just in case you didn't remember, i'll remind you that you're asian

ugh, so i fell off the wagon again re: blogging, which is really depressing since 2/3 of my intern year is over. i meant to document my intern year , or at least use my blog as a means to process the pretty significant changes that have gone on this year, but i think i've always felt that i've needed to have some sort of beginning, middle, and end to every entry and the challenge sometimes (or often) seems too insurmountable. my good friend liz eaman has made it a point to do at least one entry per month throughout her residency, and i think that's something i'm going to try to do from now on.

so, not even sure where to begin here. i thought about writing because of an interaction i had this morning with an older man (mediterranean maybe?) in a coffeehouse. at first, he was friendly, talking to me about michigan (as i was wearing a michigan sweatshirt) and how he used to live in detroit. soon, he started talking about how "you people came and started selling your toyotas, hondas, and all those cars and then americans couldn't sell cars anymore." i wasn't sure exactly how to respond as i didn't want to start a confrontation (and this guy definitely seemed like he could be really confrontational). he asked if i was korean, japanese, or chinese. i was like, "i'm thai, from thailand." he briefly talked about how he had served in vietnam (had he? i don't know, he seemed a little old to have, but who knows) and how vietnamese and communists were "invisible" and "hard to see." to clarify, he told me i was "american" as he could tell that i was "born here." as he was leaving, he told me, "baby doll, i wish you the best." it was really awkward, and the barista apologized to me afterwards for his conduct, saying he had recently tried to start a fight with another customer earlier, but people knew he wasn't totally right. i was like, oh, it's ok, but it got me thinking about other experiences i've had this year where people have made comments (direct or otherwise) about my race/ethnicity.

one, white patient from rural west VA who stated that she "couldn't understand me from the way i looked" and refused to let me go through her discharge instructions ( i did, anyway) but said she wouldn't leave until she "saw a white doctor." the white doctor never came, and she ended up leaving anyway. my attending (supervising physician) was really supportive, so that was good, but i always feel like you can't say anything to patients since you have to be the one being "professional" and you're not there to challenge their sometimes terrible beliefs about race, politics, whatever, but are there for their health.

two, on my last month in the medical intensive care unit (MICU), i went to do 'morning' rounds on some of my patients (this is around 4 or 5 am) and came out to the nursing area to look at some patient charts. the nurses were discussing my name, how it's ridiculous and how they always laugh when they read it, etc, etc. they didn't see me as i was on the periphery. i got the information i needed from the patient chart and walked away. i half mentioned the incident to another colleague, and they were like, oh, that sucks, MICU night nurses can be so annoying. i was like yeah, and then that was it.

in that incident, i felt bad because i didn't say anything, which is so unlike me and my character. i couldn't even say which nurses were talking about me at this point. i just know i felt crappy about it, but talking with other interns about our whole experience (which does a lot of ups, i can say, not just these downs), one person described it as "being an injured dog and getting kicked while you're down."

why didn't i say anything? i had been up for close to 24 hrs at that point and had another six or seven to go, i was tired, i didn't want to get into a fight, i didn't want the nurses that i depend on and need to work with for the next two years to resent me or try to "get back" at me, i feel like interns are really at the bottom of hospital totem pole hierarchy, it is exhausting.

i know, you've always got to pick and choose your battles. i guess i have been in battles regarding patient care, but i haven't been in too many battles for myself (at the hospital, anyway). although this has been generally okay and i feel like i have pretty good self-efficacy and confidence and all that, it has been a pretty decent beat-down by the system.

next time, i think i'm going to try to say something.

friends and family

to take a break from writing about work life, i'm recounting some moments where i've felt like a normal person over the past few months, which generally involves connecting with friends and family on my precious days off. although im on vacation now with chris in bangkok (yay!), i normally get one day off every 7-8 days while im on the wards or in the icu. im often tempted to sleep the whole day, but then would waste an entire day off and miss spending time with chris, so lately i've been more proactive about seeing people and doing things. this has been helped by the fact that a lot of friends and family have visited over the past few months, including:

rollie and meena from michigan! our first real houseguests, they cooked us amazing vegetarian meals like dutch babies (pancakes, not people) and enchiladas. in turn, we took them to the inner harbor where both me and meena got food poisoning from phillip's seafood. crab mac and cheese sounded like a great idea to begin with, but didn't turn out so well in the end...

meeting up with judy, a fellow swattie classmate in dc, who invited us to a "crafty bastards", a local diy craft fair which also showcased a breakdancing competition. one of our fave booths at this fair was mean cards ,a collection of hilarious cards for all different occasions. judy regaled us with stories from her days of intensive russian language learning at USAID, while i ate ice cream and drank coffee and whined about intern life.

sleepover with sae-rom, a fellow AMSA GHAC'er who's spending a year at Hopkins School of Public Health and is never in town, ever.

catching up with liz and andrea in dc, who came out for the annual GLMA conference. we mostly just hung out in dupont circle near the fountain, but it was great to catch up with some michigan peeps. i've also run into former classmates at bayview, including having a late night coffee with carl miller while he was on nights in the radiology reading room, and catching a short conversation with christina weng, who kindly came to do an ophthamology consult while i was in the CCU.

going to the sauna in columbia as rachel, a co-intern's guest. chatting and drinking ice cold water out of bell jars that rachel provided.

eating a post-call early dinner with mary (friend from high school) and her boyfriend tom, before they ran off to virginia for a peace corps friend wedding.

hanging out with matt alemu, a ford school classmate, who kindly drove out to visit us to play wii with chris :) .

having my family over and taking them out to eat chinese food, thai food, italian food...yoda remembering them and being super excited! (they came to pick him up to dogsit him while chris and i are on vacation in bangkok).

snapshots of intern life

i was really good about writing for awhile, but then fell off the wagon when i started my first month on the wards (general medicine inpatient service) and then went straight from there to the cardiac icu. i've taken care of a lot of patients during that time, and had some real ups and downs, but i've also realized that i'm becoming a lot more competent and don't totally panic whenever i get a page in the middle of the night, which is a real improvement.

i've also gotten more used to my schedule, and realized it was a sad day (or perhaps a happy one?) when I got out of work after being there for 12 hrs and was rejoicing because I was going home early. mind you, the only reason i realized this was because i called chris and he was like, "um, i thought early was like 4 pm or something, not 6:30." grrr chris and his normal job! at the beginning of intern year, i did harbor some resentment against chris for working a third of the hours and getting paid disproportionately more money, but i am pretty over it and am thankful that he's able to entertain himself on my call days by doing various home improvement projects, like painting and installing recessed lighting. i also really appreciate that he drives me to work on call days and picks me up post-call so i don't have to drive after being up for over 30 hrs!

speaking of being up for over 30 hrs, i feel like call is when i really get to bond with a lot of people, including not only my fellow interns and residents, but also nursing and other ancillary staff, and finally, with patients. while on the wards, we take call every 4th night, which means that as an intern, we'll admit five patients to our service over the day and serve as the primary physician for that patient until they're either discharged from the hospital or transferred to another service.

because so many of our patients either don't have insurance or are really underinsured, their health care can often be really fragmented. as an inpatient, case managers, social workers, and medical staff attempt to bring about a smooth transition to outpatient care, but things don't always work out. this can be because a patient doesn't show up for follow-up, but that can be for so many reasons, like they didn't have a ride, or didn't have the money for co-pay or whatever. i've also been impressed by a serious lack of primary care among our patients, and tried to use the connections i make with patients to establish primary care relationships with them when possible.

one patient that i really hope to see in clinic soon had a pretty terrible infection that started in a joint and spread to the blood. patient X also had a bunch of other complications from the original infection, which required long-term intravenous antibiotics. a lot of times people can get a PICC line placed and go home and get their IV antibiotics, but if you have a history of drug abuse, that's usually a no-go. this is interesting to me, because if you don't have a urine toxicology screen that's positive, the only way you would have this kind of information is if the patient discloses to you or you have some old records documenting this (or you can just be suspicious, given their own history if there's complications related to drug use). in any case, if you are an IV drug user, you don't get home IV antibiotics because there's a fear (likely well-founded) that you'll inject illicit drugs into your central line (which goes straight to your heart). this also means that in order to get IV antibiotics, you have to go stay in a nursing facility instead of going home for up to months at a time, depending on the length of course of your particular antibiotics.

this particular patient totally denied past IV drug use, but later admitted to it when a complication happened that's more often than not seen in drug users, although it probably wasn't related in this person's case. because she had so many complications, she ended up being re-admitted to the hospital a few times during my month ont he wards and i got to spend some time with her, sharing her frustrations at failed treatments, or setbacks in the road to recovery. when we finally got to discharge her home, she asked if it was ok to give me a hug and thanked me for not just taking care of her, but also really caring about her, which was totally great.

