Sunday, August 31, 2008

Week One Done

So I am now officially through one week (and almost one weekend of medical school). The second day of class was much the same as the first: lots of information but useful information.

There came a point today for the first time (and I don't expect it to be the last) where I was trying with all my might to focus, but the information was coming so fast, I could not even follow what was being said. I've zoned out before, but that's just my being lazy. I think this is the first time my brain reached it theoretical limit. The rain came down, the reservoir filled, and then the water poured right over the dam. Let's hope its a concrete dam.

I had a spectacular day going to church, having a great lunch with friends, and then enjoying some good, quality time with God in a beautiful, secluded oak grove very near the center of campus. Here is what I had to deal with today (left). And here is who I spent the time with (right; I took the photo today at the Stanford Church). Can Sunday get any better?

Much less inspiring, but much more funny was what happened in Histology on Friday. We had our first Histology class (looking at slides of cells). We had an hour of lecture with example cells, describing what to look for. Then we got our microscopes and tried to find the cells on our slides that they described.

I thought, "Great! This looks really easy! I'm pretty good at identifying shapes! Gee Golly Gosh!" And I looked at my first slide. I had used a microscope pretty extensively in my old lab, so the controls were very familiar. I saw other struggling with their microscopes. "Amateurs," I thought. "I'll condescend to their level and help out the poor devils with the focus. So sad..." I helped out as I could with loading the slide, and focusing on the cells. Child's play. Then I sat down at my microscope, loaded the slide, then quickly and efficiently moved down to the appropriate zoom. And I didn't recognize a single cell.

My heart raced. I began scanning violently around the slide. "Where in the **** are the Neutrophils?! ****! For that matter, where the **** are the Erythrocytes. I can't even find the ****ing Erythrocytes!!" Thus was my thinking (**** represents, 'world', 'shucks' 'heck', and 'bi-concaving', respectively).

I turned to my neighbor (who seemed to actually know what the **** was going on) and asked if I could look at her slide and she could point something out to me. And from thence came my deliverance. It was a different slide. I could clearly see Erythrocytes, Neutrophils and even an Eosionophil on her slide (peripheral blood smear looks like left) . I talked to the TA and got my own slide. I waxed prideful again, able to easily identify every cell type on the peripheral blood smear. I confidently moved onto the bone marrow slide.

"****," I thought. "They all look exactly the same. Probably another mislabel." I checked again with my neighbor. "****," I thought again, "It's just like mine." I went back and tried harder to look for differences. There were no differences! They were all purple dots that looked exactly the same. And I was supposed to tell the difference between promyelocytes, early myelocytes, late neutrophilic myelocytes, and metamyelocytes, and I couldn't even tell the difference between a myocyte and an erythroblast!

I looked for help. The TAs were occupied. Some people were packing up. Finished! And I just started my second slide! "Oh no! I had expected to be the dumb one. And it begins now, on day two!" I bemoaned to myself.

One of the TAs had projected his slide onto a TV screen and began describing the differences. And he did a darned good job. I then was able to see the subtle differences and remembered them fairly well. And by the end of that hour I got pretty good at blood histology, and actually (but just a little) started to like it.

P.S. The photo is from Wiki public domain, so don't worry course administrators, I haven't posted course materials

Thursday, August 28, 2008

Day One


Last night I struggled with insomnia. It took me 90 seconds rather than the usual 30 to fall asleep. Needless to say, I was anxious about my first day of class.

I got up before my alarm, which is usually the start to a good day. I made a sandwich and packed my lunch, pretending like I'm going to have time to do that this year. A tasty roast beef sandwich with fresh tomatoes, onions and lettuce, topped with mild cheddar, olive oil, vinegar, sea salt, and freshly ground pepper. Mmmmmm. It took me 1/2 an hour that I didn't have to make my lunch. I'll be quicker tomorrow.

Off to class!

