please help

If you read this you probably already know about this or got an email from me about it, but I'm going to hope there is one person who reads this who I don't know or who is otherwise unaware. A student at my school is fighting leukemia for the second time, and needs a bone marrow donor. Please consider signing up in the marrow registry to see if you could be her match, or someone else's.



TO REGISTER AS A DONOR:
http://www.marrow.org/JOIN/Join_Now/join_now.html
From NOW until May 4: Use code APAMSA509 for FREE REGISTRATION
For more information about Natasha and donating, visit:
http://www.facebook.com/home.php#/group.php?gid=65568844747&ref=share

Also, there is always great need for minority donors.

The support of our school for Natasha reminds me of how presence matters within a group, regardless of what the concrete connections between people are. It's easy to acquire a sort of distaste for the impersonal nature of being in a group, of wanting to remove yourself from it so as to differentiate yourself. To the extreme I think this can end up being something to regret. This is not, of course, to say that we should identify ourselves solely by the outlines of a group at the sacrifice of forgetting what we want and value as individuals. But it seems to me that being your own person doesn't require denying that you are part of something. Even with everything else that goes in the world these days, it's something I often forget. I think the microcosm of school, and the need for people within any sort of community (the limited one of our university and the all-inclusive one of people in general) to remain aware of one another, reminded me of it.

So many people work their entire lives to impact others, in different ways. They acquire skills, build organizations, talk to people. In your jobs, in your personal lives, there is a sense of making some sort of impact, whatever that may mean to you. And I mean impact in a general sense, because so much of what we do is to shape our own lives or those of others, from the small things of going to class or consoling a friend, to the big things of building a family and career, and that is all impact. This takes five minutes of your time, and when else will it be so easy to have the huge impact of possibly saving someone's life?

Once you sign up, you'll receive a simple kit that involves swabbing your cheeks with Q-tips and sending them back. As for the marrow donation itself, please see below for myths and facts. Please consider signing up, and PLEASE spread the word: email your friends, post it on facebook, blog about it. Post the video (http://www.youtube.com/watch?v=CAvv-7L3J-k), or the facebook group link (http://www.facebook.com/home.php#/group.php?gid=65568844747&ref=share). It's not spam. She's only 26 years old, and really needs your help to find a donor and survive beyond the next six months.

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Myths and Facts about Bone Marrow Donation
MYTH: The bone marrow donation procedure is painful.
FACT: General or regional anesthesia is always used for this procedure. Donors feel no needle injections and no pain during marrow donation.

MYTH: All bone marrow donations involve surgery.
FACT: The majority of donations do not involve surgery. The patient's doctor most commonly requests a peripheral blood stem cell (PBSC) donation, which is non-surgical and does not require a stay in the hospital. If marrow is requested, it is a surgical procedure, but there is still usually no stay in the hospital.

MYTH: Pieces of bone are removed from the donor.
FACT: Pieces of bone are not removed from the donor in either type of donation. A PBSC donation involves taking the drug filgrastim for five days leading up to donation in order to increase the donor's needed blood-forming cells. On the fifth day, blood is taken from the donor through one arm, passed through a machine that separates out the blood-forming cells, and returned through the donor's other arm. In marrow donation, no pieces of bone are taken; only the liquid marrow found inside the bones is needed to save the patient's life.

MYTH: Donating bone marrow is dangerous and weakens the donor.
FACT: Though no medical procedure is without risk, there are rarely any long-term effects from donating. Only five percent or less of a donor's marrow is needed to save a life. After donation, the body replaces the donated marrow within four to six weeks. The NMDP screens all donors carefully to ensure they are healthy and that the procedure is safe. The NMDP also educates donors, answers questions at every step, and follows up after donation.

MYTH: Donors have to pay for the donation procedure.
FACT: Donors never pay for donating. All medical costs are paid by the patient's medical insurance or by the patient, sometimes with NMDP assistance. The NMDP reimburses donors for travel costs, and may reimburse other costs on a case-by-case basis.

