Friday, May 27, 2011

The Art of the Written Word

I'm currently home at my parents house in the souther suburbs of Chicago.  At times when I'm here I look through some of my belongings / collections that have been left here, or perhaps stored indefinitely (until they move).  One of my desk drawers is full of letters, cards, pictures, sketches, poems, etc. all sent to me from various individuals over many years.  Chances are, if you have ever sent me or hand delivered to me or my mailbox something in envelope it is either in this drawer, in a box in the basement, or a drawer in my current apartment.  Yes I've kept them all.  From birthday cards that say "Happy Birthday to a special 7 year old" to a post card from NYC with a bum on the front holding a sign saying "Money for weed (at least I'm being honest)."  On occasion when I'm here I browse through my collection and always tend to return to about 9 or 10 "Letters of Note."  Sometimes these letters make me cry a little, usually they make me smile, but mostly they allow me to remember just how lucky I am to have had some of these individuals in my life.




The first, and perhaps most prized letter I tend to go back to is one from Gampi.  It was written from Long Boat Key, Fl on March 26th, 1992.  The letter talks about the beach and a pelican and how he when he gets home I'll teach him to do cartwheels and handstands.  He was the only grandfather I've had and a wonderful man.  I only with I could have known him longer.  He passed away in peace at home, though in a hospital bed with a morphine drip supplied by my mother.  He'd contracted Hepatitis C due to a blood transfusion that he didn't need after a cardiac surgery years before.  None of this really contributes the quality of his character though.  He was a man that if someone needed something done would be there, even if just to screw in a knob for a drawer.   A favorite story of my mother's regarding him was when he drove out onto LSD to pick her up in the middle of the past most famous Chicago Blizzard when she was about 20.  Cars were stuck then just as they were this year, except that year there were more fatalities.
My favorite memory was when he came to pick my sister and myself up from school in his big old conversion van one afternoon.  Now he often did just this but this day was different, and we weren't expecting him.  My sister, Courtney, and I always fought over who got the front.  Usually he would intervene but this day he didn't and Courtney won out. Chances are it was a race to the van when we saw him pull into the parking lot, I think that's how it usually went.  So I begrudgingly got into the back seat while Gampi chuckled at my disappointment.  However, in the back seat I saw a large cardboard box and inside that box a Sheltie puppy.  I was elated, on cloud nine, couldn't have asked for a better afternoon.  This pup was soon dubbed Duke and if you thought a child loved going to their grandparents house before, well after this that was the only place I ever wanted to go.  I adored dog for quite some time.  

Gampi was self made man, hard working, successful, and artist, a photographer, and animal lover, a dreamer, a prankster, a ketchup lover, a migrator (yes Florida in the winter) a friend and neighbor, an honest businessman, a father, a grandfather, an explorer, a reader, just someone who lived every day God gave him to the fullest even up until his last.  Him and my grandmother were always quite the pair.  They were two people who knew how to live life right.  I hope have half the joy and zest for life he had, liver failure and all.


