Happy Memorial Day

Hi all,

I am in Minnesota for a friend's wedding so there will be no new blog today. I hope you have a happy memorial day, and I hope you take a moment tomorrow to honor those men and women in the military service who have passed away. Also, congratulations to my counterparts at other medical schools who are or have graduated.

Craig

Danse Libre's Spring Show

Hello Reader,

Thank you for following this blog. Ostensibly, this blog was designed to be primarily for my medical related life, a window into what it's like to be a medical student. Most of the blogs have that intent: describe a day or discuss a patient interaction or opine on a medical issue. But of course, I have lots of interests outside of medicine (blogging being one of them). In at least one blog in the past, I alluded to one of my other passions, social dancing. I first started dancing swing, waltz, hustle, polka, tango, etc. as an undergraduate and I quickly fell in love, joining a group that performs a waltz and polka at the annual Stanford Viennese Ball.

This past year, I joined Danse Libre, a vintage performance dance group that recreates dances from the 19th and early 20th centuries. It has been an amazingly fun experience. We are putting on a big show which happens every 2-3 years in Palo Alto on June 4 and 5. We will be performing 16 dances in period attire including Victorian waltzes, polkas, and parlor games of the 19th century, American hesitation waltzes and one-steps from the roaring 20s, and the elegant foxtrot and early swing of the 1930s. It ought to be a really fun show. Since it's a huge part of my life, I decided to write a blog about it in the off chance that this is someone's cup of tea; we would love to see you there.

The Academy of Danse Libre presents "M is for Mazurka", a Dancing Whodunnit!

Experience dances from the Victorian era through the 1930s in this murder mystery of intrigue and dance. Also featuring performances by the Swing Cats Rhythm Revue.

TICKETS: http://danselibre.org/show.html

Friday and Saturday, June 4th and 5th.
Doors at 7:30pm; show starts at 8pm.

Cubberley Theatre
4000 Middlefield Road
Palo Alto, CA 94303

Tickets available from members of Danse Libre in person, online ($13), or at the door, day of the show ($15 / students $12).

Rita Charon

We had a visiting professor Rita Charon come talk about narrative medicine. I was thrilled because she is one of the leading experts on stories in medicine. She completed a PhD as an attending at Columbia and then applied her expertise in developing a curriculum on literature, humanities, and medical education. I was lucky enough to join her for a short story workshop which I absolutely loved. We read Colm Toibin's "One Minus One" and the discussion was fabulous, reminding me of my undergraduate creative writing courses. One of the problems with medical school is we become so immersed that we forget our passions of a previous life; I had so much fun discussing the core elements of writing - point of view, symbolism, theme, literary devices - that so many of us learned in undergraduate English classes and have forgotten since.

Dr. Charon also gave a lecture and grand rounds on narrative medicine. In one, she emphasized the importance of story; patients and their illnesses tell a story. Their lives are wholly affected by what is happening to them and we cannot take the science and disease out of the context of an experience. The history given is a narrative with a character and lilt that is often lost when transcribed into a medical record. Whether it ought to be this way, I don't know, but we must recognize that medicine begins with storytelling. She also talked about evidence that writing about experiences in a hospital, whether by a physician, medical student, or patient, enriches that person's livelihood. It was a thorough pleasure to have her speak to us.

ACLS

Part of the Coda block involves getting certified for Advanced Cardiac Life Support: how to treat medical emergencies such as cardiac arrest. While we all have the basic knowledge of the diagnosis and management of such conditions, ACLS provides a regimented structured way of approaching these emergencies. We reviewed EKG rhythms, algorithms for treating them, and team management. Then we had a practical session with mannequins; a clinical scenario would be given to us and we had to lead a team, directing them through whether to defibrillate, which drugs to administer, when to start CPR, and what the diagnosis might be. It was really fun and educational. I realized that even though memorizing the algorithms is pretty straightforward, under pressure, it can be hard to think through things methodically. Running a team is also harder than I thought it would be. It takes a lot of leadership to communicate well, delegate tasks, and solicit input from teammates. Thus, I realized ACLS training is merely the first step; learning what to do from a textbook and practicing it in a sterile environment is very different than handling an actual emergency.

