August 2015

Summer Stories Part I

MedCamp as Simulation
by Renee Ridley, M1

The choice to attend MedCamp was an easy one for me. I had been out of school for a while and was a bit concerned due to my age (52). According to the advertised description of MedCamp, it was created to match very closely what we would be doing as medical students.

Upon arrival, the experience was equated to a simulation. I could relate to this, as I had been involved in numerous simulations as a nursing professor. Although students typically want to go through simulations without error, the purpose is to allow mistakes so that they are corrected in a safe environment where nothing counts and nobody gets hurt.  

As an M0, it's one thing to experience the ritual of sitting with soon-to-be-peers in a classroom where lectures, discussions, and exams will soon commence. It is quite another to actually monitor and evaluate your response to this whole process. 

Will I be good enough? Do I fit in? Can I physically and mentally hold up to the rigors of so much information in a short period of time? As it turned out, we all had similar concerns, and the obvious answer to all of these questions was “Of course!”, as evidenced by the TAMHSC Admissions Committee inviting us in!

MedCamp was the opportunity to move past these questions, determine how we could each navigate the obstacles thrown our way, and still make it out on the other side. It was comforting to understand what "everybody makes it" actually means; the purpose of MedCamp was not simply to pass (although, a criterion score was still part of the simulated curriculum). On the contrary, the goal was to let us live "it" so we could each individualize our own paths to success. Resources abound! 

As "it" became a well-known noun in our vocabulary, we all celebrated this short yet powerful word with a YouTube video featuring Shia LeBeouf's "JUST DO IT" campaign. If you've never seen it, just Google it and several renditions will pop up. It is guaranteed to make you feel empowered, inspired, smarter, and a whole lot saner than Shia LeBeouf.  

In the end, I learned that I am not only a wife, mother, nurse, and friend; I am now and will forever be, a learner of medicine—currently, an M1 medical student at the best school ever. Life is good!

Ben and Reflections from the Seventh Grade
by John E. Pippen Jr., MD, FACP

In September of 1967, a time of great turmoil in the US, I entered my own time of turmoil. It was called seventh grade at Frank M. Black Junior High. I guess you could call Black a rough neighborhood as schools go, but that would be like calling Mogadishu a slightly challenged urban area. The new seventh grader at Black had to watch out for thrown objects, robbery, and general mayhem. And that was just in homeroom.

By near the end of the day, the heat and constant fear of loss of life and limb really took a toll. In the 1960s, most of the schools in Houston were not air conditioned. If you have never been to Houston, it is home to some of the worst climatic conditions in our solar system. By sixth period in September, one could generally swim in the humidity. Algae growing behind the ears would surprise no one.

As I stumbled into room 113 for my first day of sixth period English, my main goal was survival, not staying cool. Most athletes at Black had sixth period sports, but being skinny and unnoticed by the coaches, I was relegated to sixth period with the rank and file in English class. This meant staying clear of some really mean dudes that had been in seventh grade a few times already. Fortunately, most were hot by this time of day and further distracted by the exposed thigh of platinum blonde Cindy Peters, who had a fondness for net hose and maximal leg exposure. Generally, I could expect to survive if I went to the opposite side of the room from Cindy, who was like a pied piper for long-haired homicidal hoodlums, which made up the majority of males in the class.

I have not even gotten to the teacher yet. She scuffled her osteoporotic carcass into the room, found a piece of chalk, and proceeded to write her name on the board.

"Hello class, I am Mrs. Ben R. Guisti."

I could not withhold a chuckle when Ricky Hall mumbled, "Can we call you Ben?"

This got me off to a bad start with Ben, who looked right at me at the peak of my chuckle. Ben had a drop of sweat on her pointy coati-like snout, the result of a hot flash secondary to years of estrogen deficiency, not to mention that it was a good 94 degrees. The sweat fell off just as she said, "Young man, I will not tolerate your disruptive snickers in a class as important as seventh grade English."

Ben said it with the quivering voice of someone who had just about had enough of a career that must have started in the 1870s. If the reader is anticipating further unfavorable interactions between myself and Ben, limited patience will suffice. As she passed out the state-issued textbooks, it took little time for several of the older seventh graders to move straight to mischief. In the first-day sentence construction exercise was the following: The ____ woman served him a ____ for breakfast. Again, it was Ricky Hall setting the tone by grabbing a neighbor's book and deftly penciling in the words … I am not going to write them, but you get the idea. I mean come on, what seventh grader can suppress a chuckle when that is passed around? Again, being close to Ben's desk, I was the sole target of her consternation.

"Young man, you have disrupted the start of my class twice now, once by inappropriate laughter, and once by defacing state property. Will you attempt to aggravate me further, or will you be content to rest on your laurels?"

"What's a laurel?" mumbled Ricky.

"Now strike through those horrible vulgarities you wrote in the textbook!" Ben said. I was about to deny the crime but remembered the code of silence and did not want my head shoved in a toilet, so I just mumbled, “Yes ma'am.” This garnered me about five minutes of respect from Ricky, but he was back to concentrating on Cindy's thigh pretty quick.

