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Drawing Blood

JeffJeff Wonoprabowo -- I'm not a big fan of needles. Never have been, either. So you can probably understand the anxiety I felt when I first heard we were going to have a blood lab for Pathology class. I had a blood lab in Anatomy & Physiology class when I was a senior in high school. In that blood lab we were supposed to prick our own fingers in order to figure out our own blood type. It took me multiple tries. The first few tries were unsuccessful because my right hand just couldn't prick my left hard enough. Maybe I just have a fear of pain. When I finally drew blood, I couldn't get enough. I only got one drop (the first drop was supposed to be thrown away). At the end of the lab I had two or three fingers pricked, each having donated a single drop of blood that could not be used.

Well my anxiety turned into trepidation when I found out that we weren't going to be finger-pricking. Instead, we would be pairing up and drawing blood from each other -- with a tourniquet, needle, vacuum tube, pumping fist, and all. To top it off, most of my classmates have never drawn blood before and my skin isn't light enough that my veins are easily visible.

Our class was split into two sections. One section would go in at 1:00 and the second would go at 2:30. I was in the second group. A few days prior to the lab, I started overhearing people talk about this lab and trying to partner up. I figured that I could easily find a partner once I got to lab, so I didn't bother asking classmates if I could stick them with a needle.

When it was time for my section to begin, I was ready on time and found a seat in the lab. I looked around, but it seemed that most people were already paired up. So I sat and waited a while. I noticed someone who had no partner, but she soon found someone. I stopped looking for a partner once our instructor began showing us how to draw blood using a volunteer. They had a camera so we could all watch what was happening on some large LCD TV screens.

Anyways, I finally found the one person in the lab who still didn't have a partner. He offered to let me draw blood first. I accepted and started laying out my supplies. After I laid out everything I needed, I tied the tourniquet on his arm and started looking for a nice vein. That was the easy part. This guy had white skin and large, superficial veins that were easily visible. I wiped the area with some alcohol wipes, uncapped the needle, pointed the bezel up and nervously looked at the arm.

I'm glad one of the nurses was standing right next to me as I pushed the needle in. "You're barely in," she said to me.

I pushed in deeper, and then popped the vacuum tube into place and -- nothing. "Now, pull out a little more," she told me.

I pulled back slowly and suddenly blood rushed into the tube. After I got what I needed, I took off the tube and turned it over a couple times.

Mission

accomplished. At that point I was just glad I didn't need to poke my partner multiple times.

My first time drawing blood was pretty exciting (although I may be just easily amused). It is a little strange pushing a needle into someone. I know it gets old very fast. Nurses do it all the time and think nothing of it. And with time, I'm sure I'll think nothing of it either (and probably won't feel it's worth writing about either). But for now, it remains unnatural. And for now, it's still something interesting enough (for me, at least) to write about.

October 26, 2008 by Jeff Wonoprabowo | Comments (10)

An Encounter With Oriental Medicine

JeffJeff Wonoprabowo -- A couple weeks ago I made a trip to see the chiropractor with four classmates as part of a requirement to observe complementary medicine in action. This week the same group of us went back to the same facility, but this time to see some acupuncture in action.

Well, it turned out we had more in store for us than just acupuncture. They split us into smaller groups (2-3 students) and we rotated through the clinic spending 1 hour observing different doctors (with OMD degrees) and interns (students about to graduate).

My group consisted of another classmate and myself. We began our first hour in the "pharmacy." Now, I type pharmacy in quotes because it is not the pharmacy most people in the United States are accustomed with. The pharmacy had a large wooden cabinet with lots of drawers, and each drawer was filled with, maybe, three or four different herbs/roots. One of the things they had was ginseng. The ginseng looked like small instrument reeds (for clarinet or saxophone), and I sucked on one while my classmate chewed hers. While my mom has taken ginseng before in a tea form, I never tried it. It must be an acquired taste and after I spit it out, I excused myself as I went to get some water.

After I had my drink of water, I had my pulses read. Apparently, a lot can be discerned by reading the radial pulses. The intern noted that I had a quick pulse and she checked my tongue; she told me it was very red. Those two meant that I had a lot of "heat inside" and that I probably am easily irritated. She didn't tell me anything about the state of my heart, lungs, kidneys, or spleen (all these organs are supposed to be represented in the radial pulses).

The rest of the day was spent with various OMDs. I saw acupuncture, cupping (http://en.wikipedia.org/wiki/Fire_cupping), scraping, and heard about acutorture. I know that acupuncture has been studied and there has been evidence that it can be helpful in pain management. But aside from acupuncture, I don't know of any researching into the techniques I saw. Moreover, I didn't really understand what they were treating when they used the techniques.

