"People sometimes sneer at those who run every day, claiming they’ll go to any length to live longer. But don’t think that’s the reason most people run. Most runners run not because they want to live longer, but because they want to live life to the fullest. If you’re going to while away the years, it’s far better to live them with clear goals and fully alive then in a fog, and I believe running helps you to do that. Exerting yourself to the fullest within your individual limits: that’s the essence of running, and a metaphor for life — and for me, for writing as whole. I believe many runners would agree"

— Haruki Murakami (What I Talk About When I Talk About Running)

One thing I've realized these past two years is that it is important to have shared goals and your own goals.  My current shared goals are success throughout medical school.  But I always knew I needed my own outside of school.  And while I love company during my workouts, runs, rides , swims, etc... its something I've never fully shared a passion for with anyone.  These times are always my plans and my goals for that day or for training for an upcoming race.  Sometimes I think how great it might feel to accomplish these things fully with another but in the end I know, some things are just sweeter when you know you were able to push yourself to succeed on your own.  I've felt more fulfilled and alive after a finishing a challenging race or pushing myself through a long workout than any single exam, finals week, or even after boards.  I never feel like I deserve anything special, its simply a sense of self satisfaction

(Because I don't want to take any credit for actually reading that book, I took the quote from a friend's blog, it just seemed fitting)

Infectious Disease

For the past few weeks I've been spending a most of my time at a hospital in southern suburbs in Chicago working with and learning from Drs Ogbara and Azad.  Both have been wonderful mentors and teachers thus far though very different.  I questioned starting on this rotation (though I didn't have much choice) because Infectious Disease is actually something I might be seriously interested in.  I like the idea of being able to treat and likely cure a problem without hurting the patient or continuring chronic care.  However I don't like the thought of treating mostly hospital acquired infections due to ventilators and foley catheters.  Africa here I come!  I've heard various recommendations about how to go about scheduling and picking rotations and such.  Its all conflicting here and there.  I know starting on an ID rotation won't kill any of my chances in the future, in fact it might be a rotation I have with the greatest improvement and during which I continue to have the most optimistic spirit on a daily basis.  But enough of that,  I'll start with some things from my experience with Dr. Azad.

Pre rotation I'd heard Dr. Azad described as an Indian princess who floats around prescribing antibiotics and curing infections.  When I met her I immediately recognized this description to be right on the money.  Dr. Azad is beautiful, well dressed (great shoes), poised, and confident.  She keeps her private life to herself and is straight business and seemingly unmarried.  She also loves dogs.  I've previously mentioned a Dr. Farley in my posts,  I hold Dr. Azad on the same level (without knowing any dirty divorce issues).  Oddly it seems I have a trend of my favorite doctors being the well put together females who still value their appearance and the male physicians who stay in shape and have the drive and desire to pursue extreme athletic adventures and ourdoors activities.  (for example my favorite resident gave a presentation on ischemic colitis and mentioned that this is actually a complication in long distance runners... an interest of his as he is a regular runner).  Perhaps these are superficial draws toward mentors but I'd like to think instead that they highlight a future that isn't commonly seen.  So many female physicians don't keep themselves up and so many males lose any and all muscle tone they may have had in college if they ever had any.  I realize my lifestyle can fit in with my future if I continue to make it a priority.

Her appearance makes her that much more intimidating.  She began our time together saying she wanted to tell our school that she no longer wanted students straight out of second year with minimal clinical experience but that we would make the best of it.  ay!  Welcome to ID service!  However once that was said there was no mention of any lack of skills, rather I think due to fear of inadequacy I worked even harder and improved on consult and progress notes.  I have no fear talking to any patient about anything and I can even hold a conversation for about 10 minutes with a patient who is non-responsive, encephalopathic, or simply unable to talk.  I know what to add to set my notes apart.  I also know some of these add ins will take a little extra time and chart searching for me to be able to appropriately document but that it might make all the difference in leaving an impression.  I've learned strategies to creatively learn things.  Who knew considering a drug causing a bacteria to die like a building explodes would help me continue to remember it since that day.  Really what I learned was the why behind bugs and drugs, the the what.  Exactly how I learn.  I'm not a memorizer, I need to understand.  Many non-medical individuals might think medical school and medicine is straight up fact, memorize, regurgitate.  Not so my friends.  Sooooo much more, its like a puzzle you must know the where, why, and how before you can use any memorized knowledge and simple write some orders on papers to apply to a patient like they are a page out of a text book.  And even if you think you know your facts cold, someone's life / parent/ child / spouse/ best friend / etc hangs on the results of that decision.

