Friday, September 30, 2011

FX field trip: SFMOMA and Yerba Buena

For our second FX class, we did another icebreaker (people bingo - my favorite), and then headed around the corner to the SFMOMA to check out a great photography show called Face of Our Time.

(I had seen most of the Richard Misrach project from his presentation at SF Camerawork almost a year ago. The Jim Goldberg work were amazing; I still can't get some of those images out of my head.)

Nayali and Paula
Jim Goldberg exhibit
Whitney and Mariana

Afterwards, the students interviewed each other. Because we have two separate classes for digital and film, even students who had been in the program for a while didn't really know other students if they had been in different venues. The new mentors and students already so engaged with the program, which rubbed off on the older mentors and students; everyone was just totally open to the whole experience of the day.

FX student interviews
FX student interviews

Thursday, September 29, 2011

First Exposures 2011: day one

In the middle of getting my course shined up for the new academic year, First Exposures started again. I missed it.

first day of FX, 2011

Jenesh is back, and this will be our last year together. She's come back from the summer calm, focused, and thoughtful about the year ahead. While I was worried about her running herself ragged on the same academic treadmill that I was on at her age, she seems to have been able to step back and assert herself in surprising ways. I will never ceased to be amazed at not only how quickly these students can change, but that they can change to be even more awesome than they were before.

Naomi is also back this year as a junior mentor. It's so rewarding to interact with her again, this time as an adult. Since she's been away from the program for a few years, she doesn't know many of the newer students and mentors, and she wound up clinging to me a bit as she navigated the altered landscape. Because it's Naomi, however, it took her approximately 4 minutes to make friends with almost everyone.

We did our usual first class icebreaking.

first day of FX, 2011
first day of FX, 2011
first day of FX, 2011

First project: create a photo story using our shoes (one of the younger students deadpanned, "who comes up with this stuff?!" which broke up the entire group with laughter).

first day of FX, 2011
first day of FX, 2011
first day of FX, 2011

The program has really been stretching itself out of the regular comfort zone. The students we've been taking on have all had their own unique challenges, but that reaffirms that what we do is good and important and necessary. I give a lot of props to Erik for keeping the mission vital and adaptable. This will be a great year.

first day of FX, 2011

bluesy version of "Ace of Spades"

Watching this "making of" video of Motörhead recording a slowed-down, bluesy version of "Ace of Spades" (aka, my iPhone's favorite song) makes this commercial more bearable. Via Laughing Squid.

Tuesday, September 27, 2011

Atul Gawande, "Personal Best"

My cheeks burned; I was mortified. I wished I’d never asked him along. I tried to be rational about the situation—the patient did fine. But I had let Osteen see my judgment fail; I’d let him see that I may not be who I want to be.

This is why it will never be easy to submit to coaching, especially for those who are well along in their career. I’m ostensibly an expert. I’d finished long ago with the days of being tested and observed. I am supposed to be past needing such things. Why should I expose myself to scrutiny and fault-finding?

Atul Gawande has a nice piece in the upcoming New Yorker on the potential value (and concerns) of coaching for non-athletes. We've been kicking around the idea of professional coaching for trainees (students and residents) in our medical education reform discussions, but it's interesting to see the idea applied to already practicing physicians and teachers as a parallel to elite athletes: yes, you're the best, but how do you become even better?

It's interesting that Gawande couches this experience in terms of getting better results, defined for him as fewer surgical complications and errors. Errors in medicine mean death and disfigurement. They mean lawsuits. They mean an erosion of the trust of your patient. The messaging here is to open yourself up to the scrutiny of errors in the quest of making fewer. Discomfort now for a higher purpose later, which is basically the story of becoming a doctor in the first place.

The hardest thing that we teach the students to do is how to say, "I don't know the answer to that." That lesson becomes harder and harder the further along in their training the students travel. It's almost as they learn how capricious the human body can be, they need to instill some certainty into their lives in order to function. In decision-making, that's a help and a hindrance. And if that hindrance is poor patient outcomes, then we owe it to society to push for uncomfortable critique even for the experts because the rewards are absolutely worth it.