Elevators

Sometimes the infrastructure of the hospital frustrates me. The worst thing in my experience is the elevators. There are times of the day when I climb nine flights of stairs not for the exercise but because it's faster than waiting for the elevator. At the general hospital, I never take the elevators because they're too slow, but what's more ridiculous is the seven-story hospital only has one stairwell for everyday use (other exits are for emergencies only). I don't understand this. Decreasing elevator wait time will markedly improve services delivered. Patient transport is less harrowing, physicians are happier, and you don't have people accidentally talking about patient information in a hallway because they've already wasted five minutes waiting for an elevator. Even more importantly, code teams could get to emergencies faster; currently, code teams have a key to override an elevator's controls but I see them barreling up and down stairwells because they can't risk the elevators being too slow or not working.

Lost time to elevators happens to everyone: doctors, residents, medical students, nurses, techs, therapists, volunteers, patients and their families. How much time could we save by fixing this vertical challenge? I don't think it's an impossible task; indeed, hotels have figured it out. What would you think if you checked into a hotel and waited five minutes for an elevator to arrive which then stopped at every floor until your destination on 15? Why do we accept this as everyday life in the hospital?

Image of the elevators in 240 Sparks, Ottawa, Ontario, Canada shown under GNU Free Documentation License, from Wikipedia.

Revision: Ménage à Trois

Ménage à Trois

If I loved you
fifty years ago at the altar
I mean it no less today
as I wet your lips with moist swabs
and read the paper waiting for you
to make the obituary.
When I came last night,
you looked the same. Eight years
and illness haven't masked familiarity.
I stayed by your bedside
until Martha came this morning.
She brought the blanket we used
that snowy night eight years past
wives, neighbors, lovers.
You moved on after that,
new house, new car, new kids,
but I kept your glasses on the nightstand.
Before Martha leaves, I ask her
to hold your hand and she stays a moment
by your yellow body
before meeting the lawyer
to discuss discarding things.
You wanted them thrown away,
but I tell her I'll take all of it
even the second ring.

Teaching as an Intern

We had a lecture on teaching as an intern from one of our master teachers at the VA. For pretty much all of us, teaching on the wards will be a new role next year. What do we do with the freshly minted third year medical student when we really don't feel that far removed from their shoes? How do we manage to role-model good behaviors and pass along words of wisdom while we're tired, overworked, stressed, and sleep-deprived?

I really want to be a good teaching intern next year. I love teaching, I value my own education, I learn the most when I teach, and I think it's an important responsibility. But it's pretty much impossible (and inefficient) for an intern to sit down and give a mini-lecture or chalk talk. What I learned is that intern teaching happens throughout the day in bits and spurts, recognizing that most moments are teachable moments and that most of them are less than 5 minutes long. Part of medical school is that hidden curriculum, learning the culture of inpatient medicine. Whether this culture is laudable or not, medical students must learn how to present a patient, write orders, call a consult, and sign-out; teaching how to do this is as important as teaching facts. Furthermore, this "hidden curriculum" is taught through modeling; the good intern is the one that models admirable behaviors and attitudes, thinks aloud, and explains what he does as he does it. The good teacher does this without imposing himself on the student; he facilitates that interaction between student and content rather than teacher and student, or worse, teacher and content.

From the last 20 years as a student, I've realized asking the right questions is really hard. When lecturers pose a question to a large group, silence occurs if the question is too hard or too easy. The effective lecturers pose the right question to their audience: challenging but not impossible, thought-provoking but not esoteric, general but not too general, specific but not too specific. The good questions stimulate the learner to solve things critically rather than dig around their memory banks for factoids. The good questions make the student feel good about himself yet also uncover things the student didn't know before.

Anyway, teaching is very important to me and it was a fantastic lecture to have to remind us that teaching is a skill we must prepare and practice, and that though we may be doctors, that does not automatically imply that we know how to pass our knowledge on.

Coda

Let's rewind about a month. The last block of medical school prior to graduation is called "Coda." As a summation course, it reviewed key concepts for internship, provided a space for reflection, and gave us time to do our laundry, run errands, etc. It was pretty light but fairly high yield with lectures like shortness of breath, IV fluids, airway management, and sepsis. They really pulled in some of the top faculty for these lectures including department chairs, beloved teachers, and residency directors. I really think it was useful for us to have a preparation-for-internship block.

