Life under the quill

I've got a final on Tuesday and one on Thursday, plus a not-so-optional mini-board exam on Friday. I spent much of the day reviewing pictures of nasty dermatological diseases and looking up which leukemias and lymphomas are deadly and which are your friendly garden-variety lymphomas that you can live with. Tomorrow I'll review slides of blood smears and all the microbes that can cause nasty syndromes including who's most likely to get what. Then finally I'll go in on Monday and spend a few hours with our lovely dead partners, those cadavers which are now mostly parts since we cut all the tendons to look inside their joints.

Now let me ask you, do we really need eleven separate muscles in the back of the forearm when one does very nicely in the upper arm? Is it really necessary for there to be a different named nerve covering the webspace between your big toe and the next?

So yes, right now my brand new userpic pretty accurately depicts my mood. I've got 60 hrs to cram it all in there. Tomorrow's gonna be another 2 coffee day!

I wasn't sure if I should go apple-picking today. After all, I have studying to do for finals and everyone else backed out at the last minute. On the other hand, we've had a fairly rainy fall and today we woke to a bright and crisp, blue-sky day. It simply wouldn't be fall without it!

I drove out, past strip malls, past the highway, and suddenly entered another world of rolling hills and trees in flaming color. First stop, Pattersons' which was a disappointment. They're a commercial farm, but have a couple of acres of apples for picking. All of them were Red and Gold Delicious and most were thoroughly picked over. "When are your Cortlands and Macintoshes in?" "Oh, they're the first to come in in September. Try next year." When I strayed too far I was shooed away from the Family Fun Fest. Apparently you can only have fun for an additional fee.

I left with not a single apple and made my way over to Eddy's Farm. The dirt road led through acres and acres of trees, full of apples of every color. There were Golden Delicious, yes, but also Winesaps, Jonathans and Cortlands (ha!), Empire, Suncrisp, and Melrose. They pointed me to the Mutsu, a green apple with a wonderfully complex flavor. I wandered through the trees, feeling the brush beneath my feet, hearing crickets in the clover, smelling the wine-sweet smell of rotting apples on the ground. There were so many varieties I didn't get a chance to even see them all and I came home, bags full, with visions of apple butter and apple dumplings and apple pie dancing in my head.

I know it's silly. I didn't actually need 14 lbs of apples. But my heart needed sunshine on my face and crisp fresh air, and THAT was definitely worth the price. Now I can feel it's Fall!

Today I got a little package in the mail: three CDs from the Tanglewood Festival Chorus. These happen to be the three latest CDs that I was involved in the recording of. I popped it in and glanced at the names in the program and oh, how the memories do come back!

I have nothing like TFC here to replace it. Currently I sing 15th century works with a student early music chorus on campus. It's less the variable quality that I mind than the variable dedication. In TFC, pretty much everyone was grateful to be there and putting in every ounce of effort (and more).

I now have five CDs to commemorate my four years with Tanglewood. The three Pops CDs, "Oscar & Tony", "The Red Sox Album", and "America", as well as two live recordings of the BSO, "Daphnis and Chloe" and the world premier of Bolcom's 8th Symphony. There are the TV recordings of the Xmas Pops which I was involved with all four years, and I've got programs from every show I ever did.

But I don't want the nostalgia. I want to sing.

Just have to remember I can only do one thing at a time. First, finals in hematology, infectious disease, and immunology. Second, contacting the Cleveland Orchestra about auditions.

Occasionally we have focused training on a particular exam. Today we went over to the VA to learn the head, eye, ears, nose, and throat exam, aka HEENT. It's one of the marginally invasive exams we do, terrorizing wee little babes by sticking things in their ears (usually smaller than the things they stick in their own ears) and down their throat and up their nose to take a look. Well, turns out you can do all this on adults too. We had a lovely retired ENT doc teach us the techniques on us students, with five of my fellows and myself stepping up alternately to volunteer. I happened to be last, so I had the "pleasure" of experiencing a nasolaryngoscope. Yup, you latin lovers have put it together: this is a fiberoptic cable/camera assembly that you stick up your nose and all the way back to visualize the vocal chords. How often do you get to see your own vocal cords? I was game!
( The not so gory details )
After all was done, they handed me a picture (screen capture) of my very own larynx and ear drum! I wanted to put it on the fridge, but for A's sake I think I'll keep it posted at school where people don't mind such things. I probably won't be an ENT doc since I don't imagine myself as a surgeon, but I am happy I had a chance to see those little vocal muscles I try to use so much. And all it took was having a camera up my nose. Hmmm.

