A Diabetic Condemnation

I don't often describe myself as "flabbergasted." First of all, I think it's an odd word. Second of all, it takes an awful lot to shock me that much. But I was definitely in a state of flabbergast today.

The stimulus? A rather traumatic translating session at the free clinic where I volunteer.

It all started out rather routinely. The patient was a middle-aged woman with unregulated diabetes. Her blood glucose -- which should be around 90 mg per 100 ml of blood -- ranged from the mid-100s to 200, according to the self-checks she did at home. This morning at the clinic, it was quite a bit above 200, and her previous visit it had been above 300. Not good. Really not good. Clearly, her current combination of medication and lifestyle wasn't working. But insulin wasn't an option, as she had tried it previously and suffered side effects that made her afraid to take it again.

The physician I was working with was obviously frustrated at her lack of improvement. He asked me to ask her what she'd eaten for breakfast, thinking that perhaps a sugary meal was to blame for the high blood sugar that morning. Turns out she had a licuado (shake) made of banana, strawberries, and milk, plus an apple. My guess is that she thought she was being healthy, while what she was really doing was causing her blood sugar to skyrocket with all of that natural sugar. (Yes, it's natural, and yes, it's fruit, but it's still sugar.)

The doctor shook his head. "She's eating like she's going to the electric chair," he said, half to himself, half to me. But clearly not to her. "Don't translate that," he hurriedly added.

I just sat there, a plastic smile on my face. What was I supposed to say? As a translator, I'm supposed to repeat everything that is said in the exam room in the other language so that it is as if there were no language barrier. But I couldn't bring myself to repeat those words. Less for fear of angering the physician than for fear of horribly upsetting the patient. But, I will admit, both fears were active.

I'm not saying the physician had any ill will toward the patient. Quite the reverse -- he was vocalizing his frustration at her non-compliance, her lack of improvement, and her potentially grim future. (The complications of diabetes include kidney, heart, vision, and circulation problems, among others.) But he did it in a way that was not inclusive, that didn't engage the patient, but rather left her out of the loop at her own doctor's appointment -- a place where she deserved to understand everything that was going on.

I don't know what I should have done. But I know what I won't be doing when I'm a physician.

The Laws of Motion (& My Thoughts)

To paraphrase Newton (and my physics book): An object at rest remains at rest as long as no net force acts on it. An object in motion (with constant velocity) remains in motion, with the same speed and in the same direction, as long as no net force acts upon it.

Question: Does Newtonian Dymanics apply to one's thoughts?

My thoughts, you see, seem to be traveling a million meters per second. Without an opposing force, they show no signs of slowing down. And physics is the culprit, the force that put my thoughts in motion in the first place.

Well, maybe not physics itself. My fear of physics. Even more precisely, my fear of not doing well in physics.

I realize that this is a rather irrational fear, one not based on any evidence. So far, I am doing quite well in physics -- I believe I am near the top of my class, in fact. A's on my homework, labs, quizzes, even my first exam.

I have an A in the class. So why am I afraid of it?

I'm not sure. Perhaps because physics doesn't come to me quite as naturally as chemistry or biology do. I really have to wrestle with the material in physics, sometimes on a problem-by-problem basis. It's tough and taxing. Or maybe I'm scared because I have seen people work really hard in other subjects and NOT get the result (i.e., the grade) they wanted, and I see the possibility of that happening to me in physics. They don't give out A's for effort, after all. Or maybe I'm letting the pressure get to me a bit, all the talk about needing to keep your grades up, to do well in your post-bac courses ... and I'm afraid that if I don't ace physics this semester and next, I won't achieve my end goal: getting into medical school.

Regardless of the reason for why physics produces a sinking feeling in my stomach, I need to deal with it as best I can. I don't think I'm going to transform my viewpoint and suddenly *poof* love physics (although I do find it interesting). No, I don't expect magic.

But I do need to exert a force on my thoughts to slow them down. Because according to Newton's laws, they'll just keep going unless I do something.

