Wednesday, September 30, 2009

I did it!

The tests were long, tiring....and successful!

I passed both the lecture and the lab with flying colors!

It's time to celebrate.

Tuesday, September 29, 2009

A Weekend in the WIld, Wild, West

Maybe not so much.

I worked on Legislation and Regulation the whole ride to Seattle (and my memo), worked all day on Friday on my memo, reunioned like it's 1999, got up, did more memo work, did more reunioning, and finally was done around six oclock. Just in time for some wine, dinner, bed, breakfast and a trip the airport.

Fortunately, I had a nice relaxing ride home, studying torts the whole way.

More importantly, we did make it to Trina's reunion. It was great; the people were nice and I got to be arm candy. She was definitely the coolest one there!

Monday, September 28, 2009

Wish me luck!

Tomorrow is my first Anatomy exam. The lecture exam is 3 hours, followed by a one hour practical exam in the lab. It covers all of back and limbs. I have to know 110 muscles, their attachments, innervations, blood supply, etc. Plus, 99 bones and all their features. Plus, ligaments.

Plus, reading a bunch of radiology (CT scans, MRI, etc.). Plus, a bunch about how the nervous system works. Plus, the first eight weeks of development (embryology). Plus a bunch of common pathologies of all the above.

I'm doing remarkably well panic-attack-wise when I look at that list. I don't feel like I 100% know everything on the list, but I know most of it and I am hoping I can recognize the rest.

After the Anatomy exam I will get back to you about the other major happenings - like flying home to Seattle, my 10 year high school reunion, etc.

In the meantime, use your extensor pollicis longus to give me a thumbs up!

Tuesday, September 22, 2009

Trinidioms #66

"Don't be a sour blanket"

I swear we've had this one before...

A Contradiction in Our Criminal System

We tend to think that moral blameworthiness is indelibly linked to intent. Evil intentions are, in a way, the ground of moral evil.

And we think of the criminal system as having something to do with blameworthiness.

And yet, in criminal law, we rate blameworthiness by outcome, not intent (we usually want intent included, but the RESULT is the key). Does someone actually die when you intend to kill? The outcomes aren't tethered to the intention, and yet we punish based on outcomes.

A tries to kill B, but only with regret. He succeeds.
C tries to kill D, with glee and malice, and fails.

We punish A much more severely than C.

There are theories that may answer this paradox, but it is worth thinking about.

Interesting article; Subsidies for Corporations in the 1850s and 60s.

I just read a fascinating historical article by Martin Horwitz, called "The Transformation of American Law: 1760-1860"

Basically, he traces the rise of negligence liability as opposed to strict liability, and how negligence eventually overcame strict liability in that period.

Negligence theory operates on the assumption that we should only have to pay someone if we harm them culpably, that is, if we should have been acting differently than we did. There was some early basis for this, but it was only grounded in legal duties (contracts, or the role of various statesmen) that we failed to perform. The modern definition (act like a reasonable person would in the cirucmstances) hadn't yet come.

More dominant early one was strict liability. We still have this today (although it all but disappeared in the period in question). With strict liability we say, okay, even if you weren't negligent, you still caused this injury. You chose to act, and you derive the benefit from your actions. You have to pay the costs (of hurting others), even if you acted responsibly. The idea is that you don't get to externalize (i.e. make others pay for) the costs of your own activities. Fair enough.

As this period came to a close, negligence began to dominate all areas of liability. This brough with it a huge social change and an enormous hidden subsidy. Corporations could do whatever they wanted (as long as it wasn't negligent) and injury the people and property around them, and they didn't have to pay. They were able to externalize the risks of their activity to the weakest. It became a matter of the the "inactive" those who weren't engaged in activities that injured others) having to pay for the "active" (the corporations), more than a proportionate share (they weren't just buying their goods; they were taking it on the chin most every time they were injured by the production or product from a corporation).

What does all this amount to? A huge legal subsidy for corporations in the antebellum period; a massive regressive redistribution of wealth. It doesn't just have to come through taxes!

I'm a nerd and thought that was interesting. Maybe I'll write about retributive and utilitarian theories of punishment next...

Monday, September 21, 2009

Mondays and being happy!

So I was thinking on the way to the library this morning...

I'm tired. And I was good this weekend. Didn't sleep in that late (well, kind of on Saturday), didn't drink too much wine, got just about enough rest and exercised and ate well. And I love school, but I still feel so, Monday!

What is this all about? I love the professors, content, students and setting. I like being busy. I like learning so much. I look around me and am awed by the setting I'm standing (sitting at the moment) in. What's my deal?

The problem is me. Mondays maybe are legitimately a little rough for us all, sure, and to be fair to myself, I can't expect it to be much better for me. But my larger point here is more important.

No matter how great the setting, we are stuck with who we are, and our happiness is predicated mostly on that. Psychologists tell us that we have happiness set points--the place we usually sit in terms of our attitude toward life. Win the lottery, lose a spouse, we vary widely, but if we don't have a psychic break or get clinically depressed, we return to our happiness set points eventually. It's weird, but life has shown me that it is true.

