Baby Animals

Super cute baby animals!!! http://my.backchina.com/forum.php?mod=viewthread&tid=1108388

I especially like the chimp, the kangaroo, and the donkey. :D

Thanks dad!

PATB #4

Parents are the Best #4:

Me (after arriving at a hotel): Wow, I'm not used to being treated so well here. 
Dad: No surprise, you are a doctor to be and should be respected in any place!
Me: Haha..in reality, I still feel like a little kid.
Dad: Good, keep the heart and every kid you meet will love you.

Connecticut

-Very poignant entry about what it's like to a mother to a child with mental illness: Thinking the Unthinkable

-Twelve Facts About Guns and Mass Shootings in the United States

-Unbelievable. Tragic. Can't imagine what being a parent in that situation is like. 

Personal Statement Advice

Wish I had read this article earlier.  It speaks about really being "personal" in a personal statement as opposed to what I was told - to just write something safe so I don't sound like I'm cuckoo.  Always a fine balance!


Excerpt:

As the director of an internal medicine residency program, I read hundreds of personal statements every year. I know many program directors who find them irrelevant at best, and I confess I can't blame them. These statements usually follow 1 of 3 scripts: The candidates relay a medical catastrophe that afflicted them or their family. Curiosity is piqued. They indulge their curiosity by poring over endless tomes of biologic sciences and end up in medical school. Or, they know that they've wanted to be a doctor since conception. They were always exceptionally skilled in the sciences but really wanted to help people. Medical school was the natural conclusion. Or, lastly, the curious case of Mr. X, who tells me a great deal about the unfortunate patient but surprisingly little about the candidate. All candidates then have some sort of revelation during their internal medicine clerkship, and that is how their applications arrived on my computer screen.

I hate them all. Not the candidates, but their personal statements. Because there's really very little that's personal about them. The major thing they've told me about themselves is that they are very much like 90% of the other candidates for my program, or that they've engaged the services of whatever essay mill produces such stultifying prose. I'm not sure which is worse.

Turi McNamee, MD. In Defense of the Personal Statement. Ann Intern Med. 6 November 2012;157(9):675

Nerdy Jokes

Since I'm a nerd and I love all things nerdy:
20 Spectacularly Nerdy Science Jokes (Thanks ML)

Typing While Sleepy

Trying to send an email for research while very sleepy:

Dear Dr. O-----,

I've entered in some data, and I have had a few questions.  I've modified the excel sheet you gave me with all her nephews looking at it.  

Nephews? Huh?? Thank goodness I read over this email before sending it.  I think I was subconsciously thinking about my roommate's nephews because she was talking about them during the day.  

Grandmother's fashion tips

Conversation at the dinner table:
Grandmother: Is that really what you wear every day?
Me: Yes...
Grandmother: You dress so old fashioned!
Me: O_o  ...YOU dressed old fashioned!

Watching TV:
Grandmother: you said you didn't like dresses, so do you like skirt pants? (pants that look like a skirt)
Me: No...
Grandmother: come try my skirt pants!
Me: No thanks.
Grandmother: Come, come, try it on and see!
Me: No, please.
Grandmother: (while pushing my head) come on! Let me see how you fit, and I can get you skirt pants!
Me: No! No! Please don't make me!
Grandmother: Well, you said you don't like dresses, so you should wear skirt pants.
Me: I never said I DON'T like dresses, just that I don't care for them!

Obamacare

Interesting article about what the changes being implemented I'm the healthcare system.

Interesting quote regarding evaluating hospitals based on surveys:
“You go to Disney for a great vacation experience,” Dr. Rhonda Scott tells The Wall Street Journal. “You go to Ruth’s Chris for a great dining experience. Do you think it is a great experience when I tell you that you have stage-four cancer and you may be dead in three months?”

Panda Baby! - Mr. Sausage

Babies are so cute, especially when it's a baby panda from the San Diego Zoo!

Here's Sausage in his earlier days:

Him as a newborn (quite a feisty one!):

Here's more panda fun from San Diego Zoo pinterest:

Source: iwastesomuchtime.com via San Diego on Pinterest

Things I've Come to Hate from Studying for Step2

Things I've come to hate because I always get the question wrong:

• Metabolic disorders - ase, ase, ase...they're all just some kind of ase deficiency
• Recreational drugs/alcohol - just say no!
• Factitious disorders - people! Stop harming yourself on purpose!
• Endometriosis - seriously, that tissue is annoying enough by itself.
• Viruses/bacteria that shouldn't appear because there's a vaccine - for heaven's sake - no, for your KID'S sake, please, please, please vaccinate your kids!  The article about vaccines causing autism was a complete sham - it was withdrawn with apologies!  So no excuses - vaccinate your kids!
• Vitamin deficiencies - stop being so picky and just eat that meat and veggies (or take vitamin supplements), which leads to another issue...
• Vitamin overload (like A) - yup, too much of a vitamin can be bad too
• Psych diagnosis timelines: difference between schizophreniform vs. schizophrenia is one is 1-6mo of symptoms while the other is >6mo of symptoms.  Really?! Really?!
• Sex- causes so many problems, diseases. Especially those pap smears - too many options, can't keep them straight.  Would make things a lot easier if people just didn't have sex, ever.  But as my friend astutely pointed out, that would make life as a pediatrician a lot harder.

Interesting Thoughts! and more cuteness.

Hm..which pill would you choose? http://www.rofldepot.com/which-pill-do-you-choose_2069.html

This is so adorable: Level one guard dog

Gangnam @MIT

Nope, my profs were never this cool: Gangnam @MIT (thanks kp)

Ever wonder what "Oppan Gangnam style" really meant or what the song is really talking about?  For the longest time I had no idea why it was so popular when that guy was dancing around so strangely.