So here's my plan: surround my physics experience with positivity. That doesn't mean light scented candles or sing happy songs while I do my physics homework problems (too distracting, not to mention just plain weird). No, what this strategy means to me is that when I wrestle with a problem (or maybe more like five or ten of them), I reward myself in some way. I call or e-mail a friend, write a short blog post, or read (a non-school book) for 15 minutes. Do something positive after physics problems so that I associate the two. Ergo, physics doesn't seem so scary.

Will it work? Will the force I exert through my "positive associations" be enough to slow my racing thoughts? I don't know. There's only one way to find out. So here goes.

(Note: Giving myself the time to write this blog post was a "reward" for doing more than a dozen physics problems today in preparation for an upcoming test. And let me tell you, I feel pretty good about things at the moment ...)

Medicine: East and West

In mid-September, I attended a lecture on traditional Chinese medicine at Dominican University. I wrote this essay as an extra credit assignment for my biology class, but thought I would share it here as well.

When I think of the field of medicine, I think of procedures, treatments, and methods based on years (sometimes decades, or more) of rigorous research and scientific inquiry. With a father in medicine and a mother in nursing, that’s simply how I grew up. But my parents – and my liberal arts education – also taught me to approach new information with an open mind.

At Tuesday night’s lecture on Traditional Chinese Medicine by visiting Fullbright scholar Chia-Feng Chang, that was sometimes a challenge for me. Not because I went in with a closed mind, but because the core beliefs and philosophies of Chinese medicine are, in some respects, simply so very different from those of Western medicine. That said, I did take away from the lecture that there is more than one way to conceive of “medicine.” And I believe that each tradition deserves respect, regardless of one’s personal beliefs.

As a pre-medicine student, my plan is to focus the next several years of my life on studying the “hard” sciences – introductory classes such as biology and chemistry, and upper-level courses such as anatomy and immunology. So I had to keep my jaw from dropping when Dr. Chang said, “Anatomy is not essential to Chinese medicine.” Rather, she went on to say, practitioners of Chinese medicine see the body as an integrated whole rather than an assortment of parts. My immediate reaction to that was that, “Well, don’t you need to understand the parts to understand how the whole works?” I had a hard time wrapping my brain around Dr. Chang’s perspective, at a very basic level.

Another component of Traditional Chinese Medicine that was difficult for me to understand is in the field of pediatrics. According to Dr. Chang, Traditional Chinese Medicine physicians would examine the three middle fingers of a baby or young child and make diagnoses based on characteristics observed only from those fingers.

I think I found these aspects of Traditional Chinese Medicine difficult to comprehend because at its roots, Chinese Medicine is based not on scientific experimentation, but on the structural similarity of the human body to water, nature, and the heavens. In seeing these similarities, Chinese Medicine practitioners developed a theory that blood and Qi (energy) flow through a series of of  “circulation channels.” They then believe that all illness is due to congestion or blockage of Qi and blood. To cure an illness, the blockage must be relieved and flow and harmony restored to the body.

While the mystical aspects of Traditional Chinese Medicine do not appeal to me, they do to many people. And I personally know people who have benefitted from Chinese medical practices such as acupuncture and herbal remedies. So while I lean more toward Western medicine myself, I know it is not the only path. I respect the other paths; they are just not my own.

Caritas et Veritas: Love and Truth

On September 28, I attended a symposium at Dominican University about our school's motto: Caritas et Veritas, "Love and Truth." I wrote this essay as an extra credit assignment for my biology class. I thought it important enough to share here, too.


I couldn’t have asked for a better birthday present. Exactly 29 years after I entered this world, I was sitting in the Old Pool room at Dominican University listening to a discussion about how our school motto (“Caritas et Veritas” — “Love and Truth”) plays out in science and math courses. While not everyone’s birthday wish, perhaps, nor cause for celebration in everyone’s estimation, it was exactly what I wanted to be doing that day. Of course, the Caritas et Veritas symposium wasn’t held just for me – I’m not quite that egocentric – but I certainly took away plenty from it, on a personal level. And not necessarily what I’d expected ...