This was confirmed last year. No work stress, money stress was fairly minimal, and sometimes weeks without the other things that people tend to complain about. I love it. But you know what, I wasn't that much happier. I was happy (but I usually am), and I was certainly more relaxed. There were those months leading up to the trip where the stressors were really high, so I was even a bit less happy (and so I did feel a change while on my trip), but the truth is, that my setting only allowed me the opportunity to return to my happiness set point. And I did.

What's this have to do with Mondays? Well, I'm thinking that no matter how much I love my job or school, maybe my happiness set point will always make me feel at best ambivalent toward Mondays (a social scientific stretch, but bear with me). Maybe I shouldn't use Mondays as a barometer for how much I love my occupation.

Or, maybe I need to change my brain. The one thing that is most notable for changing happiness set points is meditation. Monastic people are actually some of the happiest people in the world, as it turns out. I don't see the monastic life coming my way, but it does make me think.

If I want to be happy, I only need change my circumstances enough to make sure they aren't preventing me from joy, that they aren't some sort of chronic stressor or depressant. Otherwise, I'm going to have to develop my inner life.

(I don't know why I was thinking about this today, except for the Monday thing...anyway, a window inside my head).

Then again, I love my life as it is. So maybe the semi-bliss that it is is good enough. =)

Saturday, September 19, 2009

More on Jewish Lawyers

I was having a conversation with one of my Jewish classmates last evening, about why Jews are so overrepresented as lawyers (among other prestigous careers as well).

She said, "when I was about to leave for law school, I met with my mentor, who happens to be a Jewish professor of law. I said, "I'm nervous about learning this whole legal reasoning thing. He said, "what are you talking about? You are a practicing Jew. You've been doing legal reasoning your whole life." It's true, my family spent each Friday night thinking through an ethical question from the vantagepoint of the Law. Also, we were always comparing the Law and the law of the United States, both in origin, substance and form."

Wow, well, that would do it.

Friday, September 18, 2009

Einer Elhauge

One of my professors finished number one in his class at Harvard. Besides being internationally renown and perhaps the fastest thinker I've ever encountered (although we are discussing his speciality, so I don't know if that counts) he also had memorized our names and faces BEFORE we came to class for the first time.

Yep. That's smart.

I also just found out that one of my professors recently argued in front of the Supreme Court (ho-hum, ho-hum) with her brother, a law professor in Texas. I bet their parents (if they are alive) made it to that one.

Thursday, September 17, 2009

More on my classes

In case you were wondering what I'm studying.

Torts: In a productive society, a lot of interactions among people and groups happen, and out of those productive (and other) interactions, harms arise and need to be compensated. This is the basic idea behind torts. It's been so interesting thinking about fault based (e.g. battery, negligence) torts and what it means to be negligent or how to define an intended act and even more to think about no-fault torts, (e.g. strict liability, workman's comp). No fault lawsuits seemed pretty cruel to me, until I figured out what they are all about.

If you operate a business and, say, you store a nasty chemical and something freakish happens and it leaks and people get sick, you are probably held liable. Even if you weren't negligent--you did your due diligence. So you aren't held liable for negligence (and can't get punitive damages, which are the big ones). But, we figure it's better that the actor pay than the innocent who was harmed. It's considered a gamble you take when you engage in activity (in this case, money making activity). I like this concet.

Okay, I'll try to get briefer. Civil Procedure. This is the most technical of my classes, it's all the stuff between deciding you have a complaint to the judgment and potentially appeal. It's all the rules (except the rules of evidence, which are another class) for how a civil action works. There are millions of rules (technicalitlies, some would say) that govern the way we engage in civil action. What I enjoy most are finding out about why each rule exsits, what problems are trying to be solved, and, of course, how to strategically employ them.

Criminal Law. Lots about culpability. Also, we ask, why punish? Retributively? For utilitarian purposes (deterrence, rehabilitation, locking people up so they can't do more bad stuff)...anyway, a lot of big why questions, and then how questions that follow. Also, the stories and hypotheticals are really grisly.

Legislation and Regulation. This professor is the most "Socratic"; mostly he just constantly disagrees with you, no matter what you say. But he's very nice about it. This is the class that gets into judicial interpretation of statutes, which is a HUGE area of judicial practice, and among the most controversial. Textualism and Purposivism are the major theories we are dealing with. It's funny, everyone has opinions about this, but it's such a layered and loaded field. It's easy to opine on it until you get in to the nitty gritty details.

In this class, we just spent a day on the definition of a vegetable (tomatoes and whether they should be taxed...an old case) and on the definition of the word use (in a certain statute about using a gun to further a drug crime, someone traded his gun for drugs and ended up with a 30 year sentence because the court decided to read the statute literally). I finally get why Bill Clinton said "it depends what is is." He was a law professor for a time, after all.


To my conservative friends: you'll be happy to know that Harvard Law school is loaded with textualists (at least students). Hopefully the professors can do something about this... =)




Finally, there is Legal Research and Writing. That's the class where we learn to write legally (read: boringly) and how to use library resources and databases. Maybe not quite as exciting.

Trinidioms #65

"Bite my butt."

The funny thing about this one is that I said it once as a kid and got teased about it (by my best friend) for at least a year.

Trinidioms #64

"You're a twert"

Bodies are so clever...