A bit of senility was nibbling around the edges of Ben's brain as she lost interest in my alleged transgressions and moved toward checking roll. After this painstaking process that seemed to take days, the roll sheet was to be placed on a clip by the door. Ben could not find the clip, given her advanced stage of macular degeneration. Lizzie Kirk, one of the class teacher's pet types, finally got up and helped her find the clip.

Things did not really get better as the semester progressed. The class did read a lot of good short stories, some of which were a metaphor for the long academic haul needed to finish medical school. We read Sansom's "The Long Sheet," in which a group of captives are asked to wring a long sheet dry, only to have water constantly added.

Ben gave us a project in which we were to make an art object related to one of the stories that we had read. I made a decent drawing of a church that was in one of the stories. The problem was that I had to carry it around all day before turning it in to Ben at the start of sixth period. Being a seventh grader, I of course left it in the desk that I was sitting in for fourth period. When I went back to get it, I found that it had been destroyed by some Manson Family types that must have known it was important to someone. I could not turn it in, so I ended up with a poor grade for the semester.

Shortly after my one semester at Black mercifully ended with a transfer to Scarborough Junior High, there in Wyatt's cafeteria on 43rd Street, was Ben in the line, staring at the Jello. My mom poked me and told me to say “Hi” to Mrs. Guisti. To Mom's horror, I said "Bye Ben!" as I moved on down the line toward the chicken-fried steak.

Some names and identifying details have been changed to protect the privacy of individuals.

A Healthier Banana Bread
by Cullen Soares, M2

Dry Ingredients:

• 2 cups whole wheat flour

• 2 teaspoons baking powder

• ¾ cup coconut sugar

• 1 teaspoon ground cinnamon

• ¼ teaspoon or pinch each of ground nutmeg, cloves and allspice (if available)

Steps:

1. Mix flour, baking powder, sugar, and spices thoroughly.

2. Mash bananas with a fork and then mix with egg whites, vanilla, and oil.

3. Mix dry ingredients into wet ingredients.

4. Ensure that it forms a thick, semi-solid batter. It should not be so thick that it needs to be scooped out (like cookie dough), but not too thin that it is easy to pour (like pancake batter). Add milk of water in small increments to achieve the necessary consistency.

5. Sprinkle a little wheat flour on raisins and nuts. Fold in raisins & nuts. Do not mix too much.

6. Preheat the oven to 350°F.

7. Pour into a greased pan.

8. Bake for 45 minutes to 1 hour depending on your oven. Check if it is finished by inserting a toothpick and seeing if it comes out clean.

9. Remove from oven to cool. Once cooled, remove from pan. Slice and enjoy.

Comments:
This recipe has a several features making it healthier. Whole wheat flour is used instead of white flour. Coconut sugar is used instead of white sugar. Coconut sugar has a lower glycemic index, which may be better for diabetics. Additionally, coconut sugar is usually an unrefined sugar. If you choose to use regular sugar, use ½ of a cup since it is sweeter. Egg whites are used in place of a whole egg, lowering the cholesterol content. Applesauce is used in place of butter, although there is still a small amount of oil added. You could omit that as well, if desired. If you want to convert this recipe into zucchini bread, substitute the banana for grated zucchini.

Summer Stories Part II

Charts and Numbers
By David Harmon, M2

She was the youngest patient that day—barely out of her teens. She was in pain “all over,” she said. I felt helpless reading her chart, her story, her ailments. As I trudged through each piece of information in her file about infections and medications, a dark side of my thinking screamed, “This is hopeless; just do your job, log your results, and move on.”

HIV. I could not stop the flow of textbook information pouring from my brain: promiscuous lifestyle, unsafe sex, dysfunctional and broken household, probably non-compliant with daily medications, etc, etc. My first-year medical student analytical skills were resounding so loudly in my mind that it was hard to pay attention. For a moment, there was a touch of arrogance in my lofty thoughts; “I may not solve the problems, but at least I am right about one of these conclusions.”

The next page promptly left me frustrated, sorrowful, and silenced as I sat in my quiet office. “HIV acquired from rape” in her early teens.  A few other phrases from the page came into clear focus: “Two kids,” “Lost custody,” “Threw away prescription—did not care to live.” My mind went blank.

This young patient’s multi-infection diagnosis was not the worst part of her story. She had a life engulfed with hurt, loss, pain, and hopelessness. Her decision to let life drift numbly into nothingness no longer seemed like an overreaction, but rather a simple solution to the battle she faced in the weeks, months, and years ahead: medication for the rest of her life, stigma of a chronic disease, and shattered dreams.

As I was finishing reading her chart, I read about the beautiful dreams she had had—and still fostered. After surviving multiple infections, episodes of septic shock, and infections due to immunosuppression, the patient reported that she wants to live! The odds of life are stacked against her a million to one; but, as I read further, a fire began to ignite in my soul and I wanted to shout, “Go for it!”  