ive had lots of little moments like this throughout residency so far. sitting with an italian immigrant patient an talking about where our families are from and who makes up our family now and listening to him talk about how he used to go dancing in the city. taking a break from writing history and physicals with a co-intern to watch music videos together on youtube 20 hrs in to a 30+ hr shift. holding a patient's hand when he requested to be taken off oxygen so that he could die peacefully and with dignity, without noise, without machines. saying goodbye to another patient who had been through so much in his fifty years of life, and feeling sorry that i'd never gotten to buy him the fried chicken that he'd asked for, feeling even sorrier that he couldn't eat in the last two weeks of his life. a unit secretary feeling sorry for me as i fell asleep at a computer and bringing me a fresh cup of coffee that she'd fixed at 4 am. feeling proud of myself when i got an arterial line on my first stick, feeling bad about myself when i couldn't thread a central line, and a little less bad when the resident couldn't do it either. seeing people suffer and recover, and really respecting the strength of a lot of people in times of great distress.

i think that's what i've most appreciated about my intern year so far -connecting with people.

death and the icu

so, i haven't written in awhile, and im coming up on my last of eight calls this month in the ICU (intensive care unit). there are two icu's we rotate in as interns, the cardiac icu (CCU) and medical icu (MICU); this month i've done two weeks in each unit.

as my first inpatient month, the cardiac icu was a bit of a shocker. the first week, i worked 95 hrs and was a bit overwhelmed by the experience even if i wasn't super busy admitting patients. like learning a foreign language, it took a bit to get used to the EMR (electronic medical record) and ordering system they have at bayview, and figure out who to talk to to get things done. i have a better grasp of how the whole hospital works after a month, but im sure i still have a lot to learn.

i actually have really been enjoying critical care. one of my friends laughed when i told him this, and said "yah, the patients don't talk!" that's part of it, maybe, but i really like patients most of the time, and often, patients' families, some of who can talk A LOT.

part of being in the hospital so much as an intern makes me feel disconnected from what's going on in the outside world. even though i try to read some news websites while im at work, i am pretty much clueless about what's going on, including at first, all the talk about "death panels" in the media. i mean, it's pretty sad when i learn about death panels from someecards.com or rely on youtube clips like bernie frank's diss of this woman who compared obama health care reform to nazi germany to see how misinformed so many people are about what is actually going on. that's not necessarily the point of this blog though, so i'll stop here, and share some patient stories with you.

from the cardiac icu:

an elderly man was admitted to the cardiac ICU with a heart attack. our attending was excited because it might be a manifestation of stress cardiomyopathy, which can happen when people experience some kind of huge stress, whether it be a crazy surprise party or a death of a loved one. it ended up not being that, but i talked to him a lot anyway one morning when i went to check on him before rounds. his wife had passed away at home hospice a few weeks prior to his heart attack, and he was still in grief. he talked about how they had been married for almost sixty years, how she had made him happy, and how he hoped he had done the same for her. he also shared how proud he was of his daughter, who had taken both him and his wife in when he couldn't take care of his wife's needs as much anymore, and how they had all been there together when she passed away. then, he joked that nobody really wanted to listen to the ramblings of an old man anyway, and i replied that i did, if he wanted to talk. he decided that he wanted to rest, but thanked me for listening. he was later discharged from the hospital in pretty good condition, and i was really impressed with his daughter who was managing to keep it all together while her parents were nearing the end of their lives. i hope she gets to hear from him how proud he is, because she was a real patient advocate for her father, refusing tests that wouldn't change management and that would also make him uncomfortable. they had decided together that he did not want to be resuscitated or intubated (have a tube put down his throat and be connected to a ventilator) and i really think this is such an important discussion to have while you still have your wits about you and you can communicate what you'd like to happen with someone close to you.

on the flip side, from the medical icu:

a middle-aged man was admitted to the medical icu after being found down at a nursing home. it was difficult to piece together what exactly happened, but our best guess is that he had an episode of low blood sugar, causing him to go into seizures and eventually asystole (flat-lining). he was successfully resuscitated but never responsive. he ended up having continuous seizures for days before high doses of multiple anti-seizure medications could control them; his mri showed multiple infarcts (aka dead matter). he had no family, so a friend was located who eventually agreed to act as his medical decision-maker (aka surrogate). it's definitely a tough situation to be in, and we have not withdrawn care yet, even though the prognosis is really poor and he's being kept alive by machines.

and finally, i did experience my first death during a code, or resuscitation, in the unit. i didn't know a lot about the patient, but he was supposedly very functional, living and taking care of his wife with dementia, and his death was really sudden and a big shock to his family. he came in in a really bad way, and we all thought he was going to die, but then suddenly the curtain to the room was being pulled and the crash cart was being pulled in and the code was going, an X-ray was done and it came up with the lungs in complete white-out, blood was pouring out of the endotracheal tube, and it was over.

i've had patients die before, but for some reason, this time felt different, even if i wasn't his primary caretaker, and just participated a little bit in his care before he passed. we talked about dealing with death at one noon conference earlier this year and what stuck in my mind from that time was how often you just erase the patient's name from the board where you keep the census and then fill out the death certificate and forms and then that's it. that's kinda what happened in this situation; i followed my resident who told the family that their loved one had passed, there was crying, and then a short visitation with the body after he had been cleaned up by the nurses. then his name was erased from the board, and we went on doing our other work, rounding on patients, putting in orders, admitting new patients to the unit. later on in the night, we were discussing the case with another resident who came to visit, and i almost couldn't even remember his name when we were trying to find the X-rays to show him. i felt terrible about it for a second, but then i reminded myself that i only knew him for less than an hour, and what i did know about him wasn't anything at all about his life, but just his death. this was sad to me, but that's what sometimes happens in the unit, and i hope he is resting in peace.

my secret life as a psychiatrist

so, im on this rotation named 'med-psych'. i actually thought about doing med-psych combined residency and was thinking this month might be like that, but the name med-psych is somewhat of a misnomer. the month is more a combo of physical diagnosis rounds, lectures, simulated patients, reflecting on experiences, clinic, and some psych here and there.

psych was actually one of my most fave rotations in med school, so im happy to be doing some psych this month and learning about how the psych department interfaces with medicine as a consult service and what services are available both on the inpatient and outpatient side of things.

i was basically just oriented on my first day on psych consults, saw a patient with the attending, and then listened to social workers in the ER talk to the attending about cases. the next time i was back on consults, the attending was swamped, and asked if i wanted to see a patient on my own. of course, i said yes! it was my chance to be a true med-psych person for one day.

the consult was to evaluate a woman who had some chronic chest pain for anxiety. i fumbled through my disorganized papers and kicked myself for not having on hand the lecture notes on anxiety disorders that this same attending had given me a few days before. i was paying attention during the lecture, i swear, but it still helps to ground myself before i go to see the patient. in any case, i read some stuff quickly online, looked over the patient record, and then went off to see the patient.

when i entered the room, the nurse was giving some medication, so i just said "Hi" and waited for him to finish. the first thing the patient said to me was, "Hi! You're really beautiful." internally, i was like uh-oh, this could be trouble. after saying thanks for the compliment and asking how she was doing, i introduced myself as an intern with the psychiatry team. the patient totally flipped and yelled at me to get out, saying she did not want to see a psychiatrist, did not need to see a psychiatrist, and didn't want anything to do with psychiatry. i tried to clarify that i was not an actual psychiatrist (but was working with the psych consult team) and just wanted to ask her a few questions. the nurse had my back (yay!) and was like, 'why don't you just listen to what she has to say before you tell her to leave?' unfortunately, this was to no avail, and she kept yelling at me, saying she was going to sue the hospital, asking who had sent me, etc. i switched tactics and asked her if she'd had a bad experience with psych before, but she wouldn't respond. eventually, i ended up leaving, and the nurse was like, "well, you can't help people who don't want to be helped."

i was dejected as i headed back to one of the doctor work rooms to page the psych attending. i felt like i had failed without even trying, and wasn't helping out because i wasn't able to complete the consult. when i talked to the attending on the phone, she apologized for putting me in that situation and said that i'd done what i could do. patients who are competent have a right to refuse psych consults (or any other procedure) but i still felt like there was unfinished work to be done on her - i hope the primary team was able to sort things out.

after my unsuccessful attempt to see a patient alone, i accompanied the attending to see a pleasant man who was totally manic after he had been taken off his psych meds during a medical hospitalization. he was seriously talking a mile a minute, not making a ton of sense, and constantly on the move. the psych attending miraculously was able to get him to sign a voluntary commitment form for him to be transferred over to the psych ward after spending about 10 minutes with him, redirecting him at times, and just trying to listen to what he had to say (which was a lot). i hope he gets back on meds that help him get back to his baseline and he can go back to living in his pseudo-assisted living facility for people with chronic mental illness.

despite not having gone into psych , im happy i had a chance to do some psych consults this month and attend some psych lectures, which i've really enjoyed, except for an off-topic comment by one of the lecturers about how he didn't believe that accepting pens or other paraphernalia from pharmaceutical companies was a conflict of interest. "As if we were so easily swayed," he muttered. it was the end of the lecture and i didn't want to drag it into lunchtime, but under my breath i was like, "We totally are! And there's tons of EVIDENCE to prove that marketing makes a DIFFERENCE in physician prescribing patterns." and then i remembered from amsa days that the APA has a really terrible record of accepting all kinds of $$ from pharma and that ive rarely seen a pharm-free psychiatrist. oh well - have to choose your battles, right?