And here's a Gangnam parody (ironic that it's a parody of a parody): MIT Gangnam Style

Election Webcast About Politics, Taxes, and Healthcare

Interesting MIT Alumni webcast about politics, taxes, and healthcare with Professor Andrea Louise Campbell.  Unfortunately, you need to sign in, so here are some interesting points from the webcast:

• Compared to other countries, US citizens' taxes are low - 3rd from the bottom.  
• Example of country that has higher tax and not fiscally in turmoil:
• Germany: Has 1/3 higher tax than US, and invests in education/training and infrastructure.  If there is too little taxation, there is a lack of investment in the people and structure.  
• So most countries have universal healthcare, why is it so difficult for US citizens to accept universal healthcare?
• During WWII, there were a lack of workers and a cap on wages, so to attract workers, employers started giving benefits, the most popular of which was health insurance from private insurers.  That continued after the war, and the government also passed a law for no tax on income spent by employer for health insurance, which further solidified the system.  Now, for the people who do have insurance, they like what they have, and don't want something new/change.  They are afraid that they're choices will be limited under a universal healthcare system.
• Benefits of single pay system of universal healthcare (like Canada): administrative cost much lower.
• 2/3 of population represented by Medicaid ("poor ppl program") are poor and children, 2/3 of spending are on disabled seniors - so the majority of spending from Medicaid is actually spent on disabled seniors.
• Effect of election on Medicare ("old ppl program")/Medicaid:
• Obama: relatively same amount of spending on Medicare/Medicaid (as needed federal spending - no maximum/cap on amount of money spent in those programs).
• Romney: capped federal spending on Medicare.  Voucher will be given to elderly to buy premium for private insurance.  Also capped federal spending given to States for Medicaid (currently Medicaid is a combo contribution of State and Federal). 
• Effect of election on taxes:
• Obama: increase 4% on top 2 brackets (wealthiest) of tax payers.  
•  Romney ("Ryan Budget"): decrease total taxes from 20% of GDP to 16% of GDP - never been so low since before WWII, before interstate highway system, Medicare/Medicaid.  To do this, most notably, there will be changes in Medicare/Medicaid as noted above.  
• We used to have 25 tax brackets, now 5.  Now with low caps on fewer brackets, it means we're not penetrating the top brackets (of wealthy people).  
• Most americans, when asked whether they want a central government with less power, if the government is wasting their tax money, etc, they say "YES!".  But when you ask the same people whether they would like to spend more money on public education, the poor, healthcare for the elderly, they also say, "YES!"  - "So US public is a little bipolar?" ..."Yes..."

Match = Economics Nobel Prize

The residency match (program that matches medical students to residency programs) got the Economics Nobel Prize!  Well...not exactly.  The person who invented got the Nobel Prize for it and other matches like organ donations: http://www.nobelprize.org/nobel_prizes/economics/laureates/2012/popular-economicsciences2012.pdf (Thanks JO)

12 med student stereotypes

Which kind of med student am I?
12 med student stereotypes (thanks kp)

Top 15 Free Android Medical Apps

These are quite useful! Top 15 Free Android Medical Apps (from iMedicalApps):

1. Medscape*
2. Epocrates*
3. Skyscape
4. Evernote
5. Calculate by QxMD*
6. MedPage Today*
7. Harvard School of Public Health
8. Monthly Prescribing Reference (MPR)
9. Standard Dictations
10. USPSTF ePSS (electronic preventive services selector)
11. PubMed Mobile*
12. Ob Wheel
13. Eponyms*
14. Speed Anatomy
15. Calorie Counter by FatSecret

*I downloaded

Others that I like: Prognosis (clinical cases)

Common Baking Subsitutes

This will come in handy for baking!
http://allrecipes.com/howto/common-ingredient-substitutions/

Carry Your Own Burden

Scrub's lesson on carrying your own burden (as opposed to dumping it on someone else).  And also how the grass may look greener on someone else's yard, but everyone has their own burdens.

Becoming Homeless

This is an interesting article by a women who struggled with being homeless growing up with a mom who had a mental illness.  Becoming Homeless

The religious references of this article were saddening - twisted messages.  Tithing was never meant to be a bargain with God, and Jesus' principles have nothing to do with material wealth (other than, don't pursue them). Sighs...mental illness is such a destroyer of livelihood.  

Old Spice

Something to keep me motivated to exercise more...
Old Spice

Asian Women

Amusing, and true:

(Thanks MNZ!)

Confirmed by another friend:  Friend's Taiwanese mother recently changed her stance on dating from "You may only marry Taiwanese girl!" to "You may marry whomever makes you happy!" 

Soon I'm gonna be looking for a pulse...

Also ridiculously hilarious: http://static.fjcdn.com/pictures/How_a3d51c_1870969.jpg

Making Friends as Adults

Interesting read...now that I'm approaching becoming a "real person" and actually getting a job.  Thankfully (or maybe not so thankfully), I don't have to worry about the "couple's friendship" yet.
Interesting/funny quote about making friends when you have kids: "I spend whole days with people, I’m like, I never would have hung out with you, I didn’t choose you. Our children chose each other. Based on no criteria, by the way. They’re the same size."
Why Is It Hard to Make Friends Over 30?

Five Year Old's Hair Cutting Interview

OMG! I just listened to this interview and it is the cutest, most hilarious thing ever!  HAHAHAHAHAHA! :D  
Five year old cuts three year old's hair - their interview

Highlights (pretty much the whole interview):

Sadie: It was so hard to cut!

Dad: Why did you think she needed a haircut?

Sadie: Cuz it was all the way down to her tush! And if she grew it any longer, when she wiped her butt, her hair would go into the toilet, and it would be gross!

Eva: It was really itching my hips

...

Dad: when did you realize something had gone wrong?

Eva: when i was finished, and i looked at it and was like, 'uh oh, this is bad...bad, bad, bad"

...

Eva: look at my haircut, mommy, isn't it nice? And mamma looked at it and she said "gasp!"

Sadie: I heard yelling, Eva crying...

Eva: "SADE! EVA! WHAT WERE YOU THINKING?!"

Sadie: "what were you thinking to cut your hair?! "

Eva: I was crying, and I said, "Sadie cut my hair..."

Sadie: And I told you not to!

Dad: And what did you do with the hair?

Sadie: I hid it under the radiator.

Dad: Did you think we would like it?

Eva: No, but didn't think you were going to scream like that, though

Sadie: Hair cutting takes like a lot of concentration.

Eva: I learned not to do it again, EVER again.

Sadie: That was really, really, really terrible, but everyone does that kind of stuff sometimes. It happens like once, or twice, or three times in every life ...or twice...i mean, or once

...   

