Making a Difference: My Reflection on El Salvador & Kiva.org

Meet Jorge Raul. Jorge has never met me, nor have I ever met him, but I have met and seen many faces of Jorge in my recent trip down to El Salvador on a medical mission with Mayo Clinic and Operation Blessing. When you realize that much of the world has it much worse off than you, suddenly life takes on a new perspective. Take for example my experience working with our doctors examining the many old ladies who came into our free rural clinic in El Salvador complaining of muscle fatigue and bone pain. Muscle fatigue was simple: despite their old age, they were still working hard in the fields in the scorching sun to scratch out a living. The bone pain? Easier to diagnose than to treat. These ladies, despite their best nutrition, were calcium deficient and are developing osteoporosis. "Increase your calcium intake" we advised them, advised them until we realize that their nutrition consisted of only rice and beans, day in and day out.
"milk is too expensive," they told us. Cheese was a fantasy.

Such societal disparity was shocking to me as I worked in the mountain villages of El Salvador where just a short 40 minutes away was the commercialized hub of San Salvador where I had just dined on sushi at Benihana's the night before and was comfortably lodged in our air-conditioned hotel with wifi, a flat screen TV, bottled water, and a daily hot breakfast. Suddenly a knot of guilt tightened across my belly as I tried to swallow the fried chicken, biscuit, and slaw that was being served to me during our lunch break at the rural clinic. "These starving people are so graciously watching me stuff my face with chicken," I thought to myself, "I wonder if these children have even tasted chicken before?"

While we took no measures to provide ourselves with any extravagance on this trip, in contrast we were basking in luxury compared to the lifestyles of these people whom we were serving. Our $26 a night hotels and "U.S. comparatively half-priced" Benihana's dinners suddenly carried a lot more superfluous cost when we learned that these people living in the hills had to buy their bottled water on the few weekly dollars that somehow they generated through their agriculture or industry.

I could go on complaining about the deprave social condition that we as humanity have let ourselves stoop to, that such circumstances that I've described actually exist, but in continuing to do so, I lend my voice to nothing more than the numerous politicians, the bureaucrats, and the institutions that talk the talk of change and do little in effect to make a difference.

So let us talk about making a difference. In 2006 Muhammed Yunus, a Bangladesh economist was awarded the Nobel Peace Prize for his work in microloan banking. Gambling against human self interest, Yunus took a chance at the novel notion that poor people nonetheless being poor were still good people. These were people who didn't want to remain poor, Yunus thought. They were products of social circumstance and were suspended because of no means of upward economic mobility. So, Yunus thus started the Grameen Bank in which he started loaning outmoney to the indigent that had a need for money - a plan for industry, or an idea to help themselves out, and what he discovered was a phenomenon that is growing globally today.

There are people like Jorge out there who have an idea, who have an industry, who have a means to get themselves out of the poverty that is tethering them down -- but they lack the equity, the first chance, and the gamble of trust that most financial intuitions operate by when they calculate the odds of their institution ever seeing the money they loan again. Here's were you and I and Kiva.org come in.

Kiva, a non-profit organization which works with other global NPO's and NGO's find people like Jorge who have a plan and have a need. In fact Jorge even had a bio:

Jorge is 42 years old and he lives with his wife and children. He has three children that are the ages of 15, 9, and 4 years old. They are all in public school. Jorge sells chicken and his wife sells food, and they used to always have leftovers. They always used to have to pay people to take away the leftovers until Jorge got the idea to raise pigs and to feed the leftovers to the pigs. He now has 180 pigs. Jorge needs $525 to buy live pigs and food for them. Since Jorge has been in the group Finca, he has progressed economically. Also, he has learned to be punctual in making his payments on loans for his business. Jorge’s dream is to buy a truck for his business.

Merging Yunus's microloans ideas with the global reaches of the internet, Kiva has harnessed the individual's capacity to make a difference. Philantropy now crosses all boundaries as individuals can help individuals directly for as little as extending a $25 loan to someone in need. The beauty of this social experiment is that Yunus's gamble paid off. To date, over 98% of his loans are repaid, and Kiva through their affiliate partners boasts similar returns.

Though this is but a small step in the marathon humanity runs against poverty, it's one small step that I've taken to make a difference directly in someone's life. You can choose to donate separately to Kiva if you wish, but Kiva, unlike many other institutions that will skim your donation, assures you that 100% your money is going where you intend it to go.

Foregoing a meal at Benihana's today may be a small sacrifice that I make, but with Kiva.org I hope that that sacrifice can make a bigger difference in Jorge's life. I invite you to learn more and make a difference at:

http://www.kiva.org

I See London, I See France...

