Listen to the Body

Listen: It can tell us many things if we just pay attention to its whisper. Listen: Because by the time our body is yelling at us, it may be too late.


As I grow older, I know that I will witness the passing of many close and loved ones. I am afraid, although I know it is inevitable.

Yesterday, my boyfriend's young friend passed away of lung cancer at the blossoming age of 32. He was married, has a 1 year old baby boy, healthy and fit as can be. Thirty Two Years Old. Far too young... Do the good really have to die young?
My boyfriend met up with him a month or 2 ago as this friend was in TX for a business trip. He said that the friend seemed fine, but he did ask my boyfriend how his health was. My boyfriend laughed saying, everything is good, just getting older and fatter. The friend, however, said that his lower back has been really aching lately. In early May, he finally went to the doctor and they diagnosed him with metastatic end-stage lung cancer. He died only a few weeks later, complete shocking everyone. Even a mere 4-5 days before his death, he was eating home-made food from friends, saying how delicious it was. Just a week before his death, he was writing to people that although the treatment is aggressive, draining, and sometimes painful, he is feeling better and feels physically and mentally ready for a full-blown chemo or radiation therapy. And then he just... dies. At 32.

Listen to your body... At 32, so young and fit... a chronic back ache that seems strange and misplaced really might be your body telling you "something is wrong! get it checked out!" Just make a quick appointment to a family doctor... go to a screening. If you can, just order some X-rays. Really, not as expensive as MRIs or CTs or PET scans. I would much rather be labeled a hypochondriac then to realize a disease too late.


My mother also told me that her lab member came to her this past week, saying that he has stage 4 renal cell carcinoma. Prognosis... I don't know... But the tumors on his kidneys are large. My mother cried and cried and cried. She noticed that he had been losing weight lately, and her co-worker just said, yea! I've been working out every Thursday after work, and I feel great afterwards. But think about it! Working out one day a week can't lead to noticeable weight loss... That was probably another big sign the body was trying to shout out.

Cancer Screening

There was a free melanoma screening event going on at several of the local hospitals/clinics today, so I took my boyfriend there. He has many many moles all over his body, and although he is Asian, that isn't an automatic guaranteed protection from skin cancer. These screenings are free and there for many good reasons with good intent, so why not use the available resources?

First, I had the doctor check his back, which has a light colored but large mole which the doctor said is probably is a birth mark and nothing to worry about. Although the shape is large and irregular, the mole itself is even in tone and very light. He has other darker spots around his back that he should stay aware of but are too small for any kind of intervention at the moment.

I then asked the physician to check his legs, which do have darker spots/moles. Indeed, he pointed to a few more which were a little darker and bigger and requires attention to make sure they don't get bigger or change in any way.

Then, he found a lesion in the lateral portion of his calf. I knew he had that mole/moles - I called it the triangle of moles and jokingly told my bf that I will use that mark to identify his body if his face had become too damaged. I honestly thought it was a clump of three moles that were close together, and my bf said he thinks he's had for quite a while. So I wasn't too worried. The doctor, however, did say that was very abnormal and needed to be removed and biopsied immediately - within a week. My gut says that it's benign because it's been there fore the 2 years that I've dated him and I don't think it's changed in the 2 years I've been with him either.

We'll set up an appointment this week to get the lesion excised.

But the lesson is - free screenings are such great events. Everyone should take advantage of them. They're preventative and can catch diseases which have great prognosis with early intervention. People may scorn and say - oh hyperchondriacs - but really, better safe than sorry. This is a perfectly rational and reasonable way to ease any anxiety and make sure your health is at its best. Nothing is lost at all. What is truly ridiculous is to freak out and pile up with worries and pay hundreds of dollars to see physician after physician for expensive diagnostics... when quick screenings are free. Even a quick trip to the family doctor is relatively cheap with insurance. And, what is truly sad, is to notice something about your body that doesn't seem right then NOT do anything about it... until it's really too late.

Life is too short.. take small preventative measures early on and prevent major damage and pain later on.

Hospital Visit

For our last college mentor session, Dr. Cx took us to Parkland to meet with a patient and also get practice hearing various diastolic and systolic heart murmurs.

Regarding the latter, I am still extremely bad at detecting the murmurs. I have no idea what I'm looking for and where I am looking for it. But, Dr. Cx said that he was a junior resident before he could hear some of the murmurs. But once you hear it once, you will always be able to hear it. That is reassuring.