I got out the door at about 8:30 for a 9:00 class. Another beautiful bike ride across a beautiful campus with beautiful weather (forebodingly warm at a quarter to nine) put me in an even better mood. I sat down next to two amazingly cool people in the front row of my first class ever at Medical school and got ready to start. The lecturer came in and started talking about the history of molecular biology. What surprised me was 1) he was a good speaker, 2) he actually wanted us to learn 3) he was funny 4) we talked about how prions are basically exactly the same as the Borg in Star Trek, a point we expanded for about 10 minutes. So I was sold on my Molecular Bio professor.

After two incredibly interesting hours of class, we went on to a Cells to Tissues class. The lecturer here started at about 25% the speed of light and never slowed down. This class was also very interesting. We talked about cells and stem cells (normal ones in adults) and how powerful they are. I am continually blown away (and expect this will not end) by how incredibly well designed the human body is. One reason why stem cells stay so rare is to minimize copying errors; they only grow when they need to, and they stay as close to the target tissue as they can. And the balance is also incredible. If intestinal tissue grew only 5% faster than it should, after one year of growth, it would increase its size by 10 times. Cancer is a small imbalance (~1%) of too much growth (or too little death). It's amazing that we don't always have cancer everywhere.

I ran over to the Financial Aid office to ask for money on my lunch break, but got back with plenty of time to eat my delicious delicious sandwich and chat some more (it happened to be about water infrastructure... oops).

The post-lunch lecture was Anatomy. This class I was a bit concerned with as I have never taken an anatomy class. The good thing about the class is that both the professors are Brits, which makes for endless entertainment and makes them seem inconceivably smart. We learned about the chest cavity. We had about an hour lecture on it before we headed off to the Anatomy Lab... dun dun dun.

Before we got to meet our cadavers, we had to change into our scrubs. It was like high school gym all over again. 40 guys in a locker room stripping and putting on funny blue clothes brought back memories.

We entered the Anatomy Lab and found our table. There were two sections of the room with twelve tables each. On the table was a blue fake leather bag with a big black zipper on it, each with the shape of the body visible by the folds in the bag. We walked over to the table, received instructions, observed a moment of silence for the donors, and unzipped the bags.

The cadavers were covered with a damp sheet, with an additional cloth over the hands and the face. The skin didn't seem real; it was too plastic-ey and pale. I took the plunge and made the first incision for my group along the clavicle. At first, it seemed unusual, but not as eerie as it should have been. We took off the layer of skin and fascia to reveal the pectoralis major.

To get to the serratus anterior, we needed to move the arms out to the sides. We took off the cloths and moved it out. This is when it started to feel like a body, once we could see the hands. Also noticing the armpit hair and other things which I didn't expect reminded us that it was actually a human we were working on. Even then, it was only a passing thought; the really interesting part was the intercostal muscles and the corticoid process and the other parts of the anatomy, not as much as I would have expected, the emotional side of the body.

We completed the dissection and washed up. We went back to the locker room and changed back into normal clothing. It was 5pm. We had class 9-5. And we will have class 9-5. We are all really tired and it's only the first day. I expect we will learn to strive at this pace, but we have not learned that yet.

That being said, medical school doesn't seem to be that hard. There was nothing today which I had trouble learning. The only challenge is keeping this up. Can I learn that much every day for two years? Medical school is a marathon, and one we have all been training for. If I can maintain this pace, I'll pass with flying colors (not that my colors will fly any more than the next man with a Pass/Fail grading system). I do not have significant fears that I will grow weary, but this, I suppose, is a great risk.

The second, and more likely, is distraction. There are about a billion opportunities for doing great things here. I just cannot get too distracted from class. Nothing seems to be immediately threatening, but those would be the two predicted 'modes of failure' (as Civil Engineers say), so should be protected against or reinforced.

P.S. I still smell like formaldehyde.

Monday, August 25, 2008

The Exodus

I've just written about what I like about Stanford. Now comes the previously untold story of how I got here. "Here" being after Day 1 of Orientation. And not "How" like in a philosophical or historical sense, just how I drove up the 5 and stuff like that.