I’m a post-bac pre-med student. So clearly, I’m interested in science. What not everyone knows is that I’m also interested in literature. In fact, I was a high school literature textbook editor for nearly two years, specializing in American and English lit. So when I saw the lecture title, “A Gradual Dazzling: The Nature of Truth in Literary Studies,” my heart skipped a beat.

But honestly, the first three speakers (on ancient Greek drama, Romance literature, and contemporary Irish poetry, respectively) bored me. Not because the subjects were boring, but because the speakers were boring: they simply read from their (very technical, very specific) papers. I found myself struggling to follow along. Then Ellen McManus got up to talk about the field of Literary Studies, and trends in the field. I found myself wishing she had spoken for the entire hour. Each progression of the field, starting with the T.S. Eliot-inspired “New Criticism” (which saw literature as telling a special “slant” truth different from psychology, science, religion, etc.), to Postmodernism (truth is an artifice in ALL texts), to the influence of cultural / queer studies on literary studies (you must uncover the historical truths embedded within the context of the text) fascinated me. But the most recent development – called “Consilience” – has me rapt. Believers in this philosophy of literary study are also called “Literary Darwinists.” They draw on evolutionary science to understand literature, and believe that different kinds of knowledge (i.e., science, psychology, literature, etc.) should be linked together in a nested way. I find this philosophy, also called “vertical integration,” very interesting. I desperately want to find out more about it. (Note: I have already contacted Dr. McManus via e-mail and gotten her recommendation on two books about Consilience that she thinks are good places to start. My Amazon.com order is supposed to arrive this coming Wednesday ... and I can't wait.)

After the literature seminar, I attended “What does Caritas et Veritas Mean in Science & Math Courses?” I was interested in this lecture both because I am taking three science courses (physics, chemistry, and biology), and also because my chemistry professor, Dr. Daniela Andrei, was one of the panelists. The panelists talked about how veritas – truth – is evident in that there is usually a “correct” answer in science and math courses. Caritas – love – they said, is evident in their interactions with students. One example they gave is that they work very hard to teach critical thinking skills to their students through encouraging participating, making connections between old and new material, figuring out what type of question they are being asked, etc. After that section of the presentation, I asked a question: whether the presenters thought they could really teach critical thinking skills to students at the age of 18 or 20, or whether students needed to enter college with those skills already learned (and primed to be perfected). It wasn’t a rhetorical question; I was really interested in the answer. But I felt the question was dodged, or perhaps misunderstood. Professor Aliza Steurer responded that she believed you could learn at any age. Which I agree with, on a certain level. However, there is plenty of research out there that shows that students who don’t learn certain basic skills by early elementary grades (i.e., reading and certain math skills) are essentially screwed for the rest of their education. Now, whether this is a product of the quality of those students’ education or the plasticity of the brain is another matter. But I really do wonder whether students need to have acquired some skill set by a particular age, and past that age (which may be somewhat dependent on the person), they just can’t. Or at least, not as well or as flexibly or with as much dexterity. Motivation figures in as well, in addition to whatever base level of intelligence a person has. And when you start talking about that base level of intelligence, you get into the nature vs. nurture debate, going back to infancy (and perhaps even the womb) ... it becomes a very complex issue with perhaps too many branches to keep track of at once.

I think I’m fascinated by the whole issue because I had a very non-traditional educational upbringing, and I often wonder how that has affected me. My parents are both very well-educated (a family physician and a nurse with her master’s degree), and they worked from the beginning to create educational opportunities for my two younger sisters and me. Reading was a constant activity in our house, from day 1, for example. But the really atypical thing was that we were all homeschooled for several years (my first year of public school was sixth grade). Of course, we had textbooks. But that was only the beginning of our education. Area museums provided hands-on science, history, and art exhibits to engage us on those subjects. The local butcher had what we needed for every dissection possible. Chicago’s ethnic neighborhoods offered the chance to study microcosms of the world’s countries, up close (including a taste of each country’s cuisine). On vacations, we studied ecosystems and plant and animal life. Life meant – means – learning. How did all of that affect the way I absorb, process, and maintain information? I don’t know exactly, but I believe the effect was a positive one.