:D (Thanks mnz)

Warm up the stethoscope

Have you ever had a patient this cute? You better warm up those stethoscopes before listening. :) Warm up the stethoscope (EC)

Colorado Mass Shooting NYTimes

What a powerful article detailing what it's like to go through the mass shooting from a medical perspective: Colorado Mass Shooting NYTimes

Can't imagine going from this: "Fresh out of medical school, she had begun the first year of her residency only three weeks before and was still getting used to introducing herself as “Dr. MacKenzie.” "

To this: “I think a lot of us have seen very bad gunshot wounds before,” Dr. Sasson said. “But some of the pictures that I think many of us have stuck in our heads to this day are just some of the most horrible injuries, people with their guts hanging out, people with their brains coming out.”

My T.C.W.

Darn it, why is Scrubs always so spot on?: My T.C.W.

1. How lonely you can feel even though there are so many people around
2. Appreciate the people who are in your life, and DO overlook the small things - like someone not liking beef jerky or your other favorite food, having your engagement ring go through the digestive system, or not getting as much attention because a baby is in the equation.
3. I should get a wingman.
4. Practice on dogs too keep my game up.

Okay, maybe the last two are a little off.

Medical Student Abuse - NYTimes

Haha, this article is interesting and kind of funny and sad at the same time: Medical Student Abuse - NYTimes

I actually don't remember third year being that abusive, but maybe it's because I have bad-memories-amnesia?  There were definitely a lot of times when I was scutted out, but in general, I liked most of the residents I worked with.  A lot of times, I don't think I really worked with attendings enough for them to remember who I am or get angry at me, or perhaps I just have a mild temperament or a different tolerance of  "yelling" after growing up with a tiger dad. Haha.  

Epitome of Frugal

I really hope med school doesn't drive me to such despair.

"My House is Smaller Than a Parking Lot": Jamie Joseph and her husband downsized from huge apartment and two cars to a tiny 128 square feet house and no cars.  Few snippets:

• Nutty: When we first started, a lot of our friends and family–including my mother–thought we were nuts. Now, after seeing how satisfied we are, they think we’re at the head of the pack.
• Premise:  I lived in Davis, California, where I was commuting two hours a day, stuck in traffic, saddled with $30,000 of debt–mostly from student loans–and constantly stressed. I started using shopping as an outlet for my emotions. Instant gratification! When I shopped, I felt better and didn’t have to deal with whatever else was on my mind.
• Effect:  One of the biggest effects of having less stuff and spending less was I didn’t need to work at a job that made me unhappy!... When it comes down to it, Logan and I aren’t really about austerity, but we want to spend on experiences rather than things. We save a lot, but are also able to spend extra income on going out to eat, biking, camping and traveling. I’m much more aware of my community and my environment–I notice the seasons change and participate in my community more. Not to mention with biking, walking and eating right, I feel so much healthier.
• Take home message:  I’ve learned that stuff doesn’t matter in the long run … it’s people you’ll never get back. I want to make him proud.

"Extreme Cheapskates Spill Their Secret":  "Reusable toilet paper? 

The subjects of the TLC special, "Extreme Cheapskates," go to great lengths not to spend money—whether by using cloth toilet paper, eating unorthodox cuts of meat (i.e. goats' heads) or foraging food from strangers' plates at restaurants.  ...
These happily married "fiscal fasters" travel the world, get creative with cooking and saved enough to put a child in the Philippines through college. "
As a med student gaining debt exponentially, I'm highly tempted to consider some of these things sometimes...

"I Ate Out of a Dumpster: Night as a Freegan": "I ate food out of a dumpster. And so are increasing numbers of educated, employed and perfectly sane people. 

The movement is called freeganism, and to protest what they perceive as society's wastefulness, its adherents use unconventional methods to get things for free. Especially food.   

To find out whether a person could actually get a balanced diet from dumpsters—or if freeganism is just idealism gone awry—I attended a freegan trash tour to see what kind of food a typical night of dumpster diving yields.  "

Yup, the new anthropological study - Freegans.

Freegan-fest

Radiology Highlights

Oh...how I'm going to miss radiology (of course, because of the interesting cases and not just because the hours are so darn great):

• Chest Radiograph:
• • Aortic Dissection
  • Sarcoidosis
  • TB???? - AFB has been negative
  • Artificial heart (Syncardia) for L-transposition of the great arteries - looks REALLY intriguing on radiograph with valves and pneumatic pumps (1 of 2 ever done at BJC???)
  • Huge broncholith (histo?blasto?), hemoptysis, right upper lobe collapse
• GI/GU
• Ischemic colitis (mesenteric embolic disease)
• Pancreatic cancer with common bile duct and SMA involvement (non-operative) - so sad!
• Adult polycystic kidney disease s/p transplant- ginormous grapes in place of kidneys!
• Torsion - midline cystic mass in female with "fallopian knuckle"
• Pancreas divisum - see two bile duct not connected to pancreatic duct
• Pericardial effusion (chronic) - possibly lupus, scleroderma, malignancy, or TB/infection
• Empyeme with abdominal abscess - split pleural sign
• PE/tumor
• RARE: S/p Nissen fundoplication, had ischemia of that portion that perfect, causing extravasation of stomach contents that fistulated with the bronchus - creating a bronchogram on the upper GI!
• S***kabob! - major booboo.  This is as much as I'm gonna say about that...
• Pediatric:
• XR of nail through foot
• Heart transplant
• Severe limb malformations (syndactyle, etc.)
• Ureterocele --> obstruction
• Cystic fibrosis s/p lung transplant
• Tetralogy of Fallot
• Duodenal atresia
• Volvulus
• INtussusception
• Renal Agenesis
• Congenital Diaphragmatic Hernia
• Neuroblastoma
• GI/US:
• Ginormous thyroid nodule + biopsy
• Epidiymoorchitis - increased enhancement/vascularity/inflammation
• Schatzki's Ring
• Rotator cuff - trapezius atrophy and fluid in bursa, h/o lymphoma
• Gallbladder mass - likely adenocarcinoma
• Screw in intestine - psych patient

Funny olympic faces

"There's something on each diver's face that just reads, 'this stunt is kind of difficult.'"
http://thefw.com/olympic-diving-funny-faces/

Danny and Annie

This is truly a heartbreaking love story.
" Brooklyn couple Danny and Annie tell the true story of their twenty-seven-year romance, from their first date to Danny's last days with terminal cancer. You have to watch it. " (cup of jo)

A Miracle Inside the Aurora Shooting

I was asking a friend if she ever wondered why did the Aurora shooting happen, or why God "let" it happen. Well, this may not be the complete answer, but it's definitely something: http://bstrait.wordpress.com/2012/07/22/a-miracle-inside-the-the-aurora-shooting-one-victims-story/

NICU - first time my patient passed away...