in conclusion, even though my med-psych month is ending, im sure ill have *tons* of psych issues to deal with in my own clinic (ive already had two patients with bipolar disorder) and also on the wards. more to come! :)

strong work: night float, part 2

so, i don't anticipate describing every patient i ever see in residency on the blog, but i did want to talk briefly about my second night as night float, when i served as the admitting intern.

i admitted one patient overnight on my first night float night, which was a good way to start - it was also slow, so i definitely would've done more if there were more patients admitted to medicine. at the outset, it seemed to be a pretty straightfoward case - young woman, nausea, vomiting, abdominal pain for a couple days, CT scan showed signs concerning for pancreatitis. the basic treatment for pancreatitis is really straightforward - nothing by mouth, lots of IV fluids, pain control. great way to start out, learn basic ordering in the computer system.

i went to talk to the patient and her boyfriend and learned about what had been going on - it seemed like the pain had been going on a lot longer, and i got some other information, but the working diagnosis was still pancreatitis. she seemed really anxious, didn't have insurance, and didn't really want to stay. i tried to 'talk her down', let her know what the plan was, and told her i would check in as the night went on. looking at her bloodwork over time; however, i noticed that her blood count was dropping. this could be due to a dilutional effect, where the IV fluids you get 'dilutes' your blood count so it appears that there are less red blood cells than there really are. her blood count kept dropping over time though, so i told the resident i was concerned that there might be more going on even though the patient "looked" great. he agreed that the blood count was low, and it was still low even after we repeated the blood draw, so we decided to get another CT scan, just in case she was bleeding.

as predicted, when i called the radiology resident to ask if she could read the CT, she questioned why we would order another CT eight hours after the patient had just gotten one. i told her that the blood count had dropped considerably and we were concerned about bleeding. she said she didn't see anything, and then i was like, ok, well, better safe than sorry.

as i was getting ready to catch a few winks of sleep, the radiology resident called me back and said on further review, there was hemorrhage in the cul-de-sac, but she couldn't identify the source of the bleeding. i called the general surgery team to evaluate her right away and they said they would see her. after a couple hours, i called them back to see if they had any recommendations and they determined that the likely source of the bleed was a ruptured ovarian cyst. i felt happy because this was on my differential (a list of possible diagnoses you think of at the outset), and then called gynecology to come take a look at the patient before handing her off to the day team who would assume her primary care.

there was more to the story than just this, like keeping the patient informed about developments, trying to enforce rules about family (or boyfriends) staying in the room overnight but letting the patient know that i was still on her side, and making sure everyone was on the same page. when i left in the morning, i was proud that i'd been part of "catching" something that could have been easily overlooked, and also happy that the resident i'd worked with had given me one of the best compliments that a doctor-in-training can get - "strong work!"

patients and patience

so, as many of you know, i 'officially' started residency at johns hopkins bayview on july 1, 2009, which is the official start date for residencies throughout the us. in reality, most of us start before, and we had three days of orientation before starting our first rotation on june 25th.

i started on one of the "easy" months of intern year named "Med-Psych". med-psych is basically a smorgasbord of physical diagnosis rounds, where we go see patients with interesting findings and work on honing physical exam skills, attend different clinics (derm, psych consults, and our clinic where we follow patients over 3 years) and lectures, work on physician-patient communication skills, and do touchy-feely activities talking about our experiences, which i generally like. we also do one weekend of night float.

so, as a doctor, i have my 'own' patients, patients that i serve as the primary care provider for. i saw my first patient in my first clinic on my first day of residency. after a whirlwind orientation by our trusty senior resident attending, i grabbed the chart and walked in. the patient was new to the practice, so there were no old records to look at - just starting off afresh.

even though my first patient was there for a physical, he also was establishing care for the first time in awhile and i spent most of the time just talking to him. he was older, around my parents' age, and he reminded me of a trucker, in a lonely type of way. he had some pretty wicked tattoos, and i asked about them - many of them were related to martial arts, and we ended up spending some time talking about that, and buddhism, and meditation. after we had gone through all the required questions and physical exam and i finally (half) figured out how to complete all the paperwork for a new patient, he said,

"thank you so much for listening to me! i can tell you really care - that's why you went and got that MD after your name. i'm really glad you're my doctor."

i was kinda speechless, and was just like, "thank you. im glad youre my patient" or something lame like that. but it felt great, because i was so nervous, and he was my first 'real' patient, and i was happy i was generally on the right track.

my second patient of the day was a woman who had a genetic condition that had caused both physical and mental delays since birth. she was wheelchair-bound and had to have all her needs taken care of by her mother. talking to the mother, i was totally amazed at her strength and ability to find ways to make sure her daughter was involved in family activities. i really didn't have a clue about lots of her medical problems, but tried to get social work involved because it sounded like she was having lots of problems coordinating care and payment of a lot of the things she needed to take care of her daughter properly. i haven't had a lot of experience with disabled people or patients, and hope to learn more in the future.

after my first clinic i was feeling better about myself. my medical assistant that helps me out, patience, and the supervising resident, liz, also totally saved my butt helping me figure out what - and where - everything was in clinic, and that i had filled in everything properly. next stop: night float.

there are two things you can do on night float: cross-cover (take care of urgent issues that come up at night for patients whose primary md's have left for the night) and admit patients to the hospital after the admitting team has capped (met their limit) or after a certain time (midnight?) so the admitting team can take care of the patients they've already got.

the first night at the hospital i was on cross-cover. the day float really took time to transition and orient me, which i was super grateful for, and then she handed me the 'float' pager. one of the first tasks that i was asked if i wanted to help out on was to try an arterial blood draw from a patient who was a hard stick because she had blown most of her veins injecting drugs. she was totally NOT happy to see us, and totally sensed that i clearly wasn't 100% confident about doing the art stick. she ended up yelling at me before i even got a chance to try and said she wouldn't allow me to do it, that there was no way i could possibly be a doctor. she also stated that didn't understand why she was being experimented on, and demanded that the senior resident supervising me try. the senior defended me (i was so grateful, especially since we had just met like 10 minutes before!), explained to the patient why we had to do the blood draw, and calmly convinced her that the procedure was necessary. unfortunately, the senior couldnt get it either, and the patient kept being belligerent.

after we left the room, i felt relieved and thanked the resident for sticking up for me. she was really supportive and said she was sorry to had to deal with that my first night, but i know i totally will have to deal with patients not agreeing with everything or totally trusting me. at the end of the encounter, the resident mentioned that she believed that the patient also needed to take responsibility for the situation we were in - if she hadn't blown all her veins, we wouldn't be having to put in lines or trying to stick her all the time to get blood. i hadn't thought about it this way before, and im still trying to wrap my head around how i feel about it. so that was my first inpatient experience at the hospital. the rest of the night went pretty well, and by the end of it, i was feeling pretty ok about calling a nurse back, ok'g orders, and being called 'doctor'.

tanyaporn wansom, md, mpp in thailand!

not much to say about graduation. the end of the year was hectic for me, trying to finish up papers and projects for my last semester of policy school, making sure things were in order. i loved the policy school's speaker, bryan stevenson from equal justice initiative, and did not love the med school's speaker, sanjay gupta. i felt more a part of my policy school class (having spent the last three semesters with them) but still an outsider in a lot of ways. for med school graduation, a lot of my family came into town, which was great, but it was also weird thinking about finally having those letters after my name and being officially done with school. anyway, i didn't thinka bout it too much, and tied up loose ends in michigan pretty quickly after graduating to head off to thailand for a month to work/play with some of my favorite people!

i was kinda disappointed since i spent a ton of time applying for awards/grants and had received rejection letter after rejection letter until the end of april, when i found out that i had been awarded the jw saxe fund prize for public service to go to thailand and work with karyn at thai aids treatment action group (ttag). this was fab news during the midst of finals, and chris found a super cheap ticket for me to fly to bangkok on northwest even on really late notice. as the most supportive husband in the world, he also volunteered to pack and move our entire house to maryland. he is amazing, for sure!

so, thailand was totally amazing even though i was really stressed out about going. i was only there for a month, but still got to do a ton of stuff and be involved in projects im really excited about. quick snapshot of work-related activities:

• Participated and helped out at a weeklong hepatitis c training for community advocates, iv drug users, and people living with HIV/AIDS in cha'am outside bangkok. two awesome trainers, tracy and lei, from treatment action group (TAG) in NYC led the training with karyn, and i jumped in and helped out with medical advice and other activities. this was the first time i was really called 'doctor' by everyone all the time, which took awhile to get used to, but was also kinda exciting! my most fave compliment was at the end of the training, when a woman (below)told me "i thought you were an iv drug user when we first started the training because you looked so tired and out of it (i had literally *just* gotten off the plane when we started), but then i realized you were a real doctor and your explanations really helped!"

• Translated at a training for a study sponsored by UBC in Vancouver based out of Mit Sampan Harm Reduction Center in Bangkok. The study is basically a really long interview conducted by peers (former/current users) for users re: all kinds of risk behaviors, police interaction, health status, etc. My co-translators included an ex-physician who now owns a small bookshop catering to college kids and a transgendered woman, who convinced me to accompany her to a photography exhibit/benefit for SWING (Sex Workers In Group). as a previous volunteer at EMPOWER, i hadn't seen surang (the head of SWING) and tee for YEARS but they immediately remembered me at the greeting table and we had lots of hugs and catching up - i hadn't even been married the last time we'd seen each other, but good to know that i can return, and that people still remember me!