It was also wonderful to see my classmates again. In fourth year, we are dispersed as students spend months in a lab, on away rotations, or abroad in a foreign country. This was the first time we all recongregated as a group. We went out to lunch, we spent the breaks between lectures sharing pictures, we sat around after class chatting. Everyone says that fourth year is the best year of medical school; it really is.

Image of a music Coda symbol is shown under GNU Free Documentation License, from Wikipedia.

How?

This is the last of these touchy-feely graduation posts. How did I feel the night before commencement? How did I feel the day of? To be honest, neither day was flooded with emotion. The night before, I had a moment of anticipation, a touch of anxiety, a paradoxical "I-knew-this-was-coming-yet-I-can't-believe-it's-here." I was excited, yet it was not uncontrollable giddiness, merely a subtle undercurrent in the things I did. I don't think the realization that I was graduating really hit me until later. The next day, I was overwhelmed with to-dos: getting things ready, making sure I had directions, taking pictures with friends, teaching my parents how to hood me. I tucked away my feelings, and at the beginning of that day, emotion trailed me. I felt a little disbelief that this was all happening, a sense of pride that I was here, an overwhelming welling of gratitude. By the time I sat down in my seat at commencement, my emotions caught up and I was really moved by the pomp and circumstance of this occasion. Graduation is a big deal because we make it so, and my feelings would not permit otherwise. How lucky, how fortunate, how wonderful it was for me to make it here. How supportive my company of family and friends. How thrilled I was to be sitting with my classmates. How nervous to walk on stage, how confused about what it means to be a doctor. The feelings kept on coming. In the end, I decided that writing about this over the last few posts was a way to try to capture something so effervescent and so precious.

What? Part II

My parents and I arrived at Davies Symphony Hall early morning. My classmates and their families milled about. After becoming accustomed to seeing my friends in scrubs, it was wonderfully surprising to see them dressed up. The venue was fabulous, the perfect amount of space while remaining cozy. It filled up, even to the upper balcony. The hall featured a "cloud" of convex acrylic reflecting panels as a ceiling and an organ built-in to the rear wall. We took lots of pictures and lined up in the depths of the building. Then, a brass quintet playing pomp and circumstance heralded the procession as we emerged to the applause and cheers of a packed house.

Dr. Hawgood, Dean of Medicine, gave a warm and thoughtful welcome with his distinguished accent. The speaker was Ezekiel Emanuel, Special Advisor for Health Policy and Chair of the Department of Bioethics at the National Institutes of Health. I was impressed; he has a degree from Oxford and a PhD in political philosophy. His talk was amusing and inspiring, as commencement speeches are. The senior address was given by my classmate Jed and he did an outstanding delivery. He's one of the best public speakers I know. This was followed by the presentation of the Gold Headed Cane award; I'll reserve the history of this for another blog (since I like history of medicine).

Finally, Chancellor Desmond-Hellmann conferred us the degree of Doctor of Medicine. We came onto stage with our parents (or other loved ones) for the hooding ceremony. The first time I heard "Dr. Craig Chen" felt surreal. Was that really me? I walked onto stage and shook hands with Dr. Irby, Vice Dean of Education. Then in a UCSF tradition, my parents hooded me. I really liked this; it was a lot more personal and meaningful than having one of the associate deans hood me. We all took a picture before leaving the stage.

After all my classmates were hooded, we took the Oath of Louis Lasagna that we had recited at the white coat ceremony. The most special aspect of this was the languages. Students whose first language was not English went on stage to recite the first line of the oath in their native language. We had 17 languages represented, including Arabic, Yoruba, Cantonese, Farsi, Greek, Gujarati, Hindi, Japanese, Korean, Malayalam, Mandarin, Punjabi, Russian, Spanish, Tamil, Urdu, and Vietnamese.

It was such a wonderful ceremony followed by a lovely reception. It really spoke to me and played the role of that rite of passage I desperately needed. I hope that I uphold those virtues of the oath I took and those wonders of the title I received.