I looked up with a heavy heart from my computer screen into my empty office. I finished my chart abstraction in the format my Principal Investigator preferred and closed out of the patient’s chart. Only a few more charts to review before the research work day was done.  How many more patients had similar stories whose deeper meaning I had missed in the mass of paperwork?

I have a long way to go. Jumping to conclusions about what I believed were rational deductions about this HIV case was not only ignorant but also arrogant. I misjudged the patient from a simple chart review, and it took a thorough chart review to revoke my judgmental attitude.  If I truly care about people, as I believe I do, why then was it so easy to jump to conclusions rather than seek to understand first?

Often we ask ourselves why life smiles on some and knocks others down. It saddens me to see how one horrible event created a vicious chain of unfortunate events in this young patient’s life. As I continue to learn and work toward my dream profession and study what I am passionate about, I must not take for granted the privilege which has been given to me. Every day I will have the opportunity to encounter patients with the same stories as this patient. Life has turned its back on them, and hope has fled to the other side of the world, but I have a chance to make them smile and remember that the story is not over.

Days are Long, but the Years are Short
by Joseph Joo, M1

I woke up before the sunrise. Since first year in college, I had imagined this day for quite some time. I just could not get much sleep overnight; I was still experiencing the lingering effects of jet lag from my family trip overseas. After the morning presentations, eventually the moment came – I walked briskly across the stage, shook hands, and received my white coat. I, along with the rest of the student body, read out loud the oath of commitment, took some pictures and then proceeded to look for my dad. I found him rather quickly. We smiled and embraced each other. In that moment, my dad whispered, “I’m so proud of you, son.”

In the preceding weeks, I had visited South Korea for the first time since 2001. It had been fourteen years since my dad, mom, younger brother, and I moved back to the US. I could not help but to realize again and again how those years had seemingly flown by. During the trip, I stopped by many tourist attractions and tried different types of food, almost too many to recall. I took many pictures of landmarks, caught up with old friends, and revisited old neighborhoods. Amongst all that, however, the most memorable moment came when my family went to visit my grandmother for the first time since I was in fifth grade. Driving to her house, I could sense that my dad was anxious. Upon seeing her, he quickly walked over to embrace her, and I heard him say, “Mom, I’m home.”

I realized in that moment that it was the first time I could remember my dad saying those words. Once I moved back to the US, my dad worked tirelessly to re-establish and set a foundation for the family. Years had passed since I had last been in Korea to see my grandmother. In the US, I had always observed my dad being a steadfast leader in a variety of aspects: in his profession, in the community, and within our family. But it wasn’t until this moment that I could appreciate him for the first time as not only a father, but as a son and an older brother. As a child, I visited my grandmother regularly. Now, as an adult fourteen years later, I was finally able to have the perspective to grasp the depth, magnitude, and implications of that moment.

Being a son of immigrant parents who, as many others can readily attest, faced immense challenges to establish themselves in this country, I am no stranger to the idea that circumstances oftentimes preclude a person from being very idealistic, or experiencing life to the fullest. I am certain that there were many things my dad wished he could have seen, done, or experienced but did not have the opportunity. I realize with increasing frequency that I am able to do the things I do, including pausing to reflect through writing, because of his commitment and sacrifice.

Looking at my dad for the first time through my new perspective reminded me that people are all sons, daughters, brothers, or sisters in their own way. I realized that people, before they are students, or professionals, have superseding roles as family members and friends. In the future, when I have the privilege to encounter patients, I will see them as much more than just the physical or mental conditions that bring them into the clinic.

I have no doubt that being a medical student will bring forth immense personal and professional growth. As it occurs, I do not want to lose sight of my family, friends, and mentors who have supported me along the way. I want to remind myself that I chose to pursue this career for the people who make the art and science of medicine matter. I will strive to cherish and savor the long days as a medical student, taking notice of the relationships between my patients and their families. Before the years pass by, I want to make the most of each opportunity and reflect regularly not only as a student, but also as a son and brother along the way.

Something Great
by Brian Nguyen, M2

Maybe we are meant for something great
But who could ever measure greatness on a scale?
Who could ever predict or speculate
Whether our plans and aspirations will triumph or fail?

I hope you’re up for a challenge or two;
Maybe we are meant for something great.
I hope your goals are worth the hullabaloo
And certainly well worth the wait.

Maybe we’ll cure the world of a disease and state,
“Forever I eradicated cancer and the like!”
Maybe we are meant for something great
Like teaching our children how to ride a bike.

Not quantifiable, tangible, or visible is virtue,
But with family, friends, and dedication we can create
A small or large difference in whatever we do.
Maybe we are meant for something great.

tHANK YOU

To our amazing faculty mentors: Barbara Gastel, Mary Elizabeth Herring, Gül Russell, & AJ Stramaski

Faculty Editor: Karen Wakefield