Marks of the trade

In any sub-culture or field, there are codes that people use to identify with each other. As a second-year med students (the sophomores of med school), I feel on the cusp of cool -- we're beginning to learn clinical stuff (as opposed to those poor first-years mired in basic science), we think we've figured out med school, and yet we're still stuck in the library instead of on the floors, in the academic rather than clinical years of med school.

So to make myself feel cooler--and for efficiency as the workload has increased--and because they actual make sense to me now, I've started to pick up medical abbreviations:

The causes of aseptic meningitis? HSV-2, HIV, VZV, LCM, EBV, and CMV, among others (and yes, I know what those stand for)

The write-up of a disease? Well, you have to know the Sx, Si, Dx, and Tx

Just wait: soon my handwriting will be abysmal.

Getting mad about healthcare disparities

At our school, there's a well-known CBS news clip about Dr. Bob Paeglow, who serves the Arbor Hill community in the broke part of Albany, in which the TV anchors conclude by calling Dr. Bob "a saint." Well I don't think we should call someone a saint for seeing poor patients; I think we should be outraged that not everybody is doing it.

This morning we had an introduction to rehab medicine, an important and underutilized field of medicine helping some of the most disadvantaged and underserved patients out there, the impaired and disabled. The lecture was great and highlighted physical limitations that health care providers often overlook. If anticipated, these limitations can be addressed and mitigated, sparing a patient with a disease from experiencing impairment or disability. The problem is that many of these interventions require drastic changes to the patient's environment (house renovations, special vans, etc.), which cost money and are often not covered by insurance. Such changes have been known to bankrupt even the insured.

In contrast, at lunch I attended a guest lecture by an alumnus whose practice is situated in a homeless shelter in San Antonio, Texas. Ninety percent of her patients are uninsured (and Texas has rejected a Medicaid expansion) -- as a result, she described with pride learning to manage chronically ill patients on the bare minimum.

Why do we spend so much time learning about ideal healthcare when most people--and yes, I need some stats here--don't have access to the ideal?

Courtesy Physicians for a National Health Plan, www.pnhp.org

Possibilities

This morning I volunteered at a flu clinic targeting Albany's refugee community, families from Bhutan and Nepal, Thailand, Iraq, and Africa, among others. The clinic came about a joint effort between Koinonia Primary Care, Albany's Refugee Health Round Table, and SUNY's School of Public Health. Koinonia is a family medicine clinic and federally qualified community health center serving the Arbor Hill community; most of their patients are African American and religious Christians, although they are open to all and serve some refugees as well. For this event, there was a specific drive to reach a different community, including Muslim families.

Accordingly, the student groups who volunteered for the flu clinic came from three campus clubs: Care from the Start, where students see patients at Koinonia; IMANA, which runs clinics at a mosque; and AMCRI, which works with the refugee families directly. We learned to fill syringes with vaccine and give shots, while downstairs, interpreters welcomed families and explained paperwork. Dr. Bob of Koinonia supervised but once we got running, we ran entirely independently, even training the next group on our own.

So what if we had a student-run clinic every Saturday, built out of the three clubs whose efforts currently run in parallel? Imagine the possibilities...

Then I came home to a quick lunch of cold sesame noodles, all components made ahead of time and just in need of assembly. A lunch produced through cultural exchange:

I am reblogging* this recipe from here, which was adapted from Fuchsia Dunlop's cookbook Land of Plenty, which translates Chinese recipes for American home cooks. Think of it as a recipe that has traveled a long way to your computer screen.

(*I used the condiments that I happened to have at home, and thinly sliced cucumbers instead of the other veggies.)

Problems as patients

A question I am frequently asked by my younger brother is, "So when did you become such a nerd?" My latest answer to this question would be, "When I started using Harrison's Principles of Internal Medicine."

Our deans have told us to start thinking of classroom medicine in terms of patient presentation, and vice-versa, using patients we meet as opportunities to study diseases in greater and more memorable depth. While I didn't take their advice at the time, it must have sunk in. Second year is about disease, which presents in people -- it is relevant to turn not just to First Aid for the boards but to Harrison's tome of the natural history of disease. After meeting a real patient with gallstone pancreatitis this week, I looked up "gallstones" and "pancreatitis" to understand what causes them, how they are related, what symptoms they cause, and how they can be treated.

This morning we were shown a cartoon of an imaging study showing where Alzheimer plaques cause damage in a brain (in red):

The amazing thing is that you can connect those locations to the normal function of those parts of the brain (e.g. hippocampus and memory, parietal cortex and visual-spatial processing) and then relate them to symptoms in Alzheimer patients.

Anyway, it's starting to click, and that's cool. So, what's for dinner?