But I digress. The last session I attended was “Seeking, Detecting, and Even Deleting the Truth: How Neuroscience is Changing Our Understanding and Powers Over Truth.” I will address the last two speakers first. While I found the subjects – using brain imaging as lie detection and drugs to delete memories – to be interesting ones, I find them extremely problematic. From the evidence presented, it seems that there are serious functionality issues with the lie detection / brain imaging idea. I certainly would not want it used to test my guilt / innocence at this point in time. In terms of the memory erasure idea, while it does seem to work in rats (which is fascinating), I see some ethical considerations in using this on humans. Also, I would be concerned as to how this would affect the rest of the memory system. I found these two topics very thought-provoking, but not particularly practical.

I connected more with the first presentation, which more about the philosophy of science as related to Veritas (truth). First of all, I found Dr. Scott Kreher’s* definition of truth – “Truth is how the world really is” – to be very interesting. Not that I disagree with it, at this point in my life. In fact, I find it very appealing. However, had you asked me 15 years ago, I would have responded with a much different definition of truth – “I am the Way, the Truth and the Life. No one comes to the Father but by me.” That Biblical passage still rings in my ears more than a decade after I (very decidedly) left my conservative religious upbringing behind in favor of a more empirical approach to the world.

Dr. Kreher’s definition (or perhaps explanation) of science also intrigued me: Science is a set of processes that allows us to approach the truth. (emphasis added) If you think about it, that’s so obvious. Scientists so often replace old facts, hypotheses, even established theories with new ones, based on newly discovered evidence. Practicing science requires a certain level of humility. Yet so many people look at scientific discoveries as unalterable FACTS. They don’t question them, or think critically about them. I think part of the fault there lies with the media (of which I used to be a member). A scientific paper or study will come out, and the evening news will report it in a skewed way, for maximum shock value, as a truth (or nearly so). When really, as Dr. Kreher said, “We’re always just approaching the truth.”

As I said, the Caritas et Veritas Symposium was like a gift. At each lecture, I received something to ponder, to take with me. Not merely because I went to the lectures. That’s not enough. But because I brought myself, open and vulnerable, and willing to refine my own definition and understanding of Caritas et Veritas, both in relation to my education and to my life in general.



* My biology professor

Lost & Found In Translation

It's allergy season -- especially for those sensitive to ragweed, like Maria Juarez. * She came in to see the nurse practitioner at a local free clinic reporting a runny nose, itchy throat, sneezing, and wheezing -- all of which had lasted for weeks. She used to take an inhaler, but had run out. Over-the-counter allergy medications made her sleepy. Maria wanted to know if there were any better ways of controlling her symptoms.

Sounds like an easy enough clinical encounter, right? Except that Maria spoke only Spanish, while the nurse spoke only English. That's where Mark * and I, Spanish medical translators at that free clinic, came in. Our job was to translate everything that was said from one person to the other to make sure the appointment went smoothly. 

For people who live outside their native countries and who aren't fluent in the second language, this happens all the time. But for those of us born and raised within the same borders, it's something we rarely, if ever, have to think about. But while you read this blog post, it's something I want you to actively consider.

It's so easy to take verbal communication for granted: understanding, being understood. That is, until you can't understand, or be understood. I know from experience that this position -- especially in the medical context -- feels like one of powerlessness, of vulerability. And it is. You feel at the mercy of those around you because you can no longer fend for yourself. Nor defend yourself, for that matter. You must take others at their word. What other choice do you have? 

I had no other choice. I was 15, in a foreign country. And we're not talking on the other side of the border here. We're talking across the ocean, across continents. In China. Beijing, to be more precise. I had a fever, sore throat, reduced appetite, and was generally miserable. Was it an infection? Some rare disease? My high school chaperone thought not, but took me to a doctor to be on the safe side. 