Source: www.marrow.org

genius

 There is much to say about my dad who is amazing, some of which I hope to share in the future. For now, this earned an entry all to itself. What is this? I asked the same thing of my dad, the maker of this mighty contraption. It's a book-binder.

My dad builds a lot of things. Without any prior experience for any of his projects, he browses Home Depot, buys what he thinks he needs, and builds. An outdoor stove, a storage house, the stone landscape leading to our front door. But I think this one most sums up why I am so crazy about my dad. My dad reads a lot of Vietnamese books. He decided that instead of buying them, he'd make them. He finds them online, copies them into word documents, and proofreads and edits them (he also proofreads books he already owns). Because he prints four pages on a piece of paper (two on each side), so that they can be folded and read like a normal book, he must first place them in Word accordingly. This is a bit hard to describe, but what it means is that from left to right, pages 4 and 1 are printed on one side of a paper, and pages 2 and 3 are printed on the other, so that when it's folded it reads 1, 2, 3, and 4.

He built the above with some slabs of wood, and this other silver and black device seen that was designed for another purpose (I don't know what), which allows him to change the length of the contraption and keeps the pages bound in the width that he wants. He places glue across the binding, waits for it to dry, and gets to work on the covers...the end product is this:
 
The zoom of my camera lens was too high for me to hold a book open with one hand and take an adequate photograph with the other, so I used a stapler to showcase it. My dad would've come up with a better solution but I ended up liking this aesthetic. After I asked a million questions about this meticulous process and commented on the many details this entails, he laughed and said, "When you actually do it the details keep arising!" When I told him I was impressed, he laughed and said, "If you can think up something, you can do it." These sorts of things have always sounded more right to me in foreign languages.

blindness

I have a throbbing headache, of a kind that would follow lots learned in a compact time but in my case is the result of considering the ONE thing I learned today that I'll actually remember. So we learned about a disease where the blood vessels in your head are inflamed, and when this affects the vessels to your eye, you can suffer sudden blindness. You have to treat this immediately with steroids, to save the other eye from blindness. Something I appreciated from lecture that can't be read from books was the comment on the context of the patient. The professor noted that because patients with this disease are often elderly with numerous co-morbidities, treating them with steroids is no light decision. Steroids affect just about every part of you, and it will worsen your diabetes, osteoporosis, and heart disease, all of which one elderly patient probably has. With perhaps not a very extended time left to live, the question arises of whether saving sight is worth exacerbating life-threatening conditions. Our professor posed this question and answered yes, because when blinded, the elderly often pass away within a few years. Such loss is difficult to adjust to, and depression is a co-morbidity as well, even as its path to loss of life is not as clearly defined as say, a stroke. While blindness leads to concrete things that affect health and may lead to death, like falls and fractures, it's really the general state of not seeing that is harmful.

The image of a body whose many parts have lost their respective vitalities, fighting for its sight, made me a little sad, but it also seemed right. I'm glad that when people choose to struggle, it's not for subsistence but for substance.

skin

Last year we went to the British Art Museum to develop "observational skills." Even as someone who likes art, I didn't think this experience would be particularly fulfilling of its purpose but it was. We formed groups of four and were each assigned a painting. We were given something like twenty minutes to study the painting and plan how to describe it as objectively as possible to the rest of the group. And they were serious about "objective." You couldn't make any assumptions about what things were or what people were doing; you can say a person is smiling but you can't say a person is happy. People who knew me and my over-contextualization and over-feeling thought it'd be near impossible for me to avoid subjectivity. But most of those things arise from intrinsic details, and the only way to contextualize is to see those things first. That said, from day to day we have very little space to focus on just those. And while it might seem limiting to only see the very basics, it can actually be pretty expansive. You're forced to pay attention to every shade of color, the size and placement of objects, and relate things in the painting only to each other and nothing outside of it and so you find much more in that square. It makes you search for how things are defined in the first place. Someone was burned for calling a church a church; he had to reach far for something like "building with raised column." Anyway, it was really nice to sit and just look for some time.

