La Ceiba mission: Day 4

Today, I worked with anesthesia. Lots of intubation opportunities, as well as IV placement in pre-op between cases.

[Photo 1 and 2: 1970's era equipment, still functioning!]

[Photo 3: hmm...this will come in handy...]

[Photo 4: helping to improvise a headlight using my eyeglasses.]

Dinner was at a local steak restaurant.

[Photo 5 and 6: "filet mignon," i.e. steak wrapped in bacon.]

Tomorrow: off to the OR!

La Ceiba mission: Day 3

After the morning run, breakfast, and Devotional, we were off to Hospital Suizo! Today was my day in clinic.

[Photo 1: patients waiting in line to be seen by ENT and Internal Medicine. The line stretched out the door and down the hall for about 30 feet.]

[Photo 2 and 3: we have to reuse as many supplies as possible. Otoscope funnels, laryngoscopes, and the like are sterilized and recycled.]

[Photo 4: standard set of antibiotics.]

ENT clinic zoomed by; I helped scribe notes during each visit, with each visit seemingly lasting no more than 15 minutes at a time. Except for a couple of stragglers, all patients were done by lunchtime. For the rest of day, I floated between PACU and pre-op.

[Photo 5: a picture with the first patient I ever started an IV on. Guess there wasn't too much space in the PACU for a photo...]

Another busy day tomorrow, this time with anesthesiology!

La Ceiba mission: Day 2

Quick rundown of day 2 in Honduras:

* Run to the hospital at 5:30 AM.
* Breakfast and Devotional
* Church service at 9 AM
* Pizza lunch
* Field trip excursion to the jungle
* Dinner, pools, hymn
* Found out that Osama bin Laden is dead

[Photo 1: Ekua and I were the only med students who went on the jungle river excursion. A total of 24 members of the mission trip went on the field trip.]

[Photo 2: We took a bus from hotel to a train station. This was our train.]

[Photo 3: The sign to the wildlife refuge.]

[Photo 4: An idea of what the railroad tracks and surrounding foliage looked like.]

[Photo 5: The sign at the end the railroad tracks.]

[Photo 6: The welcome center had a sign about manatees. Unfortunately we didn't see any in the river.]

[Photo 7: A puppy who greeted us at the dock.]

[Photo 8: The puppy enjoying a dirt backrub.]

[Photo 9: We had to tie two boats together in order to take the trip.]

[Photo 10: A blurry zoomed-in photo of a Great Blue Heron.]

[Photo 11: A shot of the river and surrounding jungle.]

[Photo 12: One of many mangrove roots along the river's edge.]

[Photo 13: The jungle closing in.]

[Photo 14: Blurry zoomed-in photo of two monkeys we saw in the trees.]

[Photo 15: Blurry zoomed-in photo of bats sleeping on a coconut tree.]

First day of clinic tomorrow!

La Ceiba mission: Day 1

Day 1 of the Honduras mission was a travel day. A quick post with photos.

[Photo 1: me at DTW around 4 AM, backpack full of supplies, nametag, and most importantly, mini Purell holder.]

[Photo 2: my checked bags, before they disappear into the abyss.]

[Photo 3: The Lord's Prayer in Spanish.]

[Photo 4: layover breakfast in Atlanta. Peach pie in Georgia, along with bacon/egg/cheese bagel, hash brown, and OJ.]

[Photo 5: outside of San Pedro Sula airport in Honduras.]

[Photo 6: change from cotton shirt and jeans to polyester shirt and shorts. Welcome to Honduras!]

[Photo 7: roadside medical services provided along our drive from the airport to La Ceiba.]

[Photo 8: a peacock at a truck stop on the way to La Ceiba.]

[Photo 9: waiting in line for lunch at the truck stop. No, it wasn't cooked peacock.]

[Photo 10: lunch was arroz con carne y cebolla, y vegetales.]

[Photo 11: beautiful mountains outside of the clinic where we'll be working. Made a stop at the clinic to drop off supplies.]

My fellow med students and I had take-out pizza from a Pizza Hut at the end of the block where our hotel is. After some time in the pool, it's time to turn in for the night. Busy day tomorrow!