The more moving part of the day was our talk with our patient. She is a 25 year old woman battling stage 4 breast cancer that has metastasized all over her body... 25 years old.
She said that she felt a lump on her breast around 18-19 but didn't really do anything about it. However, around 24 years old, she said she couldn't eat anymore because of nausea and pain, lost about 60 lbs. The doctors originally said she had gastroentitis... the horrible thing is, they felt a lump on her breast and took an X-Ray, but she never got the results back. She's currently in a little law suit but that is absolutely terrible. The neglect and mistake of not even looking at an X-Ray result probably cost the patient her life... or severely shortened it. When they finally diagnosed her with cancer, she was already stage 4. The amazing thing is, however, it's been 14 months since her diagnosis. She has gone through bouts of chemotherapy and radiation therapy, and though she never feels 100% well or herself, she still is trying to live life normally. That's absolutely amazing..

But god... 25 years old. That is way too young. way way way too young.

End of Anatomy Block

Today, we had our anatomy lecture final, concluding the anatomy block of medical school year one!
I thought about this for a while, but I won't be holding and observing the body's internal organs for a long time... maybe never... definitely never for those students not interested in surgery of any type. From now until the third year when clinical rotations begin, we'll be studying from books and lectures, with the occasional patient interview and clinical skills lessons (giving physical exams, taking blood pressure, phlebotomy next year...).

Now that anatomy (and the stress of the exams) is over, I'm beginning to miss it already and am developing an even greater appreciation for this course.

Really and truly, I don't think I would have been able to learn half as much if we had learned anatomy by lectures and anatomy atlases alone. First, how do you truly visualize depth perception? Orientation of all the organs and blood vessels? When I think about anatomy, I actually think about the dissections I've done, where I saw the structures, to what they were connected, and their general orientation. Also, Netter's Atlas may show the typical body, but there is a lot of subtle variation that I think is important to understand.
And then, there is nothing like holding a heart in your hard, looking at it from all angles, and connecting what we see with the functions we've learned through lecture. Now that's real integration.

This week, our class is holding a vigil for our donors and their families. My tank mates are to write a note of some sort to "Gertrude," to be cremated with her, and hopefully we'll also write a letter of gratitude to her surviving loved ones. It must have taken great courage for them to allow the body of a loved one to be used for our learning. Because we've learned a lot from her. Head to sole of the foot, we've dissected and looked into ever space and crevice.

Hopefully what I've learned these past few months will stay with me for a lifetime.

Waimea Canyon - Kauai, Hawaii

first in-patient visit

53 year old man who came to the ER one day ago complaining of a sharp pain on his right side which radiated to his back, worsened when lying down, and was exacerbated by deep respiration. He had clear stomach distention. He expressed a history of alcoholic consumption and has also suffered from bilateral lower extremity edema.
Upon removal of 5L of fluid from his abdomen, he showed clear signs of improvement and the pain has been alleviated.

This was essentially how I presented my first in-patient to my mentor (as practice.. after she and other repeated it a few times). We had to have a Spanish interpreter with us, which was quite a new experience, but I think I had some pretty good practice. I'll be having to do a lot of presenting like this once I start rotations at the hospital.

Later, we went and looked up his chart and found that this gentleman most like has hepatitis C. The doctors are repeating the test to confirm before telling him the news. My mentor says that most likely, looking at his past and current state of health as well as SES, he only has a few months to hit. That reality hit me pretty hard.

I am really glad that medical school weaves in real patient interactions like these. I think it really reminds us what we are in medical school for. Not to make good grades. Not to learn how to pass a pass/fail course with good efficiency. Not to aim for top x% to make it into a certain residency program. We are here to learn how to treat, cure, and save lives. We are here to learn how to heal.
I have to admit that I forget this little detail all the time and get focused on other aspects of medical school. But that's why I really appreciate this 2 hour session with our mentors every week - brings the larger picture back into perspective.

Eric Morton Wang. ~in memory~

The "Obesity Epidemic"

I was just pre-reading for tomorrow's biochemistry lecture on fatty acid synthesis, regulation, and mobilization, and was amazed yet again about how fat the U.S. is


We've all heard these stats but let's refresh ourselves:

~325,000 deaths in the US are obesity-related. Second highest preventable deaths next to Tobacco being #1

A child born in 2000 will have ~35% life-time risk of developing diabetes. That prevalence is THREE TIMES higher than current 2010 rates

In 2003, ~75 billion dollars were spent directly treating obesity-related diseases. ~100 billion dollars if indirect costs related to obesity are included


And what was absolutely shocking!
In a Dallas County study, 34% of residents had non-alcoholic fatty liver disease. 34%!



Oh, and here's the line-up for this year's Texas State Fair (courtesy of thebradsblog.com)

Another amazing creation from 2009 TX State Fair: Fried Butter

picture courtesy of Kevin Brown, MSNBC


Update! (10/5/2010) CNN.com also wrote about this year's TX State Fair.
I really want to try a fried frito pie now...

アメリカの医学部への道

This is a (heavily peer-edited) Japanese essay I wrote earlier this year.