I guess it was kind of inevitable, that eventually one of my patients was going to pass away.  I actually didn't expect it.  Maybe I was naive, maybe I wasn't paying attention, or maybe I just had so much hope for the little kid.

The initial prognosis was already pretty bad.  It was a twin-twin transfusion syndrome, and my kid was the donor that became a recipient after laser therapy gone awry.  One twin was "donating" its blood into the other twin, and the laser therapy was supposed to stop the twin-twin transfusion from happening, but instead, the roles of the twins got switched.  My twin is supposed to have the better prognosis overall, but had brain bleeds and heart failure post-delivery- common complications.  The heart actually had gotten better, but the brain was slowly decaying.  The bowel perforation didn't help either.

Things were actually quite stable.  While there were no significant signs of impending doom, he had so much edema, it looked like he was a full term baby.  But then you see his tiny little button nose, and realize how puffy he really is.

Each day, we were hoping the little guy would keep on peeing, wouldn't increase his heart rate too much, and keep his oxygen saturation high.  It seemed like we were always playing this tag game with him: we would decrease his fluids, decrease his ventilator settings, and hope he tolerates it, but then the next day he would stop peeing or drop his saturations, and we would go back to square one.

Finally, one day, after being off for a day, I came back hoping things would still be stable. But he had significantly dropped his sats and urine output such that he had to be on a lot of supportive medications and got changed to an oscillator.  When I checked on him, he still moved his little puffy hands, maybe even grasping my fingers.  But before I knew it, there were already talks of redirecting his care.

I was hoping it wouldn't come to this.  I couldn't help wondering if maybe he would've been in better shape if I had checked an albumin level and infused him earlier.  Perhaps we should have checked his heart function earlier as well?  But ultimately, I think in the the back of my mind, I knew his brain function would have never recovered.  

It's puzzling how each person has a different way of dealing with the days before letting a loved one go.  Some prefer spending each waking second with that person and treasuring every last bit of love, while others prefer to distance themselves early while they can, before more emotional attachment could form.  My little guy's family chose the latter.

But no worries, the little guy was loved plenty the few minutes before he went to heaven.  He was dressed in normal cloths as best as the nurses could manage and surrounded by nurses and other healthcare workers holding him, watching him, and capturing him forever in the form of photographs and little footprints.  He even had his little toy puppy watching over him.  And after all the ceremonial acts were done, he was given plenty of sedation, and taken off the ventilator.  As the minutes ticked away, all we could do was watch him slowly turn bluer and bluer, while occasionally taking little gasps of air, until his heart stopped beating.  I didn't know why I didn't feel any sorrow at that moment, but when I held his little body and touched his button nose, emotions rushed in.  He had hardly lived on this earth, and he was gone. Just like that. But for me, it was like he was still my little baby whom I visited each morning to listen to his quick heart beats, coarse breath sounds, and just possibly, a gurgle in his stomach.  

Sal Khan's Commencement Address

What a wonderful and funny speech!  Here are some highlights:

• Of our many close friends from MIT, 90 percent are married to each other.
  
  Now, I think this many friendships and marriages coming out of one place, as romantic as the Infinite Corridor may be, begs some introspection.
  
  In fact, so extreme is the coupling that I have observed here that I have sometimes suspected that this whole place is just a front for a DARPA-funded human breeding project.
  
  However, there are simpler explanations for all of this MIT-MIT love. The most likely of which is that the admissions office here has a somewhat unhealthy habit of only accepting incredibly attractive people. 
• I always tell people that MIT is the closest thing to being Hogwarts — Harry Potter’s wizarding school — in real life.
  
  The science and innovation that occurs here looks no different than pure magic to most of the world. The faculty here are the real-world McGonagalls — that’s you President Hockfield — and Dumbledores. There are secret tunnels and passages with strange wonders and creatures around every corner — some of whom may just finish their thesis this decade.
  
  Also like Hogwarts, MIT brings young people from around the country and world who are a little bit off-the-charts in their potential for this “magic.” Some come from environments and communities that celebrated their gifts. Others had to actively hide their abilities and passions for fear of being ostracized and ridiculed. Students come to MIT from every religion, every ethnicity. Some from educated, affluent families, others from ones that live at or near poverty. But they — you, we — shared a common passion. Something that made us feel a little different. We sensed that MIT might be a place where there were others like us. Where we could challenge ourselves and develop our craft. 
• You will actively seek other MIT people out. When others talk about an intellectually challenging experience they had or complain about how hard they had to work, you will glance at the other MIT grad in the room and share a quick smirk.
  
  And if you are the preferred gender for each other, then you also might just realize that they have a certain twinkle in the eye. A certain beauty to the tilt of their head when they are deep in thought. Their competence and expertise makes you wonder what type of civilization you could create together. In short, you discover that you find them irresistibly attractive.
• Start every morning with a smile — even a forced one — it will make you happier. Replace the words “I have to” with “I get to” in your vocabulary. Smile with your mouth, your eyes, your ears, your face, your body at every living thing you see. Be a source of energy and optimism. Surround yourself with people that make you better. Realize or even rationalize that the grass is truly greener on your side of the fence. Just the belief that it is becomes a self-fulfilling prophecy.
• If you find yourself arguing with someone whom you respect and love, try to surrender your own ego to the shared identity you have with that person. In the heat of an argument, do the opposite of what your pride tells you to do. If you have the self-control, stop talking and give your opponent a random, super-mega hug.
  
  Make people feel that you care about them. And here’s, a well, a little secret, the best way to do this is to actually care about them.
  