And we might also have seen some underpants (or lack thereof) in one of these galleries documenting our dinner excursion through the Montmarte district of Paris. Rest assured the facade of these buildings including the historic Moulin Rouge was as far as we got as we settled for a nice little Italian bistro over the cabaret that evening. In a whirlwind 8 day trip, our journey spanned over 11,000 miles with over 60 hours of travel and as we straddled Greenwich--even crossing over two hemispheres. I brought along the Canon XSi to break in - so pardon some duplicate series of pictures as I was trying to play with the settings and didn't prune these 3000+ (40GB+) worth of photos yet, everything here was taken as is, minus the videos, and scaled down to smaller size. Just as a reference itinerary, this is what David and I covered in the 8 days that we were gone on our version of The Amazing Race:

1. Sunday November 16, 2008: Travel 350 miles by car from Rochester, MN to Chicago O'Hare, hop on a connector flight to Dulles, Washington D.C., enjoy a three hour layover, jump aboard another plane for an 8-hour flight to London Heathrow, figure out how to use the London Underground system and buy an Oyster card, jump on Monday morning's 7am commute to St. Pancras station.
   
   
2. Monday November 17, 2008: Realizing that we arrived too early for our 1 pm Eurostar train to Paris, we meandered the British Library near St. Pancras, enjoying the Magna Carta and various original texts such as Leonardo Da Vinci's notes, Isaac Newton's letters, and Galileo's sketches. The Eurostar was a lost memory due to sleep deprivation, but after pit-stopping in Paris, we walked the Champ de Mars, and ascended the Eiffel Tower
   
   
3. Tuesday November 18, 2008: Visited the Palace of Versailles, the Hospital Museum (Musée de l'Assistance publique - Hôpitaux de Paris) and walked by Notre Dame Cathedral by night. Ascended the Arc de Triomphe, and ended up in Montmarte for dinner and shopping.
   
   
4. Wednesday November 19, 2008: Revisted and ascended Notre Dame Cathedral (Notre Dame de Paris) proper, saw the museum and crypts of Notre Dame, walked through Hotel Dieu and then saw 2-million skeletons in the Catacombs of Paris. We finished the day blitzing through the Orsay Museum, blistering our feet through the Louvre and finished the day at Place Monge, which ironically enough was not happening at all at 10:30 pm at night, though we managed to sup on escargot outdoors at a cafe that spoke not a speck of English.
   
   
5. Thursday November 20, 2008: 5 am Eurostar trip back to London was equally not the most exciting though we arrived plenty early in London to beat the opening of most places at 10 am. We hit up the British Museum, ate out of the supermarkets where food was actually affordable, and visited the Hunterian Museum of John Hunter (1728–1793) as we came in part to study history of medicine by also reading the biography of John Hunter: The Knife Man. We went by Westminster and Parliament but by 3 pm apparently the sun sets in London so we decided to go crash and recoup from sleep deprivation early.
   
   
6. Friday November 21, 2008: London Bridge (Tower Bridge), and the Tower of London started off our day, and effectively ended the daylight too since there was only about five hour's worth. We took a boat to Greenwich and straddled the Prime Meridian with a foot in each hemisphere. A walk through Leicester Square and Trafalgar Square ended our evening.
   
   
7. Saturday November 22, 2008: More walking. More blisters and bursitis. Buckingham Palace probably had a changing of the guard, but we were too pooped to wait and find out, so we walked onwards and across the Thames from Parliament and Big Ben and Westmister Abbey, in fact we walked all the way to the Imperial War Museum where we stayed longer than we expected, and ended up skipping St. Paul's Cathedral, though we walked in and looked around without paying its hefty entrance fee. Finishing the night in Oxford Circus we supped on fish and chips in an English Pub, and nearly died on the late-night tube back to London Heathrow Airport (but that's a story you'll have to ask either David or me)
   
   
8. Sunday November 23, 2008: After a night slouched in the Heathrow airport, reverse Sunday November 16, 2008th itinerary from Heathrow, add 1 hour of lost luggage in Chicago, and we've made it back home from our week of too much fun which was catalyzed by the two of us discovering $48 round trip tickets to London from Chicago.
   