M3 year: the End-Game

There are only two weeks left in M3 year.

I'm currently drafting this blog post using Offline Gmail on a plane flying back from California. This weekend I was back in the sunny Bay Area for the wedding of one of my close high school friends. Reconnecting with my old crew (some of whom I hadn't seen since high school graduation seven years ago) and updating them on the latest news in my life have helped me internalize the opening sentence to this post. As incredible has it might seem, I essentially have just one year left until folks start calling me Dr. Luke Li (a prospect that seems so unreal at this point).

The future is certainly looking bright. First off, I'm extremely excited for my upcoming medical mission trip to La Ceiba, Honduras with the Christian Medical Association (a trip I think I alluded to in earlier posts). During the week-long vacation between M3 and M4 year in the first week of May, five fellow classmates and I will be flying down to Honduras with a team of clinicians, surgeons, nurses, and interpreters to provide ENT surgeries for the residents of La Ceiba. From what we've heard so far, this will be the opportunity of a lifetime for us medical students. The limited number of people on the trip means we will be much more intimately involved in patient care with more direct responsibilities in clinic, in the OR, and with anesthesia staff compared to our roles at Michigan. Internet access will most likely be limited, but I'm hoping to post updates while I'm down there.

[A map of Honduras. La Ceiba in on the northern coast.]

After the Honduras trip, I have an exciting M4 schedule to look forward to. Whereas the M3 year curriculum is completely composed of required rotations, M4 year only has four required rotations, one of which is an Internet course designed to be taken during interview session. The rest of the year is composed of months set aside for vacation, interviews, and electives. Although I might be adding or changing courses later in the year, my schedule is pretty much finalized and includes the following:
  • Period 1 (5/9/11 - 6/5/11): Emergency Medicine at St. Joseph's in Ypsilanti (alongside fellow Phi Rho member, bowling teammate, and weight-lifting partner, Brandon Smith)
  • Period 2 (6/6/11 - 7/3/11): Vacation month (time to take both USMLE Step 2 Clinical Skills and Clinical Knowledge tests)
  • Period 3 (7/4/11 - 7/31/11): Away Psychiatry rotation at Wright-Patterson Air Force Base in Dayton, Ohio
  • Period 4 (8/1/11 - 8/28/11): Away Psychiatry rotation at Lackland Air Force Base in San Antonio, Texas
  • Period 5 (8/29/11 - 9/25/11): Internal Medicine sub-internship at the Ann Arbor VA hospital
  • Period 6 (9/26/11 - 10/23/11): Neurosurgery ICU at the University of Michigan
  • Period 7 (10/24/11 - 11/20/11): Advanced Medical Therapeutics (the online course)
  • Period 8 (11/21/11 - 12/18/11): Interview month (no classes, but lots of travel, at least I hope)
  • Winter Break (12/19/11 - 1/8/12): three glorious weeks of holiday
  • Period 9 (1/9/12 - 2/5/12): Interview month
  • Period 10 (2/6/12 - 3/4/12): Hospice/Palliative Care elective
  • Period 11 (3/5/12 - 4/1/12): Infectious Disease elective
  • Period 12 (4/2/12 - 4/29/12): Anesthesiology elective
  • After about 1.5 weeks of vacation: Graduation!
As you might be able to see, my schedule is particularly front-loaded. As soon as Period 6 is over, it will be smooth sailing from then on out.

Outside of school, I've been taking full advantage of outpatient Pediatric work hours to enjoy life to the fullest. As I already mentioned, I flew back to California for my friend's wedding. I was touched to see that his entire wedding party was composed of former high school classmates. All together, there were (I think) 12 of us there to celebrate the event. It was a veritable high school reunion!

Back in Michigan, the Phi Rho M2s are close to taking their USMLE Step 1 exams. (Ah yes, the great med school circle of life.) In addition, I'm really happy to see members of the Phi Rho M1 class enjoying The Healing Blade card game that I introduced to the house. For those of you who are unaware, The Healing Blade is a strategy card game modeled after Magic: the Gathering (1990's throwback, holla'). Instead of mythical creatures, though, players of The Healing Blade choose to be either bacteria or antibiotics. I've already heard that the game is actually helping the M1s during their current Infectious Disease sequence.

