About to break the 80-page mark on my "shitty draft." Arnie taught me that term, saying its utility is widely recognized. Get words on the page. Don't worry about anything. Fix later. Move forward. I want to have this shitty draft done by the end of January. And then the Great Revision will begin.
Mind you, I still don't have final approval on this project.
Having a hard time working on the more difficult medical scenes and getting a firm idea of my "new" characters, Sean and Declan. Trying to remember how I've gotten to know the core characters better as I've gone, and that the same thing will happen with these two. Seems really hard to condense a medical visit into a scene. I'll hopefully bring the first big Sean-Declan-Jess scene to the January WIP. It will be fun to have a writing workshop with my medical school classmates.
Loving the Woody Guthrie biography. Excellent description of his mother's decline and death from HD, some very dramatic events. His misconceptions about his risk are also interesting, and I'm just getting to the point of his early symptoms.
Sunday, December 13, 2009
Friday, March 20, 2009
Wilderness med application essay
I post this with sadness that so few people are included in this course, but I thought I would share the majorly hippy musings that were somehow accepted...
******
Today I saw a bumper sticker that said, “Trees are the answer,” and I had to agree, having repeatedly experienced the powerful physical and psychological restoration that can happen amid trees, plants, dirt, and fresh air. Nothing is more grounding than sleeping on the actual ground. I’ve come to understand nature as the source of health, and disease often as a symptom of human separation from nature.
What is the mechanism of action of the potent medicine of wilderness? Natural environments stand as a role model of health. A plant in its ideal ecological niche demonstrates a vitality that we rarely see elsewhere. The model of photosynthesis -- light into sugar, carbon dioxide into oxygen -- reminds us of possibilities of transformation and symbiosis.
As a future psychiatrist, I want to facilitate my patients’ access to this form of medicine. Only so much psychological work can be done “on the couch.” Lessons of the wild directly address issues at the core of some psychiatric illnesses. Connection to the larger ecological web counteracts the sense of isolation in depression and anxiety. Competence in planning and navigating an excursion offsets the helplessness of chronic disease. Overcoming fears of open places, animals, or water proves that other fears can be overcome back home. And awe in the presence of beauty addresses a less quantifiable element, the existential underpinnings of mental illness.
It is well known that psychiatric work can only be done in a setting of safety. My residency training will teach me to care for patients’ psychiatric safety, but if I am going to facilitate excursions, their physical safety will need to be my fundamental priority. The Wilderness Medicine elective would be my introduction to the skills I will need to make my vision reality.
Aside from psychiatry, I also have a strong interest in botanical medicine and partake in wildcrafting trips around Northern California and Mexico, where we respectfully harvest medicinal plants from their native environments. I have learned a lot about safe plant identification and the plant medicines available to treat minor illnesses and injuries in the field, but few people I’ve traveled with have more than basic knowledge of first aid. As someone who straddles the mainstream and “alternative” medicine worlds, I am in a unique position to complement the wildcrafting community’s medical approaches with the allopathic skills necessary in certain situations.
The study of wilderness medicine is necessary to balance out our hospital-based training, with CT scans and specialist consults at our fingertips. It is the ultimate in primary care, the foundation of all medicine, demanding another level of resourcefulness, improvisation, and judgment. I very much hope to leave the clinic/hospital for a few weeks this summer to reap the health benefits of time in wilderness as well as acquire skills that will help me to allow others to do the same.
******
Today I saw a bumper sticker that said, “Trees are the answer,” and I had to agree, having repeatedly experienced the powerful physical and psychological restoration that can happen amid trees, plants, dirt, and fresh air. Nothing is more grounding than sleeping on the actual ground. I’ve come to understand nature as the source of health, and disease often as a symptom of human separation from nature.
What is the mechanism of action of the potent medicine of wilderness? Natural environments stand as a role model of health. A plant in its ideal ecological niche demonstrates a vitality that we rarely see elsewhere. The model of photosynthesis -- light into sugar, carbon dioxide into oxygen -- reminds us of possibilities of transformation and symbiosis.