I drove up to Stanford a week ago Monday. For whatever reason (but probably because I hate doing paperwork and usually protest by doing it poorly), I did not get have any information on things like where I was living and where to meet for the get-to-know-the-class camping trip called SWEAT, (Some Weird and Eccentric Acronym-Thing). I thought it was Tuesday, but that was the end of my knowledge. I had learned by this point that my phone, which was a very nice PDA, did not do phone-things like receive calls ever and made them only when it felt like it. It was under these circumstances that I drove a Prius up to Stanford loaded with all of my earthly belongings. 15N->210W->5N = 7 hours.

The drive was mostly nice. I like Kettleman city, but decided to stop at Bakersfield instead because I was too hungry. After a half-hour of clogging my arteries, I continued on. It took me about 7 hours to reach Sacramento, where I would stay on Monday night with my buddy at Davis Med. We met up, and he pretended to study while we talked. I crashed at his place.

The next morning I left early and headed for Stanford. I didn't have a map of Stanford, but I did have one of California, so I followed signs into campus. Once there, I tried to find the housing office. Not knowing anything about Stanford, I was unsuccessful. I had found a single phone number online for the housing department, so I called that. After 4 attempts of failed transfers and leaving messages, I was finally connected to someone who knew where it was. I drove right there, told them my name, showed ID, and was given a key. Simple as that.

Having figured out my housing, I decided to call Josh, the guy who was leading the camping trip (and ironically enough, the guy who used to tell me to wash dishes at UCLA), and he told me where to be the next morning. I then moved all my stuff up to my room (6th floor).

The way my roommate wanted to partition the room, I've basically got a studio to myself (instead of a shared bedroom + living room), which is fine by me. I've got a great view of the campus from my window, and privacy. Not that I really understand privacy, having had at least one person sharing my room since college began (in one case, 3 others shared my room). I kinda like it, though I can see the potential for greed in having MY space (which should always expand and never be infringed upon); I've never really had the luxury, but am certainly enjoying it (hopefully with minimal greed).

The next day we left for SWEAT. I was driving for one of the car-camping groups. Just to save my precious reputation, I wanted to go with the hard-core backpackers, but for the aforementioned loathing of paperwork and procedure, didn't sign up early enough.

Our leader was a second year, and he guided us with his fancy phone GPS. We tried to meet another group of people in Stockton for lunch, one of the girls told us they drove south from where we were. It turned out that by "south" she really meant "north," but with corroboration by the GPS, we headed south. Once we were clearly outside of any recognizable city in "French Camp," I got off the freeway and turned around amidst cries of, "It's a GPS, it can't be wrong!" It turned out that it was. We ended up finding them and getting some really good Mexican food in a sketchy part of Stockton.

We arrived and the lounging began. The three days were filled with mostly eating and waiting to eat again. We did typical camp stuff (day hikes and swimming) the first day. When it came time to build a fire, nobody knew anything about fires (except me, of course, being an Eagle Scout). Not that I was particularly good at building fires, but, being the only backpacker, my paltry knowledge was sufficient to bedazzle the poor group of campers. The concept of tinder->kindling->fuel was black magic to those who looked on in awe of my powers to control the flames. So thus I established myself as the great and wise woodsman. You know what they say: "In the land of the blind, the one-eyed man is king." [As a side note, it was pointed out to me that the saying would be more accurate if it went "In the land of the blind, the one-eyed man is stoned to death," thought the traditional story was what applied to me.]

The second day we decided to go for another day hike. A group of us decided to extend the day hike into a long day hike. One girl said she wanted to do it, I said I'd go to, and before we knew it, another four people had peer-pressured each other into going. Fortunately at that point, nobody knew that it was probably 4 miles each way or else they would never have attempted it. So a group of green campers embarked on a journey that very well could have killed them. Fortunately, they all survived and with minimal griping, so little in fact that no violence was done even to the most whiney among us. Everyone was proud of themselves upon completing the journey.

The last day we did a skit. Being the car camping group, we had procrastinated our task of coming up with a skit until the last minute. We discovered that it was not the last minute, because other groups actually started after we did. In the end, we came up with a very funny skit mocking our own laziness. The other groups ranged from obscene to confused. After a little bit more socializing, we drove back home that night.