Monday, September 26, 2011

These are your friends, five gin cocktails into your Sunday afternoon.

ward shadowing vocabulary list

  • vasculopath: patient with significant vascular disease or disease risk factors.
  • heparin bridge: when patients on warfarin (oral anti-coagulant) need to go into surgery, the warfarin is stopped due to bleeding risk, but heparin (IV anti-coagulant) is given instead to prevent blood clots.
  • capsule capture: way to record images of the digestive tract for use in medicine, in which the patient swallows a small capsule that contains a tiny camera.
  • TEE: trans-esophageal echocardiogram.
  • pseudomonas: gram-negative, rod-shaped bacteria recognized as an emerging opportunistic pathogen of clinical relevance.
  • po: per os, by mouth.
  • lisinopril: ACE-inhibitor used to treat hypertension, congestive heart failure, heart attacks, and renal and retinal complications of diabetes. Increases serum creatinine due to unknown impact on kidney function.
  • stimulant vs. standing laxative: a standing laxative softens the stool or otherwise makes it easier for the stool to move through the intestine more easily. A stimulant laxative causes the intestine the contract, increasing the movement of the bowel.
  • DPOA: durable power of attorney
  • linezolid: antibiotic alternative to vancomycin, "reserve antibiotic." Expensive, but can be taken orally without adjustment in dosage.
  • TIPS: transjugular intrahepatic portosystemic shunt
  • ERCP: endoscopic retrograde cholangiopancreatography. Used for both diagnostic (e.g., diagnosing conditions of the bile duct) and therapeutic reasons (e.g., removal of gallstones). Invasive. Main risk is pancreatitis.
  • MRCP: magnetic resonance cholangiopancreatography. Used to visualize biliary and pancreatic ducts; however, cannot remove stones if seen at the time. Non-invasive.
  • HIDA: hepatobiliary iminodiacetic acid scan. Nuclear imaging procedure to evaluate the health and function of the gallbladder.
  • cholangitis: infection of the common bile duct or biliary tract.
  • cholecystitis: inflammation of the gall bladder.
  • C. diff: Clostridium difficile, gram-positive bacteria that causes severe diarrhea and other intestinal disease when competing bacteria in the gut flora have been wiped out by antibiotics.

Friday, September 23, 2011

"this is an atypical day"

When the first year medical students took their first standardized patient assessment last week, one theme that emerged from the debrief was that their level of skill was not deserving of the white coat that we make them wear. We try to explain to them that by virtue of starting the training, they are already becoming acculturated to the identity of being a physician, and instead of feeling unworthy, they should instead work as hard as they can to become worthy to their patients.

I should have taken my own advice as I crept into the hospital today to shadow my first ward team.

There are lots of perks to my job. One is free, informal medical care. Another, however, is that I can contact almost any of the physicians I work with and say things like, "hey, would you mind if I shadowed you on rounds some morning?" and the answer is almost always yes. I have never taken advantage of this in the past, for a tangential reason that the students touch on: while I will never receive a white coat during my tenure, I feel unworthy to be another body taking up space in the business of saving lives. However, I apparently know enough to not to be annoying to either patients or the team, and so I sat still while the attending listened to presentations by the interns.

I've worked with Jackie for at least five years, and it's interesting to see how similar she is in "doctor" mode to her "teacher" mode. She still uses "fantastic" to describe information that she's happy about, and still asks a lot of related questions to check fund of knowledge of her team. However, instead of feeling extraneous, like it sometimes does in the classroom, it feels encouraging in the hospital setting. While the patient should be and is the most important thing in the presentations, I found myself heartened by the fact that she still tried to push the team's knowledge and give them something of value to take away from the session.

During the second patient round, I found myself looking around at a familiar setting. Same bed, same tray with toothpaste, same NG tube suction device on the wall. It was strange to think of myself on the other side of my dad's hospitalization. Now I was the one who knew what was being talked about right outside a patient's door, or that the seven minutes that was spent at the patient's bedside was easily tripled just in discussing the patient's current status, assessment, and plan behind the locked door of the ward room. Stanford is nice because they had set up an actual folding bed in the patient's room on which her husband could sleep, instead of tacitly allowing him to sleep on the floor by her bed, which is how my mom and I spent our nights after my dad's sugeries. I was touched by that foresight in resources.