Good day at med school today.

Last night the administration let us know how our third year is organized. Basically we rank a few options and then get entered into a big lottery to see what order we do things. The third year of med school is typically the "hardest". It's our first chance working full time in the hospital, our first time being on call, our first time doing most procedures, and generally the steepest learning curve of the entire process.

What does it involve?
6wks of studying for the boards (imagine your grad school comps -- it's like that)
8wks of neuro-psych
16wks of Pediatrics, OB, and family medicine
16wks of Medicine and Surgery
16wks of research

While we are on research we'll be like regular grad students with a lot of work, but total flexibility. On the rotations through each department we will be completely at the whim of our residents. They've stipulated that we can only be put on overnight call every four nights (instead of the older every 2) but it will still be a big change. I'll have a free weekend about once in four which makes it a little difficult to plan vacations! At the same time, this will be a thrilling year of trying everything, the ultimate variety. What could be better than trying something brand new every one to two months? Of course, as anyone who's lived abroad knows, one month is only barely enough to begin to understand the language and culture of a new environment, but it is a start.

Six months until I start "3rd year". Six months till the fun is over and the excitement begins!

Lately I've been busy with med school, prepping for the anthropology midterm, and fighting the insidious lethargy that accompanies cold rainy days. Mon-Fri I'm at school, either learning new material or reviewing old material with the Finest Study Group Mankind Has Ever Witnessed. Then Saturdays I spend following a doc at an urgent care facility. When thinking urgent care, think "This can't wait till I see my regular doctor, but it's not really an emergency." I spend the day checking sprained ankles for sensation and waiting for rapid strep test results. It keeps me busy and gives me a nice range of patients: yesterday I saw a 1yr old and a 91 yr old and plenty in between.

Occasionally one gets a glimpse of other issues at hand. We're in the midst of a series of medical law lectures and just encountered the Wickline case. It's a little frightening to imagine the consequences and the precedent set. ( Of Malpractice and Finance )

What to do, folks? What to do?

This week the President gave two speeches, one to Congress about passing a healthcare bill, and one to children to encourage them to stay in school. Some parents are keeping their children home from school, lest they be indoctrinated with such radical messages. As for the healthcare bill, "Fox was the only major broadcast network that didn't air the speech, choosing instead to proceed with the season premiere of "So You Think You Can Dance," the third time this year the network has ignored a presidential appearance in prime time."

Come on, people. Don't any of Fox's viewers think it odd that they are only permitted "analysis" and never allowed to see the original speech? I watched every single State of the Union address by Bush, not because I agreed with him, but because I felt it was important to know in what direction he was leading the country. Don't they even believe it is necessary to an informed citizenry, or are they truly trying to live in an artificial world where they are spoonfed all their opinions?

Anyone who watches Joe Wilson's "apology" will understand he's using his newfound publicity to his political advantage. I'm hoping that there are more people disappointed with his outburst than proud of it, but I've already seen comments applauding Wilson for "having the balls" to stand up to Obama's "Nazi" policies.

In many cases, it's hard to stay informed, but when the President speaks to the people in Prime Time, you sit down and listen. You don't have to agree, but as a "news" organization you don't program it as if its less important than a reality show and then rail against it as the newest greatest threat to our democracy.

Shame on you Fox. Shame on you.

This summer I was rather busy, so I only managed to read a few regular books. To be fair, these books were Dreams from my Father (Obama's), Dickens' Bleak House, and the ever classic Crime and Punishment, so it kept me busy.

I also read Offbeat Bride, the Anti-Bride Guide, The New Jewish Wedding, Instant Weddings, Best Friend's Guide to Planning a Wedding, and Making a Successful Jewish Interfaith Marriage. These don't warrant separate reviews, but let me just make it clear that I feel incredibly lucky. I happily ignored suggestions that I "manicure once a week for the two months before the wedding" and I ended up paying $200 instead of $1000 for the dress. I did not have a fiance who wanted no part of the planning, and I had neither a mother nor mother-in-law who took over the events. I do not have Christian parents who think we're both going to hell for not believing in Christ our Savior. I do not have Jewish in-laws who grieve at the loss of their son and all future grandchildren. Pretty much things went well! It was fun to read them anyway, but mostly it was fun in a "thank God I don't have to deal with THAT" sort of way.