I got the idea that cupping and scraping were used for muscle pain. But I would venture a guess and say that they use it for more than just that. It looked like it might feel nice, though. I might have to go find a cupping set and try it.

The acutorture was something that I really did not understand. The doctor I saw who does this stepped out and instructed the intern to explain to us what acutorture was. The intern, though, seemed really nervous and flustered. He couldn't explain it at first, but finally managed to say that it was like physical therapy. I'm not sure how accurate that statement is. I heard (from classmates who saw it done) that it is quite painful.

A lot of what I saw was foreign to me even though my ethnic background is Chinese. They say the results of these techniques speak for themselves as their patients are satisfied with the results. But the explanations they give about meridians and channels seem off-putting for many people who train in western medicine. Personally I found the visit fascinating -- almost a cultural experience. My curiosity has been piqued. But whether I go back as a patient or not... well, I don't know yet.

Has anyone had any experience with Traditional Chinese Medicine? I'd love to hear about it, good or bad.

October 17, 2008 by Jeff Wonoprabowo | Comments (21)

What Is PM&R?

JeffJeff Wonoprabowo -- I have yet to figure out what specialty of medicine I would like to enter. Fortunately, "they" tell me that I have plenty of time as I am just at the beginning of my second year. In an effort to discover the specialty of my dreams, I occasionally attend interest group meetings. The problem is that every time I attend one of these meetings, I pick up on the aspects of the specialty that make it appealing. I mean, what specialist would really come to an interest group meeting and tell you all the negatives?

The most recent interest group meeting I attended was for the specialty of Physical Medicine & Rehabilitation (PM&R) where the physiatrist (PM&R specialist) was proud to let us know that the school has one of the five PM&R residency programs in the state of California.

Of course, free lunch was provided. I showed up early and picked up my croissant sandwich, two cookies, and a 20 oz. bottle of root beer. As is my custom, I chose an aisle seat in the back row so that, should the need or desire arise, I could make a quick and easy exit.

PM&R is a specialty that is somewhat difficult to define. The presenter noted that it is sometimes hard to tell people what he actually does because of what PM&R is not.

PM&R is not an organ specific specialty like Nephrology or Cardiology.

PM&R is not a procedure specific specialty like Surgery or Anesthesiology.

PM&R, he said, is more like a general specialty like Family Medicine.

Within the practice, the doctors in PM&R deal with stroke patients, amputees, and athletes. They work with various medical specialists (doctors, physical therapists, etc.) to help patients rehabilitate and regain as much mobility and function as possible.

At the end of the meeting I was still there. And I left with another specialty that looks pretty appealing, too.

****

If you're interested, you can also check out the website of the American Academy of Physical Medicine & Rehabilitation.

October 9, 2008 by Jeff Wonoprabowo | Comments (3)

A Trip to the Chiropractor

JeffJeff Wonoprabowo -- A couple weeks ago I spent an afternoon at a university in Southern California that offers degrees in Oriental Medicine as well as Chiropractic (Doctor of Chiropractic). The afternoon was spent at their University clinic where four classmates and I had a chance to observe the chiropractors. The trip was part of an LCME requirement that the curriculum must cover a certain number of hours in complementary and alternative medicine (CAM). (The LCME is the Liaison Committee on Medical Education and is the accrediting body for all medical schools offering an M.D. in the United States.)

We were asked to pick up a handout from our school office about chiropractic care. Admittedly, this handout did not inspire very much confidence. The tone of the article felt like the authors were desperately trying to convince the readers that chiropractic care is effective and safe. I'm not saying it isn't. For the record, at this time I am undecided on whether or not I will recommend patients to a chiropractor once I am in medical practice. I think I need more info to make a decision either way.

The article talked about how manipulative therapies could help in the treatment of headache, disk herniation, neck pain and upper extremity disorders, asthma and COPD, digestive disorders, and even otitis media. The word "treatment" is important because even the authors admitted that chiropractic, in some of these instances, is only used to treat symptoms and not to cure the ailment. The claims of being able to treat such a wide range of problems were backed by research studies the authors cited. However, the authors noted significant criticisms of the early literature, citing a number of problems that I hope would not have been allowed in peer reviewed journals like the New England Journal of Medicine and the Journal of the American Medical Association.

Needless to say, I was a bit suspicious when I arrived at the chiropractic clinic. We took a tour and I waited for the grandiose claims that they could heal anything a medical doctor can. Fortunately, they never came. The staff there told us how they felt that the treatments they utilized had to be backed by evidence found in the primary literature. They didn't believe they could heal everything and they felt that they knew when it was time to refer patients to a medical doctor.