As a future psychiatrist, I want to facilitate my patients’ access to this form of medicine. Only so much psychological work can be done “on the couch.” Lessons of the wild directly address issues at the core of some psychiatric illnesses. Connection to the larger ecological web counteracts the sense of isolation in depression and anxiety. Competence in planning and navigating an excursion offsets the helplessness of chronic disease. Overcoming fears of open places, animals, or water proves that other fears can be overcome back home. And awe in the presence of beauty addresses a less quantifiable element, the existential underpinnings of mental illness.
It is well known that psychiatric work can only be done in a setting of safety. My residency training will teach me to care for patients’ psychiatric safety, but if I am going to facilitate excursions, their physical safety will need to be my fundamental priority. The Wilderness Medicine elective would be my introduction to the skills I will need to make my vision reality.
Aside from psychiatry, I also have a strong interest in botanical medicine and partake in wildcrafting trips around Northern California and Mexico, where we respectfully harvest medicinal plants from their native environments. I have learned a lot about safe plant identification and the plant medicines available to treat minor illnesses and injuries in the field, but few people I’ve traveled with have more than basic knowledge of first aid. As someone who straddles the mainstream and “alternative” medicine worlds, I am in a unique position to complement the wildcrafting community’s medical approaches with the allopathic skills necessary in certain situations.
The study of wilderness medicine is necessary to balance out our hospital-based training, with CT scans and specialist consults at our fingertips. It is the ultimate in primary care, the foundation of all medicine, demanding another level of resourcefulness, improvisation, and judgment. I very much hope to leave the clinic/hospital for a few weeks this summer to reap the health benefits of time in wilderness as well as acquire skills that will help me to allow others to do the same.
Tuesday, March 10, 2009
On discovering coffee
It took almost 32 years, but coffee finally got me. If anything could convert to a caffeinator, it would be medical school. The third year of medical school.
It's like all vices. It made me feel terrible at first. That's how I avoided it for this long. It is anxiogenic, and I'm looking for an anxiolytic. It gave me acid bowels. Three hours later, I would want to die. But I persisted through it. Like the hacking after the first foul drag of a cigarette, the sour face after the first unexpected bitter bit of beer, those symptoms have settled into a low-grade physiologic disturbance.
And the taste! I'm tired of nettle tea! A vehicle for cream! I'm tired of unsweetened rice milk!
It's like all vices. It made me feel terrible at first. That's how I avoided it for this long. It is anxiogenic, and I'm looking for an anxiolytic. It gave me acid bowels. Three hours later, I would want to die. But I persisted through it. Like the hacking after the first foul drag of a cigarette, the sour face after the first unexpected bitter bit of beer, those symptoms have settled into a low-grade physiologic disturbance.
And the taste! I'm tired of nettle tea! A vehicle for cream! I'm tired of unsweetened rice milk!
Tuesday, October 28, 2008
A contest
The first sentence of a certain unnamed ob/gyn review book is "Pregnancy is the state of having products of conception implanted normally or abnormally in the uterus or occasionally elsewhere."
I invite readers to submit their own first sentence of an ob/gyn review book. First prize is a massage at Spa Brownie.
Mine:
Pregnancy is a total trip.
I invite readers to submit their own first sentence of an ob/gyn review book. First prize is a massage at Spa Brownie.
Mine:
Pregnancy is a total trip.
Wednesday, October 8, 2008
Two ways to make an Ob patient cry
1. Tell her the sex of her baby. Today was the first time I had seen that moment, and I teared up, too. Labia are remarkably distinct in a 20-week fetus! The couple was there with their daughter and had expressed wanting a boy, for variety, but when they heard they were going to have another daughter, they still got so happy. She went from an amorphous "it" to their little girl. I have always liked the wait-and-see, surprise route, but this was clearly very special, too, a moment when she became more real to them.