What? Part I

I like rites of passage. I think I am the kind of person who finds ceremony, ritual, and tradition meaningful, imbued with some sort of depth and epiphany that one misses in everyday life. Graduation calls attention to this transformation that happens in bits and pieces. The becoming of a doctor is a four year process, scattered over 1000+ days and blog posts, but the day celebrating this accomplishment also completes it. I am no different today than I was two days ago. Or indeed, a year ago since most of the core learning happened during my third year of medical school. But the title of doctor was unbecoming until graduation. Even now, it is still an awkward appendage, but at least it feels in some way bestowed.

This celebration draws together community - not only family and friends, but also the academic community at UCSF and the medical community at large - and serves as a confirmation, a welcoming into the fold of physicians. It recognizes that medical school is not the easiest four years. It cherishes that bond we've formed as a class through experiences that few people go through. It shows us how proud our greatest supporters are of us. It carries pomp and circumstance.

I think the finality of medical school only comes with reflection, at least for me. It is in the quiet moments, the interior of thoughts, the typing of this blog that I begin to understand myself. Receiving the title Doctor of Medicine - an assumption of an estate of healer - is not so much a summation of my medical knowledge or clinical skills but rather the recognition that I can help others and the oath to do so. Now, I feel comfortable with people facing the gravest, most terrifying, and most personal of challenges, and I want to be there for them. I put on the white coat and stethoscope four years ago, but that's just a piece of cloth and a rubber-and-metal contraption. Those accoutrement now feel heavier because they are accompanied by those rights, responsibilities, and privileges accorded to me not by some title, but by a body of work and dedication.

Where?

Both images of the Louise M. Davies Symphony Hall shown under Creative Commons Attribution Share-Alike License, from Wikipedia.

Why?

"The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head." - William Osler.

"Remember, the only difference between us and those we serve is our current good fortune." - Dan Lowenstein.

“If I have seen farther, it is because I stood on the shoulders of giants.” - Isaac Newton regarding Galileo and Keplar.

When?

I know I've said this before, but I parse my life in four year chunks. At the conclusion of each four year partition, I am convinced that those last four years were the most pivotal and momentous of my life. This is no exception. To me, the last four years represent an intersection of passion and vocation. I love medicine. I love teaching. I love thinking of the important questions. I love floundering as I try to confront them. I love taking care of people. I love comforting people at the hardest moments of their life. I love numbers. I love being obsessive-compulsive. I love stories. How lucky am I, to have found this cliche of a profession, the kind where if you find a job you love, you don't have to work a single day in your life?

The last four years have also represented the transition from passive learning to active participation. Up until two years ago, school has been lecture and textbooks and multiple choice exams. But as I've entered the clinical realm, I've engaged and grappled with the realities of medicine which are messy, imperfect, and unclear. I've encountered death and dying, responsibility and challenge, and the fear of the unknown. This immersion into the day-to-day ups-and-downs has been a major change in my life in the last two years.

These last four years also involved the development of professional colleagues; though I love my college friends very much, it is my medical school friends who understand the actual experience of being on call or participating in a surgery or reasoning with a psychotic patient. These friendships I've built will blossom into support systems when I need them, advice when I need consultations, and role models in my professional life.

The four years have passed quickly. Perhaps a few rotations have moved like molasses, but as a whole, I am quite shocked and overwhelmed to be here already. Time is one of the most fascinating concepts in philosophy, and one that seems especially present now. Days move slowly (especially the ones that start at 5am), but years fly by. How could it be that tomorrow, I graduate? Just yesterday, I remember receiving my white coat.

Who?

The class of 2010 is a medley of students; about half came in with me four years ago, about half took a year off, and a few others took even more time to do other degrees or projects. I am really honored to be a part of this class though. We have an amazing cohort of students who have such impressive accomplishments that inspire me beyond belief. My friends have done Rhodes' scholarships, published in Science, worked in clinics in Africa, campaigned at the White House, and designed clinical studies. They've achieved things I can't even imagine doing.

Working with my classmates on the wards has been a pleasure and an honor. They have taught me so much. The richest discussions I remember involve sharing my cases with my classmates (and fellow blogger) on my sub-i. My classmates help me see things in different lights, consider alternative diagnoses or plans, and deliver better care. And beyond that, they've become role-models for the kind of student, doctor, and person I would like to be. They've buoyed me when I've needed emotional support, they've cheered me on when I stagger in on my final post-call day.