• Wrote a brief report at the CDC on my project re: the use of Binax testing to detect S. pneumoniae from alarm positive, subculture negative blood cultures. Don't know if this is going to go anywhere, but hopefully something comes out of it.

• Got hired by Karyn to write a policy brief for TTAG/MSF Access to Meds Campaign re: hepatitis C treatment access in Thailand; will also touch on issues in China and India.

• Dave (Amalee's husband) hooked me up with some people at his work, the Mahidol-Oxford Tropical Medicine Research Unit (funded by the Wellcome Trust). They do some really interesting work re: malaria and meliodosis, and I'm trying to set up an elective in October/November with them in Ubon Ratchatani now!

So, the month was totally productive, but also totally fun! Highlights included:

• A day trip to Petchaburi with Nan & company (what Chris refers to as "lez trip" - this was lez trip #3). A new girl came with us this time and brought two of her male cousins, one of which was Thai-American, like me! We spent the day eating massive amounts of food in a raised hut next to a river and floating down the river in lifejackets. It was relaxing and awesome.
• Spa date at Divana with Tracy (Hep C expert!) and Karyn and Ott
• Lounging around near the pool and on the balcony during the Hep C retreat with the gals
• Dinners with a great couple, Paul and David, who have done MSF work in Thailand for ages. I was totally embarassed, however, when I drank a little too much wine at their place and ended up lying down on the floor of their bathroom while trying to not pass out.
• Eating at new places in Ari and hanging out with Dave and Amalee
• All-you-can-eat buffet madness with old Thai friends and new ones (from IFMSA!)
• JJ Weekend Market and Katak and catching up with Nan

great trip overall, and i was really happy chris supported me in going. we'll be back in october for vacation!

matching and moving

despite my best intentions, i again have fallen off the face of blogspot status post (medicalese for after) match day. the past three months have seen a ton of things fall into place, and i feel like my professional life - and my life with chris - is really moving forward. quick flashback to match day:

1) match day.
prior to match day, you submit your rank list and then wait for three weeks to find out the result of your match. i actually ended up making a lot of semi-last-minute changes after talking out things with chris and others, but ultimately ranked programs in the order i thought would best meet my needs (and also that of chris and yoda!)

the week of the match, you first get an email on the Monday telling you whether or not you matched. the night before this email went out, i told chris i was going into preventive med or something if i didn't match because i didn't think i could deal with the scramble.

while I was at the Ford School, a friend I met on the interview trail instant messaged me: "I matched! Check your email!" I quickly found the email with the subject line, 'Did you match?' and then you open it - I got, 'Congratulations, you matched!' . this was good, but i still had no idea where i matched - i had to wait for a few more days to find out!

on thursday, chris stayed home from work so we could match together. i didn't end up attending the school's 'celebration' because i knew very few people in the class i ended up graduating with (i entered with the class of 2007 and did three years with them) and just opened my match results on the computer. the subject of this email was 'Where did I match?'
and this is what i got when i opened the email:

March 19, 2009

AAMC ID: 11458085
School Code: 145
School Name: University of Michigan Med Sch
Applicant Name: Tanyaporn Wansom

Congratulations, you have matched!

Program Code: 1237140C0
Program Name: Internal Medicine
Institution Name: Johns Hopkins/Bayview-MD

i was kinda freaked out because i just read the top part, and was like, what, i matched at Michigan? but then kept reading and was really happy to see that i matched at Johns Hopkins Bayview Medical Center. i had done a 2nd look there over the winter holidays since we were down there visiting Chris's extended family and really liked the flexibility of the program, the residents, and also the ID faculty and substance abuse/HIV clinic faculty that i met with while at the hospital for the day. Chris was also thrilled because he wanted to be near his family and we knew there would be tons of jobs in the area, esp. with the government.

right after i matched, chris disappeared downstairs because he had been eyeing this job posting on monster.com for months. i helped him throw a cover letter together even though i was like, weh, i want to celebrate (but good for him to get a job too!). he was interviewed on the phone and then got called in for a hardcore all-day interview less than two weeks later. After the interview, he was offered the job right away. so that was cool - he is now officially assistant VP/network services manager at sandy spring bank, which is a local community bank with 50+ branches in maryland/dc/va. we both feel super incredibly blessed that he was able to get a job in this economy, especially one that would help him move into the management track and let him be based close to home.

my parents were super pumped to hear i was going to hopkins bayview although my mom was sad that i was (officially) leaving michigan. i finished celebrating with friends from the med school and Ford school at Dominick's.

matching is much more anti-climactic than you think it might be, but i think it's just waiting and waiting. it was exciting to get text messages from my friends matching around the country though and a relief to know where we were going to finally end up!

2) post-match day: househunting!

one of the chief residents who i'd gone to med school with referred us to his realtor, wendy slaughter (he chose her out of a phone book because her last name sounded like someone who would fight for you, and he was right!) after talking on the phone with her, she helped chris and i find a lender (and get pre-approved for a mortgage), narrow down our price range, and identify things that we wanted in a house (# of bedrooms, garage, stuff like that). once that part was done, she sent us all the listings that matched our criteria, and we chose around 25 that we liked from the ads/virtual tour online.

two weeks after matching, we headed down to maryland for the weekend, where wendy had organized a 2 day tour of all the houses that we liked. in between coffee stops, getting a little lost in her pilot, and snarky commentary all around, we narrowed down our field to two or three places. one of the places we loved was a foreclosure, and when the price dropped on it a week or so after we looked at it, wendy helped us put in a bid right away, hounded the listing agent until he got back to us, and advised us on what to do once multiple offers got to the table. luckily, our offer was accepted, chris was able to do the home inspection while he was in maryland for his job interview, and we got everything squared away for closing.

only chris attended closing so i could take acls and go to thailand (subject of another post later). most people thought it was weird that i wasn't present (it is our first house and everything), but you know, that's just the way we roll sometime. in the end, it was really fortunate that i DIDNT attend closing because i had to emergently wire $$ to chris - he learned the hard way that banks clearly DON'T accept personal checks for closing costs/down payment, and need a cashier's check. just an fyi for all you house-buying ppls out there. :)

ok, this is a good update for match and house right now. more and more updates to come!

it's been a long time

it's been a really long time since i last blogged. looking at the time stamp of my last entry from thailand, it's been about nine months. im kinda shocked by how easy it is to let go of something you do so regularly because it's not a priority and you don't make time to do it. writing is one of those things for me, but i don't want it to be. it's just one of those things that's perpetually on my to-do list, and today i was like, i am writing a blog.

the task is sometimes overwhelming because the longer i wait to write, the more i don't know where to start. so much has happened since last june, in my personal life, and in the larger world as a whole. some quick snapshots:

• the 2008 american presidential election (yay obama!)
  
• finishing my 4th year of medical school with an emergency medicine at Henry Ford Hospital in the city of Detroit,
• attending the International Federation of Medical Students' Associations General Assembly in Jamaica
• meeting up with Liz and Suhani for a weekend in Denver (and having breakfast with Alex and her fiancee Matt)
• going back to the Ford School for my final year and making some new friends :)
• welcoming home the newest member of our family, a miniature schnauzer I named Yoda, from a local rescue
• surviving the madness of interview season, emotional roller coaster waiting to be offered (or not be offered) interviews, scheduling travel to and from the airport, thirty flights in a little over thirty days, crashing on friends' couches, loving/hating places i didn't expect to, keeping an open mind, testing my small talk skills, the finality of the rank list, waiting waiting waiting...
• chris joining me for weekends in new orleans, seattle/portland, and christmas holidays in baltimore/dc, exploring new places, falling in love with new orleans, the prospect one exhibition, the lower 9th ward, the devastation of katrina, rebuilding and ghosts and roots and houses, and understanding a little more about catherine and her love and her life there!
  
• spending three weeks in South Africa, first time to the continent, two weeks helping to teach a STATA workshop at university of capetown, living in a dorm again, connecting with new people, mountains, oceans, animals, confronting poverty and racism and hope, one week traveling with Chris in Kwazulu-Natal, more on this later...
• trying to keep up with working out at fitness together (the personal trainer/fitness studio), losing close to thirty pounds in a year! and feeling good about myself!
• spending a lot of time at caribou coffee and having an elderly man tell me my smile was a gift :)
• the requisite AMSA stuff, being chair of the Global Health Committee again, and being excited about the future of AMSA and helping people go abroad and find their paths and dreams!
  
• realizing i'm going to leave michigan after six years and being happy and sad about it all at once! yesterday we spent time with a lot of different friends here - breakfast at northside grill with michelle and brian debbink, lunch with rollie and meena, cora's first birthday party at emily and ali's (and chatting with paula anne and kevin), joey's birthday with all the fitness together trainers, and coffee with nick (chris's coworker) and his gf joanne. i was like wow, we have a great community, and we're leaving! but it's totally time too!

so this is my first blog and im excited to be back!

leelawadee

the leelawadee flower (known as rangipani in English) has emerged as a theme from my short six-week stay in thailand. a super fragrant flower, it was previously named lan-tom and not grown domestically because it was associated with temples and its name also reminded Thai people of ra-tom, which means sorrow. H.M. Sirinthorn renamed the flower to leelawadee, and since then its popularity has soared among Thais throughout the country.

my leelawadee experiences have included:

1) Going to Leelawadee spa with Karyn, a good friend from TTAG. There I enjoyed a great foot massage and also a Thai-style facial, which involved some sort of honey scrub.