2. Tell her that her low-ish levels of amniotic fluid could mean a) her bag is broken and she'll have to be hospitalized until she delivers, b) her placenta is pooping out, or c) she's not even listening anymore. I don't know, it was this crazy example of how we freak people out over probably nothing and why I understand a minimalist prenatal approach without lots of technology and tests. OK, so this woman has a little oligo, but suddenly we're discussing what she would do if she underwent fetal non-stress testing and discovered huge dips in heart rate, and oh no, we're hypothetically discovering this when the baby is 25 weeks, which is technically viable but they baby could have lifelong health problems. Seriously, this doctor was conjuring images of her being ambulanced to UCSF from Eureka and even said at once point, "Now I know you don't want your baby to die..." (That sounds worse out of context than it actually was, but still!) I was like, how did we get here? With these tests that tell you your risk of Down's syndrome is now 1 in 690 instead of 1 in 200. What does that even mean? Even though this patient wasn't even being evaluated for Down's risk, she somehow still had to assert, "I would keep this baby even if it had Down's!" I don't know, it was a very confusing visit for me. We feel like we have to prepare patients for the worst, but what ever happened to crossing bridges upon getting to them?
2. Tell her that her low-ish levels of amniotic fluid could mean a) her bag is broken and she'll have to be hospitalized until she delivers, b) her placenta is pooping out, or c) she's not even listening anymore. I don't know, it was this crazy example of how we freak people out over probably nothing and why I understand a minimalist prenatal approach without lots of technology and tests. OK, so this woman has a little oligo, but suddenly we're discussing what she would do if she underwent fetal non-stress testing and discovered huge dips in heart rate, and oh no, we're hypothetically discovering this when the baby is 25 weeks, which is technically viable but they baby could have lifelong health problems. Seriously, this doctor was conjuring images of her being ambulanced to UCSF from Eureka and even said at once point, "Now I know you don't want your baby to die..." (That sounds worse out of context than it actually was, but still!) I was like, how did we get here? With these tests that tell you your risk of Down's syndrome is now 1 in 690 instead of 1 in 200. What does that even mean? Even though this patient wasn't even being evaluated for Down's risk, she somehow still had to assert, "I would keep this baby even if it had Down's!" I don't know, it was a very confusing visit for me. We feel like we have to prepare patients for the worst, but what ever happened to crossing bridges upon getting to them?
Saturday, October 4, 2008
To be known
Sometimes I feel like the worst part of third year, worse than the long hours and being "beaten with the idiot stick," as Chunk puts it, is feeling awkward and intrusive and out of place nearly all the time. People not knowing what you are doing there and what they are supposed to do with you. Which was why I particularly loved my OHNS (that's the new way to say ENT) surgical team on Thursday. They were just like, "Hey! Great! Check it out! Here's what we're doing!" Same with a neurosurgeon on Monday. (Yes, I saw cerebellum.) Every day I appreciate how amazingly nice someone is to me.
But then there was a day when I saw two people who really know the real me and care about me on a deeper level, and it felt so good to see them that it made me sad to think about the superficial level I survive on normally when I'm here. I saw Dr. Jeff from the Health & Healing Clinic, and he looked at me like my doctor dad and made me laugh spontaneously and genuinely. Then as I was getting on the elevator with my medicine preceptor, my stream of trying-to-sound-like-I-belong BS was abruptly interrupted upon seeing Holly, my body/mindworker, of all people! It was so surprising, and she is so intense, I was kinda speechless and dumbfounded. Having her see me in this context, having her presence pierce this place, really threw me. And made me want to have some more sessions with her!
Anyway, this is all to say that our coworkers can be the nicest people and most generous teachers in the world -- and we can be grateful for them! -- but they will never substitute for our true support system. I think if I ever saw Scott or Mom or Chunk within these walls, it would have the same effect: a direct comparison, collision, invasion. Confronting the difference between how I feel around them and how I feel around everyone else here.