Now for Dr. Ogbara, I'm spending my last two weeks on ID with him and while the patient population is very similar to Dr. Azad's the experience has been very different.  With Ogbara things are very relaxed.  For example we sit a lot, can chew gum, get poked fun of good heartedly, and talk about all sorts of thing.  He calls likes to joke with one of the other students as an alcoholic (ie aspiration pneumonia), as having troubles with priapism (sickle cell needing plasma exchange), and always going out for liver rounds (happy hour...).  He's hilarious really, but has such a thick Nigerian accent it took awhile to understand him.  With Dr. Ogbara I've learned more about broad categories of treatments for diseases and risk factors for various infections.  I don't think I'll ever forget the most common causes of various skin infections, pneumoniaa, and UTIs.

Overall the more important things I've learned
1.  Taking the time to actually talk to the patient about life will put a smile on any hospitalized patients face.  Also taking the time to visit with families is a huge report builder and makes patients happy.  Actually sitting down to talk makes a huge distance too
2.  Find a way to connect with with a patient whether it be because you share a similar heritage and love for dutch Windmill cookies and wooden shoes, went to the same place for a vacation... a short stint in Rusia payed off, or your patients visiting nephew has a crush.
3.  Introduce yourself to the nurses and carry on a conversation with them daily.  Always say hi when you see them
4.  Work with other students from different services, you'll understand more of your patient's case and procedures as well as the potential for getting to see and participate in different procedures
5.  Residents don't care at all about morning report, but sometimes there is free breakfast and there is always coffee
6.  If you're nice to the cashier in the cafeteria she'll give you nearly free coffee.  70 or 90 cents down to 5 cents.  I can't complain
7.  Residents aren't scary, most attendings aren't either
8.  Codes really do happen, and patients really do die in hospitals both overnight and during the day
9.  Have a standard joke during your initial physical exam that will make everyone chuckle
10.  Even in a short white coat, most people in the hospital think you're really legit
11.  No matter where I am or what I'm wearing I'll still be called "Just a kid" or a "nurse" by many people.  I'm ok with looking young :)  I'd much rather graduate medical school at the age of 26 than the average age of 29.

I still have one week left on ID service, goodness time has flied.  Fortunately I get a long weekend before it to do some reading on general internal medicine and read over some of the notes I've taken already.  I think I'll be asking for a rec note out of this (I know I know first rotation but just in case why not) so just might pick up the final Saturday shift our team needs to cover.  Overall, I'm still excited every day to go to the hospital and see my patients, yes even the encephalopathic ones that smell bad and can't talk to me.  I love realizing I'm picking up a little bit more information from charts each day.  And I love when patients smile in a friendly manner because they recognize me as I walk in their room.

sitting, waiting, wishing

This morning before rounds I heard a "lovely" rumor that Board scores were released.  After going through phase one of heart palpitations and chest pressure, phase two of nausea, and finally phase three of light-headness I found myself in a state of heightened awareness / anxiety.  Traffic couldn't have moved slower on the way home... really people what are you doing on the Ryan at 1:30 already.  (Thanks Dr. Ogbara for letting us leave so early)

Needless to see post a couple must do errands that I thought might not get accomplished post score checking I finally log in only to find.... Scores were only released up til the Friday before my exam day.  Continuing to wait is faaaarrrrrr worse than logging in to actually check.  grrrrrrrrrr!  I was hoping for a long weekend full of celebration and relief.

Always wear sunscreen

Those of you who know me know that I am a HUGE advocate of sunscreen.  I wear spf 75 on a daily basis on my face and neck.  I do sometimes neglect other exposed skin on a daily basis unfortunately.  (Let's face it, sunscreen isn't so great smelling and weather lotion or spray leaves an unwanted coating on your skin)  However every run, bikeride, swim, long walk, extended period of time outside I always make an effort to cover my epidermis.  I check for moles regularly and freak out about the smallest change.  I had a mole removed at one point leaving me with an attractive keloid scar secondary to an allergy to cat gut stitches.  Its improved since the lesion was excised but still... unsightly.  What's sad is I still get the occasional stranger to believe I was shot and many foreigners are convinced I was born somewhere where the polio vaccine is still used.  My old derm and I were tight.  I'm still working on a new one I like.  I miss Dr. Wise despite him potentially thinking I was neurotic.  