One doctor shared about how a patient of his had asked for a breast exam, thinking that a chiropractor would be more familiar with how the body should feel. He said he refused and referred her to a medical doctor, stating that he did not have experience in breast exams. Another doctor, when asked of the difference between chiropractors and physical therapists, stated that there isn't much difference.

Apparently there is a wide range of opinions within the chiropractic world. The doctors and students I met there seemed to be more conservative in what they felt they could properly treat (unlike the authors mentioned above).

I had the chance to watch as a young athlete was treated. At the end of my stay I was very impressed with the interns' (3rd year students) depth of knowledge in the areas of biomechanics and the musculoskeletal system.

I'm glad that the LCME wants us to have some familiarity with CAM. So many people take CAM treatments in one way or another that it is important for doctors and medical students to understand what is going on -- whether we believe in it or not.

October 1, 2008 by Jeff Wonoprabowo | Comments (10)

I Want To Make a Difference

JeffJeff Wonoprabowo -- I'm worried about how I feel about the upcoming November Presidential elections. I'm worried that I will be so frustrated that I decide not to vote.

At the moment, I'm not sure who I'm going to vote for. This coming election may very well be the first presidential election I vote in. But I can't stop feeling like my vote won't matter. That's why I didn't vote in 2004. And that may be the reason I have lost some of my excitement about this election.

For all the talk of change during this election season, how much change can my vote bring about? I don't live in a swing state. I live in the Golden State. It's a state where McCain doesn't have much of a chance of winning the 55 electoral votes.

It doesn't really matter who I vote for. Whether I vote for Obama or McCain, California will still send its 55 votes to the Democrats (I've heard that California is considering giving its 55 electoral votes to the candidate that wins the popular vote). The sense of my-vote-doesn't-matter is not encouraging.

That worries me. Because while thinking about this political situation, I started wondering about a medical one. In a course called Understanding Your Patient, we learned about teaming with our patients to bring about change -- change in behavior, diet, lifestyle, or even just taking medications. Compliance, our professor told us, sounded like a word that a ruthless dictator might use. Doctors shouldn't be forcing change upon patients. Lasting change requires a patient to decide that change is what he or she wants. Teaming with our patient is the most effective method to bring long-lasting results.

But what happens when I have a patient who is non-compliant? What happens when my 55-year-old patient with 40 pack-years refuses to quit even though the biopsy comes back positive for lung cancer? And what happens when I get a patient desperately needing a liver transplant who cannot get over his drinking problem?

When I inevitably find myself in a hopeless situation because a patient cannot or will not follow the healthcare plan, then what?

It'll be a situation where my "vote" means nothing. And I'll feel frustrated, I'm sure. In the political arena, I am considering not voting. In the medical arena, I'm not sure what I'll do because I've never been in that situation.

I'm worried about how I feel about the upcoming November Presidential elections. I'm worried that my feelings about voting might carry over into patient care -- that I'll get so frustrated I decide not to care.

September 24, 2008 by Jeff Wonoprabowo | Comments (12)

A Medical Student Is...

JeffglassesJeff Wonoprabowo -- There seems to be a public perception that medical students are all brilliant, Type-A, assertive individuals. If that were true, wouldn't one expect a physician population with those same three characteristics? Pretty much any nurse will be more than happy to talk about working with some -- to put it nicely -- not-so-brilliant doctor. So I must either conclude that not all medical students are brilliant, or that a number of students enter medical school smarter than when they leave. I prefer to accept the former. Besides, if I am a little like other medical students, then the former would have to be true. Because while I may occasionally have flashes of those traits, sometimes lasting only seconds at a time, I would not consider myself a brilliant, assertive, or Type A person.

But there are two things I have noticed about medical students. I'm sure, like all generalizations, there are exceptions (and I do acknowledge the possibility that I am the exception and I'm just describing myself). But again, from what I've noticed and observed, most of us share these two traits: 1) We're cheap, and 2) we're lazy. Here's a few of the instances that have confirmed these observations:

Most of us are cheap -- but only because we have to be. We're diving deeper into debt each year ($40,000 - $50,000 for those relying solely on loans at private schools), and we don't really have time to take on a side job. Living with less-than-desirable funds is a huge influence on our lives.

So how do you get a large group of medical students to an event? That's easy: free food. Just set the food out and the swarming begins. One of our professors loves bringing in snacks when he lectures. He's one of the class favorites. His lectures are pretty good, too. I often don't rush up to grab a handful of crackers, licorice, or cookies because, well, I'm lazy.

Most interest group meetings always include free meals. If I remember correctly, I've heard of three events in the past two days that will be offering free meals.