Ok, so let's say you drink some methanol (a bad idea, since it's toxic and poisonous). But, maybe you were looking for something cheap and thought denatured alcohol would do the trick (ethanol with a splash of methanol, used for industrial purposes, sold at an auto parts shop).

Your body would take that methanol, oxidize it to formaldehyde, then to formic acid...then it would get stuck. If you'd drank Jim Beam instead, your body would oxidize it to acetaldehyde, then to acetic acid, which it can totally handle and break down into other things pretty quickly. But, your poor body is stuck with the formic acid. Bummer.

Since it's hanging out as an acid in your body, it starts messing with your overall pH. Your blood starts to get too acidic. Now, your body is prepared for minimal pH changes. There's a bunch of CO2 in your body that mixes with water to form carbonic acid. (Carbonic acid can give off a proton - which is what acids do, and then it is called bicarbonate which can take on a proton - what bases do). This is called a buffer system - it can flex either way and help "buffer" the effects of pH changes.

So, this is the cool part. If you've got that nasty formic acid causing your whole body to get too acidic, you will start involuntarily breathing really deep and fast (called Kussmal breathing). The idea is you will get CO2 out of your body way faster than normal. Thus, there's way less carbonic acid that can be made, so you will (theoretically) get less acidic. Depending on how much methanol you drank, your body might not be able to keep up, then, you'd need dialysis to get it out. But, it's still a cool impulse.

And, it's the same reason that people who hyperventilate when they get nervous might pass out. They're actually inducing an alkalosis (making their body too alkaline or "not-acidic") by removing too much CO2 too fast. Their body says, "that's no good" and stops the CO2 loss by knocking them out.

Isn't that cool?

Wednesday, September 16, 2009

My classes are theoretical

And I love it.
Big fancy schools like Harvard are criticized for this, but as I've mentioned before, we've been told that "We don't just want you to understand the law, we want you to understand why things are the way they are, and how they should be. You will be the ones who write the law of the future."

Anyway, so that's pretty cool. We spend a ton of time on cases, but integrated into those discussions are a lot of ideological underpinning kinds of stuff, like why we punish, what the aims of litigation are, how the system is stacked to favor certain actors even though the rules are set toward impartiality, etc. It's really, really fun.

If you are a nerd, of course.

The Socratic Method

In law school lore, the Socratic method is supposed to be this humuliating and chilling experience where you are made to look like a boob constantly.

Of course, lore is crap. At least regarding my classes. It's true, many people did have hard experiences, and it's also true that many of them went to Harvard, but these days things are a bit more affirming.

In my classes, my professors started into their questioning (they ask us about cases we were supposed to read) by saying something like this.

"Okay, everyone. Now we are going to do the Socratic part. We are all in this together, and it's okay if you mess up. You'll get the hang of it. Okay...Mr. Davis?"

"Yes?"

"Tell me, in Temple v Synthes, was the key issue Subject Matter Jurisdiction or Party Joinders?"

"Um, jurisdiction."

"Hmmm, well, maybe, do you think it might have been joinders?"
Yeah, joinders."
"Right! Wonderful. You're getting this!"

That's not exactly what happened (and it wasn't me), but there have actually been moments that follow that tone almost to a t.

So, not exactly brutal (and Socrates wasn't that brutal anyway, and, for that matter, noone really knows what he talked like, they only know how Plato presented him and made hiim sound smarter than everyone else (although he might have been)). But I digress...

So, yeah, the professors are nice. At least mine are. It's no "Paper Chase." Maybe more like legally blonde (I don't actually remember the movie, though, so I can't say for sure).

Tuesday, September 15, 2009

Trinidioms #63

"Well, you've been hurtling insults at me."

Yale girl's death

I'm sickened and saddened by this horrible tragedy.

It's really hitting home for me today. When Trina and I visited Yale, we separated for a few hours (which included her walking to the medical school (where the incident happened). Trina ended up in an unforseeable (but highly important) meeting and we didn't have cell phones. We had arranged a meeting place, a deadline time, and then there was our hotel, the only other conceivable place she could be. Trina NEVER misses a these kinds of deadlines (this is the only time in six years together).

She was hours late with what I had thought was the opportunity to call (the front desk at the law school). She hadn't called (she actually had, just couldn't get through--so they thought she didn't call).

I was sick when I took the taxi back to the hotel. When I returned to our hotel and she wasn't there either, I panicked. As I was getting on-line to contact the school (my next step was going to be 911), I found an email that said something like,

"I'm so so sorry. I know you are terrified. I'm in a meeting with the dean, and I am certain you would tell me it was worth your pain to create the opportunity. Still, I'm so sick knowing what you are going through. I'll contact you as soon as it's done."

I spent about twenty minutes sobbing. I actually had believed something happened to her.

That said, this Yale gal's story feels all the more poignant. They found her body five days after the crime, the day she was to be married. I'm so so sorry for her fiance and her family and friends. While I cannot imagine what they are feeling, I can imagine what fearing it would feel like, and that enough was a dark and unmanageable chasm of despair.

My heart goes out to them.