I thought I'd abided to my normal sunscreen application protocols this past Sunday when I chose to spend some time at the beach instead of the Pride Parade.  While I was successful in finding pleasantly empty near north side beaches my sunscreen application was not up to par.  I am still burnt; my booty is bright red, no joke.  My long ride yesterday could have been a good bit more comfortable.   Padded shorts only do so much.  I'd post pics but I'm not entirely certain they are appropriate.

To sum up, and oldie but goody.  Some good advice starts this song off, I couldn't agree more

Philippians 4:19

Today while more stressed than I've been yet throughout this whole board review process I decided I needed a break and some time for myself simply relax.  I had no idea what this should entail.  I thought through the vast list of things most people do to relax (television, movies, happy hour, massages, manicures/pedicures, shopping) and then to my usuals (a workout, grocery shopping, going to bed a little early, looking up airfare, reading a magazine, cooking something nice.)  Yes, I actually had to think about how to go about relaxing.  Well my usuals have all be used up the past numerous weeks and while I'm up for a run I'd already put in an early spin session.  As far as most others that came to mind, they were negated as either I don't have to money for them, I didn't think I'd be able to find anyone else to take a break with me, I didn't have various resources, or they simply aren't things I like to do... drinking to a stupor, no thanks

So what did I do, of course I called my mother with a mini-melt down.  She confirmed my thoughts that I needed a break and said informed me that another 8 mile run would not qualify as taking time for myself.  So she suggested a yoga class or something.  This is something that had come to my mind earlier but the average going rates of  $14 - 20 a class just wasn't going to cut it. 

I ended up trying to settle with some fresh watermelon from the farmers market and an iced (decaf) coffee.  Wasn't so effective.  Tried convincing one friend into making plans for gelato later and another into going to the puppy store with me.  No go.  So I again contemplate the yoga idea and I go to my handy Corepower yoga app on my phone to see if they even have a class I'm interested in at a nearby studio.  Lo and behold a FREE!!!!! 75 minute hot flow class in honor of the Oak Park studio reaching its one year birthday.  Step 2:  recruit a friend and a sister!   Step 3: a triple surprise!  Following class fresh fruit, sangria, and free massages :)  The Lord does provide.  

I'm now home studying away yet another Saturday night (6 in a row, but who's counting) I'm not particularly pleased about it but I have come to accept it knowing that in 3 days I'll be done with this phase.  And next Saturday night I will not be sprawled on my couch reviewing practice questions or browsing powerpoints

Fare Forward

“Not farewell, but fare forward, travelers”

 –T.S. Eliot The Dry Salvages

Farewell USMLE step1.  It will be 8 weeks before I know your outcome but ‘til then, out of sight, out of mind. 

Pre exam... what to expect?  Do I know enough? EEEEK!  A bit nervous.  Here goes nothing!
2 years of work for an 8 hour exam to evaluate it.  So it goes.
Yeah, I'm that lame girl who messed with her macbook camera to pass time in the morning before exam start

Farewell to the past two years.  It has been whirlwind, crazy how much life has changed, how much I’ve changed (just compare the prices at j. crew now and two yeara go… I don’t want to talk about it), and yet how much I’ve grown, especially in knowledge.  I have no disappointment saying farewell to this stack of books.  Two  year worth of classes, three trimesters each year, and each trimester with more credit hours than even my overload semesters throughout college.  I remember hating finals week at Rhodes and thinking I always had so much work.  Well, I created most of that work for myself, but I now know I had no idea the amount of time one can spend studying and still have all sorts of other things they need to do.  On the other hand, while I was recently home I looked at my father’s bookshelf and noticed many books he has solely on the kidney.  That which that stuck out most was a two volume compilation from about 12 years ago on this essential organ.  Each of these books in and of itself was probably twice as thick as any textbook I’ve purchased for medical school.  It’s humbling to realize how much I still have to learn and how much I know I’ll never actually know.  (as an aside, I would not be surprised if my father has actually read those books cover to cover and actually knows everything in them, he could probably have written.  It’s disgusting how smart he is.  For that matters, he’s probably read similar books on just about every organ)