Afterwards we examined photographs of skin lesions and went around the room describing them, similar to the paintings. It was more difficult, because rashes and irregular shapes aren't as situated in a larger picture. Since then I haven't been exposed to any dermatology until reading the skin chapter today. While in general I was a little bored by the fact that there isn't as much of a "system" as with say, the lungs or kidney, after awhile all the skin problems don't actually look alike. As nerdy as it is, there's certain satisfaction in finding the distinguishing details in shade, texture and quality. The terminology became less annoying, when used to encompass certain descriptions in a word. A vesicle is a fluid-filled blister, but a pustule is a fluid-filled blister with inflammatory cells. I like when language is invented and manipulated for accuracy and nuance.

But--and the reason I began to write at all--why does the term "violaceous" exist? The skin...is...just...purple.

beeeeep

The other day we were given beepers. Since we became med students in the fall of 2007 we have visited the hospital weekly to interview patients, learning how to do a history and physical. In a few months we're going to do it not for practice but for real. People will beep us in order to do so. My beeper was much smaller than I expected. Everyone else's were small too, but I don't know what they expected.

In anticipation of the beeper's use, they sat us down today and kind of told us what our third year will entail. In one year we are to do the following "rotations," not necessarily in the following order:

Internal Medicine (8 weeks of inpatient care, 4 weeks of outpatient care)
Surgery (4 weeks of general, 4 weeks of subspecialties)
Anesthesiology (2 weeks)
Emergency Medicine (2 weeks)
Pediatrics (8 weeks)
Obstetrics & Gynecology (6 weeks)
Psychiatry (6 weeks)
Clinical Neuroscience (4 weeks)

We were told that we would be faced with three major changes during this transition from book learning to patient care: we are required to be there, to dress appropriately, and to get grades. Seeing as how I don't go to class, glean much joy from bright accessories, and have stopped taking our voluntary self-assessments, these are big changes for me indeed. But none of those came to mind when faced with a beeper and eighteen pages of logistics about just choosing the order of our rotations.

We're constantly being told not to stress. Don't stress about getting the highest score on the Boards. Don't stress about planning the order of your rotations. Don't stress about controlling your life to get the best residency after graduation. Don't stress about getting poor grades on rotations because you don't know something. These are legitimate concerns that we'll all face when being pimped by an intimidating superior with a million times your knowledge and experience, and I am sure I will be stressed. It seems to me, though, that in the midst of all this reassurance about our performance as students who are responsible for their own futures, I worry most about my performance as a person who is now responsible for others.

Sometimes that thought hits me so hard, especially during all these rites and milestones we have that make this field different than others for me. I find it difficult sometimes to convey our experience in medicine so far, and we haven't even experienced it. I felt a lot during our white coat ceremony, but what it was I can't even say. I just know it was supposed to be a marker for something. During the dinner where we received our beepers and thanked the mentors who have guided us through patient interviews since we started, we were made aware that this is a point of moving on. Combined with all the patients we've met; the science we've learned; the non-science of ethics, insurance, professionalism, social issues, and so on we've been exposed to--medicine has become all-consuming, and while that can be inevitably hard, it's made me think much harder about reasons.

In the past, getting to certain places was about a sort of validation of what came before. Getting into college bundled up accomplishments up until then into a neat package. Getting there was also a means to go elsewhere. I wanted Harvard simply because to my 18 year old self it meant a new coast and possibilities and possibilities. Medical school followed a similar thought process, where my college experience was tied up in an application to medical school. Even as each individual thing I did or learned had its own value for me independent of what it meant for school, to explain it to someone else I had to frame everything in terms of getting here. And I wanted to get here, in order to go somewhere else good afterwards. In between the markers of acceptance and graduation, I had an incredible time and learned so much wherever I was, but that can get lost amidst the bookends.