[Examples of two mighty warriors from The Healing Blade: bacteria Enterococcus and antibiotic Erythromycin]

What's more, this past week, members of Phi Rho threw a surprise birthday party for Phi Rholler bowling teammate Stephanie Royer, and this coming week I get to spend five days in the Newborn unit, essentially playing with babies all day. Definitely some worthwhile events to report, with hopefully more to come!

Psychiatry it shall be! (And subsequent rumination on choosing a specialty)

I guess the title of this post pretty much says it all. After finishing 10 of the 12 months of M3 year, I've decided to go into Psychiatry. In my last post, I mentioned some of the reasons why I was flipping back and forth between Psych and Family Med. A big part of the reason was the relative lack of physical exam/human physiology knowledge required in Psych. There is also the question of whether or not I would actually be able to do psychotherapy as a psychiatrist. One of my interests is learning how to guide my patients into seeing the world in a different way; as a psychiatrist, I would be able to prescribe medications, but I also want to help change patients' perspectives on life, e.g. CBT for-the-win. However, a lot of therapy is being conducted by social workers who often provide the same result at lower costs.

Despite my misgivings, these past few months have reinforced my love of psychiatry. During my Neurology rotation at the VA, I was fascinated by how physicians were able to treat changes in the anatomy/metabolism of the nervous system, but during my time in Neuro clinic I really wanted to delve more into patients' depression and hallucinations. During Family Med, I felt the thrill of picking up an irregularly irregular heart rhythm during a physical exam and helping my attending diagnose new-onset atrial fibrillation through an EKG, but I felt a bigger thrill during a Family Med Grand Rounds on the need to differentiate between Borderline Personality Disorder and Bipolar Disorder (the two conditions have completely different treatment plans).

[Case in point: does Charlie Sheen need dialectical behavioral therapy or lithium?]

I mentioned in my last post that I would have to get used to the idea of "not knowing something." I think this has extended into being OK with not diagnosing/treating certain diseases. Surgeons will hardly be on the front lines of detecting heart arrhythmias and they sure aren't going to take the time to sort out whether a patient is Borderline vs Bipolar (and require psychotherapy vs mood stabilizers). Family Med docs and Psychiatrists alike are powerless to treat cancer or fix blood vessels through medications or talking alone. And as a Psychiatrist, I will never have the satisfaction of starting a diabetic patient on metformin and seeing improvement in his blood sugar. However, what I can appreciate now are the characteristics of Psychiatry as a field that fit my personality well. I enjoy continuity of care (hence my initial attraction to both Psych and Family Med). Spending time in Family Med, though, helped me realize that when it comes to chronic conditions, I feel more satisfied focusing on one issue without having to disregard others. In Family Med, I loved how we could start a treatment plan and reevaluate at a return visit in 1-2 months time, but I didn't like the idea of saying, "OK, we'll treat your high blood sugar this time around and think about smoking cessation in the future." When it comes to long-term management, I know now that the illnesses I want to manage are psychiatric.
 
Having this direction in my life definitely frees up slots in my M4 schedule to explore rotations that I will never get the opportunity to experience as a psychiatrist. In addition to Emergency Medicine and Sub-I requirements, I'm looking forward to the following highlights next year:
  • Two rotations at Psych residency programs on Air Force Bases
  • Neurosurgery ICU
  • Hospice/palliative care elective
  • Infectious disease consult elective
Right now, I'm having an awesome time with my last rotation, Pediatrics. Let's just say it's probably a good sign that I got blisters on my thumbs as a result of riding wheelchairs side-by-side with one of my patients while I was on call. Time to finish the year strong!

Preconceived notions and reconciliation

After three weeks post-Surgery and three weeks of glorious Winter Break, I think I've recovered enough to blog. In case you missed my last set of posts, I put up some quick photos of the full lunar eclipse that occurred on December 20 (starting with "Live blogging the lunar eclipse"). Other than that, the past two months of Surgery have been a blur of days walking to work before the sun rises and nights walking home after the sun had set. Sitting down to eat dinner with my friends in Phi Rho Sigma for the first time in weeks after finishing my last day of Surgery was an indescribable experience. I could feel my face light up; my change in attitude was palpable.