And one professor (neurologist) holds Bible studies once a week during lunch (yes, I do go to a Christian medical school). Lunch provided. The lecture hall is usually pretty full. Tomorrow is Indian food. I think I'll make my way over there for some food -- physical and spiritual.

A classmate told me that he buys Stater Brothers (a grocery store) gift certificates at the Student Services Center. They charge $92 for a $100 gift certificate. I don't know why I haven't heard about this before, but I think I'm going to be generous and buy myself a gift certificate.

Our Microbiology course director has decided that he wants to make classes more interactive. He ordered personal response devices, similar to these. The system records our responses and displays a graph showing how many students selected each answer. He wanted all the second years to go to the Dean's office and sign one out, but because of a mix up, we didn't get the email telling us to do so. So he brought them to class and told us to go sign them out at the office. A couple classmates strongly suggested we just pass around a paper on which we could all sign our names and write down the ID number of our device. It almost seemed like we collectively refused to walk to the dean's office.

Well, after thinking about it while writing this piece, maybe I shouldn't call myself and other students cheap. Financially responsible might be the more appropriate term. And we're probably not all that lazy. The last example is just medical students thinking efficiently. We conserve energy when we can.

By the way, has anyone else seen these traits in medical students? Or am I just transferring what I see in myself onto those around me? What words would you use to describe medical students? (Notice my attempt at audience interaction? See, I learned something from class.)

September 18, 2008 by Jeff Wonoprabowo | Comments (17)

No Downtime in Second Year

JeffJeff Wonoprabowo -- You can't afford any downtime. That was the message I heard from one of our professors (who also happens to be one of our deans) during the orientation to second year. As he is one of the course directors for Pharmacology, he suggested that we make flash cards. And those flash cards, he told us, should always be with us. Because should we find ourselves with a little spare time, we can pick them up and look at drug names, their mechanism of action, and what they are used to treat.

It's all quite overwhelming. The night before orientation -- and even walking to orientation -- I was very excited. Almost the kind of excitement I felt coming back from summer vacation in elementary school.

The excitement, though, has dwindled. Although it isn't all gone. I'm still pretty hyped. But the anxiety has also gone up.

I'm worried about the course load. The people I've talked to/heard from say that it's just harder than first year. A lot more stuff.

But I'm also looking forward to learning about diseases. The curriculum here at Loma Linda has us learning "normal" during first year and the diseases during second year. It should be fun.

I also got pretty excited when I saw that, scheduled on our first Friday, was a lecture entitled "Overview of Mental Disorders." After reading Kendra's post on Med Student Personality Disorders, I can't wait to hear what I have! And that's the way it is with the rest of our schedule. To my inexperienced eyes, it looks like the year will be jam-packed with info. But the info looks more clinical than last year. And for someone not interested in research as a career (at least not at this point), that is always a good thing!

Before orientation, I joked to my cousin that my excitement would be gone within two days. I certainly hope it stays a lot longer than that.

September 10, 2008 by Jeff Wonoprabowo | Comments (4)

Lessons Learned From First Year

JeffglassesJeff Wonoprabowo -- I'm sitting here in my room on the island of Kauai. It's the week before classes resume and my second year begins. Coincidentally, I've met two of my classmates on Kauai within two days of arriving on the island.

Being this close to the start of a new school year, I can't help but remember the feelings I felt before starting first year. I also can't help but think about what I've learned during the first school year.

My cousin, who is now an OB/GYN, told me to just study like I did in college. Unfortunately for me, I hardly studied at all in college. I was in an undergraduate program that was heavily math-based. I used to cram and be alright for tests because all I needed to know were theorems and/or concepts. The rest could be figured out or derived during an exam. Medical school was a big shift for me because now the majority of my studying consists of rote memorization.

So, from the perspective of someone who has had his share of first-year struggles, here are some of the lessons I learned from first year.

1. Figure out your learning style and figure it out fast. This one seems like it'd be common sense. But sometimes students find out that their way of studying isn't working and instead of changing their approach, they go at it harder. Personally, I felt that going to lectures helped me. But I know many of my classmates hardly ever showed up. If you thrive in a good group study, seek out some classmates and make a group. If not, then don't be forced into one. However, even lone "study-ers" can benefit from the occasional discussion with classmates.

2. Seek help. Students who make it into medical school are used to being near, if not at, the top of their respective classes. It might be hard to ask for help. If you need help, put aside your pride and ask for it. At my school there are tutors available for the first and second year students. I think that if I had sought out a tutor, I could have had some better scores. Don't wait until it's too late to get help.