The second letter I came across that really struck me this evening is one from sister, sent with a birthday gift my freshman year of college.  Of course everyone is a little homesick their freshman year and birthdays are a little lonely when you've only been at school 500 miles from home for two weeks and your day happens to come.  So this letter was very welcome, though perhaps worsened some of the homesickness.  For the life of me I can't remember what all came with it, but I suppose that indicates where value in life lies, not necessarily with "things".  This was a remember when note.  A few bullets from it.  Dear S'more, Remember when... "We went and played under the bridge by the creek"  "We used to try to hide from Kelly Flanigan... always to no avail in the end"  "We made a fashion show in the basement"  "We played dream phone until we had to photocopy the sheets because we used them all up"  "Everyone used to argue because no one wanted to put the lane lines in"  "we used to play ninento over and over and over"  "We made a lemonade stand on the golf course"  "Caroline and Katy wanted s'mores and Amy and Courtney wanted oreos, so we split into 2 camp and were forever more s'mores and oreos"    She ends her letter with encouraging me to think of more and send them her way.  I regret to say I don't think I ever did this but better late than never.  
Oreo, Remember when we got welts on our legs from running through the golf course sprinklers?  Remember when we used to sled down our driveway and go airborne over the slow plow ice?  Remember when you used to paint our nails with tinker bell nail polish and days mom was going shopping so we'd be occupied picking it off the whole time she was trying on clothes?  Remember when we would ride out bikes to the Trolley barn for lunch and then the creamery for dessert?  Remember when it used to take me 30 minutes to eat a small vanilla ice cream cone?  Remember calling a special someone "Dudah" and then all of a sudden we started to get in big trouble it?"  Remember when we had two fish that always got ick?  Remember tweets...?  Remember having to wake up at sunrise to go out on the boat, and then eat lunch on the boat, and then stay on the boat all day because we had to get every minutes worth of time out of it?  Remember helmet girl (goodness what was here name, Tess? Tara?..?) in our Ski school class at Boyne every year?  Just a few things for memory's sake :)

Goodness I'm sappy this evening.  Not sure where that all came from

A third letter of note for the evening comes from one of my old roommates mothers of all people, Mrs. Leila Mischer.  Now most people here don't know Leila, if you did you'd understand the extra charm it adds to the letter.  Now my own mother also has a tendency of writing a monthly note her three children (though these have been lacking recently... hmmmm) that I value but this note came out of the blue.  Mrs. Mischer has by no means been a stranger to me since the summer before jr year of college.  I was moving into a house her daughter, Morgan Jane, and another friend of ours Maria Cowley.  So Leila came up to Memphis early to help buy some things for the house to check everything out.  While she was there I was about to take a final in 1 of 2 Physics courses I was taking over the summer as well in the middle of a lot of lab work and still volunteering.  Typical pre med student...   Thus my first encounter with Leila rushing through Target and Bed Bath and Beyond and Macy's and you name it.  Throughout the following two years i saw her on and off as she was traveling through Memphis, or at Rhodes to see a field hockey game, or graduation.  I also spent some time at the Mischer house in Houston for Morgan Jane's debutant ball.  Mrs. Mischer is without a doubt the most gracious hostess I have ever met.  This was again reinforced after a stay at their house in near Vail.  Well, this specific letter came after a dinner I'd shared with her, Morgan Jane, and another roommate (Katie) and her boyfriend at the time. This evening I was a little frustrated because I'd also been asked to invite a guest to dinner and he refused to come.  Nothing out of the ordinary, but as always disappointing.  This was Senior year and we were all talking plans for the next year.  I was at the time undecided about what institution and what type of medicine I'd be attending / learning the starting the coming August.  I don't remember all that much more about the dinner but it was lovely, good company, lots of laughs, and absolutely wonderful food.  For those of you in Memphis we were at BlueFin in Cooper Young.  I can't believe it was the first time, and only time, I was there.  In the mail a few weeks later I received a letter receiving encouraging advice from Leila.  The letter started out saying she hoped she wasn't presumptuous about writing.  No, I didn't think so at all.  Her advice was regarding means of navigating through life at times of change.  "If whatever you are reflecting on gives you a sense of life, fullness, positive anticipation, or excitement - or a sense of expansion- pay attention to it!  That could very well be an indication of a direction that would be good for you.  On the other hand if a decision, experience and person ect gives you a sense of constriction, of low energy, of deflation - pay attention to that too.  The world can be so complicated but if we can stay in touch with who we are - our truth - which we experience through our bodies then I think one has a great chance of living the life that is uniquely theirs to live.  The one only that only YOU can fill"  Now she closes the letter with my favorite part "You are pretty and you are very smart and you have a wonderful personality.  you have all you need"  ok j/k not my favorite but always nice to hear or, more specifically, read :)  Sometimes words like that from an unlikely source are more encouraging than those from someone close to you who you  might regularly hear similar things from.