While many of the young students we encountered in Beijing spoke English, this doctor evidently did not. Gestures and body language will only get you so far. Fortunately, there was someone to translate the Mandarin to English. This was more than a dozen years ago, so I don't remember whether the translator was a member of the doctor's staff or had come with my chaperone and me, but no matter. She was able to make the situation clear: I had a throat infection, and should take antibiotics for a week or so. I remember the doctor handing me a bottle with lots of Chinese characters printed on it, which was a little frightening (not being able to read for myself what was in the bottle). But again, the translator came to the rescue and explained the dosing instructions and contents. We thanked the doctor and made our way back to our hotel, much relieved. 

Looking back on the situation, I completely took that translator for granted. Very Eurocentric of me, expecting there to be someone who could speak English (although I can hardly hold that against myself at 15). But what if there had been no translator? I doubt very much that the Chinese doctor's message would have gotten through, and I certainly would not have taken any of that medication without knowing exactly what it was and when (and how often) I was supposed to take it. 

And now I find myself in the translator's role. A human cultural-linguistic bridge. I am helping to transform that feeling of powerlessness into one of power, into ownership of one's health care. And that feels like a job very much worth doing.

* Names have been changed to protect people's privacy.

There's Always Room for JELL-O

Any halfway decent cook knows that you can't put certain fresh fruits -- kiwi, pineapple, and papaya, to be exact -- into gelatin (commonly known as JELL-O). Well, you can ... but the gelatin won't set. Which rather defeats the purpose of making JELL-O, doesn't it?

Any halfway decent scientist knows why. And after Monday's biology lab, all of the students in Dominican University's Biology class (including myself) do too.

I will explain. But to do so, we must zoom in to what's called the "particulate" world, the world we can't see with our own eyes ...

The failure of the gelatin to set has to do with a type of enzyme (protein) called "gelatinase" found in those tropical fruits. (In case you were wondering: Yes, these fruits do contain protein.) If active, gelatinase breaks down the gelatin protein found in your typical packet of JELL-O, preventing the JELL-O from setting.

How does this work? Understanding this phenomenon requires a bit of biology and a bit of chemistry. (But don't be scared! It's actually really cool how this works.) Proteins, such as the gelatinase found in the tropical fruit mentioned, are organic molecules that have very important roles in the function of living cells (including our own cells). One role that many proteins have is that of an enzyme, or biological catalyst. These catalysts basically facilitate chemical reactions in living cells by reducing the amount of energy required for those reactions to take place. Without these chemical reactions, life would cease. So proteins (as enzymes) are pretty important to us, and to other living things.

Enzymes function as a result of a very specific three-dimensional structure. This structure is determined by the DNA that "spells out" the instructions for making the enzyme. Each enzyme, then, has its own unique structure. Because of this individualized three-dimensional structure, each enzyme usually fits, in the same manner as a lock and key, with only one other molecule (called a "substrate") and catalyzes a reaction there. So each enzyme does one specific job. The enzyme will not function (act as a catalyst) if a different molecule is present. This property is called "enzyme specificity" or "substrate specificity."

However, proteins are very sensitive. If they get too warm, or the solution around them changes in pH (how acidic/basic the solution is), then the protein can lose its three-dimensional structure. And when that happens, the protein can no longer bind with its substrate -- the key doesn't fit into the lock anymore. This is called "denaturing" of a protein.

Now let's return to the "macroscopic" world, the world we can see unaided by microscopes and chemical models. The world of the lovely, green, sweet-and-sour kiwi ...

Like all good scientists, once we learned the principles of how enzymes work, we tested them out. Using (yes) kiwis and (yes) gelatin. Raspberry gelatin, actually. The experiment was simple, yet elegant, explanatory, and enlightening. Here is my data chart. I will explain it below.