I took pages of notes, mostly jargon and acronyms that I wanted to look up later. The medical student on the team, who I knew pretty well, spend some time explaining terms to me. I think he was grateful to flip the role to teacher for a little while. While we were visiting the third patient, we ran into another med student. One of this team's patients had been transferred to her team's care, so she gave an update on the fly. This was the second unexpected hand-off of information, the first being a quick conversation by the elevators with another attending about how to proceed with another patient's treatment plan. I was impressed with the sheer amount of information that gets transferred, in both formal and informal ways.

Of course, no walkarounds with strangers could be complete without a comment on my hair, which occurred in the final patient's room.

"I love your hair," the patient's roommate murmured. I usually give a part-humble, part-magnanimous response, but I knew that she didn't need another strange person in her room patronizing her when she just wanted to get home. I thanked her shyly, and tried to press my body into the wall to stay out of the way.

Saturday, September 17, 2011

SF Opera: "Turandot"

As part of our attempt to be more adult-like, Whit and I went to see the SF Opera production of Turandot by Giacomo Puccini.

photo courtesy of SF Opera // Cory Weaver

The only other opera I've seen was The Daughter of the Regiment, which was a comedy. Puccini does not equal comedy. This is the beginning of Act I:
In a quarter swarming with people near the Forbidden City, a Mandarin reads an edict: any prince seeking to marry Princess Turandot must answer three riddles - and if he fails, he will die. Her latest suitor, the Prince of Persia, is to be executed at the rise of the moon. Bloodthirsty citizens urge the executioner on...

The two leads, Iréne Theorin and Marco Berti, were strong (although Berti was pretty stiff in the expression department). However, they were both totally upstaged by Leah Crocetto as Liu: she blew the audience away during her solos, and received the most energetic appreciation during the curtain call.

The most famous song from this opera is "Nessun Dorma," which has been sung by basically every tenor, including this guy. But no one does it like Pavoratti (who played his first Calef with SF Opera in 1977):

Wednesday, September 14, 2011

"a wild and crazy guy"

This was no longer an experiment. I felt a huge responsibility not to let people down. Arenas of 20,000 and three-day gigs of 45,000 were no place to try out new material. I dabbled with changes, introducing a small addition or mutation here and there. But they were swallowed up by the echoing, cavernous venues. Though the audiences continued to grow, I experienced a concomitant depression caused by exhaustion, isolation, and creative ennui...The hour and a half I spent performing was still fun, but there were no band members, no others on stage, and after the show, I took a solitary ride back to the hotel, where I was speedily escorted by security across the lobby. A key went in a door, and boom: the blunt interior of a hotel room. Nowhere to look but inward.

I just finished Steve Martin's Born Standing Up, in which he discusses the nascence, evolution, and ultimate disengagement with his stand-up comedy career. Awesome, honest read.

Tuesday, September 13, 2011

Tori Amos, Night Of Hunters

Oh my god, dudes. Tori Amos has a new album coming out on September 20, and it's currently steaming over at NPR Music. From the album release announcement:
“It’s a 21st century song cycle inspired by classical music themes spanning over 400 years. I have used the structure of a song cycle to tell an ongoing, modern story. The protagonist is a woman who finds herself in the dying embers of a relationship. In the course of one night she goes through an initiation of sorts that leads her to reinvent herself allowing the listener to follow her on a journey to explore complex musical and emotional subject matter. One of the main themes explored on this album is the hunter and the hunted and how both exist within us.”

The idea that Tori Amos could create an album that incorporates variations on classical themes (examples include "Nocturne Op. 9 No. 1" by Chopin and "Sonata in F minor K. 466" by Scarlatti) while simultaneously generating and sustaining an album-centered storyline just reaffirms that this woman is a musical genius.

The video for the first single, "Carry," was released on August 17.

Here's an interview and a "behind-the-scenes" look at the making of the album.

Friday, September 9, 2011

Stanford LGBT medical education research group = rock stars

In 2009, a group of Stanford medical students undertook the tremendous task of surveying and analyzing the LGBT education curriculum in U.S. and Canadian medical schools. And this week, their research has been published in the Journal of the American Medical Association.

The good news is that this publication has been accompanied by tons of awesome press:

Now, the bad news:
Most US medical schools report dedicating only 5 hours to educate physicians-to-be about the health needs of patients who are lesbian, gay, bisexual, or transgender (LGBT)...And about one-third offer no such clinical training at all.

Well, crap.