2) Eating at Leelawadee restaurant with Nan and P'Dong around Ramkhamhaeng - super yummy food, live music, and nice Thai-style decor (refer to previous entry).

3) Receiving a Leelawadee Madam Heng gift set (two bars of soap, one shaped in the form of a leelawadee flower) from my mom's seamstress, who i also visit when i come here. This gift set commemorates the King's 80th year on the throne.

All these Leelawadee experiences happened during different weeks of my stay, but constantly reminded me to appreciate the vast amount of natural beauty in gardens (even within the madness of Bangkok).

nakhon phanom

im wrapping up my time here in Thailand and have had the fortune of going on two work-related visits to Sa Kaeo (near the Thai-Cambodian border) and am currently writing from Nakhon Phanom (near the Thai-Laos border). the visits have been super short (one night, two days max) but useful; i've gotten to tour the labs and find out more information re: the Binax project i'm working on (see previous posts). while touring the lab at Nakhon Phanom provincial hospital today (~350 beds), it occurred to me that i've never toured the lab at UMHS or any US-based hospital. perhaps this is something i'll look into when i'm back on my path/ID elective at Michigan.

Nakhon Phanom is a border town and very chill. after we arrived at the airport around 5:30 pm yesterday, we took an hour-long 'boat cruise' in the Mekong River, complete with karaoke and fried pork balls. it was striking to compare the two riverbanks, with the Thai side being much more developed than the Lao side. from the river, you can see many temples (wats) and also this huge church that runs a school (on the Thai side). the lao side is mostly small huts and also a small fisherie where it seems that fish swim in (but then can't swim out). at the big pier on the lao side, i was notified that there was a Lao Duty-Free store which primarily sells liquor. Thai and Lao people can freely cross the border but can't spend the night (same as Cambodia, and they can only stay in the province bordering the country of origin).

after the cruise, we ate dinner at this pub/restaurant named O-HI-O with live music (basically two dudes with guitars singing cheesy thai songs - common throughout the North, and also Chiang Mai). the local staff we were with were amused that i was actually born in Ohio. across the street, this huge long tent was set up with a stage for a wedding. it appeared as if some sort of talent show was going on, but i was informed that was part of the wedding, which got me to thinking that it would be amusing (albeit somewhat painful) if our weddings were talent shows as well.

after dinner, we got coffee at this cute coffee house and i got a nighttime tour of the 'city' which included a stop at the movie theater (which was closed for the night) - a movie is 40 baht (a little more than a dollar) and there are two screens. although i love bangkok, i could see why it would be appealing to live in the provinces, and appreciate the slower pace of life here.

this afternoon, i'm going to visit a famous temple in the area (wat that phanom) and also Ho Chi Minh's house in this Vietnamese farming community here. who knew that Ho Chi Minh spent years hiding as a farmer underground on the Thai-Laos border while plotting Vietnam's independence from France? apparently, the original wooden hut was eaten by termites, but they've rebuilt it. border history is really fascinating!

ok, off to lunch now. more soon!

working at the ministry

it's a little ironic that the shortest amount i have in thailand is the one where my mentors have given me the most (defined) project and work. due to crazy scheduling issues brought about by my own disorganized life last year, im only here for barely six weeks on the OC Hubert Fellowship, a program sponsored by the CDC Foundation. i am learning a ton and really wish i could stay here way longer! a short run-down of the project:

the project im working on is looking at the utility of Binax testing to detect Strep pneumoniae. S. pneumo. is one of the leading causes of death in children under five (a vaccine is available, but it's expensive for this part of the world) and also affects tons of adults. unfortunately, it's a tricky bug and hard to culture because it likes to autolyse itself after 24 hrs (or less). enter the Binax test, which is an immunochromatographic assay (think pregnancy test, with two lines - one control, one appearing if it's positive) that was created to detect S. pneumo. in cerebrospinal fluid (CSF, or spinal tap fluid) and urine. however, someone came up with the idea to try and use it with the blood they were already getting for blood cultures here as part of a larger pneumonia surveillance study. preliminary results show that the Binax test is really sensitive at detecting S. pneumo. and often will be able to find cases that have negative subcultures. today i'm visiting a provincial lab near the thai-cambodia border and got to tour the hospital and facilities, see how the lab is run, and collect some important information. i also got the chance to speak with some research nurses about hiv/aids, answer their questions, and watch them consent and enroll some patients in this other respiratory pathogen study. it was refreshing to see that they respected patients' wishes to refuse enrollment, although i still find it much more difficult to say no here as a patient (especially if you're hospitalized and don't have a lot of money).

in any case, i really like the office where i'm working as a whole. i have two mentors, an epidemiologist and a physician with an MPH, and they're very supportive and task-oriented, which i find refreshing after previous experiences here. i usually meet with at least one of my mentors everyday or every other day, am learning some basic SPSS skills to analyze data, and feel helpful because i can help bridge the thai-english divide (although most of the staff speak excellent English). the office where i work is housed in the Thai Ministry of Public Health (Thai MOPH) but it's part of the International Emerging Infections Program (IEIP) within the Thai-US CDC collaboration. TUC seems pretty cool to me so far and has made a big difference in these two provinces where the pneumonia surveillance activities are occurring by building lab capacity - the hospital im visiting in Sa Kaeo today just got a PCR machine last month! i'd be interested in seeing how the improvement in diagnostics have impacted clinical care, as the head lab person i talked to today noted that their ability to diagnose a common pathogen like S. pneumo. has increased dramatically (they used to only successfully culture one or two cases a year, and now it's close to 3% of all blood cultures done! i very much appreciate the chance to visit the sites in the provinces and am getting a much better global view of the work that's going on with the Thai-US projects (and hope to be more involved in the future!)

more work updates later. last random fact: did you know S. pneumo. is really prevalent in the Arctic Circle? me neither, but apparently the poster we're preparing is being held in Iceland this year because it's heavily affected by S. pneumo. (and they always pick locations based on where the pathogen they're focusing on is super prevalent). kinda cool, though iceland seems to be a super pricy place to have a meeting!

back in bangkok

after a year filled with ups and downs, i returned to bangkok & thailand. the last time i was here, i was leaving my fogarty site in chiang mai, feeling super nervous (but excited) about returning to clinical medicine as an M5, and looking forward to the match. it seems that things do indeed come full circle as i am in a similar position this time around, although i am only spending six weeks here instead of many months. when i return to the US in a month, i will be an M6, looking forward to my last (real) clinical elective, ER at Henry Ford, and getting ready for the match (again). i feel like this scenario may repeat itself again before i start my intern year, but we'll see.

since my fulbright year, thailand has been a bedrock for me. it was the place where i found a connection to my past, where i became proud of my cultural heritage instead of trying to hide it, and where i experienced a small sense of loss and disappointment that our generation was no longer made up of families with eight or nine siblings (as my parents' was). thailand was also the first place where chris and i really spent time together, where we traveled, where we ate a ton of food. thailand was also the first place where i really started to understand the human effects of poverty, of HIV/AIDS, of the tragedy when people died of preventable illness. thailand made me realize that difficult issues like drug use and commercial sex work and corruption were real and affected real people, people that i knew and respected and loved. thailand made me appreciate lots and lots of shades of gray. thailand made me wonder why it was so physically easy to move back and forth between the Global North and Global South all within a block or a city or from the capital to the provinces or especially to a neighboring country. bangkok reminds me of what it is to have so much and so little, exemplified by a series of thoughts i've had since being back:

1) Bus fare

bus fare has gone up a lot since i started coming to thailand, and another fare hike was recently approved, drawing outrage from the working poor who need to use the bus system to get around. to put it into perspective, the cheapest buses used to cost 3.5 baht for a trip, but now will cost 8.5 baht (up 1 baht from previous fare increases), and because most poor people need to transfer at least two or three times, this seemingly innocuous price increase can easily amount to over 100 baht a month.

the subway and skytrain, both of which i often use, are quite expensive compared to the bus system & don't reach a lot of areas of bangkok. although i often try to take the bus, it is definitely a choice for me and i can easily take a taxi to get where i need to go. for example, i usually take a taxi to work since it's most convenient and it costs me 80 baht for the fare and 50 baht for the tollway (necessary to save about an hr's time sitting in traffic). to put this into perspective, the minimum daily wage in Bangkok (which is the highest in Thailand) is 194 baht a day, or a little over $6.