Now, while we may stress because the Boards and rotations are to lead us somewhere, the concern for me lies in making the present worthwhile regardless of where it takes me. I doubt the people who will let us learn about them at their most vulnerable will care much where we go for residency after school or the kind of career we'll lead. I'm not immune to caring about these things (I would like to be in a path that will fulfill my reasons for going into medicine, in a location I like and with people I love), but harder and more important than achieving them, I would like to do well by the people we've been waiting to care for, in the moment we meet them and not for anything before or after.

moles

By way of scrutiny from my mother and ex-boyfriend, I learned that my face contains numerous small flat black moles. I say flat to qualify moles because they aren't raised as I thought defined moles, but I can't think of what else to call them. My mom once called the two that are in proximity, in a sort of diagonal that follows their course between cheek and chin, twins. The fact of her saying this is fuzzy, but has sharpened from my thinking it.

Murakami has a thing for ears, and as I recently discovered, moles. I read a story of his the other day that made me smile hard and aloud: "There was a single mole, he noticed, on her right earlobe. His older sister had a mole about the same size, in the same spot. When he was little, he used to playfully rub his sister's mole when she was asleep, trying to rub it off."

The story, called Chance Traveler, begins by saying that he is narrating this story in his own voice. He wants to relate some strange events that have happened to him, that never get much response when he tells them in conversation. Even when written, people don't believe him because they assume that as a novelist, all his stories must be just stories. He'd like to try again, after telling us these strange events are real, and says he'll "stick to the trifling, insignificant ones."

This is the first one:

*

"From 1993 to 1995 I lived in Cambridge, Massachusetts. I was a sort of writer-in-residence at a college, and was working on a novel entitled The Wind-Up Bird Chronicle. In Harvard Square there was a jazz club called the Regattabar Jazz Club where they had lots of live performances. It was a comfortable, relaxed, cozy place. Famous jazz musicians played there, and the cover charge was reasonable.

One evening the pianist Tommy Flanagan appeared with his trio. My wife had something else to do so I went by myself. Tommy Flanagan is one of my favorite jazz pianists. He usually appears as an accompanist; his performances are invariably warm and deep, and marvelously steady. His solos are fantastic. Full of anticipation, then, I sat down at a table near a stage and enjoyed a glass of California Merlot. To tell the truth, though, his performance was a bit of a letdown. Maybe he wasn't feeling well. Or else it was still too early for him to get in the swing of things. His performance wasn't bad, it was just missing that extra element that sends us flying into another world. It lacked that special magical glow, I guess you could say. Tommy Flanagan's better than this, I thought as I listened--just wait till he gets up to speed.

But time didn't improve things. As their set was drawing to a close I started to get almost panicky, hoping that it wouldn't end like this. I wanted something to remember his performance by. If things ended like this, all I'd take home would be lukewarm memories. Or maybe no memories at all. And I may never have a chance to see Tommy Flanagan play live again. (In fact I never did). Suddenly a thought struck me: what if I were given a chance to request two songs by him right now--which ones would I choose? I mulled it over for awhile before picking 'Barbados' and 'Star-Crossed Lovers.'

The first piece is by Charlie Parker, the second a Duke Ellington tune. I add this for people who aren't into jazz, but neither one is very popular, or performed much. You might occasionally hear 'Barbados,' though it's one of the less flashy numbers Charlie Parker wrote, and I bet most people have never heard 'Star-Crossed Lovers' even once. My point being, these weren't typical choices.

I had my reasons, of course, for choosing these unlikely pieces for my fantasy requests--namely that Tommy Flanagan had made memorable recordings of both. 'Barbados' appeared on the 1957 album Dial JJ 5 when he was a pianist with the J.J. Johnson Quintet, while he recorded 'Star-Crossed Lovers' on the 1968 album Encounter! with Pepper Adams and Zoot Sims. Over his long career Tommy Flanagan has played and recorded countless pieces as a sideman in various groups, but it was the crisp, smart solos, short though they were, in those two particular pieces that I've always loved. That's why I was thinking if only he would play those two numbers right now it'd be perfect. I was watching him closely, picturing him coming over to my table and asking, 'Hey, I've had my eye on you. Do you have any requests? Why don't you give me the titles of two numbers you'd like me to play?' Knowing all the time, of course, that the chances of that happening were nil.