I will eventually review DfmF, Bleak House, and C&P, but in the meantime I have a date with a wonderful cup of coffee at my local cafe!

This week Greg Mortenson came for Case's convocation ceremony. It's kind of like an anti-graduation. It's the ceremony where all the faculty and deans get all dressed up in their robes and bring a speaker in to welcome the new students and encourage them to do great things. They'd picked Three Cups of Tea as a summer reading for the new Freshman class, and as a special bonus, the brough Greg Mortenson to campus.
( Tales of Perseverence )
Some people are geniouses, and we can tell ourselves we can't achieve what they achieved because we don't have the talent. Greg Mortenson achieved what he achieved because of sheer hard work and stubbornness. That's something we can all aspire to. We may not make the same decisions. After all, leaving your family to pend 3 months of every year abroad is a difficult sacrifice. Heck, letting your husband run off for 3 months a year leaving you with two kids is a sacrifice. But I suspect if you want to do something great, you just have to put your priorities in an unusual manner and work harder than most people. That alone can yield greatness.

So in light of that, I encourage you all to travel (or simply look with open eyes within your own community), be passionate about something, and make it a priority. Simpler said that done, but not so hard as it would seem!

When I was in high school, I remember learning about the wonders of DNA and how perfect its design, how it and its correction mechanisms allowed flawless replication for thousands upon thousands of cells.

Well yes, it's pretty good. But flawless? Not by a long shot.
We make mistakes. Mostly it doesn't matter, but the processes that require lots of replication are likely to run into problems. Babies for instance. They involve lots of mixing and matching and about one in three never makes it to the showroom floor. They just quietly get scrapped as the body returns to the drawing board. Skin proliferates a lot too which is why it has so many problems. They don't even count skin cancers in cancer counts because it's just too common and would overwhelm the numbers. We also all have to produce gobs and gobs of blood cells. They don't last forever after all. Red blood cells only last about 3 months and other types of cells last significantly less. What happens when DNA replication screws up? You get lymphoma, leukemia, polycythemia.... There are dozens of different disorders. 5% of new cancer cases in the US are lymphomas, and that adds up to a lot. They just mentioned that precursor white blood cells in older men will not infrequently lose the Y chromosome. I can't imagine misplacing a whole chromosome (even a small one like Y) like a pair of car keys.

So really? We're not perfect. But it's still pretty damn close!

Hot.

So hot the cats are lying in pools of catness on the floor. So hot, the cicadas have finally come to Cleveland and are partying it up all night. So hot, our tropical houseplant is blooming up a storm outside. We have resorted to eating our fabulous homemade chocolate ice cream with mint chips. (Ooh, negative mint chocolate chip never tasted so good!)

It keeps saying the storm will break, but today it only condensed on me as I rode up Edgehill from school.

May it break tomorrow!

After a long wait (a supposedly "short" engagement), A and I finally got married this past Sunday! It was all we could have wanted: our families mingled happily, we had crowds of friends arrive from all over the country and beyond, people got teary-eyed during the ceremony and happily danced the afternoon away afterwards. Thanks go out to all the people who managed to get out to sunny Cleveland that weekend, and special thanks to all the people who helped early and at the last minute to make sure everything was in place for our day.

How does it feel? Lovely! Not so different as just more of the wonderful. In the last three days we played two of our new games, watched two sci-fi/fantasy movies, and enjoyed actually getting a full nights sleep without waking up to the thought of "we didn't buy the glass yet!" or "what about the flowers!" Now the only trouble is how to catch up on the last 10 days of med school! Still, I have no doubt that if I can cram wedding planning into 5 months, I can find a way to catch up on 10 days of school.

Leftovers never tasted so good:

Eggwhites (leftover from making custard for ice cream)
Most of a zucchini
A few mushrooms
Some leftover roast garlic
Cheddar cheese
Olive oil and italian spices
= Muy delicioso dinner omelette!

I haven't really been in a cave for the last month, but in some ways it feels like it. Since our move to the new place I haven't read the news or LJ or in general reached out beyond the world I am creating here. But what a lovely world!

To give you a flavor, today I TAed the first year anatomy course, spoke on a panel, went to a cake tasting, arranged for the cellist, scheduled a dress fitting, and had a lovely chat with a viol da gamba player who gave me all sorts of leads for early music in Cleveland.