Beyond my peers, I have been so lucky to work with the outstanding faculty here at UCSF. They are truly dedicated teachers and physicians, and really represent the kind of doctor I hope to become. These are the teachers who have inspired me to go into academia. They've not only taught me facts, but how to approach problems critically, challenge pre-existing paradigms, and think outside the box.

I would not be here without the support staff. One of the most amazing people at UCSF is the guru behind the third and fourth year rotations; Maureen is a wizard is she navigates hundreds of rotations and hundreds of students vying for them. The support staff have the hardest jobs and are always underappreciated. So, thank you for those behind the scenes that have made my education so smooth.

Lastly, thanks to those who have made my experience here what it is. The first year students in my small groups, the students ahead of me who gave me advice, my friends outside of medicine who put up with me, and my family -- thank you.

Dear Reader

Dear Reader,

Thank you for reading this blog. I truly appreciate your time and attention, and thank you to those in particular who leave thoughtful comments to what I write. I've blogged for a decade now, but this last journal chronicling medical school has been different because of you. This is the only blog I've made public, and I've heard from readers from so many walks of life, so many different countries, so many various backgrounds, many of whom only know me electronically. Well, thank you for reading this. I honestly have no idea how I come across in this forum, and it's awfully frightening to me to put myself out there.

Medical school is a long, sometimes dismaying, sometimes challenging, but generously rewarding journey. There are blogs here where I've expressed disappointment or dissatisfaction with the system, but overall it has been such a transformative experience. I am a much different person now than I was four years ago. I've not only learned so many more facts, but I've had so many more meaningful interactions, scary situations, passions and curiosities. Writing about them has certainly helped me understand myself and these last four years.

This journey comes to an end this Friday. Graduation has sprung upon us and captured me by surprise. In just five days, I will accept those rights, responsibilities, and privileges of a doctor of medicine. To be completely honest, I don't know how I feel. It is a little overwhelming right now. But I hope that in my free time, I can do some reflection and discover a little bit of those deeper and more elusive emotions.

Free time, however, is a rare treat these days. I am still planning out my blogs for this week. The truth is, I have so many more things to write about including the last "rotation" of fourth year entitled Coda, which I will probably have to explore after graduation. When I have time, I will write, but this week may be a little unpredictable in terms of journal entries.

Thinking long term, I am not yet sure what I'll do. I'll certainly keep blogging through this summer, and I'm fairly certain I'll keep some form of online journal in residency. Time will be a rate-limiting factor, and I have some ethical and legal reservations of being an MD who writes openly to the public. Hopefully in the next month, I will resolve what I want to do in the future.

As for this blog, if you find any entries offensive, inappropriate, unethical, or otherwise bothersome, do let me know. I am very, very aware that what I'm writing about can be personal, encroaches upon privacy issues, and reveals aspects of medicine that the lay person may not have known. I know I write about issues that are controversial. My intention is never to offend anyone, to remain wholly ethical, and to hold myself to a high standard of online journalism. Please let me know if you think I ever cross the line.

Thank you again for following along.

Craig

Revision: Wedding Dance

Wedding Dance

What guile is this, that crimson dress unfolds
over skirt of ivory, petticoat of lace,
and white gloves conceal smoothness untold,
and innocence frames such a charmed face?
For months, we rehearse at furious pace,
waltzing in jeans, drenched in sweat.
There's hardly a trace of poise or grace
and dismayed, I begin to forget
why, why this labor? why this haste? Yet
the moment you appear, epiphany breaks,
your face radiant as the day we met,
and joy washes away the months of aches.
Do you take me for this dance?
Do you take me for romance?

Unexpected Death

N.B. Some details have been changed. This was written a while ago.

A patient I was following died today. He was the classic House of God "gomer," a pleasant elderly man with dementia whose neurologic disease had progressed so far that he could not answer questions, follow commands, or communicate at all. He had some pulmonary problems so we were consulted to help with his care. We made some recommendations about a week ago, and since then, I have been following him from afar. Unfortunately, yesterday he aspirated (entry of secretions into the lungs) and suffered an inferior MI (heart attack). Discussion between the primary care team and the durable power of attorney concluded that palliative care was the best route to take. He passed away today.