Monday, September 14, 2009

Jewish Lawyers

I'm from the West Coast, or the left coast as they like to say in the South Apparently (so I'm told by one of my Jewish colleagues from the South). He says everyone should live in the south at some point in their lives. Who is the world is he kidding?

Anyway, speaking of Jewish lawyers. I've never been really exposed to the semitic stereotyping that has long marred our culture, but I was vaguely aware that Jewish people were known for inhabiting the lawyerly field.

Well, guess what? Not just inhabiting it, but dominating it on a per-capita basis. The Jewish population at Harvard is massive. I'm sure there are more Protestants around, but barely, and given the comparison in US population of Protestants v Jewish (see, I'm writing v. like in case names already), it's dumfounding how many Jewish people are here.

And not just the students; an enormous number of faculty too.

So what does this do for my stereotypes? Well, I'm going to go with this one, and instead of seeing it as an international conspiracy like the fascists did, I'm going to see it as really freaking impressive. What a robust and impressive community! And I love that a communty so dedicated in its faith is also so committed to doing good, doing well, and to an intellectually robust life of the mind.

The rest of us should take note.

I passed!

Just found out I passed the first test!! Passing is 75, I got a 90!

Whoo-hoo!

Just took my first test of medical school...

Think it went pretty well. Here's hoping!

PS - (It was in Biochemistry)

Sunday, September 13, 2009

Boston is Diverse

I've never been in such an ethnically diverse city (well, I'm sure New York and London must have been, but whatever).

It's absolutely astounding. We live in a district with a lot of MIT Graduate Students (which means they are frequently from outside the US). Our area is actually mostly known for it's Portugese immigrant population. It was formerly an Italian district (street names like Sciarappa) and there are still quite a few Italians around (Millie across the street has been here sixty six years--which means she moved in near the end of World War II!).

There are the massive groups of Irish and Italians that characterize Boston, of course, but the variety has only just begun. The black population is substantial, and it's really unfair to link African descent into one category. Such a large percentage of the population are immigrants around here, I don't even know when it's appropriate to say "Portugese American, or African American". Anyway, the variety of color, shapes and sizes, languages and cultures among just the African people around here is astounding. Absolutely astounding.

And then there's the Eastern Europeans, the rest of the Europeans, the Russians (who, I guess, are actually Europeans too), the gads of East Asians and Indians (and other subcontinent people, I'd wager) as well. There are lots of Canadians too, but I don't know if they really count as different; just better health care I suppose. I hate how they say pasta (pah stah) too.

Oh right, South America! Not a lot of Mexican people around here, but plenty of Brazilians and other South and Central American people. It's easy to forget that South American is situated quite a bit east.

Anyway, I can walk down the street anywhere in this town and hear a half dozen languages when covering a few blocks. It's especially pronounced when using public transportation (which is how we get around).

I love it. It feels so rich, so cosmopolitan, so diverse, so...I don't know, international. Since so many immigrants from so many countries start here, you can this sense of it being a place of hope and opportunity, a real destination for those who are coming to America to create a new life, seek assylum (a lot of political refugees around here) or even just get an outstanding education.

Picturing people with their...

So, you've heard the junior high accusation, "He was totally picturing me with my clothes off!"

Well, these days with the amount of time I'm spending thinking about bones, muscles, nerves and blood vessels, I realized I was at the gym picturing this hapless guy with his skin off.

Ron says that's weird.

Saturday, September 12, 2009

New Friends

Still trying to decide how I'm going to do the friend thing here at Harvard.

Because I like my wife so much more than any of my potential new friends, I work hard all day between classes to get through my work (alas, to no avail, but I do get prety far). So that makes it a little hard to make friends, as does being a few years older than everyone else. Although, to be fair, I've enjoyed a number of twenty two year olds as well as the ones closer to my age.

I've been taking time at lunch this last week to eat with people, and I already have some new buddies, so that's cool (of course they get together and watch college football on the the weekends, which is great and everything, but I'd rather not spend four hours watching a bunch of huge twenty-somethings in tights beating the crap out of each other.) So, I'll either have to find something else to do with them, or make some more friends I suppose.

There is the issue of not living on campus too--a huge portion of the population does and so naturally ends up hanging out (well, getting wickedly drunk I think) with each other. Mostly, though, these are the youngest ones and frankly, I'd rather pass.

Still, all that said, everyone is friendly and I really like most of the people I meet. I'm just trying to figure out how to balance the work/personal aspects.

One thing that we are trying to do is get to know some couples. We had Vietnamese food with one of Trina's school friends and her boyfriend (who happens to go to Columbia Law School) last night. That was fun...I think couples are an avenue that holds much promise.

Anyway, still getting the hang of things, but loving it very much.

I failed my first test at Harvard Law School!

Well, okay it was a quiz (a miniscuple part of my grade), and it was open book (!!!). There were only three questions and I was busy with other homework, so I just kinda got fed up and just picked on.

So I missed one out of three questions, which I'm pretty sure means I failed.

Glad to get that out of my system!

Trinidioms #62

"Take your jokes aside"

Friday, September 11, 2009

Trindioms #61

"Little rings come in good packages."