Which is just to say, it's been a busy life. The good things are that my sweetie and I cook for each other, the apartment is looking more and more lovely, and the weather continues to be a startlingly beautiful mid-70s and partly cloudy every blessed day. The bad things are that with all we have to do we don't actually have an unplanned weekend until after the wedding, we had a rabbi disaster, we took a friend to the ER, we still have boxes that cannot be unpacked, and between the wedding, the move, my work, and my TAing, I now only have 8 days to read Crime and Punishment for my book club!

All in all, life is good. I haven't actually fallen off the face of the earth, and I will have a more interesting in depth look at med school just as soon as classes start up again. Forgive me if I've missed any major events in your life in the past month. I wasn't looking!

Student loans. You love them, you hate them. Reagan made them taxable. Bush cut pack on Pell Grants. Now, private banks jockey for every student as baldly as those credit card companies that hand out free T-shirts to freshman on Orientation day. Well, Obama and Congress are attempting to make Federal loans FEDERAL loans. What, they're not, you say? No, right now students are required to have their federal loans serviced by a private lender who will skim off some interest and then sell it back to the government within a year for a profit.

This is the dashed off letter I wrote to my congressmen. Most of y'all are out there in the working world, but if you still have student loans hanging over your heads, think about writing your congress people. I could have written it better I suppose but I felt getting it sent was more important than perfection. If you can improve on it, please do.

And with that, good night!

I recently heard about the bill currently under debate to eliminate private lenders from the federal student loans system. I have to say that I completely endorse this change. Please support this bill.

Last year I left the workforce to attend medical school. Since I am supporting myself, all of my tuition and living expenses come out of loans. I spent hours sifting through seemingly identical loan packages from various banks only to then wonder all year whether my choice would still be in business by the end of my studies. At the end of the year I received a letter saying they resold the loan to the US Dept of Education.

As a student, I would MUCH prefer to deal directly with the government and not undergo the uncertainties of private banking, which seems to only be in place to earn a year's worth of interest at the expense of myself and the government. This system needs to end and it can end now with your support.

The weather is glorious, I'm caffeinated, and I'm in a cafe with my love, so what could possibly be wrong?

Well, in reality nothing much. Life is on a strong upward trend. However, this trend involved moving A's stuff, driving 11 hours and moving my stuff all over four days, soon to be followed by picking up A's stuff and collecting furniture from all over the greater Cleveland area off Craigslist. The cats are freaked the heck out. Their tails are shaking and K is hiding under the bed in distress. B is appeased with the comfort of a soft new rug that he can roll around and shed upon, but the house is in a state of disarray. I've slept in a different bed each of the last three nights and not gotten good sleep in any of them. And we just realized that in the last several days of moving we haven't done a thing about the wedding, we're spending money like water, and the new place won't have internet until tomorrow. Gah! 48 hours without internet! How can we survive!!!

So yeah, life is not so bad, it's just kind of a giant kludge of stress. However, we continue to love our new place, I have wonderful friends who hauled all my furniture up two flights of stairs, and above all, I am with my love! Just a few more days of hauling furniture and cleaning out the old place and I can "relax".

Better buy that couch soon. Relaxing on a wooden chair is just not quite the same.

Believe it or not, I'd never actually read Fahrenheit 451 until this year. I finally picked it up on hearing that Ray Bradbury was still alive and kicking. Though I am very familiar with his short stories, this was the first novel of his I've read.

This is a book which has perhaps evolved in meaning over time. When it was published, the image of Hitler's book burnings was still recent memory. Even so, Bradbury apparently said this book was not about censorship, but rather about "how television destroys interest in reading literature, which leads to a perception of knowledge as being composed of 'factoids', partial information devoid of context". In that sense it has become even more relevant than in the past. The main character's wife is completely absorbed with entertainment. She spends all her time in the living room interacting with her fictional (online) friends and constantly has a Seashell (iPod) plugged in her ear. She has essentially stopped up all of her senses with artificial inputs -- and this seems all too accurate a depiction of today's world.