  Make people feel that you are listening to them. Another little secret, the best way to do this is to actually listen.
• When you feel overwhelmed, walk alone through the woods and forget your name, your title, your education and view yourself for what you really are — another mammal wondering why it is here but appreciating the fact that your civilization has not as yet been evaporated by a supernova. 
• One of my roommates when I was two years out of college, who had formerly been a bit of a track star at MIT, and I had finished watching Chariots of Fire one night at 2 a.m. I told him that it made me feel like running. He simply told me “Don’t waste inspiration.” I reminded him that it is 2 a.m. He said “so what; don’t waste inspiration.” I looked at him for a few seconds and realized that he was dead serious. I jumped off the couch, threw on my running shoes and took to the streets.
• Imagine yourself in 50 years. You’re in your early 70s, near the end of your career. You’re sitting on your couch, having just watched the State of the Union holographic address by President Kardashian.
  
  You begin to ponder your life. The career successes, how you’ve been able to provide for your family. You’ll think of all the great moments with your family and friends. But then you start to think about all of the things you wished you had done just a little differently, your regrets. I can guess at what they might be.
  
  Sitting in 2062, you wish that you had spent more time with your children. That you had told your spouse how much you loved them more frequently. That you could have even one more chance to hug your parents and tell them how much you appreciate them before they passed. That you could have smiled more, laughed more, danced more and created more. That you better used the gifts you were given to empower others and make the world better.
  
  Just as you’re thinking this, a genie appears from nowhere and says, “I have been eavesdropping on your regrets. They are valid ones. I can tell you are a good person so I am willing to give you a second chance if you really want one.” You say “Sure” and the genie snaps his fingers.
  
  All of a sudden you find yourself right where you are sitting today. It is June 8, 2012, at Killian Court. You are in your shockingly fit and pain-free 20-something body and begin to realize that it has really happened. You really do have the chance to do it over again. To have the same career successes and deep relationships. But, now you can optimize. You can laugh more, dance more and love more. Your parents are here again so it is your chance to love them like you wished you had done the first time. You can be the source of positivity that you wished you had been the first time around.

Rest of Sal Khan's Commencement Address

Top 10 Unusual Landscapes

Some crazy stuff! Out of this world!  http://www.toptenz.net/top-10-unusual-landscapes.php

Reminder for Single Ladies

Very true.
"Can I say something to young ladies here? I'm trying to pick my words carefully here.  Your husband, whoever he is, single ladies, will have an unbelievable amount of influence over your sons and daughters in regards to spiritual things.  If you want your children to love jesus deeply, hold out for a man that is Godly.  And let me tell you this: I am well aware that Godly men are rare.  Lots of neat Christian boys, not a lot of Godly men.  And we're working our tails off for you to try to develop some into that.  But don't settle, because its better that you be lonely now than you be married and lonely later.  Are you tracking me?  It is better tha you be lonely now than for you to get married to a man that will teach your kids everything but the way of jesus." - Matt Chandler
http://windhambaptist.wordpress.com/2012/06/15/3134/

Ink blot results

I had to pick 3 of 12 cards, then think what I see first. These are my results:

12) Engaging, invigorating, wary, introspective. Object of attention as child, high self elevation

2) Attractive, forceful, erotic, nurturing. Relationship like bike puncture with puncture

3) Gifted, elusive, uncertain, searching. Vivacious and fun, but like froth on coffee, reveal "loyalty to unhappiness"

Honestly, these are so vague, I'm sure it would fit anyone at some point in their life.

Waiting for Boaz

Got this from a friend, no idea from where, but it's darn awesome:

Story of Ruth and Boaz

Me And My Cello -Happy Together

Even though I don't really play an instrument, this is just so creative and hilarious! (what would you do with your favorite person...i mean instrument?) http://m.youtube.com/watch?desktop_uri=%2Fwatch%3Fv%3DDKC-lRhvdNY%26feature%3Drelmfu&feature=relmfu&v=DKC-lRhvdNY&gl=US

Motorcyclist

Funny conversation between my friend and I:
Me: oh good, that biker has a helmet
Mw: but she doesn't have any other protective gear on.
Me: she?!!
Mw: look at those short shorts!
Me: ooh, right.
(biker zooms in front if us and shirt flares up behind her)
Both of us: wooooo...that shirt went up really high!
(we drive in front of biker)
Me: um...shirt wide open, definitely no boob.

Floating Mountains

Coolest artwork ever by Yasuaki Onishi at Rice University Galleries (can you guess what it's made of?):

Negative Space

Here's a video about it: Reverse of Volume.  It's the perfect combination of beautiful and creative!

Thanks MNZ!

Washington State Hikes

Ah...so much time wasted not hiking/camping/backpacking! I figured I should make a list of hikes in WA that seem interesting (not a complete list for sure):

Close-ish to Seattle:

• Snoquera Falls - 6mi roundtrip
• Wallace Falls - 5.5 mi, 9 falls, some kid fell some time ago...
• Poo poo point via Chirico Trail - 4.7 mi, popular paragliding/hang gliding.
• Short and sweet:
• Twin falls - 2.7 mi, 30min from seattle, interesects w/ John Wayne Pioneer trail (108 mi)
• Coal Creek Trail (2.8mi) or Lower Coal Creek (2.2mi)-  historic coal mine
• Mount Si - 3mi, very popular, fun trail and good view on top!
• Rattlesnake Ridge - 1.9 mi, panoramic view, connect to Rattlesnake Ridge trail

East:

• Enchantment Lakes near Leavenworth - 18mi, need pass
• I-90
• Snow Lake - 6mi, continues to another lake
• Mason Lake - connects to Bendara Mtn
• Bendara Mountain - 6.6mi; last 0.5mi=1000ft elevation gain
• Rachel Lake - 7mi, Rampart Lakes (11mi) even further up
• Green Mountain - 10mi, "last promontory," rough trail, scramble
• past I-90: (if raining in seattle)
• Hex Mountain - 7mi, view of Mt Rainier, snowshoe