So in the end David and I left our families behind for a week, squandered their wealth, studied some history of medicine, had a great time, came home bearing gifts, and now our trip is yours to enjoy vicariously in these many galleries! (Click the links below to enter each respective gallery which are arranged by 500 images each in chronological order)

Europe 1	Europe 2
Europe 3	Europe 4
Europe 5	Europe 6
Europe 7

Weeks 47-51: Summer Vacation and China Trip

Well I'm hopelessly behind in my blog, and out of time to do much updating as my 5 weeks of summer has wound down. But needless to say I had a great summer, 2 weeks of which I spent with a classmate David, and his wife Meghan in China all over the place. I'll fill in the details as I revise this post eventually, but in the mean time I wanted to include the pictures (note I'm still filling in captions so eventually they'll be all updated) that I took for everyone to get an early look at prior to my eventual detail filling. Enjoy!

Weeks 39-40: Research Selective

I spent the greater part of this selective learning about clinical research as I've started a project studying atrial arrhythmia's in patients undergoing hip surgery. We've met with statisticians and our work is in progress and I will report more on this as it is presented and published.

Weeks 33-38: Microbiology & Pharmacology

In a whirlwind of six weeks we discovered the most pertinent medical microbes from bacteria, viruses, fungi, and parasites that can drop you dead in hours or bloat you up for years full of worms (as pictured, Ascaris lumbricoides removed from the small intestine)

I've always been a fan of "dark biology" and read The Hot Zone when I was only 12 years old and fell enchanted by Ebola and its deadly 90% mortality rate and by its secret stateside escape in Washington within my lifetime! The sensationalism of The X-Files that introduced me to Hanta virus and it just got more interesting from there. One of my favorite books is still The Demon in the Freezer which puts into perspective the danger of not only dark biology in medicine, but also in the context of biowarfare.

To top it all off, I will admit that Outbreak is also one of my favorite movies. All this hollywood sensationalism sure didn't sway me from electrical engineering though, but let's see if it makes a redux in my career choices in the near future.

Microbiology to me was a realization that this sensationalism was not so sensational at all and as we progressively learned the greater part of the infectious disease medical spectrum I became deeply enthralled by the intricacies of each organism and how they subtly invade the body and counter attack our defense mechanisms, and even our drugs that we throw at it. Now granted that I did a stint in a microbiology lab during undergraduate years, I don't think I truly appreciated the nature of just how cool these microbes are!

I mean take for example our friend bacillus cereus, who doesn't do much than give you an upset stomach but is frequently associated with reheated fried rice? I mean how cool is that to be asking a patient about obscure details such as what they ordered for take out the night before? This is borderline crazy - but crazy in a really cool way that might cater to my attention and fascination to detail.

Needless to say there's a lot to remember and a lot to relearn, but I really enjoyed microbiology and thought that it was fascinating, and for now it seems to be bubbling up my list.

Weeks 31-32: Surgery Sective - Fresh Frozen Virtual Living Pigs?

I guess I really need to be less meticulous when it come to life, take blog writing as an example. The current date is September 30, 2008 and this article is pre-dated back to April, that's a good 5 months behind, but I guess this call-it-what-you-may "attentions for detail" helps me out in at least considering surgery as an option.

We spent a week this selective learning and practicing some basic skills on tissue, on simulation, and then I real live pigs! It was pretty interesting as we learned some of the ins and outs of suturing, knot-tying, making incisions as we worked on day one on some fresh frozen tissues next to some ENT residents who were also working on their skills on dismembered heads. Despite being acclimated to this type of environment I still find it very surreal and disturbing that yes indeed there is much 'practice' in medicine, and sometimes in the most morbid of circumstances to say the least. I mean no disrespect in saying so though as I am extremely grateful for the donors who are willing to help in medical education -- it just seems so primative though for how far along we've come, I would've thought that an entire anatomy dissection would have been in full 3D high definition tacticle reproduction right now - I guess I'm realizing that I just don't have the greatest stomach for gross (in all of meanings) anatomy and perhaps that I'm lowering pathology and radiology from my list of possible career choices.

Strangely enough I find surgery fascinating though and I guess the 'gross' factor dissipates a little more in 'real life.' I shadowed an orthopod doing hand and shoulder surgery this week and saw a rotator cuff repair as well as a procedure that removed some bones in the hand. We also had a session in Mayo's Sim Center where we did virtual colonoscopies, endoscopies, knot tying and sutures with instruments, and even a gallbladder removal that we ended up performing on a living though anesthetized pig! The good news? We got the gallbladder out without the pig crashing. The bad news? Wilbur's prognosis despite the fact was still terminal as they don't wake him up from that sleep again. I guess you can think of it as a better cause than $14.99 in your butcher's case though. Poor pig.

Well that was a taste of surgery for me, another step into a confusing realm of seemingly endless prospects to my intial urge to "want to help people." Now I just need to figure out how.