The weekend following SWEAT, I kept busy. I did a lot of sleeping in, a bit of shopping and lots of eating. I got a bike from Target so that I could be like everyone else. Normally a statement like that is hyperbole, but I'm pretty sure every one of us will own a bike by the end of this week. So I had to fit in. So I went to Target with two friends and we bought two bikes. We successfully fit two bikes and three people inside my Prius. That's right. It's a hybrid.

On Sunday I went with seven others to attend Abundant Life Christian Fellowship nearby. It was amazing! It looked like it used to be a Black Southern Baptist Church; it had a Gospel Choir, very upbeat music, and good, loud singing. The preacher was black, so the traditional white conservation of energy on the podium was not visible. There was no lack of power in the message, and more importantly, it was Biblically based. I'm going to try out some other churches, but I doubt I'll find anything better.

Orientation started today, and it was pretty, pretty, pretty good. We had a very inspirational speech by our Dean, an entertaining speech by our Associate Dean, and then a very interesting talk by an author/faculty member whose book I was supposed to have gotten and read. Neither had happened, the latter on account of the former, but the talk was very interesting nonetheless. We were supposed to have a 24-student discussion on ethics and balancing life with medicine which was quickly turned into a 6 student + 6 professor discussion.

In between all this were lots of breaks where I got to meet more and more of my class, who, as I previously described, are amazing.

Next Step
School starts officially on Thursday, and before then I've got a two-page of administrative things that I'm supposed to do. They're the kinds of things that nobody really wants to do, but are indicative of the developed world. Things like online registration and financial planning. I really like flying by the seat of my pants and am rather annoyed at having to use instruments.

I've got another two-day grace period of orientation, and Mom's coming on Wednesday, so I've got lots to distract me from the elephant in the room (the hardest class of my life starting full-force on Thursday). It's a pretty angry elephant, and I think addressing it further would only upset it, so until Thursday I plan to ignore it.

"Take no thought for the morrow: for the morrow shall take thought for the things of itself. Sufficient for the day is the evil thereof." - Matthew 6:34

Why Stanford Rocks

So I'm at medical school now, for those of you who don't know at Stanford. The last week has been something of a blur, the experiences smearing into each one another like colors on film. I don't exactly know how to sum it up, but I'll say this: I am certainly happy here and with my choice. And here are some of the reasons in no particular order:

Exciting thing A - Outstanding Class
My classmates are outstanding, I'm honored to have the chance to work with them. My choice to come here because of them was truly justified. The Dean spoke today about how Stanford doesn't just want to train excellent physicians, it wants to train leaders. The 86 of us all have that spark. We're all normal enough to hold a conversation. We're all brilliant in at least one area (most of us in several). We've all done something amazing, mostly post graduation. Some have PhDs and Masters, some are Fulbright scholars, some have started NGOs, some have published extensively. Everyone has done something amazing.

Exciting thing B - Christian Community
There are actually a good number of strong Christians here. I'm going to be able to go through this with people who share my convictions, and people with whom I can pray and grow spiritually. As supportive as church groups can be, having this core of people who will share life with me for the next two years at least will be very important.

Exciting thing C - Global Health Interest
Everybody wants in on Global Health. Though there is only a minority of people who actually have done work abroad, it seems that there is broad interest, even among the basic science people (lab rats), to help out globally. We have done some pretty spectacular things separately, and we really want to work together. We're at the beginning stages of a potentially large, collaborative project.

Other Exciting Things
The weather has not ceased to be spectacular.

The faculty has not lost their gravity of presence; when they speak, especially our Dean, they speak with authority. They are not pompous, but are such strong personalities that they command attention.

There have been several groups that I've been the only American-born person in the group. The national diversity is spectacular (though we are lacking in under-represented minorities).

We have an army of people working for us to make our life easy and our learning successful.

The food around Stanford is amazing. Thai, Chinese (dim sun), and Indian were all eaten in the past few days, most of these being ordered from the place by a person who spoke the relevant language.

Tuesday, August 5, 2008


I am in Turkey working with the UNHCR and doing a lot of really cool work. I've been updating another website, so if you are a regular blog reader and want to keep up on what's happening in Turkey, go to:

If you want to comment on any of the pages, email me and I'll give you collaborator access.