Then there are med school pals, the bridge. The name of this blog has been modified to placate one of them, that's how important she is.
But then there was a day when I saw two people who really know the real me and care about me on a deeper level, and it felt so good to see them that it made me sad to think about the superficial level I survive on normally when I'm here. I saw Dr. Jeff from the Health & Healing Clinic, and he looked at me like my doctor dad and made me laugh spontaneously and genuinely. Then as I was getting on the elevator with my medicine preceptor, my stream of trying-to-sound-like-I-belong BS was abruptly interrupted upon seeing Holly, my body/mindworker, of all people! It was so surprising, and she is so intense, I was kinda speechless and dumbfounded. Having her see me in this context, having her presence pierce this place, really threw me. And made me want to have some more sessions with her!
Anyway, this is all to say that our coworkers can be the nicest people and most generous teachers in the world -- and we can be grateful for them! -- but they will never substitute for our true support system. I think if I ever saw Scott or Mom or Chunk within these walls, it would have the same effect: a direct comparison, collision, invasion. Confronting the difference between how I feel around them and how I feel around everyone else here.
Then there are med school pals, the bridge. The name of this blog has been modified to placate one of them, that's how important she is.
Tuesday, September 23, 2008
Talk the talk
Some amazing words, lingo, and phrases from the world of medicine.
tismus: I think it means you can't open your jaw because of muscle weakness. I can't wait to rhyme it with Christmas!
defervesce: a beautiful word with a meaning you can kinda deduce... to experience abatement of fever. I just like its sonic kinship with effervesce. I can picture your fever bubbling away. Also defervescence.
phlegmon: I can already hear Scott saying, "I am PHLEGMON!" in his bad-guy superhero voice. "Solid mass formed by inflamed connective tissue, such as forms around an appendix in appendicitis."
When my psychiatry preceptor was explaining the "kindling" effect of manic episodes in bipolar disorder, he said, "The more you have, the more you have."
Today we heard about "marsupialization." You figure it has something to do with, maybe, a pouch? Indeed! "Surgical alteration of a cyst or similar enclosed cavity by making an incision and suturing the flaps to the adjacent tissue, creating a pouch." It works when a single draining of a cyst wouldn't last or wouldn't get all the material out.
Evidence of my indoctrination into this sociolinguistic culture is that I have finally stopped abbreviating "with" as "w/" and have adopted the medical "c" with a line over it. Without = "s" with a line over it. Sort of espanoly in a couple of ways: correlates with "con" and "sin," and the line is kinda like an accent. I resisted the switch, but now I'm into it.
tismus: I think it means you can't open your jaw because of muscle weakness. I can't wait to rhyme it with Christmas!
defervesce: a beautiful word with a meaning you can kinda deduce... to experience abatement of fever. I just like its sonic kinship with effervesce. I can picture your fever bubbling away. Also defervescence.
phlegmon: I can already hear Scott saying, "I am PHLEGMON!" in his bad-guy superhero voice. "Solid mass formed by inflamed connective tissue, such as forms around an appendix in appendicitis."
When my psychiatry preceptor was explaining the "kindling" effect of manic episodes in bipolar disorder, he said, "The more you have, the more you have."
Today we heard about "marsupialization." You figure it has something to do with, maybe, a pouch? Indeed! "Surgical alteration of a cyst or similar enclosed cavity by making an incision and suturing the flaps to the adjacent tissue, creating a pouch." It works when a single draining of a cyst wouldn't last or wouldn't get all the material out.
Evidence of my indoctrination into this sociolinguistic culture is that I have finally stopped abbreviating "with" as "w/" and have adopted the medical "c" with a line over it. Without = "s" with a line over it. Sort of espanoly in a couple of ways: correlates with "con" and "sin," and the line is kinda like an accent. I resisted the switch, but now I'm into it.
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