Weeks 26-30: Pathology, Immunology, Allergy

Pathology wound up to be a quick overview of all the pathology that we won't be really covering in organ systems in second year and focused mainly on inflammation, cancer, and some of the hallmark signs and symptoms of histology that all seems more like a blur. Our teacher, Dr. Grande, also our dean in the medical school did a great job accommodating our needs and taught the block exceptionally well with the help of some upper class men that helped us review and study from resources such as typed lectures, video recorded lectures, and even review podcasts to listen to. It was resource overload, but I appreciated the abundance of resources as opposed to a dearth thereof.

Immunology on the had was a little bit fresh in its organization. Three teacher taught the new course for the first time and they did a great job despite some quirks in the integration of all the materials. The medical school provided us with a textbook that ended up much too elementary and the board review books ended up to be my main text for the class although I wish I had read an immunology textbook proper for the block as it would have solidified my understanding a little better. Immunology was interesting in the sense that there is still so much unknown about the human immune system and in another sense so fascinating that our bodies have such intricate defense systems against the tiniest of organisms - some of which as I found in later in microbiology will drop you dead.

Allergy really was an extension of immunology with IgE and histamine release as the central focus. Interesting how allergy spins off clinically as such a vital differentiation from immunology, but the basic concepts were the same. Clinically I think a lot more people will see allergy as something they have experienced first hand as opposed to immunology that for the most part is passive and less acute than say the rash you got after eating the crab you just got (true story of my 9 year old crabbing experience... I think it was less the crab and more the industrial waste absorbed in the crab that I was allergic to).

The block ended in a most eventful way with a catastrophic internet failure Mayo network wide the day of our NBME (online) shelf exam final. So far our class has had the worst luck with test administration ranging from computer failures, mac incompatibilities, to now this. Who could complain with Dr. Grande though who waived the final and gave us the chance to take it electively after our selective? This was the most refreshing and low stress didactic block by far.

A Tale of Three Wii's

Finishing another block pushes me another six weeks behind on the blog, but it suffices me to say that all's well that ends well, and so it was with microbiology and pharmacology. Actually microbiology was really interesting and hopefully on my week by week recap I'll be able to highlight some of my favorite microbes for your entertainment.

Pharmacology on the other hand was not one of the most organized classes we've had here (thankfully microbiology was one of the best), so sometimes lectures went long and tangential. One day in the middle of the block I was slouched over, daydreaming, and more or less catatonic when all of a sudden in a cacophony of forgotten-to-be-muted rings and chimes I was startled back into reality as my phone started ringing, notifying me of a new text message, a new voicemail, an email, and an instant message--it was a wiialert! I didn't have a moment's time to lose as I knew that I had to act fast. Faster than an orderly running for a crash cart on a coding patient I was at Amazon.com within seconds checking out with 3 Nintendo Wii's for a pricey $750. They sold out again within a minute's notice but my order which I had attempted many times prior had finally gone through.

So the story ensues with 42 of my classmates + 1 world renown lecturer looking in my direction as I pursued the three elusive Wii's. I had postings up on Craigslist and the Mayo Classifieds within minutes, and within minutes I had two calls from people who were already interested in buying them. There was just one problem: I didn't have any of them in hand yet. One of the callers however decided to stick with me and he became Wii #1 starting my story of the three Wii's.

Wii #1 went to a man who's wife went in for surgery at Mayo and needed something to keep her entertained while she would be recovering for the next few weeks. He showed up in leathers looking like he was ready to kill, I thought he might be with Hell's Angels as he unrolled a wad of cash and gave me a cool $300. I was waiting for the ATF and FBI to jump me at any moment and I think I still am.

Wii #2 "Hi this is so and so from Luther Midelfort Northland am I speaking to Dan?" is what I heard when I picked up the phone. Confused and swearing that I heard that so and so was from Dunder Mifflen I was bracing to retaliate against this unsolicited sales call on my donotcall.gov phone number. I was pleasantly surprised however when the individual on the line inquired about the Nintendo Wii and I was even more impressed that they turned out to be a Mayo department. "Umm sure I can take a corporate check, and send it through the Mayo intraclinic courier system... or I could drop it off to you..., wait, you're in North Wisconsin!?" Wii #2 is pending a Mayo Clinic billing department corporate check. I sold a Nintendo Wii to the Mayo Clinic!