Tomato sauce in less time than it takes to boil water

Are you the kind of person who, like me, dances around the pasta pot waiting for water the boil, munching on uncooked noodles?

Sometimes I pretend that I am going to memorize flashcards during this waiting period, but instead I end up tiptoeing over to the pot every few minutes "just to check on it."

Well tonight I learned that by being extra lazy, it is possible to make a delicious fresh tomato sauce during this awkward gap between stove-lighting and pasta-box-emptying.

Whole cherry tomato sauce (two servings):

• 1/2 pint cherry tomatoes, washed
• teaspoon-ish butter
• teaspoon-ish olive oil
• 2-3 cloves garlic
• dash white wine
• few sprigs parsley
• chili flakes, black pepper, salt
• parmesan
• 1/2 pound pasta

Judges, start your timers! (Turn on your pot of pasta water.)

Heat the butter and olive oil on high heat. Peel and mince the garlic and add to the pan, cooking for a minute. Dump in your cherry tomatoes. Dash your white wine over the top. Push everything around with a wooden spoon. Stab the cherry tomatoes with a fork, then smash them with your wooden spoon. Add water as needed. Cook until sauce thickens, without burning in the pan. Mince the parsley, toss in along with seasonings, and turn off the heat.

Is your water boiling yet? (Why yes, it just started to boil!)

  

Feel free to study flashcards as you wait for the pasta to cook...

Cash money

Last week at the doctor I was given a choice between two meds and without even thinking about it, the first question out of my mouth was, "is there a difference in cost?" Immediately I thought I should have asked her, instead, which she would recommend and why. Although I am 26, this is the first time I'm paying for my own health insurance and the first time that I'm acutely aware of being a poor student. Perhaps I'm being overly cheap, but I now consider whether a doctor's visit will be billed as an annual physical (free) or not ($20 co-pay) and make decisions accordingly.

When was the first time you became aware of the cost of healthcare? When did it first begin to influence your decisions?

Friday night in med school

Study hall

Vegan interlude

Walking down the hospital halls after neuro, every twitch, twist of the neck, or odd posture appears a nail to my hammer. Neuro lectures are captivating but depressing, largely because right now we can treat only the symptoms but not the underlying cause of several diseases. However, everything we can treat is breathtaking, and soon we will have cures for more diseases! (Hopefully.)

In the land of food, it seems that fall in upstate New York is an excuse for spice-themed binge eating: s'mores to "reward" hiking, cider doughnuts to "reward" apple picking, apple and pumpkin desserts, etc. In between all this sugary indulgence, it's nice to have a few items that are hearty and comforting but healthy! Last weekend I made a kitchen-sink vegetable soup; this week I went the raw route.

"Massaged" kale salad (I don't believe in pampering vegetables, but the brief effort here pays off. Recipe took all of two minutes!)

• 1/2 bunch dino kale, stems removed, sliced crosswise into ribbons, and washed
• 1/2 or 1 avocado, cubed
• handful of cherry tomatoes, washed and sliced in half
• small handful of almonds, toasted and chopped
• balsamic vinegar
• olive oil
• pinch of salt (apparently this helps to soften the kale)

In a large bowl, dress the kale with oil, vinegar, and salt. Wash your hands and then massage the kale, grabbing handfuls at a time and rubbing them together between your fingers or palms. (Surprisingly therapeutic!) After a minute or two, the kale will be noticeably softer. Toss in your other ingredients! The buttery, nutty avocado makes this quite comforting despite the lack of cheese or bread.

Two neuro patients

Today we had two guest patients, one each for lectures on Parkinson disease and cerebellar ataxia, a disease of severely uncoordinated movement. Both patients had been first diagnosed in his/her early forties and had to adjust from a normal adult life to one of increasing disability. The second patient, a man with cerebellar ataxia, continues to golf several times a week even though he walks with a cane and suffers from slurred speech. He told us that he heard that Michael J. Fox still golfs, "and he's worse than me!" I was struck by the importance of role models.

Both patients were cheerful and good-humored, but what I really admired about them was their willingness to make themselves vulnerable for the purpose of teaching. Our lecturer, a neurologist, began by conducting a neuro exam on his patient with Parkinson's in front of the class: she did very well. He then used a small handheld machine to turn off her deep brain stimulator (magic!) and repeated the exam a few minutes later: this time, the patient was shaky and uncoordinated, clearly uncomfortable and dangerously unstable on her feet. Finally, the doctor turned the deep brain stimulator back on and the patient returned to what appeared to be a very normal, non-Parkinsonian state.