2) women and children

the friend im staying with works in the field of child protection and we've known each other since our fulbright days. during her fulbright, she helped set up this income generation project in one of the biggest slums in bangkok, klongtoey, and it continues successfully to this day! it's basically a women's group that makes really cool (mostly silver) jewelry (amalee buys all the supplies from jatujak, one of the largest open air markets in Asia, and they work together to identify and make new designs). amalee meets with the group every weekend to collect the pieces that the women have made the previous week, distribute new materials for pieces to be made in the coming week, and pay the women for their work (they can also take out small loans). the women also work on finishing up jewelry pieces it's meant to be supplemental income, and it was cool to meet many of the girls and women who participate (ranging from age 12-13? to 40's). it's also a forum for the women to discuss issues in their lives, which mirror many women the world over must deal with - domestic violence, child care, raising children alone, patience, silence, love.... next week there is a thai craft show where they will go and sell their jewelry. i will post pics and other info later!

3) natural disaster

within days of my arrival both cyclone nargis and the earthquake in beichuan devastated burma and china. if the burmese haven't suffered enough under military junta rule, the (lack of) response to those affected by the cyclone only highlights their plight and the continuing human rights abuses that continue to happen under this regime. to help people that have been working in burma (and also support the free border clinic run in mae sot), please click here.


4) the english expectation

as a native english speaker, i often feel that i become immediately more credible just because of my ability to express myself in a langjuage that i'm comfortable with. in thailand (and much of asia) people often don't want to 'interrupt' or 'cause trouble' by asking questions or saying they don't understand. the first week i started at my internship i wasn't sure what was going on, but we had an epi talk about the roll-out of influenza vaccine to people ages 65 and older throughout thailand and nobody wanted to contribute (even though i'm sure they were far more qualified than me to do so). sometimes i think it's unfair that many meetings aren't conducted in thai...after all, we are in thailand.

there's also a divide in development work and agencies between local hires and those who come to work from elsewhere. my friend has noticed this in the UN and ive also noticed it in various agencies - all admin staff (secretaries, etc) are thai, but there are few professionals that are thai - or even speak it. this leads to a thai-non-thai divide, resentment, and difficulty trying to navigate being thai-american in a western vs thai environment. more thoughts on this later!

ok, im going to try and be better about blogging. next update: work and play in bangkok!

hope and inspiration

ive been fortunate enough to listen, learn, and be inspired from various people the past few weeks. here are a few scattered thoughts about these diverse encounters:

today, chris and i joined thousands of other people in Crisler Arena to hear His Holiness the 14th Dalai Lama give the Peter Wege Lecture on sustainability. we got there early and had pretty good seats showing a profile of the Dalai Lama. even though we were all packed in, i immediately got the feeling of compassion - or loving kindness - that i was in the presence of someone at inner peace. the dalai lama was humorous, was humble, and most of all, he was real. i think that's one reason that i've been kept grounded in the faith of my parents, in Buddhism: like the Buddha, all those who provide us with advice or direction are real people, and they embrace their own humanity. some points the Dalai Lama talked about in his lecture (in no particular order) included:

-the gap between the rich and the poor, and how a lot of our (Western) lives are both unsustainable and overindulgent. he noted the paradox that many of us find ourselves in when valuing material happiness over spiritual happiness - although there is a limited amount of happiness to be found in material goods and the physical world, we fixate on having more, or believe that the next thing will bring us happiness. on the other hand, there is unlimited happiness to be found in inner peace, in compassion, and in ourselves. sadly, very few people decide to nurture or focus on their inner happiness, and suffer as a result.

-valuing humanity by realizing that the potential (in terms of compassion, or "warm-heartedness") of all humans is the same due to the ways in which we are brought into and nurtured into life. i think this was a little different perspective on 'human rights' as ive learned it, but was refreshing to think about as a practical approach to looking at human emotions and values.

-the importance of diversity (in religion) of addressing different times, needs, cultures, and places...although all of them do have similar overarching messages, it is important that they all exist because they provide different approaches for the differing needs of the world. the importance of dialogue in recognizing the beauty and strengths of each belief system. collaborating together, building community to achieve a common good.

-the need for non-violent approaches to solve conflict in the increasingly interdependent world. war as an outdated mode of resolving issues. nobody wakes up in the morning saying, "i hope to make an enemy or get in a fight today!" even with the best intentions, unfortunate things still happen. if you believe in karma, how you react to those situations will determine future events - so it is important to take care of the present, to make choices reflecting the positive effects you want to have in your life (and others).

-the need for community (and the need to see community as including even those who don't agree with you). although he didn't say that explicitly, i thought of it when he was talking about dialoguing and exchange between different religions, and how he tries to engage in that exchange whenever he can. one example he gave of was when he went to the UK and was invited to be a part of this seminar where he had to give lectures about different passages from the Gospel (and inserted some Buddhist perspectives). he described the experience as super challenging (but also fulfilling) as he was trying to lead discussions to believers as a non-believer (and that he had to learn and read the passages the night before as "homework"). many Christians at the event appreciated his lectures and later came to India to participate in meditation retreats and Buddhist lectures. this was a pretty cool example, and made me think about how i (or we) so rarely engage those that are not already part of our value system, and how we should maybe try to do that more in either our daily lives or in the work that we do.

going back to the theme of community, i was really honored to be part of a panel that celebrated the opening of this new exhibit at the National Library of Medicine at the NIH titled "Against the Odds: Making A Difference in Global Health." kevin burns nominated me to be in it, and staff interviewed me a couple of months ago to put together a short profile on me for the "ordinary people" part of the exhibit at the end. anyway, to celebrate the opening of the exhibit, there was a panel of people featured in the exhibit speaking to a few hundred local area high school students, which was pretty cool. i was totally inspired (and humbled) to hang out with and listen to speeches by Dr. H. Jack Geiger, one of the founders of community health centers in the US and co-founder of Physicians for Human Rights, Dr. Victoria Cargill, Director of Minority Research in the Office of AIDS at NIH, and Jeanne White-Ginder, the mother of the late Ryan White. before the panel, i got to enjoy almost an hour of good one-on-one time with Dr. Geiger, who regaled with me stories of S. Africa during apartheid, cases he got during his oral boards, and why it kicked ass to be an emeritus professor. he also gave me some good career advice and was just really honest and down-to-earth.

Dr. Victoria Cargill talked about running a health clinic out of her beat-up car, getting hepatitis as a resident from a needlestick and the inhumane ways she was treated by her own fellow residents, and how she never takes "no" for an answer (fave quote - when somebody says "no" i flip it in my head to "on".... BRING it ON!) Jeanne White-Ginder talked about how ordinary people can be called to do extraordinary things, and how she just tried to be the best mom she could be - before, during, and after Ryan's life. all of it was really super amazing. if you want to see the podcast of the panel, you can check it out here. Also, the interactive online exhibit can be found here. Shout-out to Hanni Stoklosa, who is also featured in a video interview in the exhibit and also online. it is really an honor to be part of a community and a movement that includes really amazing inidviduals like Ryan White and activists from ACT-UP. it is important to remember where we came from, as activists, and as people. sometimes it's hard for me to keep that perspective because i'm always used to looking forward to the future, to the next action, to what we have to do to try and make the world a better place. i realize that i don't think often enough about the past, about lessons learned, about the people who came before us, about their struggles and their strength. watching the interviews with ryan white and seeing his mom speak then, and now, i was pretty overcome by the maturity and the wisdom and the courage a young person like he could summon. it was the same kind of inspiration i felt as a young person reading his autobiography. wow, i thought - i haven't thought about this in a long time, and it feels good to have that connection again, to revisit one's past and connect it with one's future. i was thankful to be given the opportunity to make that connection, and i feel like that's what i hope to do through my writing, for myself, for whoever reads this - make connections between the past and the present, and the present and the future....

lately, for me, ive been thinking a lot about connections, about community, about how my experience fits into the larger human experience as a whole. there was a pretty cool talk by faith fitzgerald titled 'what is a human?' at the global health education consortium conference (follow the link for more of a synopsis on some of the events) in sacramento that touched on parts of humanity, and connections i had with both friends and colleagues there made me really happy - and hopeful - about the future. i spent good quality time with rohan, who gave voice to many commuter night children in uganda, heidi, a ghli'er who recently married a co-worker from cameroon, jen cohn, who is going to lead an awesome global health residency in medicine at penn, and dan, who wrote a kick-ass script for the pepfar call-in i added to the end of my presentation on the global health workforce crisis and bought me a drink at one of his favorite dive bars in his hometown. finally, i also shared fuzzy fleeces (& yummy ethiopian food) with hanni, amsa-ifmsa co-chair. it was good to make those connections and it was good to bring some action and advocacy to a venue which traditionally hasn't been organized in that way. i was approached by more than a few people (academics! physicians!) who said they hadn't done a call-in before, and it was so easy, and they would totally do it again. this was kinda sad, because these people have so much power, but then also kinda exciting, because they realized how easy it was to use that power to make a difference. i hope there will be more organizing and advocacy at ghec in the future, and am looking forward to more student involvement and direction as we move forward.

finally, i just want to say that i feel so blessed (in so many ways) to have a community that continues to inspire me. whether that's through an activist speech making students think about systematic change at a community service awards ceremony (yay rishi!) or posting an inspiring, amazing blog (yay cj!) or helping me connect to a memory of the past (multiple people, multiple ways- more on this later!), i never imagined as an awkward, gangly, angsty teen that i would be surrounded by so much love and hope. besides world peace and access to health care, education, housing, and food for all, im not sure there's much more i could ask for ;)

soros

so, during the madness of the end of 2007, i threw together a soros application and was super excited to get a phone call at the end of december saying that i had gotten an interview. i ended up going through the interview process a few weeks ago in LA, and got my rejection letter from them yesterday. the letter opened with, "i wish this letter could bring you good news. it does not." ouch. luckily, i had kinda been expecting it because their webmaster had put up four names for 2008 winners that was later taken down. however, i figured that because i hadn't heard and winners were already posted, i probably wasn't one of them.