Wii #3 Went out the door this morning. I had just come in from playing with Mikey outside in the 1/16th of a inch of snow we received last night when I got a call from a desperate women on the other end of the line. "Are you Dan? Do you still have your Wii available?" I told her I did and was immediately barraged with "Thank you thank you thank you thank you - you are my hero - thank you! Can I buy it from you right now and can we meet half way?" Considering the notion that I would need to get ready and go somewhere I was caught off gaurd on this lazy Saturday morning and mustered up little better than a prolonged "Ummmm..." "Well you see, my best friend is having a wedding and it is right now, and I'm the bridesmaid, and I didn't know these damn Wii's were so damn hard to find in the whole city (try the whole country I thought to myself), and now I'm late and I need one to give to them because that's what they wanted and I've been looking all morning." *Sigh* fine, I can get ready I thought to myself, heck I can even dig up a gift bag for it, but what frightened me was what she asked next: "So how much does a Wii usually cost? Is there anything wrong with the one that you are selling? Can you promise me that it will work?" This is an example of a very bad buying situation for the buyer, had I been a malicious salesperson I could've probably exploited this situation pretty badly and left the buyer out of money and out of luck. But being the nice guy that I think I am I only scooped her for the $50 commission and now in turn have christened a wedding with a Wii.

So there really wasn't much of a point to this post. Sure pharmacology was probably the worst of times, and this wii alert in class that day probably was the best of times, but the real enjoyment that I had from the sale of these three Wii's wasn't the fact that I could pay our utilities for three more weeks, but rather the three little crazy vignettes that I otherwise never would have acquired. So the moral of the story is: if you ever stumble upon a stash of Wii's one day, maybe try picking one up and if not to play, list it for sale and see what comes your way.

Week 25: Pathology, Immunology, Allergy Begins

So initially I thought we were done for in this block - to say that we were going to learn pathology, immunology, and allergy in six weeks? I would've told you that that was preposterous, until we met Dr. Grande. Dr. Grande is our dean of academic affairs, and I think the wheels and cogs behind our Mayo Medical School six week block curriculum. If there was someone who understood this new teaching paradigm and how it is supposed to be taught it was him. Dr. Grande is also a renal pathologist here and thus chaired not only this block, but also taught us most of the pathology we learned this block. To say the least (retrospectively) this block turned out to be the least stressful and most enjoyable of all our blocks thus far (well the ones in which we were learning some basic science), and it proved to be an effective demonstration of how medical school can be relatively stress-free while you actually learned something! The good news as we learned early on was that the six weeks spent now were only covering general pathology and that the organ specific pathology would be revisited throughout the next year as we move into organ system blocks starting block VII. Another nice change to our curriculum that was intended initially in our heavily didactic blocks was the availability of a free afternoon in which we could actually go study rather than sit in another class until 5:00pm. Dr. Grande made sure that at least three of the five days of the week this block were open, a much needed model that we could've used in histology and anatomy when days went 8 am-5pm (or later) upwards to four out of five days of the week. Since didactic blocks really aren't the most exciting things to blog about (I could just link you to our textbook and have you read it if you really are interested), I'll spend some of the ensuing five more weeks of this block focusing a tad about how each of the pathology, immunology, and allergy components went these six weeks, and a bit about the health behavior and introduction to the patient course that winded up more or less this block with our ability to complete a full physical exam.

Week 22: Medical Economics and Ethics

Our lecturers said to us this week "So you though you were coming to medical school to help people?" it only took 22 weeks for someone to try to convince us otherwise as we were lectured to this week about some of the economics of medicine. Value, as we need to interpret it, is simply quality over cost. To increase value we either improve the quality and/or decrease the cost. The problem however is that their two processes aren't exactly mutually exclusive and we end up having to make decisions that doles out the most benefit for the whole -- even at the costs to some individuals. This reminded me of one of my interviews as a medical applicant when I was posed with the true vignette of a man who advertised that he was dying and needed a liver. Well, the man ended up getting a liver willed directly to him, got his much needed transplant, and the catch? He died about a year later. So the question here is whether or not this man Todd ethically obtained a liver? To Todd this was a life and death situation and he did whatever it took to get the liver he needed (many like him have resorted to going to foreign countries to get black market organ transplants or organs from prisoners), but to the medical community this was a blatant breach of medical economics.