The immediate effect of the deep brain stimulation was awing; more than that, my visceral fear that the machine would not turn back on, leaving our guest in her more severe form of disability, gave me a glimpse of how anxious a patient must feel when a drug starts to wear off or stop working. How precarious to be dependent on modern medicine: a semblance of health can so quickly fade away.

Unexpected bit of light

I just went to see the doctor (nurse practitioner, actually) and she made me feel so much better just by talking to me and coming up with a plan. It's good to be reminded that at the end of all of this health providers can make people feel better! I do forget!

Getting into jazz as my uncle is falling out of it

I have always liked jazz: it reminds me of Saturday mornings and the Disney movie "101 Dalmatians." Certain songs by Miles Davis and John Coltrane take me straight back to my parents' kitchen, where those musicians have been on rotation for the past 20 years. But recently, as I have been studying more and have introduced music into my study routine, listening to music for many more hours a day than ever before, I have branched out, delving further into jazz... Nothing particularly creative, mostly artists I have heard at home, Christian McBride and Wynton Marsalis, Charles Mingus and Thelonius Monk.

Browsing my online music library reminds me of the cats my cousin grew up with, Mingus and Mojo, who were cared for so lovingly by his dad. My uncle was once a jazz musician and music teacher who loved to talk about jazz, although these were conversations I would eavesdrop in on rather than join. I could never keep up and never had much of an interest.

It's a bit sad and strange, then, that I should just now be getting into jazz as my uncle is losing his memory and his ability to talk about music in the way he once did. I have never met anyone more passionate about the subject.

Food as comfort, jazz as comfort...

Transformations II

The other night a friend from home asked me what we're studying these days. "Blood disorders--like bleeding and clotting--and leukemia and lymphoma," I replied. "Blood clots--ew!" was his response.

His reaction reminded me that not too long ago I couldn't have a conversation about a blood clot without feeling sick and faint. And yet without realizing it I've completely changed. We've zoomed in on clots, so that I now think about how you build a clot and how you take one down, almost as if it's construction work. What are the heritable or acquired diseases or drug interactions that impact clotting and bleeding? There's so much more than "clot--gross!" Thank goodness.

For many years I thought eggplant was gross. I didn't like the flavor, texture, or anything about it. Now I love how it's soft and meaty--a great vegetarian substitute!

Barley salad with fall vegetables:

• 1/2-3/4 cup barley, cooked in a rice cooker with 2:1 water:barley
• 6 chard or kale leaves, steamed and chopped
• 1/2 or 1 slice small eggplant, sliced 1-cm thick and roasted in the oven (I used leftovers from this sandwich that I did end up having time to make)
• few cherry tomatoes, sliced small
• feta cheese to taste
• olive oil to taste, about 1 teaspoon

Cook ingredients separately and toss together with olive oil. Enjoy warm or cold!

 

Neither of you scare me now!

Fried green tomatoes

Even I sometimes run out of time to cook. But this doesn't mean that I'm not still thinking about food, that the green tomatoes my friend and editor gave me aren't calling out to me from the fridge. I had some great plans for these beautiful tomatoes before it struck me just how little I knew about chemotherapy for leukemia and lymphoma.

Here is what I would be cooking if I were cooking.

Fried green tomatoes:

• green tomatoes
• 1 egg
• flour
• breadcrumbs
• canola or olive oil
• salt and/or parmesan

Arrange three shallow bowls or plates side by side: flour, then egg, then breadcrumbs. Slice large tomatoes into 1-cm slices or cherry tomatoes in half. Dip in flour, then a beaten egg, then breadcrumbs. Heat a generous layer of canola or olive oil in a large frying pan; when hot, lay the tomatoes out side by side in the oil. Fry at high heat until crisp on one side, then flip over (using two forks) and fry the other side. Cool on a paper bag or paper towels. Sprinkle with salt or parmesan cheese and serve right away. I'm salivating just thinking about it.

Roasted eggplant sandwiches:

• 1 small eggplant
• 1 tomato
• feta cheese
• bread or pita
• olive oil, salt, pepper

Slice the eggplant and tomato 1-cm thick. Place the eggplant slices side-by-side on a baking sheet and brush with olive oil, salt, and pepper. Bake at 400 degrees for 5-15 minutes, until soft or crispy (as you like it) but not burned. More oil = crispier eggplant. Toast your slices of bread and create a stack of eggplant-feta-tomato slices. Drizzle with olive oil if you're feeling really luxurious. Ah, the combination of textures and sweet-and-sour flavors, mm!

I did toss these into a quick stir-fry -- and yum!

Tricks for when you run out of time to cook: keep frozen soups, chili, ravioli, even prepped veggies in the freezer. Try stir-fries. Stock your fridge with snackable fruits and veggies and proteins such as yogurt and cottage cheese. Hunker down. But you know all this!