And then, without a word, and without so much as a glance in my direction, Tommy Flanagan launched into the last two numbers of his set--the very ones I'd been thinking of. He started off with the ballad 'Star-Crossed Lovers,' then went into an up-tempo version of 'Barbados.' I sat there, wineglass in hand, speechless. Jazz fans will understand that the chance of his picking these two pieces from the millions of jazz numbers out there was astronomical. And also--and this is the main point here--his performances of both numbers were amazing."

*

I typed that all out, because I like to forgo cut and paste in favor of re-typing writings (lyrics, quotes, so on) and because in a Murakami story I read a couple months ago he wrote:

"Just below her shoulder blades were two small moles, lined up like a pair of twins."

vietnamese food

I made myself a meal for the first time in weeks. It made me feel slightly more human, less robot. I made my mom's crack pork chops (with sauteed scallions and shallots, leftover from our potluck last week) with steamed broccoli and basmati rice (ran out of my other white rice). It was simple and satisfying, and made me miss my mom very much. So I made a decision that makes me happy. I decided to violate my plan of doing nothing on those six Sundays during Boards studying. I've wanted to learn and compile my mom's recipes for a long time, but resisted making this (and several other ventures) a goal during my study time at home. I wanted to let go of the need to be "productive" even on my "day off." I'd pretty much planned on being a couch potato on those no-study-Sundays. I haven't entirely abandoned this image of myself (my dad will have plenty of company on the couch). But atop of my meal today, some small coinciding events reminded me that my mom's cooking is something I want to preserve. These included meeting up with a junior high friend I haven't seen in a couple years, who still remembers how good the food was that my mom fed her when we were thirteen; being sent an article about students discovering their immigrant parents' stories way past the time they felt there was little left to know; and Allison raving about Vietnamese food.

I can make my mom's crack chicken and pork chops which have become addictive staples among those I've fed it to (hence crack), egg rolls that I steep in oil despite everyone's complaints about unhealthy because that's how my mom does it, and her various kinds of eggs (yes you can put ground beef in eggs). But I have a list of others I'd like to learn and have been limited in the past by ingredients, or her protest that I'll never make these things because they're meant to be consumed by groups. These include a tangy sweet and sour catfish soup; my favorite kind of spring rolls with boiled beef and pineapple; Vietnamese crepes with shrimp, pork and bean sprouts; and my favorite favorite meal of all time, a noodle and fish dish that she makes every time I come home. The fish is marinated and fried with onions and lemongrass, served with vermicelli. Condiments include roasted peanuts, raw onions soaked in vinegar, some pickled vegetable whose name I don't know, crispy sesame rice paper, lettuce, and other Asian greens whose names I also don't know (part of this project entails learning names). As with a lot of other dishes, you don't eat it in one big bowl; you use a small rice bowl and keep re-filling it as you go. You take some noodles and fish, add condiments to taste, and top with a key component: a pungent shrimp sauce mixed with red peppers from the backyard. I do believe the essence of my love for food lies in 1) sauces and 2) mixing things. Some people finish their burger before they eat their fries; I always complement a bite of burger with a few fries. This dish isn't something most people like on first try, but once your palate adjusts it is such an amazing blend of flavors and textures.

To prove that I'm studying and not just daydreaming about my mom's food, I'm going to impart something interesting I've learned in posts when possible. Today I learned that three out of five heart transplants are rejected by the immune system of the recipient. Getting a new heart is pretty wondrous, but it's not so easy. People miss what's theirs when it's gone. As an almost twenty-five year old, I find it a bit pathetic that I consciously miss my parents probably more than they miss me. I hope this helps keep them close.