Thursday, September 10, 2009

Processing

I am not really interested in politics, and I'm not really interested in debate. I've been presented with a lot of information about health care and how it's delivered and how the medical system works in these past few weeks. I have some burgeoning thoughts. I have very little time.

So, here's what I'm thinking. I'm going to write them out, to figure out what I think. I'm happy for you to know what's going on in my head, but please don't hold me accountable for having a perfectly coherent picture of things. This is my processing.

It really bothered me that at a "What is OB?" luncheon this week the sole woman on the panel answered the question, "what about your personal life? Are you married, do you have children?" with this answer,

"Yes, I've been married for 10 years. My husband did his PhD and postdoc at UC Berkeley, so we've been apart for 8 of those years, but it has been wonderful to be in the same state for the past year and a half."

Whoa. Seriously?! 8 of the 10 years of her marriage, this lady and her husband lived on opposite coasts during RESIDENCY, not exactly a time when you can fly back and forth every weekend. And that is the "hopeful" answer to work/life balance?

There are like 25 things about this that bother me.

First, I am surrounded by fellow med students who are living hundreds or thousands of miles from their boyfriends/fiances, etc. (I don't talk to many boys apparently =). This is a struggle, but they work at it.

Then there are the number of fellow female med students who are younger and upon hearing really basic things about my marriage act really awed and impressed about it. I say something like, "If we wouldn't have been accepted in the same city, we wouldn't have done it. One or the other of us would have gone to school, or we'd rework the whole plan. We wouldn't have split up for it." To me, that's really fundamental.

Getting married is and was a big deal for me. My idea of what a marriage is involves real, ongoing relationship. I don't see that view as "above and beyond;" I see it as really bare minimum. I get that I am perhaps a little more high maintenance in relationship than the average girl =), and have some serious communication needs. I am not trying to impose my views on other people, but I feel bothered that so many of my incredibly bright and talented peers don't expect a certain level of sacrifice (on both sides) out of relationship. That seems like a disaster waiting to happen. (By the way, when Ron and I were facing the real possibility of no schools lining up, we had a conversation where he made it crystal clear that if someone was giving something up, it was going to be him. He said he couldn't live with himself if he'd been the one to keep me from being all that I could be. If it didn't line up, I was going to med school, he'd go to law school later. So, he's wonderful.)

For many months we had a scenario that involved both of us going to our second choice schools and having a long (but reasonable) commute. He had already been accepted to Harvard at the time, which was his longtime first choice, but we began spending our time choosing to find the good things in our second choices and thinking about how we'd make it work. It would involve sacrifices on both sides, but it wasn't really a question when posed with, "what is more important, your career or your marriage?"

So, it bothers me that my relatively young, impressionable colleagues are being presented with a picture of relationship that normalizes a level of selfishness and promises a robust and healthy relationship under conditions that obviously don't allow for that.

Then, it bugged me that this OB's 80+ hour work week is lauded and impressive to this culture. How is it good for patients to have a physician whose personal life is a mess (or hollow)?

I think the real reason it bugs me is because it scares me. I really love medicine. I love the learning, the future teaching, the ability to positively impact people's health. But, I really love my husband, my family, my friends and my kickboxing too. I am terrified that being an excellent physician is going to push me to give up or squeeze down to nothing these other parts of myself. The work IS just that interesting. I see how it is compelling and you want to do that. But, I don't want to BECOME that.

It isn't like I didn't see this in the business world in my working life part I. But, it is a little easier to see that the girl who spends 90 hours a week at her consulting job making a for-profit corporation more money each quarter is trading off her life for her money. When your job is "saving lives" and "helping" is it healthy or selfish to spend your extra hours away from work? I really don't want the answer to be selfish.

I don't take lightly the responsibility that comes with the privilege of learning to practice medicine. But, I really hate the culture of medicine that honors the overworking.

In Norway, I saw a completely different picture. One of my cousins there has a partner who is an Anesthesiologist. He works 40 hours a week and if he goes over, he takes comp time or gets paid overtime. This was true during his residency and during his practice. I don't quite remember, but I think he's basically employed by the government (government pays for health care). He makes a great living and he has a great life. He said they consider the American physician working schedule "barbaric" and "dangerous to patients." I think he's right!!

Then, there's the part about the patients. It's becoming more and more accepted that working more than 80 hours a week unnecessarily endangers your patients.

But, that aside for the moment, what about the less dramatic scenario? The part where you're admonishing your patient to take care of herself, get enough sleep, eat well, exercise and manage her stress. Why should she believe me when I as a doctor can't keep any of that under control? It sets a bad example.

So, I feel like even though I love Embryology and I'm really interested in Women's Health, I'm afraid to consider OB/GYN too seriously because I don't want to live my life in a culture that constantly is trying to uproot my priorities. I am not afraid of working hard. I'm not even afraid of working long occasionally, or as necessary.

But, I am not willing to trade my work for my life.

Wednesday, September 09, 2009

Autonomy

We have talked a lot about autonomy in the past four weeks of medical school. The basic concept is that the patient is the sole source on what is best for the patient and that the parentalistic days of "doctor knows best" ought to be over.