North

• Mount Baker
• Mount Dickerman - 8.6mi roundtrip, 5.6k' elevation
• Coleman Pinnacle
• Ceder Falls up to Abernathy Ridge
• Pearrygin Lake (past north cascade, 4hr drive) - parents say really beautiful w/snow in May
• Oyster Dome - 6.5mi, view of san juan islands and Olympic mtns, oyster restaurant on bottom
• Route 2:
• Serene Lake - 8.2mi, water fall on the side
• Barcley Lake -

South

• Mount Rainier
• Mount St. Helen's
• Eagle Creek and Tunnel Falls - 12mi, beautiful gorge hike, cliffs, multiple waterfalls; at Oregan border

West:

• Olympic National Park
• Deception Pass Headlands
• Dungeness Spit near Sequim - 5mi hike to lighthouse and back
• Westport WA

South:

• Cape Disappointment State Park

The Asian Woman

Haha, this comic is pretty funny: http://abstrusegoose.com/462

Thanks SL

Gotta Be Somebody

Some how this song came up in my thoughts:

http://www.youtube.com/watch?v=75cnteFDv3o&sns=em

Best Time To Buy Plane Tickets

Article with tips on buying the Cheapest Plane Tickets

And some medical fun: Abbreviations Kill

My Sacrificial Claim

Scrubs, my new past-time that I've started in 3rd year to make me not feel too guilty (b/c I'm "learning" at the same time), actually has some pretty profound messages.  Like this past episode I watched: season 1, episode 21 "My Sacrificial Claim":

Everyone has to make sacrifices and make priorities:

• You might have to give up something you want now for something you've wanted all your life.  In Elliot's case, it was giving up a relationship with a seemingly "perfect" guy for her.  I'm assuming she's giving it up to be the best doctor she can be.  That seems like a perfect definition of a work-a-holic in her case.  Anyhow, I feel bad for Elliot...and even worse for her boyfriend.
• You might have to give up a bit of safety.  In DJ's case, it was being willing to be around sick people.  I'm surprised he made it through 4 years of medical school and intern year before realizing this fact.  But it's true.  I suppose especially true in pediatrics, when it seems like every fall/winter/spring, the pediatricians get sick.  
• You give up time for yourself to spend more time with the people you love.  I think this was probably the most important lesson to remember. Going to medical school, I've found that it's so easy to think about myself so much- my education, my exams, my studying, my grades, my rotations, my patients, my career...that I've sometimes lapsed in caring about the people who love me.  

Peds Surgery Encounters

It's good to be in the Children's Hospital! Interesting cases:

• VATS (a look inside the chest cavity) for unusual lung mass in child with possible ROHHAD - pretty much a syndrome where you get fat really quickly (and hypoventilation, hypothalamic issues)
• Gnathodiaphyseal dysplasia syndrome: Baby who came in with cartilaginous tumors of the jaw that made him look like he had 4 giant plums in his mouth.  He was born with normal jaw, but in 6 months, developed these tumors.  Other than being born with a femur fracture (bone fragility), nothing else really wrong.  Apparently nobody really knows much about this syndrome, and once-in-a-life-time-case!  Crazy stuff!  Kind of looks like this, but even bigger!
•  After taking out the tumors, baby looked a lot more normal, but sadly, it's likely to recur.  
• Bilious emesis (vomiting green stuff): volvulus
• Biliary atresia s/p (status post, aka after) liver transplant and failed Kasai procedure where they connect bile ducts with small intestine.
• Pyloric stenosis: I got to feel the "olive"! - nonbilious vomiting, hungry, s/p open pyloromyotomy
• Medulloblastoma, needed a portacath and gastrostomy for chemo
• MEN2A: Baby with constipation, go biopsy for Hirschprung's disease to look for aganglionic colon, but turns out there were hypertrophic ganglions. Pathologist recalled that being part of MEN2A syndrome, so endocrine surgeon did a thyroidectomy (supposed to be prophylactic against medullary carcinoma because rate of getting medullary cancer in MEN2A was 100%), and the baby already had cancer in their thyroid.  
• VATS for a kid with lung nodules s/p chemoradiation for metastatic nasopharyngeal rhabdomyosarcoma (muscle cancer). Yikes!
• Enormous Wilm's tumor (10cm) + nephrectomy (taking out the kidney)
• Enormous bilateral ovarian serous cystadenoma
• Kid with heterotaxy polyspenia!  (Article about it for those with access.)  It's some insane congenital condition where there's malformation asymmetric organs: malrotation of the bowel, heart malformations, multiple small spleens, bilobed lungs, transverse liver, azygous continuation of the IVC...etc.  
• Cleft palate fistula
• Gastroschisis (baby's bowel is coming out of a hole on the side of the umbilicus) + silo (to house the bowel to wait more room in belly to push bowel back in) + TPN 1mo
• LaForte I and III from ATV crash (wear helmets everyone!).  Surgery to plate the fractures was insane!  It was the first time I've seen someone get degloved (aka, scalped)!  It was pretty much like you peel off everything from the skull.  Picture examples for the non-queezy: degloving the face; degloving scalp.
• Nissen fundoplication (wrap part of stomach around esophagus to prevent reflux)
• Right lower lobectomy (via thoracotomy) for CCAM (congenital cystic adenomatoid mass)
• Handle bar injury: jejunal perforation
• Pectus Excavatum + Ravitch procedure (break cartilage, add metal bar) - Haller index 6.8
• I missed the duodenal atresia!!! So disappointed!!  b/c of oral exam...darn. Apparently also had malro!
• Interesting conditions: Diamond Blackfan anemia 
• Fontan (extracardiac) procedure for left hypoplastic heart syndrome (no left heart): IVC connected to pulmonary artery.  Kid also had previous Norwood (RA to neo-aorta) and Glenn (SVC to PA).





Hypoplastic Left Heart Syndrome

• 
  
• 
  

• Sad cases: asphyxiation due to car window, drowning in home pool, 3yo ejected from car and massive head injuries, pronounced brain dead.  

Teratomas

Hahaha! Friend of mine said studying ovarian teratoms (often find hair, teeth, strange tissue in them), reminded her of this clip:
Now You Are Family - Oh, how I love "My Big Fat Greek Wedding"
Thanks MNZ!

Chinese Accents by a White Dude

Haha, this was pretty darn impressive.  Especially the Chinese Northerner and Taiwanese dudes.