I could go on and on with letters and with my feelings about the lack of letters that are now written but I realize 1. its getting late    2. This is long   and last and least significantly 3. chances are no one had read this far.  

But as a final note what I've learned from my years of collecting letters, and writing many is the written word is profound.  That sounds cliche but it's true.  Thought definitely goes into speech.  I've learned all the neuro pathways that prove that.  But I believe more thought goes into the deliberate writing of language and subsequent deliverance.  Whether it's pressing send on an email or sealing an envelope you can't take back what you've written.  Do I wish I could take back some things I've put in ink (or on a computer screen), well yes.  But at the same time I don't regret the unfortunate verbiage that's been used.  I've learned from it, and learning is one of the best things about actions / reactions and all experiences in life.   Besides, when it comes to letters, even without all the frills of calligraphy print and sealing wax and embossed cards; a simple letter or card is one of the most delightful things to find in your mailbox on any given afternoon.  


Thursday, May 26, 2011

The Concept of Synergy

Like beta-lactams and aminoglycosides (those bugs are done for)
or
Smoking and alcohol (esophageal cancer? sign me up!)

The boards and actual medicine are full of the concept of synergy

Well this concept shouldn't be so difficult (except when you're given some crazy graph and 5 answers that all seem to mean the same thing).  All the simple things in life are synergistic
Take for example:
coffee and chocolate
a fluff and some flirt
strawberries and champagne

Well here's one more for you:  a beach and a sunset

Separately, two things that bring me many happy thoughts.  Possibly two of my favorite things. But I'm telling you, put them together and something magical happens.








And it certainly doesn't hurt when you make a new friend on your third mile down the beach.  Especially when he keeps you company the entire run back home (even if he may have initially scared you as he bounded toward you with no one else in sight).  Meet Mr. Bo Jangles.  Fortunately, Bo had a tags on him to call his home.  Unfortunately, his owner didn't end up being quite as handsome as he was.  

Tuesday, May 24, 2011

Remember when "question master" was part of a drinking game?

Now my only goal for the next two weeks it master the questions of qbank.
Then maybe a reversion to college drinking games for a night or two with no discussion or even thought of alcohol metabolism, anecdotes for toxins, just what I'm doing to my liver, and why I feel not so good at all in the morning even after probably maxing out at 3 beers.

1.  What med should you give a little boy who seems to stare into space out all the time with a blank look on his face?  Several years later he on occasion has spastic uncontrolled movements.  What med should you now give him for both problems?

2.  Your boyfriend who knows he has a metabolic deficiency decides to play a joke on you  and pees in the toilet but does not flush it.  You use the washroom a little later are horrified to find the toilet filled with dark gray.  You freak out and he's laughing hysterically, why does he think this is funny?

3.  Your gymnast friend tells you she has ringing in her airs and is starting to lose her ability to hear.  She claims she never has loud volume in her headphone.  Actually she never even wears them because she thinks they harbor bacteria.  You go to her next gymnastic meet and she has terrible performances all around, she even fell off the balance beam 5 times during her routine.  She tells you this has been a problem the past few weeks and that a similar problem caused her sister to quit gymnastics.  What chromosomal mutation does she have?

4.  What extra supplement to african american babies often need that caucasian babies don't?

5.  Your roommate has been really stressed studying for her medical school board exams recently.  She's been eating not so well but exercising like crazy to beat the stress.  You (not a med student) notice she's turning yellow and mention it.  She smiles/chuckles and says a lot of people have this happen to them when they're stressed but that there is nothing wrong with her or them.  What disease does she have?