UNOS, the United Network of Organ Sharing is the main sorting site in the United States for all patients waiting for organ donations. To get to the top of the list, politics aside, an individual must have a relatively good prognosis granted that they have a successful match and transplantation. In the case of Todd diagnosed with liver cancer, his prognosis was not good, and to the medical community his transplant was a waste of an organ - robbing someone else of a transplant who could use the same organ better and longer to prolong their life. Here's where the ethics comes in though, every time the medical community gets to play God and decides who lives and who dies someone is bound to be upset - and I can see why they would be upset too. In the interest of medical economics, medical ethics treads a very fine line too as we end up in these Catch-22 situations. Is Todd indeed not deserving of the organ because he will only survive a year with it when someone else could survive longer? Is Todd's unconventional way of obtaining an organ ethical and fair for everyone else who is waiting in line through UNOS? Would it be ethical to perform Todd's transplant even if you disagreed to the ethics of the situation? Tough case, and I think the interview question was meant to scratch this moral dilemma of helping with minimal hurting.

Well, I have my personal opinions about the situation and the problems that Todd has introduced but I'll let you ponder this one yourself, because no matter which way you rationalize your defense someone on either side of the balance is bound to get hurt and that I guess is the crux of the paradox of medicine. Economics and ethics to hurt and to heal.

Week 21: Complimentary and Alternative Medicine

I never really understood how Complimentary and Alternative Medicine (CAM) really could be reconciled under western medicine but apparently it can as Mayo has some physicians - even western trained that practice both western and eastern medicine. I did a short research assignment this week on chiropractics and from what I found in PubMed, contrary to the popular belief that it has quite frequent complications, while it doesn't usually offer a curative solution, chiropractics adverse side effects are extremely rare.

I've updated my mentality towards CAM to be: "if it doesn't hurt you and science (western medicine) can't help you, you might as well pursue CAM -- if that's what you want to do. I'd hardly recommend it to a skeptic though as I feel it still has a self-satisfying quality to the field in general. Now I am still extremely skeptical about such practices as reike that channels energy without even touching you, but I'm all for the massage therapy and the acupuncture that we had a chance to try and experience for ourselves this week. I opted not to try the acupuncture when one of my classmates nearly passed out after getting some pins placed in his ear, but hey, anecdotal evidence from the acupuncturist (also M.D.) was compelling enough for me to be accepting (though not advocating) of it.

On that note, to those that like to grow their own herbs and brew their health potions, check out the Mayo Clinic published Book of Alternative Medicine - one of the authors came and lectured to us and gave us each copies. They give their do's and don't to many popular home remedies out there.

Merry Christmas & Happy Holidays

Merry Christmas and Happy Holidays!

View the PDF version here

Dear friends and family, a cold and snowy greeting we’re sending your way from Rochester, Minnesota—a place we now call home. We moved here this past July and purchased a nice little townhouse close to the Mayo Clinic where Dan is now attending medical school.

Dan is busy studying through his first year of medical school and has finished his first blocks which included histology, genetics and genomics, gross anatomy, radiology, and embryology. Dan’s chronicles of his medical school career have begun on his blog viewable (here of course!) Needless to say, he’s glad he made the choice to come to Mayo and loves the opportunity studying here.

Carolyn is also very busy as a full-time mom and also as a part time dance instructor as well as a teacher at a local daycare. She’s also starting up private piano lessons beginning in January. She enjoys digital scrapbooking and takes care of our little bundle of joy: Mikey. Her adventures of our family are written at http://danandcarolyn.blogspot.com

Mikey is now 18 months old and he is loving life here. He’s got 12 teeth now, is fully bipedal and navigating stairs standing up, and has a repertoire of words that include: “wadder, bahbul, bawl, mmm, uh-oh, woof-woof” along with “ma-ma” and “deeyeh.” Mikey currently writes no blog, but he is going to go bonkers over his wooden train table, Tonka truck, radio flyer tricycle, musical bongo drums kit, and the other thousand items under the tree that he will discover tomorrow morning.

With that we bid you a Merry Christmas and Happy Holidays with all our love,

The Chan Family
Christmas 2007

Week 20: Sexual Medicine!

Now here's a topic you don't get exposed to typically in medical school so much as life in general as well. The irony here is that we have 35 hours of lecture in this one week of sexual medicine than we had for the entire six weeks of gross anatomy! I guess we're kind of delinquent in this subject that is too socially taboo to discuss.