Guy Playing 12 Guys: Chinese, French, Russian, Afri-American, White-American speaking English and Chinese

Worship Signals

" Whether you want to or not - you're probably going to laugh at this..." (UK Gospel.com)

Sighs, I'm a rookie.

Pediatrics Ortho

Fun cases:

• DDH (developmental dysplasia of hip) : bilateral Pembertons (iliac osteotomy and bone graft wedge)
• SCFE (slipped capital femoral epiphysis): femur osteotomy and derotation 
• Club foot anterior tibial tendon transfer onto cuneiform (no heel cord lengthening)
• Myelomeningocele kid: Right femur and left tibia derotation
• Neurofibromatosis 1 + flat foot: midfoot osteotomy, CC joint fusion, calcaneal neck lengthening (no peroneal tendon lengthening)
• Unicameral bone cyst: iliac crest bone marrow aspiration + injection with ETEX (demineralized bone matrix) into cyst
• Cavovarus reconstruction: midfoot osteotomy (m/l cuneiform, cuboid osteotomy), plantar fascia/scar tissue dissection
• Open both bone fracture of forearm. Rx: OR washout, ORIF + Nancy nails. Got to help reduce and hammer one in!
• Septic elbow - I&D
• Of course, a lot of spika casts for babies with DDH, supracondylar humerus (elbow) fractures that require reduction via flexion and pinning + casting and ankle fractures (SH-4, bimaleolar) requiring reduction and screws.  Yay for getting to reduce an elbow fracture!

Grandmother Talk

Oh man, I thought having my mom getting on my case about not having a boyfriend was bad - my grandmother just gave me a whole speech about how all she's expecting is a nice boy and some mutual love - at least I think that's what she said.  Then she made me promise something, but between my poor understanding of Chinese and the bad connection, I'm not really sure what I promised.  I'm guessing something about having a nice prosperous family in the future.  *Sighs* No point explaining that finding nice boys is not so easy when I will be living in the hospital, so all I could do was smile and nod.

Hepatic Encephalopathy

Funny email chain going around among friends:
AL: Does anybody else think this slide pretty accurately describes exam week for us also?

YW: YES!!!!! *sigh*

AS: You are astute and hilarious.

TL: Especially stage 1...
CL: I just love how peaceful this image looks. It looks like a guy enjoying an awesome slide, and then falling asleep at the bottom. 
GA: yeah...gosh i wish i were comatose
HK: How does falling on ur butt correlate to drowsiness? Also, I think this guy has some problems with his arms. Who goes into a coma with his arms raised?
ED: BAHAHAHAHAH yeah this guy looks like he's doing modern dance while rolling down a hill.

Brasserie by Niche

Yum! Brasserie by Niche supposedly has one of the more authentic French dishes. This is what I had:
Bouillabaise: pollack, clams, mussels, prawns, potato, tomato - slightly salty, but very strong seafood flavor and tender shellfish.
French onion soup: very good with crusty cheese on top, crunchy bread underneath, and thick onion soup.
Cherry clafoutis with burgundy ice cream: deliciously sweet and tart.  Probably my best choice. I'll try to make it some day.
I also tried friend's boef bourguignon (very tender beef) and roasted chicken, both of which were very good - I might even say better than my main dish, bouillabaise.  If I were to go again, I'd probably get the boef bourguignon.

On that note, why not consider the other 40 Best Restaurants in St. Louis.

*Note, I didn't take the photos, but my food looked exactly like these.

Redeem Yourself as a Doctor by Reducing a Shoulder Dislocation

I remember when we were playing frisbee and a guy dislocated his shoulder, and we all looked at the 4th years, but they refused to do anything b/c of fear of damaging nerves.  Well, in reality, that's unlikely (per ortho attending).  So, even though I'm going into peds and not ortho, hopefully someday, I can redeem myself for not knowing what to do that day and show that those thousands of dollars in debt for medical school wasn't put to waste: Reducing an Anteriorly Dislocated Shoulder.
primary-surgery.org
And while we're at it, why not also reduce a posteriorly dislocated hip? (Anesthesia please)
helig.digicollection.org

Public Announcement for All Sports Players

After 2 weeks in sports medicine, I find it ridiculous that pretty much everyone who comes in has weak hip, back, and shoulder cuff muscles.  That sums up 90% of the injuries!  Before you waltz off thinking, "Well, I've been playing sports since age 1, so I have strong muscles," the truth is, no sport actually strengthens those muscles.  According to my attending, if sports did strengthen those muscles, then he'd be out of business. (Hm...maybe that's why there hasn't been any education about strengthening those muscles).  Even if people DO do weights, mostly likely they never strengthen those particular muscles.  The only way to strengthen those muscles is through resistance training (against gravity or with light weights).  Unfortunately, people tend to only work on muscles they see in the mirror (biceps, abs), but miss the important ones like hip muscles (abductors, extensors), back muscles (core means back muscles too!), and rotator cuff muscles (which are the more fine muscles of the shoulder, not the huge bulky deltoid).

Without further ado, these are exercises to strengthen each group:

• Hips: most notorious is the "clam" or the one where you sit in the gym and move your knee apart or closer to each other.  Yup...sounds embarrassing right? That's one reason why everyone's weak there.  
• http://physicaltherapy.about.com/od/strengtheningexercises/p/HipEx.htm
• "Clam" video
• Hip exercise 2 video
• Hip exercise 3 video
• Hip exercise 4 video
• Interestingly enough, if you have "IT band" pain (pain on outside of hip or outside of knee), you probably have weak hip muscles too.  Of course, exercises for the IT band also helps. 
• Back: A simple one is to be on your stomach on a table/chair, have your upper body hang off the side, and raise your back straight.  Video. Here are some videos:
• Lower back home exercise video (0.35)
• Rotator cuff: many people who do overhead sports end up with "impingement syndrome" - which is a result of weak supraspinatous muscles.  
• Supraspinatous muscle strengthening video
• Other rotator cuff muscle exercises (2:15)
• Note: Use less than 3lb or else you'll start using other muscles (deltoids).

Remember to RICE! Rest, Ice, Compress, and Elevate! (okay, compress and elevate don't really make sense in these 3 cases).  Keep these muscles strong, so that you won't get worse injuries in the future!