the soros fellowship for new americans is a pretty cool scholarship - they pay half your tuition for grad school and then give you a stipend for 2 years. i was able to apply since im doing the MPP now and it's my first year. it was a super intense application, and i really am thankful to everyone who helped me put it together, including all my friends who read drafts and commented on it, my recommenders, and of course, my IT-savvy husband chris, who used 'Snag It' to make exhibit upon exhibit. although it was the hardest application i've ever done, i don't regret doing it, and helped me put things into perspective around the same time i was applying to the Ford School.

each finalist had two 30 minute interviews with panels of five people at each interview. the panels were made up of previous soros fellowship winners, some people from the foundation, and other New Americans. i thought my second interview went much better than my first, but who knows, really. some interesting things i gleaned from my interviews was that "AMSA is really radical" (answer in my head: what's radical about wanting people to have health care?) and "Don't pharmaceutical companies need to be compensated for all the R&D they do?" overall, the conversation was mostly enjoyable, but i was afraid after the first interview that i didn't articulate myself well enough, and maybe revealed things that caused them not to really like me in the end (like failing step 2). however, i was really proud of some of my answers, including one of the final questions in one of my interviews, which was "What do you want to be known for when you die?" My answer - and I didn't even really have to think about it - was

"I think it would be awesome to implement a policy that would radically change poor people's access to essential medicines, or find a cure for HIV/AIDS..but what I really want to be known for is that regardless of what I accomplished in my career, I remained grounded in the community, and represented their wants, needs, hopes, and dreams accurately. From my work so far, I don't want to be the person who just comes in and tells people how they need to live their lives, or what their interests need to be. If, when I die, the marginalized people I have worked with respect who I am, what I did, and saw me standing in solidarity with them - then that is the accomplishment I would be most proud of."

i got the feeling that some people thought that was a copout, but i really meant it. i'm not sure how the soros values community work (or other grand fellowships for that matter), but it sometimes seems that academia and other institutions don't place as much value on it as 'traditional' work, like how many papers you've published in peer-reviewed journals, or whatever. in some ways, my 'years off' in thailand haven't been successful in that measure, but on the flip side, i'm proud that i had the gumption to go out and seek community work with commercial sex workers, or iv drug users, or just women who needed to get an abortion in a place where abortion wasn't legal. beyond that, the lasting friendships i've made and the maturity i've gained from recognizing that it doesn't matter how old you are or what the social hierarchy or whatever - you can still help others (and mentor them!) in so many ways....that work has been the most important to me. it's made me who i am as a person, and who i hope to become.

in the end, i have to say that i was super disappointed not to win. i'm also kinda kicking myself for not applying for the FLAS (Foreign Language Area Studies) grant, which is less competitive and just for University of Michigan grad students. At the time, i didn't have my stuff together and wasn't sure if i would be able to commit to taking Thai for the whole year. it's ok though, life goes on. and i have to say, i super love my life overall. going through this process has really made me appreciate my family and friends (and googlechat). just like i said in my answer to what i want to be known for when i die, im really honored to be respected and loved and (maybe even looked up to) by all my friends - all of whom inspire me as well.

my friend sarah and i were talking about her rank list the other day, and about soros, and about academic elitism and how that impacts our lives and our choices. i am proud of myself for making the choice to stay at michigan and i am proud of my friends who make the choice to do what is best for them (in their lives) over what would generally be seen as "the best" by society, or your family, or your department chair, or whoever.

finally, i am so grateful for all the love and positive feedback i've been given over the past few weeks. this is from anjali last night: "whatever rhodes scholar. whatever robert wood johnson clinical scholars. whatever whatever. seriously. you're the shit and you've gotta keep believing in yourself. half the people who do these scholar things are really doing it for themselves and don't have a bigger vision in mind you're going to go SO far, and be respected by the people." sometimes i worry about how much of it i am doing for myself, and recognizing that even though that is a part of it (and that's ok), i definitely do not do the work that i do just to be congratulated on by someone else. i do it because i care, because im a woman of color, because life isn't fair, and because i have so much privilege it would be ridiculous and almost criminal not to do the work when people half as privileged as i am are fighting and struggling every single day.

thanks to all of you who do the work that you do. i am honored to be part of the movement.

back at it

hi everyone! i know i haven't written in forever, but im trying to get back on the blogging bandwagon. life (as always) has been crazy, and i've had my share of ups and downs over the past few months. a quick update of what i've been up to:

1) Starting my MPP (Master in Public Policy) at the Gerald R. Ford School of Public Policy at U of M. This semester has totally flown by already and I'm about halfway through the Winter term. Going back to my nerdy Swarthmore ways, I decided to max out my credit limit and take six classes (a regular full-time load is four). If any of you are wondering, my classes include:

Statistics
Public Management (The Politics of Bureaucracy)
Political Environment of Policymaking (focusing on science/technology policy)
Research Seminar on Science, Technology, and Public Policy
Health Care Reform (taught by Matt Davis, my advisor (also MD/MPP) and
Health Economics and Public Policy

I've been enjoying myself so far and keeping myself busy writing papers ranging in topics from why the CIA and FBI counterterrorism efforts failed before 9/11 & how their cultures reflect failures in public management (national intelligence is really siloed and interesting, actually) to an economic policy review of President Bush's proposed tax code reform to take away the favorable tax treatment of employer-based insurance and instead give all insured people standard tax deductions. Besides the academic part of it, I've started to make some friends who are also in my policy school classes. The fun thing about it is a lot of people are doing dual degrees in the policy school, so there's students from all different departments participating in discussions and things.

The Ford School admin overall has been super nice and supportive as well. I've been surprised at the lack of political advocacy that goes on in the student body (although I may be out of touch with what goes on after class). Being so heavily involved with AMSA and trying to include advocacy and activism in my daily life, I am kinda shocked that most people in policy school seem to be like most people in med school (although the policy people are more liberal overall). What I mean by that comment is that I feel that most people aren't making calls to their legislators, or paying attention to action alerts, or coordinating call-ins. To my knowledge, there has been no political action at the Ford School this semester and the student groups overall don't seem very politicized, but I do admit to having a limited knowledge of what is going on. If anyone wants to share other knowledge with me, I'm totally all about it. I also might try to shake things up once I get more situated ;)

2) AMSA

My life would not be complete without mentioning AMSA, of course. In the past few months, I've spoken at the first-ever premed Global Health Leadership Institute (amazing job organizing Courtney!), helped get together folks to lobby around PEPFAR (the President's Emergency Plan for AIDS Relief) reauthorization, and participated in the first-round interviews for the new AMSA Executive Director/ CEO (who was just named yesterday - yay!). I've been inspired by my colleagues, energized about the work, and happy to be a part of the movement. Some highlights of being down in Reston include:

-Thai dinner with Dr. Bill Kessler, former AMSA pres who formerly worked for the CDC and now is at the Center for Medicare and Medicaid Services in New England. We had a good chat about Thai food in general, my career, and how CMS and others decide what measures to focus on in pay-for-performance schemes. It was also great to be on an interview panel with some former AMSA presidents (who now serve on the AMSA Foundation Board) and see how they interviewed candidates and what they picked up (and didn't) in our group interviews.

-Watching the Super Bowl with Paige, Josh, Dawn (intern from Penn State and Sural's classmate), Adrian, and another intern (doh, I forgot her name). Yay Giants!

-Minerva (best Indian food ever!) with Dan Murphy

-Waking up at 3 AM to see drunk Paul Davis and Kaytee outside my door getting ready for Premed GHLI lobby day on PEPFAR reauthorization!

-Meeting new people and getting pumped about the future of AMSA!

3) 2008 New Year's Resolutions

So back in December, I was feeling kinda down about myself and about studying in general. I was unhappy about the 40+ pounds I've put on in the past three years, and I wanted to do something about it. I also realized that it was going to be tough to make major lifestyle changes if Chris wasn't on board....so I basically dragged him along with me and signed us up for a 16-week package at Fitness Together (FT) , this personal trainer place that's about a 2 minute walk from our house. Although he wasn't so gungho about it, he knew I was really unhappy and made the commitment with me to lose weight, get in shape, and stop eating such a crappy diet (we basically ate out everyday for dinner, and sometimes for lunch as well). Although this has been one of my New Year's resolutions before, I really wanted to keep it this time, and throwing down a bunch of $$ and making appointments/commitments seemed like it would get our butts in gear. You know what? It totally has!!

Basically, since Jan 2nd, we've been going to FT three times a week for 45-minute strength training sessions with personal trainers (aka getting our asses kicked). The first couple times were really painful, but it's been getting a lot better and both Chris and I have gotten a lot stronger even in the past six weeks. In addition to the strength training sessions, we're responsible for doing cardio at least three times a week. We bought a treadmill and have been running since mid-January (I totally prefer the elliptical, but running is the best!)