3. Make time to do other things. It's really easy to get caught up with studying when the pressure starts piling up. But it's important to remember to make time to do things outside of schoolwork. Volunteer to tutor high school students. Take up a new hobby. Continue an old hobby. Go to the gym. Or even go and volunteer at a free clinic so you can get patient interaction. Don't let studying define who you are.

4. Study hard. Push yourself -- at least through the first semester. Then, you can decide how much you can afford to pull back while still attaining acceptable (in your eyes) scores. It's easier to "ease off the throttle" because you're studying more than you need to, than to "floor the pedal" trying to catch up at the end of the school year.

5. Finally, visualize. Remember the reason you wanted to go into medicine. Don't forget it. Then, picture yourself done with medical school and residency, and practicing medicine. Aim for that goal. Try not to let the stuff in between -- the grueling hours of studying in medical school or running around in residency -- get you down. They might be necessary parts of the journey, but they sure aren't the destinations.

Good luck!

September 3, 2008 by Jeff Wonoprabowo | Comments (44)

How Good Do You Want To Be?

JeffJeff Wonoprabowo -- I've been obsessed with these Olympics. It's been so inspiring watching the athletes compete. The last event I saw was the Women's Beam Final where America, led by Shawn Johnson and Nastia Liukin, won the gold and silver medals. After Shawn Johnson won the Gold Medal, the commentator talked about her background.

Ten years ago she bounced into Chow's (her coach) gymnasium and began training at the age of six. During those years of training her coach asked her an important question: How good do you want to be?

That is a question every athlete must answer for himself or herself. The top athletes in the world only want to be the best. And they put their whole soul into achieving their goals, putting in hours and hours of training every day. The answer to that question determined what kind of training Shawn Johnson would need; it dictated the course of her childhood, finally culminating in an Olympic Gold Medal.

A couple of weeks ago I asked why we, as medical students, should bother learning something we'll eventually forget. A number of people commented and left what they felt was the reason for learning such things. And I think they are all very useful answers to this question.

For me, the answer is best phrased in the question I heard while watching the U.S. Women's Gymnastics competition -– the same question Shawn's coach asked her: How good do you want to be?

At the end of my first year I spent almost two weeks on the General Surgery service. On the last day I was there I spoke with the chief resident who was less than a week from completing his general surgery residency. He spoke about his training and how he felt it was very well rounded. Because he had to rotate through many services, he felt comfortable speaking to internists, neurosurgeons, orthopedic surgeons, radiologists, etc. Even though those areas were not his specialty, he knew enough to communicate intelligently about a patient. These days, with multiple teams caring for a single patient, effective communication between healthcare providers is crucial.

Someone commented that a doctor with a broad base of medical knowledge is a well-rounded doctor.

A well rounded doctor means better care for patients. And it's all about the patients, right?

So... How good do you want to be?

August 25, 2008 by Jeff Wonoprabowo | Comments (29)

Picture Perfect

Jeff_2Jeff Wonoprabowo -- Like many Americans and non-Americans alike, I have been following the 2008 Summer Olympics. It's been fun watching Michael Phelps grab a record 8 gold medals, Misty May-Treanor and Kerri Walsh dominate on the sand, and the "Redeem Team" (I'm not sure who came up with that nickname) led by Kobe Bryant and Lebron James handle business in the early preliminary rounds.

But it's also been amusing to read the news about how Beijing has focused on putting on the perfect show. First there was news that some of the fireworks outside of the Olympic stadium were faked using the wonders of modern technology. Then I read that the cute little singing girl dressed in red was, well, just cute and little. She wasn't actually singing. The real singer wasn't "cute enough" and so the red-dressed girl was told to lip-synch.

It looks like China has been doing a whole lot to convince the world that all is well and perfect in their country behind that bamboo curtain. And maybe it is. But most likely it isn't. Of course, I have yet to find any place on earth that is perfect.

The whole idea of projecting perfection, though, reminded me of some of the things we discussed in class. One professor noted that doctors have this strong desire to stick together. They want to give a colleague the benefit of the doubt. As a result most doctors are very slow to offer any criticism, often exercising their right to remain silent because they weren't present during the procedure.

I think that giving the benefit of the doubt is great. False accusations can lead to devastating consequences. But there have been instances when certain doctors no longer deserved the benefit of the doubt. An extreme situation is described in the book Blind Eye by James Stewart. In that book, Stewart writes about a doctor that got away with murder.

Would transparency in the medical field be beneficial to both doctors and patients? I'd like to think so. But sadly, with our current litigious environment, complete transparency would be a nightmare.

And so, doctors may very well have to continue painting that picture perfect image of medicine.

August 17, 2008 by Jeff Wonoprabowo | Comments (4)