward a career in medicine.

Death In The Line of Duty: The Ultimate Sacrifice

The Friday, Dec. 14 shooting at Sandy Hook Elementary School has citizens across the United States, and the globe, mourning. And thinking. In part, about ways (such as more stringent gun control) to try and prevent such tragedies. It has the Newtown, Conn. town thinking about how to move forward amid the grief and shock. According to a Chicago Tribune article I read this morning, people across the town are taking down Christmas decorations, saying that celebrating a festive holiday during a time like this is unthinkable.

This tragedy, a massacre of 20 young students and 6 school staff members, got one of my friends, who is an education major, thinking about something else. Something more personal. I spoke with her yesterday on the phone, and the shooting came up (as I know it has among so many conversations in the last couple of days). She just finished a semester of class observation at a local middle school. Over the course of the past semester, she has told me multiple times how much the students meant to her, how much - even though they were not her own students - she cared for them and appreciated them. And yesterday, she told me all she wanted to do was go to the school and give each and every one of them a big hug, even though they would likely not understand why. She had thought long and hard about what it would mean to lose a student, and how that would affect her. And she could not even imagine what those community members, including those teachers, are going through right now.

But she also got to thinking about the school staff who literally gave their lives for their students. In that same Chicago Tribune article, I read about principal Dawn Hochsprung, in an attempt to overtake the gunman, paid with her life. And about 27-year-old teacher Victoria Soto, who tried to use her body as a human shield to protect her first-grade students, was also killed. One of Soto's friends, Andrea Crowell, was quoted in that Chicago Tribune story as saying: "She put those children first. That's all she ever talked about. She wanted to do her best for them, to teach them something new every day." That day, Soto taught her students about the ultimate sacrifice: death in the line of duty.

Which got my friend thinking: Would she, as a teacher, be willing to die for her students in the same way Hochspring and Soto did? Would she feel OK about giving her life in exchange for her students' lives? "And I decided that yes, I would," she told me. I felt shivers go down my back, and tears well up in my eyes. I told her that this was a profound moment for her. Then she told me that she had begun thinking of herself more as a teacher than as a college student. This realization, I told her, was evidence of that newfound association.

And in the course of that conversation, my dear friend got me thinking (as good friends do). Would I, as a physician, be willing to give my life for my patients' lives?

Granted, there are very few instances where teachers, or doctors, are called to do that. But I believe that  it is something that people who enter service professions such as medicine and education need to consider. As a teacher, you put your students first. As a physician, you put your patients first. Above yourself. Always.

People don't normally think of medicine as a "risky" or "dangerous" profession. They often think of it as a posh one, at least financially. But there are risks involved. When a you makes a treatment decision, for example, you risk angering a patient (or a relative) and having them come after you. While I didn't find a lot of examples of this on the Internet, I did find a few:
- 2007: a Chicago dermatologist was allegedly killed by a patient who (according the Daily Mail article I read) thought the acne medication he was given made him impotent
- 2009: a Las Vegas internal medicine physician was allegedly killed by a patient, possibly because he was in intense pain from prostate cancer and might have blamed the doctor (according to the Asian Journal article I read)
- 2009: a Kentucky physician was allegedly killed by a man whose motive may have been that the doctor denied him narcotics after the patient refused to give a urine sample (according to the Associated Press article I read)

Another risk to physicians is that of contracting a contagious disease during the course of treatment. In an American College of Physicians article posted on the AMA Web site, called "The Physician and the Patient," there is a section on the "Medical risk to physician and patient." The article clearly states that doctors must put their own health second to that of their patients', and that refusing treatment to patients with potentially dangerous conditions is out of the question, ethically. Here is what the article had to say on the subject:

"Traditionally, the ethical imperative for physicians to provide care has overridden the risk to the treating physician, even during epidemics. In recent decades, with better control of such risks, physicians have practiced medicine in the absence of risk as a prominent concern. However, potential occupational exposures such as HIV, multidrug-resistant tuberculosis, and viral hepatitis necessitate reaffirmation of the ethical imperative ... Because the diseases mentioned above may be transmitted from patient to physician and because they pose significant risks to physicians' health and are difficult to treat or cure, some physicians may be tempted to avoid the care of infected patients. Physicians and health care organizations are obligated to provide competent and humane care to all patients, regardless of their disease state. Physicians can and should expect their workplace to provide appropriate means to limit occupational exposure through rigorous application of infection control methods. The denial of appropriate care to a class of patients for any reason is unethical."

Whether a teacher, physician, police officer, firefighter, or other service professional will, indeed, give up their life in an emergency situation may be difficult to predict until the situation presents itself. But it is definitely something to consider.

For myself, and for those of my readers wanting to practice medicine someday, let us ask ourselves: What would we risk for our patients?