Pondering Pediatrics

Someone blogged about their reasons about not going into Peds.  Well, here is my take on it:
1) I spent my whole damn rotation sick with URIs and GI bugs.
Surprisingly, I didn't get sick at all during the peds rotation.  But I usually get sick at least twice a year anyways.
2) Really sick kids make me desperately sad, to the point where even doing a practice question about a child with cancer ruined my whole day.
Interestingly enough, I did heme/onc clinic, and I was worried I would get really sad, but I didn't.  Maybe it's because it was an outpatient clinic, so the kids were still well enough to not have to stay in the hospital.  But in general, even the sickest kids have some spunk about them.
3) I am really, really bad at looking in screaming baby ears. And that's like half of what pediatricians do.
Hm...I guess I didn't really do too much of that.  I suppose when it has to be done, it has to be done.  I think after taking care of my baby brother, I've learned how to be tough with kids when necessary.
4) I found medicine involving non-sick kids to be really boring. Strep throat? Boring. Rashes? Boring. Otitis media? Boring.
I just enjoy seeing the kids.  Even if they just have a cold, they're just a joy to be around.
5) Parents = mega aggravating. (Of course, now I deal with adult children, which are also mega aggravating.)
True...unfortunately.  But I figure if you can get along with the kids, that's half the battle.
6) When I saw a cute baby, I mostly just wanted to play with the baby, kiss him all over his cute little pudgy face, and then go home and make lots of babies. And when I couldn't do those things, I got frustrated.
That's also very true, minus the make lots of babies part.  I suppose if I really need to play with someone, I can always find my little bro.
7) Whenever we'd have guests at peds club, they always complained about their salary. (I saved the most shallow reason for last.)

Ah, the money issue.  I'm just hoping God will provide.  Also helps that I've always been a minimalist.


Although my clerkship evals weren't as stellar as I had hoped (should've scheduled it later in the year), peds turned out to be one of my higher shelf scores. 


After doing orthopedics where the resident talked daily about how awesome it is that you can just find a problem and fix it, I actually started thinking about surgery since the general stereotype of surgeons are "jocks" and I figured I was fairly athletic.  Although I do like how there's a definite fix and I love the mechanical/hands-on part of surgery (considered doing mech-e as an undergrad), there were definitely aspects of general peds that were more appealing.  My calm, detail-oriented personality seems to be more fitting for general pediatrics.  I like having the chance to talk to patients and really getting to know them - especially those cute little kiddos!  I also like having the opportunity to follow patients for a long time, given that I tend to be someone who remains friends with elementary school friends. I like coming up with a differential and going through all the evidence of ruling out things.  One of my favorite parts of medicine was going to resident rounds and see them go through the thought process of coming up with a diagnosis.  Ah...too bad there isn't really one thing that encompasses everything, except for maybe family medicine and possibly ob/gyn.  But trying to do everything makes it seem like it would be too difficult to be good at anything in particular (family medicine), and ob/gyn seems to be relatively simple internal medicine stuff, and when it gets more complicated, they get consults anyways.  I suppose it's true with general peds too that the more complicated stuff gets consulted on.  Ah, that's the dilemma of medicine: do you want to know very little, but know that little stuff very well or know a lot, but not anything in particular that well?  

#Whatshouldwecallmedschool#

Wow, whoever started this was brilliant:  #Whatshouldwecallmedschool#  I've been laughing my socks off...oh, the truthfullness of it all is hilarious. Some of my favorites:

• Trying to do a physical exam on peds
• When sleep deprivation catches up with me post-blam
• When M3s on rotations give M1s advice about school
• When there is someone in lecture I've never seen before
• Arriving to your surgery rotation
• How I feel whenever people around me complain about being stressed (not looking forward to intern yr)
• The first time you correctly diagnose something in clinic, you're just like...
• My understanding of the musculoskeletal exam
• When I saw my first natural birth (not true, but the face is priceless)
• Can't wait: When you're a post-match MS4
• When socially inept MS3 tries to correct attending on rounds - lol!
• When you try to place your first foley - rofl!!
• Putting an IV in for the first time - oh, good times!
• First Day on Psych - she's hilarious :D
• 
  

Notables:

• Unfortunately, my communication with non-med people has significantly deteriorated.
• This baby is too cute: During the 4th lecture of the morning
• ...and this one: Derm lesions
• Oh...the Trendelenburg gait.
• The first time I heard a murmur in clinic - yup, it's that rare.
• But...I don't drink coffee: No coffee?
• Hahaha...Can't find a nerve?  For me, it's more like, "Oops, that was a nerve."
• Sighs, sadly, this is true: M3's starting rotations
• Morning post call, when I see the sunlight - so true!
• Anytime a lecturer promises to end early - heart throb
• My first day on 3rd yr rotations - sadly, it's true
• When I'm typing up a pass/fail case report
• This pic is just pretty awesome: When I start taking an exam I thought I was prepared for
• The extent of the derm physical exam - oh, I love Jim Carrey
• Sadly, so true: When my friends with jobs have houses and cars that are equivalent in value to my level of debt half way through medical school (more like 1/4 way)
• When you get pimped by your attending - 3rd guy is way awesome
• After I press submit on the final section of the usmle - cuteness overload!
• When you see a disease in clinic right after learning about it in lecture - I'm gonna look back on this with embarrassment
• When you pass the under-preserved body in anatomy - yup, our body
• When someone tells me they don't like first aid - cuteness overload!
• Oh...the ophthalmoscope: can't say, can't see.
• What you hope doesn't happen on your first delivery!
• I should've used this to my advantage: black box
• This one's pretty cool: Who wants to write discharge summaries?
• Oh...anatomy book
• Hahaha...so true: When med student, fellows, residents, attending are all in the same room
• How I feel when I gown and glove in the OR....well, it's more like: I can't move or I'll explode.
• Free food, free food, free food!
• Cuteness: When a patient is on tones of medications..., How I feel trying to exercise after two years of med school and stress eating
• How I feel after pulling an all nighter before an exam - this is pure evil.
• Most adorable seal ever: when I let my classmates practice the abdominal exam on me
• Wow, this dude is incredible: After a fun long day of surgery
• Oh...medical school.
• So cute and so true: Radiology