I'm not going to get too heavy into medical school curriculum reform in this blog post, but I will say that yes, this topic is important. There are also lots of other topics that medical schools are not covering. They are all important, because the stakes (the patient) are so high. However, the current model of medical education (the "2+2" model -- 2 years of preclinical education, 2 years of clinical experience) doesn't allow space for adding in everything that needs to be there. Medical school is stuffed to the brim, and many programs are grappling with how to restructure and overhaul their curricula. So, even though the amount of education about LGBT patients should be increased, it's not as simple as saying, "let's just add an additional 15 hours into the mix." There's not an easy fix to any of this. Hooray, future physicians!

Thursday, September 8, 2011

homonym atrocities

There's something asinine about people who make corrections in library books. The person is probably saying to him/herself, "well, I would hate for the next person who read this book to get 'they're' and 'their' mixed up in this sentence and disrupt their literary experience" but what the person really thinks is, "next person, look at how intelligent I am!" It's the bookworm's humblebrag.

library book corrections (not mine) library book corrections (not mine)
[Los Altos library copy of Stiff: The Curious Lives of Human Cadavers by Mary Roach]

Tuesday, September 6, 2011

"if I'm not dead in 24 hours, it's safe"

While I was visiting Vegas two weeks ago, my parents made the decision to visit Northern California for Labor Day weekend. I think we were all a little nervous, because my dad's health has been swinging towards the non-ambulatory side of the spectrum, but it turns out that being in the cool California weather (with multiple trips to markets bursting with summer produce) does a body good. All the back and leg pain he had been complaining of over the last few months magically disappeared for the four-day trip.

It's strange to be the adult that you had always hoped your parents would treat you as. My parents were always good about not babying me, but this is the first time that they've spent time in my grown-up world. There's a subtle shift, an implicit trust that I am not going to suddenly screw up my life.

Highlights of the trip included:
  1. Heirloom tomato and peach stock-up at the farmers' market.
  2. Whole crabs at Fisherman's Wharf.
  3. Multiple family movie nights (To Catch A Thief at the Stanford; All About Eve at the hotel; Giant at the apartment).
  4. Wonton soup and stir-fry dishes at the local Chinese noodle house.
  5. Successful chocolate cake baked for Whit's birthday (this recipe is boss).
  6. Mom proclaiming my homemade umeshu "oishii," and then trying to sneak all the plums into her mouth.
  7. Wine tasting at Picchetti, accompanied by peacocks.
mom and heirloom tomatoes
chocolate cake
official winery mascot
crab legs

Friday, September 2, 2011

missus cellophane

My friend Jen Henry held her most recent fashion show at the Royal Resort my last night in Vegas. Jen has her own vintage clothing shop, but is becoming more known for her elaborate cellophane dress designs. There are far better photos of the actual dresses, but after the show one of her models decided to showcase her synchronized swimming skills in the hotel pool.

model getting ready to dive
solo synchronized swimming
remnants of dress

Thursday, September 1, 2011

SSPS end-year celebration

I'm the unofficial photographer for the Stanford Society of Physician Scholars, meaning that I occasionally get emails from the organizers asking if I'm free to photograph a particular event. I'm happy to oblige, because it's a way to grow my experience in event photography without the anxiety of high expectations.

This week, I shot the end-year celebration for the group, which was combined with an awards ceremony for collaboration projects with medical students. I wound up with a free fleece vest out of the deal. Perks!

Stanford Society of Physician Scholars End-Year Celebration
Stanford Society of Physician Scholars End-Year Celebration
Stanford Society of Physician Scholars End-Year Celebration
Stanford Society of Physician Scholars End-Year Celebration
Stanford Society of Physician Scholars End-Year Celebration
Stanford Society of Physician Scholars End-Year Celebration
Stanford Society of Physician Scholars End-Year Celebration

Vegas trip

Having been told to burn through another 25.17 hours of vacation before August 31, I opted for a long weekend trip back home prior to the school year starting. Whit joined me for a couple of days, and we did a couple of tourist things (walkthrough the Bellagio conservatory, drinks at a lounge, and his first Cirque du Soleil show).

For some reason, I wasn't super inspired to pull out my Nikon for photos, so most here is off of my phone.

hot air balloons
bourbon cocktail
'zine library
vinyl store