Winter Break has also been a much needed respite from the daily grind of M3 year. There were lunches and movies to be had with old friends from high school. A trip to Reno with my family involved skiing, bowling, and poker. Then there were epic times with the Stanford Band, first witnessing Stanford Women's Basketball upset No.1 UConn, then traveling to Miami to play at the Orange Bowl and bask in the Cardinal's 40-12 rout of Virginia Tech. Some photos, links, and posts from all of Winter Break can be found on my Facebook profile: http://www.facebook.com/dukelukeli

[A sample of Winter Break awesomeness]

But enough about Winter Break. In just a few more days, I will returning to Michigan for the last four months of M3 year. Up next: a month of Neurology, a month of Family Medicine, and two months of Pediatrics. Although there are still about six months until residency applications start, this is about the time for me to start thinking about my future specialty, especially since I will need to arrange for M4 away rotations in the next few weeks. At the beginning of M3 year, residents and attendings would often ask my classmates and me what we think we'll be specializing in, but always with the qualifying remark, "It's OK to not have an idea this early on." Now that we are three-fourths of the way done with third year, many of us are starting to get an idea of what direction we want to go in terms of our interests. (Rest assured, though, that there are still folks at this stage of the game who have no idea, and that's OK as well.)

Which brings me to the focus of this post. Out of all of the rotations I've had so far (Internal Medicine, Ob/Gyn, Psychiatry, and Surgery), my favorite has been Psychiatry. The pathology I saw was fascinating. What's more, I loved the pace of Psychiatry. In a healthcare system that is often filled with 15-minute or 30-minute outpatient appointments, it was a huge relief for me to be able to interview patients without have to constantly look at the clock. The interdisciplinary atmosphere of Psychiatry was also a huge plus for me; social workers were essential partners in coordinating non-medically related aspects of patient care, and inpatient Psychiatry nurses were in the best position to help monitor patient treatment progress. Psychiatry was also the first time I directly experienced continuity of care; during the 6-week rotation, every student was assigned to a weekly outpatient clinic, which allowed me to see a few patients two or three times and develop a comforting familiarity with them.

However, going into M3 year, my inclination was initially toward Family Medicine. I liked the idea of continuity of care, I liked how I would be on the front-lines of primary care, and I liked what I heard in terms of procedures that Family Med docs were able to do in the office (e.g. colonoscopies, mole removals). What I'm beginning to realize at this point in my education is, regardless of what specialty I end up going into, eventually I will have to say, "I am OK with not knowing something." My favorite part of Surgery, for example, was actually getting to stitch up skin at the end of a case, but chances are I will end up with little opportunity to do so in my future career. And unless I become a Family Med doc that does obstetrics, I may never be able to deliver a baby again (my favorite part of Ob/Gyn).

Granted, one could argue that I came to that decision point of "not knowing something" when I went into medicine. After all, I will never be able to understand quantum physics, the law, or even calculus as in depth as some of my friends. Yet, my whole concept of being a doctor before medical school was wearing a stethoscope, listening to people's hearts and lungs, moving limbs around, etc., which is why I'm hesitant to commit 100% to Psychiatry. Don't get me wrong, there would probably be times during a career in Psychiatry when I might have to test someone's reflexes or perform some other aspect of the physical exam, but it wouldn't be a routine part of my practice.

For those reasons, I'm leaving Family Med on the table as a possible specialty, especially since I've heard that Family Med docs manage many basic psychiatric conditions. In the end, I will have to see if I can reconcile my preconceived notion of a physician with my interest in Psychiatry. What helps reassure me during this process is the knowledge that regardless of what field I choose, I will be able to help others in a meaningful way.

End of the lunar eclipse live blog

All I can see now are clouds, without any patches of clear sky. Plus, my phone is running out of batteries. A quick kudos to the folks at Posterous for their iPhone app, which let me upload these eclipse photos so quickly. Hope you all enjoy these pics!

Lunar eclipse, live

Blessed to have a patch of clear sky to enjoy the full eclipse. Photos taken around 11:50 PM PST.

Just a side note: all of these pictures were taken with my iPhone 3G through the lens of my telescope.