In the 1950's only 30% of doctors told their patients the full truth about their diagnoses and treatment plans. At that time, it was assumed that it was the doctor's job, with all his knowledge and expertise, to sort out the story and tell the patients what they "needed to know." The doctor was expected to act altruistically, "in the patient's best interest" which he often did, but a lot of assumptions went into deciding what the patient's best interest was.

Now, the patient is king (or queen). The patient's definition of success in a given situation is the working definition.

For example, let's say a Jehovah's Witness patient needs a major surgery that may require a blood transfusion. It is considered a serious offense (to some, not all) Jehovah's Witnesses to ingest blood, including in a transfusion. Potentially risking eternal punishment. In the past, a surgeon who was afraid of losing the patient would transfuse the blood as necessary to save the patient's life. Now, if the patient says that sustaining temporal life at the expense of potential eternal death is unacceptable, it's unacceptable, no blood is given and that is that.

This is relevant to the latest political debate (of which I've only heard fragments, I spend most of my time reading textbooks) about the health care reform encouraging the euthanizing of seniors. According to my professor, this actually all ties together.

Historically, doctors worked to sustain life, period. Up until recent technological advances (50 years or so), that was pretty clear. Now, there are questions being raised about what is the right thing to do? If a patient is terminal, going to die in a few days and wants to leave the hospital, refuse food and tubes and die at home with their family, autonomy says they should have the right to do that.

Apparently, when given the choice, most people say they'd like to die at home. In the 1950's about 50% of patients died in a health care facility. Now, that number is more like 90%. So, why the disparity? Is it "doing harm" to use every last tool in the toolbox to try and sustain the life of someone who is invariably dying? Is that heroic? Is that tortuous? Who gets to decide?

It's complicated. At some level, I'd rather the expert did the deciding. But, as a patient I might have real opinions about how the tradeoff between quality of life and quantity of life works.

Hmmm.


This plays out in a whole bunch of ways. For instance,

Trindioms #60

"You made an interesting insight a minute ago."

Tuesday, September 08, 2009

Specialty, already?

From day one of medical school all the different specialties start recruiting.

(Quick review. Med school is four years, at the end of which you have an MD, can write prescriptions and are a doctor. But, in the US you must practice under the supervision of an attending physician for your first three years which is called residency. The residency program you choose determines your specialty. All my classmates and I will follow roughly the same course through school the next four years, then branch off into a whole bunch of different residency programs).

There is this lunch series designed to introduce us to the specialties with titles like, "What is OB/GYN?"

I think there have been a total of three lunches in four weeks that have not been filled with meetings for one interest group or another.

The real problem is, I could hardly choose a major, let alone a specialty. Most of our third year of med school will be spent rotating through the different services, experiencing them first hand and most people say that is how they decide.

Each day, I go to the lunch and come away certain I want to be a Dermatologist. This week I've wanted to be in OB/GYN, Family Medicine, General Surgery and Urology. I wonder what next week brings.

There is a part of me that wants to just celebrate that the applying and stressing about getting into medical school is over, just learn my Anatomy and plug my ears.

But, then someone comes around talking about how fun it is to practice Oncology in an academic medicine setting and I get all intrigued.

So, I'm taking votes. What kind of doctor should I be?

Anatomy

We've had our first couple of dissections in the Anatomy lab.

I love Anatomy (and occasionally hate it). But, it is really amazing to read about something and then be able to actually touch it, move it and see how it interrelates with four million other things.

I took undergraduate Anatomy & Physiology, for which I am exceptionally grateful for right now. FYI there are 206 bones in the human body, each of which have an average of 10 features I need to know the name of...easy to remember things like infraglenoid tubercle. And, the bones are considered the "easy" part that we're assigned to learn through "self-study."

Learning Anatomy is a little bit like learning a language. The lecturer will say a sentence and you'll seriously only understand 20% of the words. It's overwhelming, frustrating and exhilarating when you get it. It's this massive web of interconnected information. You try learning the features of a bone, let's say and there's this protrusion where a muscle attaches, (wait, which muscle is that, and what action does it cause on what joint?), there's this foramen (hole) for nerves and blood vessels to flow through (which nerve, what spinal cord root does it come from, how many times does it change names between the spinal cord and here? what's the path of the arteries? does it branch or split? what's the difference?) and what bone was I talking about again?

The lab is actually quite wonderful. It's on the 10th floor, full of sunlight and exceptionally well ventilated. The process of dissecting a human body is really an honor. Our school has dedicated a lot of time and attention to proper respect and treatment. At the conclusion of our time with our cadaver, we first years will host a memorial service for the families of our donors. The eight of us that worked on our cadaver will plan exactly how to express our appreciation for the learning their relative made possible.

All in all, a really special experience.

Monday, September 07, 2009

First Week at Harvard

So, a week ago Friday I started my Harvard Law School Journey.

The first weekend was full of food, laughs, and a lively discussion about To Kill a Mockingbird. Malcolm Gladwell recently suggested that Atticus Finch wasn't so heroic...which was the beginning of our discussion.

There was the bars, the tours (skipped the art museum one, to be fair) and then the big welcome day on Monday.

That was amazing. Our whole class seated in this old church that looks kind of like the church I got married in. Check out this picture on the front page of the law school web site. If you read the rest of the article, you'll see it was a day full of pretty heady stuff.