Assay of Gelatinase From Fresh Kiwi Fruit
Tube No.	Contents of Tube	Gelatin set?	Active Enzyme present?	Is the tube a control or test sample?
1	gelatin + water	Y		negative control
2	gelatin + water	Y		negative control
3	gelatin + known gelatinase	N	X	positive control
4	gelatin + known gelatinase	N	X	positive control
5	gelatin + fresh kiwi extract	N	X	test sample
6	gelatin + fresh kiwi extract	N	X	test sample
7	gelatin + boiled kiwi extract	Y		negative control
8	gelatin + boiled kiwi extract	Y		negative control
9	agar + fresh kiwi extract	Y		test sample
10	agar + fresh kiwi extract	Y		test sample

We tested 10 tubes of solutions (five different mixtures, each mixture done twice to see if we got the same result). After mixing the solutions, we set them all in an ice bath to find out whether they would set into hard gelatin, or remain as liquids.

Tubes 1 and 2 had only gelatin + water (no gelatinase). These tubes were what is called a "negative control" -- they had a known negative test in an experiment (no enzyme activity). Tubes 3 and 4 had gelatin + a "known gelatinase" -- an enzyme from a pineapple prepared by our lab professor. So as predicted, they did NOT set because there was active enzyme present. These tubes were "positive controls"-- a known positive test (enzyme acting on the gelatin). Tubes 5 and 6 were test samples -- tubes we were interested in the results of. And they behaved as predicted -- the gelatinase from the kiwi extract did interact with the gelatin and prevent the gelatin from setting! Contrast this with tubes 7 and 8, which contained gelatin and boiled kiwi extract. Remember that heat will "denature," or unfold, an enzyme. That's exactly what happened -- boiling the kiwi rendered the gelatinase ineffective, so tubes 7 and 8 did set (more negative controls). Tubes 9 and 10 were filled with agar, another jello-y substance, and fresh kiwi extract. This time, we were testing the "enzyme specificity" concept -- would the kiwi's gelatinase also work on agar, as well as the gelatin? The answer, we found, was "no." The gelatinase is specific to the gelatin, and would not work on a different substrate (agar).

As I said, simple yet elegant, and very hands-on. My kind of learning.

An End To The Silence

The few of you following my blog (thank you, by the way) will have noticed that I did not post at all during August. Or if you did not notice that fact specifically, you probably did observe that a good while went by without so much as a whisper from me. No worries, nothing is wrong. I'm not sick, I'm not dying, and as you saw from my two recent posts, I have not changed my mind about becoming a doctor.

So why the silence? Reason #1: busyness. August was the-month-to-get-everything-done-before-school. And when you have a family, a house, a husband, and other such life elements, figuring out how to manage them on a totally different schedule takes some time, juggling, and preparation.

Reason #2: business. Yes, I have my own business, called The Artful Diner. As with most artists, I won't be able to retire off my income from it, but the extra money helps, and I enjoy it. As the name implies, my work has to do with dining. And indeed, I make decoupaged dishware and beaded / wire-wrapped utensils to sell online and at art shows. At the end of July, I heard about a local art fair that I really wanted to participate in. I signed up, paid my fee ... and then realized I needed more inventory. So I spent the next several weeks in full production mode. (My dining room -- aka my "studio" -- still looks like a hurricane swept through it, much to my husband's delight.) Here is a link to my Etsy.com storefront, and a few photos of my recent work.

My Etsy storefront link: The Artful Diner



Here are some coaster sets I have painted and decoupaged with marbled paper (this is a new thing I am doing now):

Another new item for my online store this season is pillar candle stands. These are flat pieces of glass, with paper (and often vintage ephemera) decoupaged on the underside, on which you can put a tall pillar candle. The wax drips onto the flat, glass surface, and you just scrape it off. Here are a couple photos of those:

A set of six small decoupaged bowls:

A decoupaged serving tray, complete with a stand:

So rest assured: I have not been idle with my time. Between the life busyness and my business, posting on my blog fell between the cracks. But I missed writing during that time, and especially writing about science and medicine, so you may also rest assured that I will not let that happen again.