Look to the bottom for the (hopefully relatively correct) answers

If I'm stuck studying for quite some time I figure I might as well make the most of it.  Isolation, no cell phone, a stocked fridge / pantry, and the great outdoors

I think I have just about the best study buddy, even if he can't help me answer qbank questions


And we both have quite the view and running location to enjoy :)




Answers
1. Ethosuximide for absense seizures initially.  Valpoic acid for the later development of tonic clonic seizures.  You can stop the ethosuximide because Valproic acid covers both seizure types

2. Your man has alkaptonuria, nothing to worry about although he may experience some arthritis come middle age.  He is simply missing homogentisic acid oxidase.  His urine turns black when exposed to air because homogenisic acid in his urine is oxidized

3.  Chromosome 22 --> the NF2 gene.  She has autosomal dominant Neurofibromotosis type 2.  THis causes bilateral acoustic neuromas or  "schwannomas"ie a tumor affecting Cranial Nerve 8 (vestibulococholear) This nerve allows you to hear properly and helps you maintain your balance

4.  Vitamin D.  African American's require more sun exposure to effectively synthesize D.  This is not a problem in adults with sufficient diet but breast mild does not contain vit D so all babies must either have a different exogenous source or the ability to synthesize it themselves.

5.  Gilberts.  She has low UDP glucuronyl transferase.  This decreases her ability to uptake billirubin in the liver where it is normally conjugated to be excreted. 5% of Caucasians have this.  Labs would just show a temporarily elevated unconjugated billirubin when under stress.

Per typical, I didn't proofread.  and I wrote the questions myself.... I'm certain there are errors

Thursday, May 12, 2011

Lending a Hand

Sometimes, or really most of the time, its the small things that really make a day.  Yesterday it was walking out of the gym during a break in the storm to see a full rainbow.  It was practically perfect with all the colors present.  Myself and just about everyone else in the parking lot took a moment of time to enjoy and snap a few pictures.  But before I could switch my phone over to video method it was gone.  Just like that.  I do wish the pictures had turned out better









 

Today it's still relatively early and my faith has been restored in the general population.  I ran to the grocery store after my exam so I could stop scavenging around my apartment for things to put together for a decent meal.  Well actually it was due to having to skip breakfast because I had nothing satisfactory to munch on.  So walking in with all my grocery bags at once and my obnoxiously large purse was a bit of a hassle.  Of course I refused to take two trips as I'm perfectly capable of carrying that much.  There was a young man (total stranger, never before seen him) who pulled into the parking lot a at the same time as me and got inside while I was just starting the walk from my car.  Well to my surprise as I saw him about to hop on the elevator he turns around and rushes back outside to open the door for me and help with my bags and he says "I'm so sorry for not stopping earlier, I would have felt like such a jerk if I'd just gone upstairs and not helpedl you when you had your hands full."  I can't even explain how surprised I was.  I don't know his name or a thing about him other than he had a car door that was all banged up.  But this resident on the 5th floor of my building is my new favorite neighbor :)

Occurrences like this one inspire me to go just a little out of my way to make that extra effort for anyone who might need it.  It might just make a difference in their day too.

Monday, May 9, 2011

Swim Season 2011

With the recent pleasant change in weather and sunny day Chicago has finally had today and a forecast of 80s tomorrow summer is on my mind despite being in the middle of finals.  And of course with summer comes the beach and my new abode (so excited) which is conveniently only about a 5 minute bike ride to the North Beach!

I'm loving the 1 piece swimsuit trend going on.  American Apparel has put some great ones out the past couple years (well mostly...hahaha Kate) and here is one I happened upon from Anthropologie while browsing.  Unfortunately, something tells me that neither this one nor their other lovely one pieces, a pretty red one with a sash and wrap around ruffled navy blue, will not be making it to the sale rack.
The suit, the scarf, the glasses.  Love it all
Add a moped or towny bike, a breezy skirt and especially with that hat in a beach town, life would be perfect.
I'd first stop at the local farmers market for fresh berries and an iced green tea
 then head to beach with a big umbrella and a novel

Friday, May 6, 2011

1 month 1 day...