I was really affected by this. I think it is because when I saw him, he did not look that sick. He was frail, sure, and had lots of comorbidities, but every day when I visited, he talked nonsensically and seemed to be doing okay in his own little world. Then a small event - perhaps preventable - tipped him over and his body simply did not have enough reserve to heal. All we could do was let him pass painlessly and in peace.

Who's to say whether a life is worth living? Certainly, at my stage in life now, I would not want to live the life of severe dementia. But it would be absurd and arrogant of me to presuppose that judgment on others. I think this is why making advanced directives, appointing durable powers of attorney, and talking to loved ones about serious medical illness is so important. Pneumonia was once called an old man's friend because it was a quick way to go. Perhaps it was the best thing for this patient, but I don't know. Death and how to die are such elusive concepts for someone like me to understand, but oh - how important it is for me to try.

Pulmonary Consult

My last rotation, pulmonary consult, was a good one to end with. I could really tell how much I've learned since third year as the fellow gave me more and more responsibility. I think I finally started feeling like a resident, becoming more efficient, developing more self-confidence in my clinical judgment, starting to make a plan, learning independently. Indeed, a lot of residency is self-directed learning, and on this rotation, I began to make that a daily habit. The rotation itself was pretty good; I reviewed basic pulmonary physiology, pharmacology, and disease states and dabbled a little in some of the more obscure diagnoses (lymphangiomyomatosis!). I saw a good variety of patients, glad to return to the routine of clinical medicine after being out of it for teaching, interviews, and radiology.

There was a dry spell in consults for a bit and then we had a deluge the last week. One day we had six consults, almost all after noon on a day that my fellow had clinic. Thus, the attending and I fielded all the consults, scrambling about the hospital to see all the patients. It was really crazy, a preview to intern year where I might have half a dozen notes to write after sign-out. One of the more interesting yet unfortunate cases came to a close at the end of my rotation. An older man with a complicated medical history including GI bleed presented with fever of unknown origin. Despite broad spectrum antibiotics, he was spiking daily fevers. As a result of the fluid resuscitation from the GI bleed, he appeared to be volume overloaded. He also had gotten a contrast load on top of chronic kidney disease and appeared to be going into renal failure. His mental status was altered compared to baseline. After the primary team began diuresing him, a spiculated lung nodule was seen on CT, presumably the cause of his fever of unknown origin. Yet he was deteriorating too quickly; even on broad spectrum bacterial and mycobacterial coverage, he became more altered, his creatinine rose, he required more oxygen, and he continued to have fevers. We knew we needed to bronch him or do an CT-guided biopsy of the lesion, but he became more and more unstable. Eventually, he displayed florid septic physiology, becoming hypotensive requiring two pressors, tachycardic, anuric, and finally unresponsive. Unfortunately, in the end, with discussion with family, care was withdrawn. The final diagnosis was sepsis of unknown etiology. Could it have been a fungus that escaped our antibiotics? Could it have been a strange or resistant bug we didn't anticipate? Could we have figured things out sooner? A case like this always leaves me with many "what ifs."

Records

After spending some time in the clinical setting, I've realized how ridiculous hospital records can be. The first time I saw a chart, I spent an inordinate amount of time shuffling through extraneous papers, trying to figure out each page, through insurance forms and intake forms and where-the-patient's-belongings-are forms. Then there are the actual notes. Notes communicate between providers (and keep a legal record). But there are so many kinds of notes; do I read the medical student note or the intern note? The brief operative report or the lengthy summary with details of a procedure I don't need to know? The social worker's notes? The physical therapist's notes? The nursing notes?

Obviously, the best answer is to read everything. But the truth is, time and workload make this impractical. All the other notes in the chart simply dilute down the content of what's there, making it harder for me to sift through and find the pertinent information. Thus, chart biopsies can easily miss the pathology and return nonspecific debris.

Furthermore, it bothers me that physicians sometimes spend an unreasonable amount of time obtaining outside records. At a tertiary care center, many of our patients have been transferred from outside hospitals and getting those records can be surprisingly difficult. We spend time navigating operators and medical records, and then the charts faxed over are incomplete. We sift through the morass of paper, wondering whether trees and shredders would be better served if we had an improved system of communication between hospitals.