やっと来ました。８ヶ月の間不安と緊張と希望とが入り交じり、びくびくしながら待っていた返事。全米各地の医学部８校に受験したのは大学卒業後の２００９年の夏。全国統計 によると、１０人が複数の医学部を受験した場合、約４名しか入学する事ができません。実際に私がいたプリンストン大学では、医学部志望者の~９４％はどこかの医学部に入学する事ができるのですが、アイビーリーグの大学を出たからといって安心してはいられません。そんなことを８ヶ月いろいろと悩みながら、今年の２月にやっと来ました：第１志望校からの合格通知。

日本とアメリカの医学部進学で一番違うところは、日本では高校卒業後に６年間の医学部に進むことに対して、アメリカでは４年制の大学を卒業してからさらに４年間の医学部に行くところです。つまり大学の卒業証がないかぎり医学部には行けません。また大学卒業後すぐに医学部に行く人もいれば、何年か働いたり医学の知識を深めてから医学部に受験する人もいます。

私の場合は、基礎生物医学関係の研究経験が足りなかった為、医学部を受験する前に第一志望の医学部の基礎研究室で、１年間技術員として働きました。もう一つ大きな違いは、医学部は大学受験と同様に何校でも受験することができるということです。 高校３年の時、私は１８校の大学を受験しました。医学部受験は学部受験に比べて費用 (interview guide) がかかるので一般的には５−１０校に出願しますが、人によっては２０校も受験することがあります。ですからすべて失敗に終わる場合や、逆に受験校にすべて合格する場合もあるのです。様々な大学の難易度統計をみれば、自分が合格圏に入っているかどうかはだいたい予想が出来ますが、自分の結果を確実に当てることは不可能です。なぜなら医学部の入試委員会は受験生を個別に評価し、その医学部にとって最も有益と思われる受験生を選ぶからです。つまり、アメリカの医学部は一日の試験結果だけで合格か不合格を決めるのではなく、一人一人の経験,才能、学習能力を評価し医者としての道を与えるのです。

それでも医学部に受かる為にはいくつか要件があります。まず、医学部進学に必須な科目を多く履修しなければなりません。しかし専攻自体は、ひとそれぞれ興味がある、又は得意で良い成績が取れると思われる科を選ぶことができます。学部の時点で医学部進学希望者の半数が理系と文系とに分かれているのも特徴です。しかし、生物学から物理学までの幅広い高度な科学の授業や英文学も取らないといけません。医学部希望者の必須授業は、医学部で将来成功できるかどうかを篩にかけるために、必要以上に授業内容を難しくし、試験を厳しくしているらしいという噂もあります。４年間の平均成績(GPA)は入試査員会にとってとても重要な要素で、大学での成績がほとんどAの範囲でなければまず医学部には受からないといわれています。ですから受験生は大学４年間良い成績を保つ為に死にもの狂いで勉強します。医学部必須科目の授業は医学部をめざす学生の集まりで、激しい競争でした。

大学での成績以外に必要なのは、自分の実力と能力を証明できる教授や課外活動のスーパーバイザーからの推薦状。できれば３−５通の推薦状を頼み、その中の最低２通は大学の教授でないといけません。私の大学では卒論指導者が第一推薦者になることが一般的です。そして公式な条件ではないのですが、課外活動として病院でインターンかボランティアをするのも当たり前です。私は大学の近くにある病院のガン病棟で２年間毎週１時間から３時間ボランティアをしました。医者の世界をもっと知る為に、いろいろ専門の医者の下で彼らの仕事を見学しました。医者が働く場を知らないで医者になりたいと宣言する受験生の言葉はあまり信用されません。

そして最後に、受験生が一番恐れているのが医学部の全国標準入試（MCAT：Medical College Admissions Test). MCATは近年コンピューター化され、約５時間の試験です。内容は４に分かれており、物理化学（７０分）、生物学（７０分）、国語（６０分）、小論文２つ（６０分）となっています。試験では必須科目で得た知識を評価されます。試験結果は３年間有効なので、個人的なスケジュールといつ医学部に受験したいかを考慮しテストを受ける計画を立てないといけません。私は大学３年生の夏に卒論の研究をしながらテスト勉強をし、４年生が始まる秋学期の直前に受けました。結果は残念ながら自分では納得の出来ない点でした。もう一度卒業後に受けることも考えましたが、大学最後の期末試験と卒論でエネルギーを使い果たしてしまって、再び教科書を開く動機と意欲がなく、結局その時点のスコアで受験することにしました。その選択は今から考えてみると大きな間違いでした。医学部入試委員会ははじめにMCATの結果とGPAを考慮します。医学部によってMCATの点、GPA,あるいは二つの複合スコアを見て足切りを行います。