Farwell to second year breakfast!  (and more importantly, Happy Birthday Kate!)  The past two years would have been empty without all you lovely ladies.  I can’t believe how far we’ve all come together.  When I look back I think you all will be the ones who really define this short time period; not the exams, or lectures, or the labs, or the stress

I'd say we all look pretty good for a week and a day of final,
and just finishing a cumulative pharm exams :)

Fairly representative of how we actually felt

 Farewell to a faithful friend.  As I was taking Step 1 to move on to the next chapter in my life he was on a plane heading to Poland to start the next phase of his.  A two year master program overseas.   I know your love for Poland and while it’s never been on my must visit places, it recently moved up the list.  From meeting you at the age of what., 16? 17?  Blowing whistles in jumping into a cold pool followed by “Hi, I’m a lifeguard, I’m here to help? To various shenanigans I don’t want to include here.  Let’s just say I don’t think I’ll visit Ichuro for two years (good thing Ponzu is across the street from my new abode).  However, I can’t guarantee I won’t be climbing fences.  I also know you wouldn’t want your absence to keep me from trespassing at any decent and semi-reasonable opportunity.  Best wishes to you.  When you’re back in the States for brief visits, you know my number.  In the meantime, I’ll work on remember my Skype password.

Para siempre una favorita :)

Goodbye to one of my favorite doctors.  Two nights ago I learned that Dr. Wise, a family friend and my dermatologist and a teacher passed away a couple months ago.   I knew he’d been sick and actually took leave from his practice but I guess my dad forget to mention his passing earlier.  Dr. Wise was brilliant, he knew EVERYTHING about dermatology and something about just about everything else from silk worms to water quality in random countries.  It was always fun to see his name pop up in various women’s health magazines regarding skin conditions and preventative measures.  I was fortunate to have him as my Dermatologist.  He hated expensive soaps, all makeup, and scoffed at sunscreen over spf 45.  To this day I use generic baby shampoo to wash my face, wear natural makeup, and use sunscreen… spf 75… His prescription of Acutane saved my life (slight exaggeration) even if it does turn out to fry ovaries.  Note: this has not been proven.  Even so, I don’t want children so really no loss to me.  Perhaps a benefit of the drug?   I was also fortunate enough to have some clinical experience with him.  He was one of the physicians on a service trip to Blackfeet country in Montana two years ago.  The relief he was able to provide to these people with all sorts of rashes, skin disorders, and autoimmune manifestations in just one week was inspiring.  These people had gone to derms elsewhere with no success.  I really understood at this point there is a huge difference in the skill levels of physicians.  He also taught me two general practices to keep in mind while on any service.  1.  NEVER keep your hands in the pockets of your white coat.  2.  NEVER lean on anything in a patients room, hallway, or otherwise public place.  He also recommended to look up origins of words as a means of learning because it will both help you remember what that term means and you will learn a myriad of other information (ie silk worms).  I know he was planning to write a book when he “recovered”.  That would have been quite the book I imagine. 

Blackfeet child at the Pow Wow we were specially invited to on the service trip
Coco took this pic, and I love it!

Farewell Lombard and DG!  It’s been fun, really, but I was never meant to live here.  Onto a neighborhood with a 99 walk score, bike lanes, a short jaunt from the beach / zoo, lakefront path, favorite restaurants, shopping, museums, theater, indie coffee shops, the second largest Whole Foods Market in the country, and a 24-hr fro yo stand.  I can’t ask for much for (except lower rent).  Adventures ahead!

2233 S Highland (and Ikea), you've served me well.
I'll not miss you
Though never say never

"'Fare forward, you who think that you are voyaging;

You are not those who saw the harbour

Receding, or those who will disembark.

Here between the hither and the farther shore

While time is withdrawn, consider the future

And the past with an equal mind."

In Honor of National Running Day

New kicks!!!!
After a handful of almonds to a trail I went

I can still hardly believe the running store talked me into Nikes.  My whole running life I've worn Asics (with the exception of one mistake of a pair from Saucony), and now Nikes, a shoe company I've been against ever since they put out their "shocks".   :)  But they are pretty and work with my Nike+!


Get out and move!!!!!!  Today and everyday!