After listing off some of the accomplishments of my class (worked for major corporations, the world bank, the UN, over 70 ex congressional workers, 11 marathoners, a ballet dancer (I recently met him, which was quite a surprise!), and people who have worked for and started successful companies and NGOs of every sort all over the globe...the dean said something great.

She said something like, "right about now, you are listening and wondering, 'how did I get in here?' Let me tell you something, we searched the world for you."

It sent shivers up my spine. Same with the time we were in class and the professor said, "we aren't just going to discuss what the law is, or why, but what it should be. You will be the ones most likely to actually be writing and shaping law." Wow. More heady stuff.

So far, I love it. I won't get in to the hard parts just yet (I don't have time; I have to go to bed!), but I will eventually. Suffice it to say just a few of the good parts (which comprise most of my impressions).

The professors are brilliant. They have clerked for supreme courts justices, educated supreme court justices, written definitive legal theory, one (next semester) was the Solicitor General for the United States as well as a former member of the Masachussetts (still not sure how to spell that!) State Supreme Court...another is a highly regarded litigator who won landmark rights cases and has the class alternatively in stiches and enthralled when discussion civil procedure, not the liveliest topic.

The students are amazing. They are bright and accomplished, and mostly not arrogant at all. These are really extraordinary people. It's also one of the only times in my life where I am a part of a discussion on something where I'm no more a rookie than anyone else, and keeping up requires a lot of attention. People say stuff I wouldn't have thought of, and I love it. Since there are eighty people in my classes, I don't feel too stupid when this happens, and I can keep up and follow people and make my own points, but still, the pace is amazing!

Also, it's really fun to be in a big pond. Definitely not a big fish here (yet, will work on that). So far, just run of the mill. I love it. The other day, I met a fellow who almost went to NYU because of the school arrangment with his fiance, studied history, loves philosophy, would maybe love a PhD in the matter but considers himself too action oriented for that, he thinks anyway, and for now is most interested in litigation or appeals or some other more performance oriented endeavor. Sound familiar? Wow! Too bad he's a Ron Paul fan, or we'd be soul mates. Good thing I already have one of those (my sweet, brilliant wife has been an excellent support this week while balancing her own very full life with the needs of mine).

Finally, the content. This legal stuff is just so interesting. When you really get down to it, there is a reason tehcnicalities make the difference, and the technicalities are in the law for reasons and there are lots of controversies about lots of things and they are all incredibly complicated from a theoretical and detail vantagepoint, but they all get at lofty values and big kinds of questions. It's ridiculous. I'm in hog heaven.

Now, if I can just figure out how to read this stuff faster. No more seventeen hour days this week, I'm hoping.

Love to you all...

How it's going

About every other day I feel overwhelmed with excitement about the beauty and order of the human body, astonished at how it ever works correctly, feeling almost intoxicated with love about it.

Then the other days I feel overwhelmed with information, wondering if I'm ever going to know this all and having self-doubt about my abilities.

I just read back over my entry about the first week of medical school and I've come a long way!

It now really feels like it's my school, my subway, my home, my classmates, my teachers. The workload is a lot, but there hasn't been any concept I haven't been able to figure out. In addition to two weekly meetings (one in a clinical setting where we practice interviewing patients, and one with a clinician where we practice solving clinical problems), there are just three classes this term.

First, is of course, Gross Anatomy. I love it. It's horribly difficult and complicated and full of details, but I just love it. There is an inordinate amount of information to know, but it all goes together so beautifully, it doesn't feel like work to me to learn it. It feels like a privilege. Plus, it includes Embryology which I took a whole course on my senior year in college and that experience contributed significantly to my decision to go to med school. Embryology is so amazing. I'll tell you more than you ever want to hear about it if you ask =).

Then, there's Biochemistry and Cell Biology. This is basically understanding the chemistry that makes the body run. For instance we've recently been working through the details of hemoglobin...how it is synthesized, how it is broken down, how it works, what happens when it doesn't work and how we might try and fix that. I was particularly nervous about this one because I hadn't taken biochem before (many people have), but so far, so good. It is interesting and relevant and most dinner table conversations start with, "guess what diseases can be caused by protein misfolding?"

Thirdly, there's Human Behavior in Medicine. It's sort of a cross between intro to psychiatry and a best practices in medicine class. We are working through a whole variety of interesting topics in human behavior. The argument is that you are much more effective as a physician if you pay attention to the patient as a person with a family whose behaviors might be telling you more than first meets the eye. Plus, we need to understand our own biases and behaviors and how they might impact our treatment of the patient. We're also working through a number of topics that might be difficult, awkward or unnerving at first encounter in the clinic and talking about the best ways to handle them. Topics in the first section include medical student mental health, drug abuse, obesity, child abuse, human sexuality, etc. Then we move on to mid-life crises, depression, aging and dying. I'm glad to be talking about and thinking through these topics. Sometimes it is a little much to think that I'm going to really face these situations and be able to be a professional, caring, compassionate provider. It feels like I really don't know many answers right now. But, maybe that's ok. (Now and then).

All in all, very interesting ways to spend my days. I've figured out about six new ways I could commute and am slowly navigating when to use which.