私のGPAは高い方でしたが、MCATの点はそれに見合った成績ではありませんでした。 すべてはあとの祭りですが、もう少し点が良かったならばもっと州外のいろいろな医学部も目指せたと思うし、８ヶ月の長い間やきもきしながら待つ必要もなかっただろうと思います。一旦医者になるという決意をした以上、疲れてやる気がない時も頑張って精一杯努力をしないといけないということを、この苦しい経験を通して学ぶことができました。

これらの受験のための要件は受験生に共通であっても、医学部へ向かう道はひとそれぞれ異なります。大事なことは、入試委員会の審査官が受験者の履歴書を見て、その人が将来医学の世界で成功するというイメージを想像できるかどうかです。医学と医療に対する情熱を持っている事が大切です。それを体得し表現できるようになる為に、学生は早くから臨床研究をしたり発展途上国へ行ってボランティアをします。しかし医学部は、学生の多様性も重視し、医療関係以外の点で一生懸命頑張る学生も評価されます。そして、人生の様々な領域で深い経験をしてきた人、大変な試練を乗り越えられた人も高く評価されます。私の場合医者になる決意をしたのが大学３年の初めの頃で比較的に遅い方でした。それまで私は色々な経験をしたくて、動物園の研究者の元でインターンをしたり、バミューダで海洋生物学を学んだり、大学のアジア文化団体の委員長をしたりしました。多様な私の履歴書の中で大学の四年間ずっと続けた活動もありました。一つ目は大学の霊長類研究所で四年間働いた事。卒業研究も同じ研究室を選び、マントヒヒの行動学を学ぶために、大学４年の冬には大学の援助でケニヤに行く事も出来ました。もう一つは大学のヘルスセンターにあるセクシャルハラスメント被害者の為の学生カウンセラーとして働き、１年その支援団体の学生会長にもなりました。その二つの活動を通して、私は自分の科学と学習に対する熱意と他人の助けになりたいという思いを表したかったのです。

医学部受験者は出願する前に自分の経歴、成績、試験結果を見て、自分が受験に勝ち進んでいけるかどうかを吟味します。受験は医学部入学の１年前から始まります。どうしてこのように長い過程を経るのかというと、入試委員会は受験者の一人一人を吟味し、その中でさらに選りすぐった学生を面接に招待します。面接のための費用は個人負担ですから、旅費だけでもかなりの額になります。何十校も受験する学生や海外からの受験者は、軽く１万ドルを超えてしまいます。面接自体は典型的な質問（何故医者になりたいか、現在の医療制度の問題は何かなど）も聞かれるし、とても独創的で医療に直接関係ない質問も聞かれます（最近読んだ本の感想は、一番親しい友人は誰かなど）。 そして面接のあとに受験生ができることは、辛抱強くただ結果を待つのみなのです。私の場合、今年の２月についに待ちに待った返事がやってきたのです。

医学部進学を決意してから今までの自分の考えと行動を振り返ってみると、最初は医学部に受かる事だけを考えていました。本当の事を言いますと、受かる事だけが最終目的になっていたようにも思います。先が見えない不安の中でやっと返事をもらった時、安心と喜びに溢れた途端、ジワジワと医者の姿の自分を思い浮かべることができました。願っていた人生の次の段階に進められる。つまり、私は将来医者になれる。多くの患者さんそしてその人の大切な家族や友達に安らぎ、癒しと希望を与える事ができる。必死で勉強をして色々な辛い思いや大変な時期を多く乗り越えていかなければならないけれども、人の命を預けられる医者になる為には当然な事。頑張ります。まだ始まってもいない医者への道はうんと長いと思いますが、ドキドキワクワク今年の８月まで待っています。

Related Topics for Future Discussion:
アメリカのメディカルスクールの学費




無関係な写真

(blurry) Meryl Streep as Honorary Graduate, Commencement 2009

Trauma

According to the Global Burden of Disease Report, the leading cause of death for individuals younger than 45 is trauma. Out of the possible injuries, Traumatic Brain Injury (CDC factsheet) is the leading cause across all age groups.

The young are dying of trauma.


Unfortunately, due to the nature of this Cause of Death (often careless mistakes, unforeseeable accidents, etc.), funding for research on better traumatic care is limited. Trauma lacks a clear and definable target of pursuit (like Cancer). Trauma surgeons, however, are eager to learn better how to care for patients rushed into the ER with not even minutes - seconds - to spare before critical decisions must be made. Unfortunately, with insufficient academic work, surgeons must rely on instinct and experience. These are necessary skills for sure, but instinct and experience backed by empirical evidence is even stronger.


I feel that slower, more detailed surgical work is better suited for me, but I also feel that I am very calm and rational in intense circumstances. That has never been tested in a life or death matter, so I can't fully say anything, but that may be a good attribute to have for trauma surgeons.

We will see.

Missing Loved Ones, WTC Memorial - New York City