Well the taboo nature of it is gone as we learned the ins and outs of sexual health from intimacy, healthcare, stigma, culture, slang, gender issues, sexuality, disorders, offenders, and even law in the week long first week of our block four leadership block. It was actually quite interesting as not only did we have lecturers, but more impressively panels of guests. Included in these panels was a teen panel from Planned Parenthood discussing how nearly 50% of their peers were sexually active, also a couple with sexual dysfunction and their story of it (we also received their book), a panel of a sexual assault crisis team including a rape nurse, victim advocate, prosecutor, probation officer, and police sergeant. On the flip side we also had two sex offenders come in to talk to us which really chapped my hide as these guys got off easy with only 12 months in prison. 90% of sex offenders go unreported as these guys attested of that as they admitted they were chronic offenders for decades and only got busted for their last offense a few years ago. So according to the wonderful Minnesotan legal system here they only got 12 months in prison and are now on probation. What kind of messed up system do we live in here!!? I mean to contrast, if I as a physician have a romantic relationship with a patient I face 10-15 years in prison and a $20,000-$30,000 fine and loss of licensure, whereas if I go molest little boys I get off with virtually a slap on the wrist!! I'm buying a shotgun for Christmas and Mikey's never going to have a male babysitter (as 90% of sex offenders are male too).

We had a bunch of interesting lectures on geriatric sexual health (how elderly never stop having sex), transgenderism and GLBT (very interesting panel! (the man who was born a woman had me totally deceived), and interesting hands on workshops on contraceptive usage and solutions to sexual dysfunction (sex toys). Well I'm glad those 35 hours are over, but admittedly I learned about sexual health a lot more in this one week than I ever did in my cumulative education… I mean 10th grade health was taught by Coach Barnes!? - I wonder why we didn't learn very much...

Week 19: A Surgeon's Bane

The surgery work week continued Monday back in clinic from 7am-5:30pm, surgery Tuesday from 7am-5:30pm, and Wednesday and Thursday followed suit in clinic and surgery respectively. Each of the surgery days I left before the last case of the day was even over as the chief resident Dr. Shridarani stayed often to 10-11pm each night and was back at it 6:00 am the next morning. Don't get me wrong, I found from the experiences I had watching multiple surgeries scrubbed in and patient side holding retractors, pretending to review my anatomy in situ, very rewarding and very interesting, but after this week a new realization of the surgeon's lifestyle really hit me. A surgeon's schedule stinks!

Not only was I physically and mentally drained at the end of every day, but with 4-6 hour spine surgeries under hot lights, sweating, and standing on one foot watching the time go by one surgery at a time is unrelenting as well. I mean you could pay me $700 and hour, but at the end of the day, and the end of the week, and the end of my life I probably wouldn't even have the time or energy to spend it all! It is amazing what Dr. Huddleston does in the time he has each day - and that he manages to be so involved in everything on top of it all, from being the president of the bone bank, sitting on various Mayo committees including education, and also being a lieutenant colonel in the U.S. Army as well.

Friday I took off just to recover as our leadership block started up on Monday. At the end of this selective I really reflected a bit on the fact that despite surgery being very interesting, it is also a lifestyle hardship making me question whether radiology or anesthesiology might fare better to allowing me to actually see Mikey grow up which I missed this week.

For now my doors are still open - but in my two weeks to attempt self-discovery in orthopedics I think I found myself with more questions than I have answers for in choosing a specialty.

Week 18: Thanksgiving Touring Orthopedics

For my selective this time I went back with my mentor Dr. Huddleston in orthopedics and followed him. Being the week of Thanksgiving I took Thursday and Friday off to be with Carolyn and Michael as we hosted dinner this year with some friends. Carolyn has the details in the family blog.

On Monday I started off observing Dr. Huddleston's chief resident working in the cadaver lab as he exposed iliac crest for bone graft harvesting. Tuesday started off early at 6:30 am for spine conference in which I learned about how MRI's were not great diagnostic indicators of a patient's recovery. By 8:00 am I was in the operating room as I scrubbed into surgery and got a first hand view of three surgeries, the first being a Anterior Lumbar Interbody Fusion (ALIF) L5-S1 in which I even got to hold retractors. In the second procedure I watched an irrigation and debridement of a case in which the person had developed staff infection following back surgery so they needed to clean out his wound. Finally to end the day, I watched another decompression and even got to suture a bit at the end of surgery closing up the incision. Wednesday I spent the entire day in clinic as we met with pre-op and post-op patients. Dr. Huddleston even had me take a patient history of a lady. Needless to say Thursday and Friday were much welcomed days for rest and relaxation.

Week 17: The End or Just the Beginning?