A Love/Hate Relationship

One day I spend seven hours studying and I feel invigorated at the end. I am in awe of the beauty of the human body, amazed that I can know all this and swooning over the fun of it.

The next day I spend seven hours studying and I am near nervous breakdown at the end. Everything is wrong, I am incapable of all things important and life will never be ok again. I'm crying walking down the sidewalk, not even having the time to sob in private.

I hate not getting something.

The worst was learning to drive. Here's where you're saying, "oh, me too", but your mom didn't have to hire a driver's ed teacher to special tutor you. And, when she did, the tutor did not in fact come back and tell your mother, "she closes her eyes when trucks are coming the other way! I can't drive with her again."

The takeaway lesson is, I drive now. I haven't even ever been in an accident. So, all things are possible.

I love learning. Sometimes learning requires intermediately not getting something. Ugh.


Quote

Over dinner Trina says,

"Multiple variable linear regression is just, so, fun!"

Trinidioms #59

"Can I trade my mind?"

Sunday, September 06, 2009

Did You Know?

Women comprise 52% of the world's population, work 2/3 of the world's working hours, make 10% of the world's income and own 3% of the world's property?

I learned it in the Human Rights section of my Essentials of Public Health class.

Saturday, September 05, 2009

Random memory

When I was in the hospital in India, many different nurses (sisters) helped me. They were all quite friendly and anxious to learn more about me. As they paraded through they'd ask,

"Are you German?" (no, but not a ridiculous guess)
"Are you from Norway?" (yes, actually, and Denmark and Sweden)

But, perhaps my favorite...

"Are you Japanese?" (wow, wasn't prepared for that one).

No, actually I am not.

A different take on the whole "they all look the same" thing. Just call me Trina Yamaguchi.

Trinidioms #58

"I just feel like I'm dragging the train uphill by myself."

Friday, September 04, 2009

Libraries are amazing!

I just visited my local Cambridge Public Library (which happens to be diagonally across the intersection from my house, directly across the street from a Catholic church...it's an idyllic little place here).

And, wow! My friend told me I should read this book today. I went in and BAM! they give it to me for three weeks for free. Perhaps even more exciting, they have rows and rows of DVDs I can borrow for free. Real movies, recent stuff. For free! Whoo hoo!

I should have gotten into this library thing long ago. Who knew?!

Ron and Harvard

He started classes yesterday. Give him a week and he'll be back in touch, but there's a lot to do this first week. So, for now, it's me reporting.

He's having a blast, enjoying his peers, being taught by the former Solicitor General, people who clerked for various Supreme Court justices and some of the people on the winning side of the tobacco settlement.

I think his favorite moment so far was in his Criminal Law class the teacher explained that Harvard sometimes gets critiqued for taking a more theoretical approach (as opposed to teaching a lot of specifics about say, Massachusetts State law). The lady said, "You see, we want to make sure you spend time wrestling with what comprises good law, because you will be the ones making it in a few years."

Right then, he felt really, really cool.

White Coat Ceremony

I'm walking in...
Then the ceremony...
Then, I'm coated!




Photo tour of our Boston residence

We're the door on the right. (The open one, so I didn't lock myself out while taking the picture).
Welcome to the land of teal.
Up the stairs...
The office.
The treadmill room...

Thursday, September 03, 2009

Tour #2

We're on the second floor (don't worry, we'll get back to the first), we left off at the treadmill room. On the same floor, is the guest bedroom...

The main bathroom...
Then we're going up more stairs...(28 total in the house, and they're steep and my legs are still sore at the end of most days)
My closet (notice the Ao Dai from Vietnam and the salawar suits from India on the right). Next door is...
Our bedroom!

Tour #3

Next door to our bedroom, is the family room...(and Ron's closet which looks like mine, but full of man clothes).

Now, run back down the stairs to the second floor and you're just passing the treadmill room. You stumble upon the world's largest laundry room...
Beyond the laundry room is this bright light...turns out it is a...
Mystery extra staircase. We've taken to calling it the servant staircase. Now you're back on the first floor and to your right you see...

Keep walking into the middle of the kitchen and you see...


Tour #4

You kept walking through the wing of the kitchen with the table/purple chairs, through the middle with the sink, stove, fridge, etc., past the counter with the barstools and into the tealest of them all...the living room.

You peek back through the kitchen and catch a glimpse of Mr. Handsome...
Then you close these lattice-y doors and peer back at the King Teal room.
Now, you need some fresh air. All these stairs have you huffing and puffing. At the base of the servant stairs there's the back door. You walk out it...
And, here's a lovely garden setting for your relaxtion.
That's the end of the tour.

A year ago today...





We attended an organ concert at St. Nicholas' church in the Mala Strana section of Prague. Following the concert we climbed the hill to the Strahov monastery, drank beer made by the monks, ate amazing beer cheese and then waltzed over to the Castle quarter where we danced in the courtyard.

I got my first medical school interview invitation three days ago.

We've been on the road 61 days and staying without a host for 13 days.


Trinidiom #57

"I am comfortable in my own shoes."

Wednesday, September 02, 2009

Trinidiom #56

"I am on my last wit."