This book also seemed relevant to the current demise of the newspapers. Fahrenheit 451 mentions this and how people hardly even noticed when they were gone. We are now in an age when news has become "infotainment", i.e. just whatever the audience wants to hear, or rather, whatever will keep them hooked longest. It's not intended to pacify as Fahrenheit 451 suggests, but rather to create a harmless focus of people's attention. Let's all talk about Brad and Angelina or Kate and Octo-mom instead of politics and ideas. My first real understanding of this trend was back in 2003 when I realized CNN had a design team for the second Gulf War, complete with a theme song and banner. It had once been a news organization -- now it was entertainment. The internet is hailed as the new alternative. However, while the internet can be a unifying force, it appears to more often be a Balkanizing one. People no long listen to "objective" news but find Rush Limbaugh or Air America, O'brien or Olbermann, or whatever pleases their sensibilities. No one need ever be challenged. There's pap for everyone. If you don't like what someone is saying, just flip the channel.

The world hasn't yet become the world of Fahrenheit 451. More books are being published than ever before. However, I do think that the dangers of passivity still exist. We can choose to live in a world of our own construction. What will that mean for the rest of us?

Today was my first meeting on the Board of my alma mater's Alumni Association. On the plus side, I knew two of the three other newbies. They overlapped with me at Tech to varying degrees. The rocket engineer is going to fashion school to design a comfortable bra for well-endowed women -- finally, an engineer solving what is essentially an engineering problem! -- and the other is recently engaged so we had much to talk about. The third newbie, well, he won an Oscar two years ago for technical effects.

It's always a strange experience at Tech. I feel very much at home there, the culture is wonderful, but it is also incredibly humbling. Some make the most out of their humility, such as the woman to my left at dinner, fellow alumna Sandra Tsing Loh. Others are simply brilliant, designing the Mars lander or winning a Nobel Prize and getting appointed as Secretary of Energy. Invariably you hear about the successes. It only takes one or two a year to make you suddenly ask what you have done with your life.

Is it a lack of ambition? Is it a lack of direction? A lack of imagination, for as Einstein once said "Imagination is more important than knowledge"? On the other hand, times like these are when I get inspired again. It is a little humbling, but the inspiration outweighs that. How do you create the one and not the other? I think it's respect. Every person in that room went through the same four years, whether they are now a stay at home mom or the most recent Nobel Prize winner. Smarts aren't the issue here. And thus it is that I come home thinking not "I am not worthy" but "how can I use the gifts of education I have been given?" Simply passing does not interest me. Surviving med school is too low a bar. How can I make the most of where I am today?

The New York Times just released the full text of Obama's address in Cairo. It's a fascinating piece, partly because a similar address would not play well in America. The Obama campaign had to hush any mention of his muslim relatives and remove women wearing the hijab from photos during the election. Now that he's standing in a muslim-majority country, he's free to use his middle name to his advantage.

I am always grateful when Jon Stewart points out the similarities between the rhetoric in Bush's and Obama's speeches. It's useful to remember that not all things are diametrically opposed and that some positions, especially regarding foreign relations, remain the same. However, I cannot help but feel that this speech really is different, and not just different in my memory. I clearly remember Bush making an aside during a State of the Union address and speaking to the Iranian people. To paraphrase, he basically said "We know you're really a peaceful nation, so would you please rise up and overthrow your government?" In contrast, we now have our Leader giving a major speech in a foreign capital with so many elements that would never be in Bush's speech:

A greeting and thank you in Arabic

An introduction explicitly acknowledging the errors of colonialism and Cold War politicking

Multiple quotes from the Koran

Support of religious freedom including the right to wear the hijab and donate to Muslim charitable organizations

A statement that we do not presume to tell a country which form of government it is allowed to have

A promise to expand scholarships and exchange programs to promote exchange between muslim countries and the U.S. in both directions.

Of course I'm picking and choosing here a little. A republican would find it far too conciliatory and a muslim extremist would bristle at the suggestion girls need to be educated. But I like the line that Obama is walking here. I continue to be proud of the direction we're taking, and I hope that four years (at least!) of actual diplomacy will help heal some of the rifts of our world.

I'm beginning my new job this summer, working on preclinical medical curriculum, and as part of our process we are being exposed to a whole set of educational tropes, ones I've never seen before. The directors of the program helped design my school's new curriculum three years ago and are both MDs and MEds. Now some of the articles seem like a formal formulation of the abundantly obvious -- well, most of them really -- but occasionally one of them makes me stop and think.

( Rambling on Learner-Centered Teaching )

I know a couple of you out there are actually in education. Any references you found particularly good?