This is why electronic health records were (and perhaps are) considered one of the holy grails of inter-provider communication. Imagine a system where you could easily filter notes to see only consultations or arrange things by date or read discharge summaries. Imagine a system where you could simply have the outside hospital push over the information online, allowing you to instantly access radiology and EKGs. It makes no sense to me that three major UCSF hospitals each use different electronic health records, and that even within a hospital, there might be multiple systems (outpatient, ED, ICU).

Why make it so hard for doctors to do their job? Our skill set isn't geared towards calling for records, troubleshooting poor fax images, sorting through papers to find that one lab we want. It wasn't until third year of medical school that I appreciated how difficult and frustrating those tasks can be. I don't know whether electronic medical records will fix everything in our health care system, but I do think a universal standardized access system for sharing patient information between privileged providers would make my life so much easier and my work so much more efficient.

Poem: Translating my Poetry

Hi! Sorry, with graduation coming up, I've been preoccupied with a lot of other things. Today's blog is one of those silly trying-too-hard-to-be-clever poems. Every writer at some point attempts to write meta-poetry or a meta-story: a sonnet about sonnets or a poem about writing a poem or a short story about an author. It's really hard to pull off. There are two that I like, from Poetry 180 (a Library of Congress project sponsored by former U.S. poet laureate Billy Collins).

-
Introduction to Poetry
Billy Collins

I ask them to take a poem
and hold it up to the light
like a color slide

or press an ear against its hive.

I say drop a mouse into a poem
and watch him probe his way out,

or walk inside the poem's room
and feel the walls for a light switch.

I want them to waterski
across the surface of a poem
waving at the author's name on the shore.

But all they want to do
is tie the poem to a chair with rope
and torture a confession out of it.

They begin beating it with a hose
to find out what it really means.

-
Selecting a Reader
Ted Kooser

First, I would have her be beautiful,
and walking carefully up on my poetry
at the loneliest moment of an afternoon,
her hair still damp at the neck
from washing it. She should be wearing
a raincoat, an old one, dirty
from not having money enough for the cleaners.
She will take out her glasses, and there
in the bookstore, she will thumb
over my poems, then put the book back
up on its shelf. She will say to herself,
"For that kind of money, I can get
my raincoat cleaned." And she will.

-
Translating my Poetry

First, turn it upside down.

Fold it lengthwise and again into an accordion of words
or tear it into confetti
or stamp it into the peninsulas and inlets of a jigsaw.
Take care not to lose any stray letters.

Dump them all in a wok
or souffle the words
or let them stew.

Feed the bits to those around you:
an adjective to your mother
a preposition to your dog
a spillage of verbs to the homeless man under the newspaper tent
and a phrase or two to the editor.

Wait. Observe. Grow old.

Your hair ages and you start taking pills.
Some days, it takes you all morning to get started
and you decide to take on an apprentice.
A new generation of translators flock,
unaware that the art of translation is preparation of a feast.

At the funeral, an apprentice recites a poem about your mother.
The dog won't stop barking.
Even the man wearing the dirt-worn sleeping bag speaks with elegy.
The editor never makes it to the funeral;
whatever he ate, however it tasted, we may never know.

Exploring the Bay Area

As the end of fourth year looms menacingly over our heads, we've been trying to stuff ourselves with as much of San Francisco and the greater Bay Area as we can. I've been taking advantage of the flexibility of a light schedule to accomplish as much of my to-do list as possible. One of my friends and I visited the California Academy of Sciences where I snapped a picture of the albino crocodile shown above. I've visited the Cal Academy a few times and I love it; it's so close, educational, and fun. This was the first time I watched the planetarium show which reminded me of how much I love astronomy. Then we made the usual visits to the penguins, aquarium, living roof, and rainforest where we were greeted by beautiful butterflies.

The following day, friends and I did a hike out at Point Reyes. It was breathtakingly gorgeous. We took the ten miles at a leisurely pace, wading through fields of wildflowers, observing elk, making our way to a beautiful bluff. We had picnic by the beach, and listening to and smelling the ocean reminded me how beautiful California is.

All three images are mine.