For the amount of time and effort anatomy has asked of us thus far, it has continued to be unrelenting through to the end. We got barraged with the lower limb Monday, Tuesday, and Wednesday of this week and mind you - that essentially makes up half the body - and were tested immediately on both Thursday with the National Board of Medical Examiners anatomy shelf exam, and then again on Friday with our written test and practical test that spanned another four hours. Without recalling all the traumatic experiences and stress of this week and stirring up my newly acquired post traumatic stress disorder (PTSD), I survived. In hindsight the practical identification of the tagged cadavers came out a like better than we expected. Yes I have survived gross anatomy, but what have I accomplished? 1066 pages of textbook reading in short term memory, check. Virtually nil comprehension of the lower limb, check. Massive apprehension to having to learn any of these systems in greater depth and detail, check. But that was it, after Friday at 12:00 pm my brain decompressed and it's been recovering ever since. The mercy that Mayo's curriculum affords is the two week selective, the three week non-didactic leadership block, followed by another two week selective before our next basic science six weeks starts in January. Anatomy the block is over, but the long term learning is just beginning… well, beginning after I enjoy these seven weeks of neural vacation.

Week 16: The Beginning of the End

Orbit, eye, ear, parotid, temporal and infratemporal regions, pharynx, nose, paranasal sinuses and oral cavity, root of the neck and larynx - piece of cake right? Right… seeing that there was more information in this week alone of lecture than about all the previous four weeks of anatomy combined. Add that to the mounting tension of a looming final next week and it makes for massive stress and little sleep. Sunkist and Mountain Dew became my new found friends.

Mayo teamed up with Singapore to put together a review of the neck using clay models, even if it doesn’t make too much sense it's interesting to look at their art.

Week 15: Halloween Hemisection

Ready for another list? Female and male perineum, pelvis, superficial face and neck, and cranial cavity were the list of objectives for this week as was Halloween though we didn't really celebrate it. In the spirit of creepy Halloween however, one of our dissections was a hemisection which involved dismemberment of the leg and also sawing the pelvis in half (hence the hemisection) so that we can see the cross section of the anatomy through the pubic symphysis. Needless to say a disembodied lower limb was a rather creepy thing to heft around.

Halloween was celebrated by trunk or treating for a bit at church and also a little bit of neighborhood trick or treating for Mikey. As the trend continues there were virtually no trick or treaters on Halloween itself suggesting that the era of door to door trick or treating is over. Enjoy the pictures of Mikey the doggie:

Week 14: Video Gaming Good for Surgery?

Abdominal walls, inguinal region, stomach, duodenum, celiac trunk, liver, bile passages, portal circulation, intestines, superior mesenteric artery, inferior mesenteric artery, posterior abdominal wall, and diaphragm - these were the mere topics of this week's learning. If you really want to know the basics of what happened day to day, look at week 13 for a generic breakdown which really encapsulates the feel from a first person medical student perspective.

So how is video gaming good for surgery you ask? Well in an extracurricular activity this Friday, Dr. Dozios from general surgery came to the cadaver lab and demonstrated how to use laparoscopic tools to operate on a fresh (frozen, thawed, but otherwise not preserved thus retaining body fluids) cadaver. Anecdotal evidence suggest that video gamers are more articulate in their hand-eye coordination as well as their spatial perception, both components that are necessary when using laparoscopic tools and doing the surgery via a camera and monitor.

I finally got to cash in on my Super Mario Brothers investment as I picked up the tools and clamped and stapled with ease as I got a feel for laparoscopic surgery. It was a fun first exposure and one I'm glad my video gaming skills have helped develop.

Week 13: A Day in a Block of Gross Anatomy

We finished up the extensors of the upper limb on Monday and spent Tuesday to Thursday learning the whole thoracic area from the regions of the mediastinum, lungs, and heart as we dissected a whole lot of structures this week. Throughout this experience we also had some afternoons spent on our Introduction to the Patient class which teaches us practical skills of patient exam. We listened to lung sounds and also listened for heart sounds although frankly we don't have too much of a grasp on really what we are looking for just yet but only a little bit of how to do it. With time I am confident that we'll be able to master the material a bit more.

This was basically a typical week of anatomy, the ins and outs of a typical day is basically waking up at 5:30 am to preview the day's material, arrive at school at 8:00 am, lecture until 9:15 am, dissect in the cadaver lab until 11:15 am, finish more lecture and get rocked in our Audience Response System (ARS) questions which are basically quiz questions that we answer with our own clickers in 60 seconds each, and done by 12:00 pm. If we have an afternoon class, which run typically 3/5 days of the week we go back to lecture from 1-2 pm and then from 2-4 pm typically we go to a clinical setting to practice either on standardized patients or each other. I get home by 4:30-5:00 pm, eat dinner and unwind until 6:00 pm, and read, study, review and memorize until 1-2 am. The process repeats itself day in day out and you see pretty quickly that you start burning out. The handful of hours between days and between systems that we are learning just doesn't seem to be enough to solidify everything.

Needless to say this week introduced me to the terror of gross anatomy.