til Step 1 of the COMLEX, and 26 days until Step 1 of the USMLE.  I can't believe this has come about so quickly, its almost like I hardly had a chance to breath.  And what is still in between now and then?  a full weeks worth of 6 finals followed by a cumulative pharmacology exam the following Monday.  I'm so torn between what I need to be studying for.  And to make it worse, it's Friday evening, the sun is out, the weather is beautiful.  It finally seems to be the start of spring in Chicagoland.  I'm not going to lie or sugarcoat it or talk my way around it:  I'm cranky, really cranky.  To up my spirits I stopped for a diet coke.  I know I know... supposedly I quit a couple days after Thanksgiving.  But sometimes we all need something to perk up our mood, though a walk with Kate and her pups and seeing Kendra and her research poster were lovely occurrences as well.  There haven't been many times in my life when I question what I'm doing with my life.  But currently as I look around at all my peers in the real world I can't help but feel some envy for the seeming freedom of their lives.  Yes, sure, I suppose I have the same freedom.  I could sit here and decide I'm not going to study for a thing the next 3 weeks and that would basically be the end of my medical school career.  Easy as that.  Except the nearing 6 figure debt I'm carrying.  I just signed a new lease on Tuesday for a wonderful apartment in an amazing location.  I couldn't ask for more regarding my housing for next year.  I can't quite understand why I can't enjoy the thought of my upcoming move.  One of the few things keeping me going is knowing there are about 200 people in my area going through the exact same thing right now.  I'm forever grateful for how supportive and helpful everyone in my class is, it wasn't at all what I expected to find in medical school.

So instead of continuing to complain I'm going to attempt to shift my mind to something / one I'm very thankful for... that individual being my mother.  Cliche maybe with Mothers Day right around the corner.  I couldn't have asked for a mother with better influence in my life.  I know moms always say their kids are such a blessing in their life, well in my case I think it is very possible that my mother is more of a blessing in my life than I am in hers (partly because she has two other "blessings" other than myself.  I wish I could have the opportunity to celebrate mothers day with her this weekend but unfortunately I have more hours of work to accomplish than I have hours with which to accomplish it.  I'm also thankful she understand and is supportive of this.  She did marry a doctor who she met while he was in school, I think she knows the work and commitment that goes along with the education and occupation, I'm also thankful for this understanding.  I bought her a gift yesterday and I do hope that when I see her and get a chance to celebrate with her over a fondue dinner at Geja's she likes it.  Its a scarf I've been eyeing for some time out of the Art Institute of Chicago.  But it's a spring/summer scarf so let's hope that this weather sticks around and winter doesn't come knocking again in a couple weeks.

In the mean time I was inspired by Nicholas Kristof's op-ed column in the Times this morning titled "Beyond Flowers for Mom"

here's the link http://www.nytimes.com/2011/05/05/opinion/05kristof.html?src=recg



He writes about an organization that has worked to create safe birthing means for soon-to-be mothers in Somaliland.  This is a country where according to his statistics women have a 1/10 chance of dying from pregnancy/labor.  The hospital that has been built has allowed women to have a safe clean well cared for establishment for women to have their babies without such risk of mortality.  As I read this I found myself reminded of why I'm going through the education I've chosen and worked for and all the blessing that can come from it.  While I don't think I will personally ever experience the "joy" of motherhood I do understand that this is a dream for many if not most women throughout the world.  And I like that, it's kind of a uniting feature that can bring all people together for one happy natural cause.  The fact that this joy might be hindered do to poor medical conditions is not acceptable.  I do believe in miracles and despite being science-minded I believe babies are a form of a miracle and are gift.  I am happy that this group is working to keep the miracle of life continuing throughout all areas in the world.


Happy Mother's Day :)

an aside: The child in the photo is me so for all you haters... I was in fact born a blonde 

Monday, May 2, 2011

This made my day.  Considering getting a new Pathology Board Review book in the mail  (ie the extent of my spring shopping) was the other highlight of my day...its not saying too much.  Buts still, maybe Ron Paul will get a few more votes this year than in the past.  This is the first presidential election bumper sticker I've seen so far, so that has to mean something good!