We've also been keeping these "accountability food journals" where we write what we eat everyday and then have our trainers review it once a week. We've been using a lot of recipes from the Eating for Life book and follow a diet where we eat every 2-3 hrs (so 5-6 times a day) and make sure every meal we eat contains a carb and a protein. The point of it is to maintain blood sugar levels throughout the day so you don't go starving yourself and then totally overeating when you get super hungry. We keep the diet six days a week and then get a "free day" where we can eat whatever we want. So far, it's been going really well, and Chris & I spend a lot of our time cooking together instead of going out. We also feel really good about ourselves and it's fun to keep each other in check! I am totally proud of Chris for *finally* cutting pop out of his diet as well.

4) Getting on good terms with the in-laws

Yay! Even without taking any classes on negotiation and/or conflict resolution, I was successfully able to negotiate a weeklong 'vacation' with my in-laws in LA. Bonding activities included playing with my niece Melanie (im actually not that bad with kids!), eating lots of Chinese food in Monterey Park, and spending a weekend in Las Vegas at the Wynn Hotel with Chris's parents. While in LA, I also got to visit AMSA friends & previous JRF's Anjali Taneja & Casey Kirkhart, drink lots of bubble tea at Lollicup, go shopping with Chris, and actually have LA grow a little bit on me. Perhaps the West Coast may be in our future...

getting my life back...in order

i don't like disorder (but mostly in a larger, life-picture sense). my room is always messy, i tend to make piles, and i often enlist the help of chris to find (or remember) where i've placed various objects. however, there is always a grand plan in the works.

over the past few months, my grand plan was derailed a bit. everything was on track until i didn't do so hot on a standardized test. this caused me to rethink the life plan for the year and decide to:

1) Not graduate from med school this year and
2) Not match until 2009.

because of this decision, i had to figure out something to do for 1.5 years. as i had always been toying around with the idea of getting another degree, i decided to jump in and explore my options. again, there were many options:

1) Master in Public Policy (MPP) at Michigan's Ford School of Public Policy
2) MPH at Harvard's School of Public Health (SPH), Johns Hopkins SPH, or UM SPH
3) Apply for another fellowship like Doris Duke to go abroad for a year
4) Work!

this was a really tough decision for me but on the advice of some mentors, i decided to stay at michigan since it was the only place i could get my MPP in the time frame i had. the MPP requires three semesters (rather than two) and gave me more opportunities to explore and be exposed to topics i haven't covered before (like economics and health care financing). don't be fooled into thinking this was purely a career-based move, however. in fact, this decision was one of the hardest decisions i've made because it was one of the first major decisions where i actually took something else besides my educational/career goals into account.

growing up, i always thought my education and career would come first. i was confident my family would support me and didn't think too much about where my partner at the time would fit in. usually he would come along or be supportive and if he wasn't, i wouldn't let that get in the way. working against my love life, i left home, went to swarthmore, then china, then thailand. boys would never hold me back.

it looked as if a wedding wouldn't stop me. i was gone for months in geneva and then bethesda leading up to my own wedding in michigan. chris was truly committed, buying a printer and sending out all our wedding invitations (he even kept track of RSVP's!) the day after we got back from our honeymoon, i got on a flight to thailand to start my fogarty year.

even though thailand was a second home to me, chiang mai was new territory. the id fellow (poo) and her fiancee at the time (p'nui, now her husband!) took me under their wing and i definitely love them for it. it was weird to be alone. i missed chris a ton and wanted him to share in the experiences i was having in thailand. a few months later, he quit his job and came to live with me. everyone thought it was crazy, but we had a wonderful time overall. and chris got a new job when he got back!

when all this decision-making was happening, chris was completely supportive. he wanted me to make the decision that was best for my career. my parents were gung-ho about harvard. as asians, they passed along their love for name-brand education + prestige to me. i don't like to admit it, but there is a part of me that does buy into academic elitist thought. even if it wasn't the best program or the program that met my needs the best, i couldn't dispute the importance and the wealth of connections to be had there. friends offered to talk to people. i was paralyzed by the choice i needed to make.

in the end, i only applied to the Ford School. i convinced myself that i wanted the MPP degree, and this was the place i was going to be able to do it. i'm the first MD/MPP candidate here and am excited about it. people have been incredibly supportive at the Ford School, which is a nice change from some of the challenges i've had to deal with from the med school side of things.

honestly though, what it really came to down to was putting my family first. staying at michigan meant staying with chris and being able to see my parents every weekend. even though chris volunteered to fly to boston or baltimore or wherever i ended up for the year and my parents totally thought i should do it, i knew it wouldn't be good for us. and it wouldn't be good for me.

even though i do feel like i'm mostly an independent woman, i am really much happier when i'm with chris. this was really highlighted to me when both an american friend and a thai friend noted the difference in how i was as a person before and after chris came to thailand. was this a sign of weakness? i used to think so, but not so much anymore.

a high-ranking indian doc in the UN came to speak to a group of med students a few months ago. i asked her how she balanced her career and her family. her answer was:

"i've always told my husband: children first, career second, husband third." she smiled. i laughed, and said i would tell my husband that, but it made me sad. i know i couldn't do the things i do without chris's support. sure, he wasn't who i envisioned i would necessarily end up with - he wasn't an activist, or an intellectual. he WAS a fraternity leader and he was actually pretty conservative. over time, he's definitely come around (no more shopping at Wal-Mart for starters!) and he helps me do the work i do. most importantly, he's never made me choose (or feel like i had to choose) between our relationship and the time i sometimes over-commit to education, activism, or service.

in the end, who are you without the relationships you have with people? i am eternally grateful for the relationships i have with my family and my friends. i'm pretty confident i'll continue to have a productive career, but i don't want it to be at the expense of who i am.

i've had this discussion with a lot of close girlfriends over the past few months who are making similar decisions about residency, or whatever next stage they're moving to in their lives, and i think we're all moving in this direction, recognizing that there are different things that can make you happy and feel fulfilled. most importantly, it's not copping out to make decisions based on these things, even if it's not found on your CV or something that's going to go on any application. more than ever, i've come to realize that mental health and overall life satisfaction/happiness is way more about the intangible things (like friendship) than i used to ever want to give them credit for.

maybe it's taken me awhile to realize this (as i strive to be an overachiever), but it's becoming easier everyday that i continue to work on it. thanks to everyone who's been so supportive! :)

two sad things, one happy thing

i have a few unfinished blog posts rolling around, but i wanted to take a little time out to share these three things.

first, the sad things:

1) after an elderly family member of a patient i saw in clinic found out i was interested in health policy, he proceeded to share his views on health care with me. the highlight of this conversation was (and i QUOTE)

Man: "I don't believe anyone dies from lack of health care."
Tanya: "Really? That's an interesting thought."
Man: "Yes. Everyone can afford insurance but they choose not to buy it. Who can't afford their medications?"
Tanya: "Well, I see lots of people who can't afford their medications."

Conversation ends when the actual patient returns to the room from a bathroom break.

2) two other med students (and myself) attended an evening session called 'Malaria Boot Camp' hosted by Nothing But Nets, a campaign co-sponsored by the UN Foundation and inspired by a campaign started by Rick Reilly, a columnist who writes for Sports Illustrated. His 800 word column asking people to donate $ for nets raised hella money from a segment of the population (men) that were largely previously inactive in global health. At the malaria boot camp, a famous scientist from MSU spoke about how he helped develop a new long-acting insecticide treated net with the private sector. this was cool because the net didn't need to be retreated & lasted for about 5 years, among other things. In the Q&A session, i asked a question (surprise, surprise).

Tanya: 'Dr. Wilson, you've dedicated your career to trying to help those who suffer from malaria around the world. My name is Tanya and I'm here with a group of students from Universities Allied for Essential Medications. Have you considered humanitarian licensing or have you taken other steps to ensure that the fruits of your research will be available to those who need them most?"

Dr. Wilson: 'I really don't have control over anything because it's completely funded by the private sector. I hope our net is brought to market, but that's not my choice.'

Tanya: 'Do you retain any control over the patents or intellectual property used for the invention of the net?'

Dr. Wilson: 'Unfortunately not; the company retains all the rights."

Dr. who is running the whole panel and is the Director of Global Health: 'Excuse me. Public health people like Dr. Wilson who are dedicated to researching issues like malaria do not concern themselves with marketing. We are out there to try to help people, not market things." He says this kinda huffily and turns around nodding to the other panelists like they should back him up.

I was totally offended! As a leader in public health, how can he say that marketing is totally not relevant? An analogy to medicine would be that we only care about treating our own individual patients and improving their health but don't care at all about the health systems we work in. After I told this story to my brother, he even said, "What's the point in inventing an awesome net if it's never distributed to the people who will actually benefit from it?"

Frustrating.

Happy things:

Thiru nominated me for 'Most Likely to Make a Difference' on Facebook. Small, i know, but it totally made my day.

Patients also make my day a lot in clinic. Sometimes I know it's ridiculous to gain so much ego boost from little comments people make, but it seriously does go a long way. Some of my faves from this month:

"She is the best med student in the whole med school!" - from a professor to a patient after she offered me a position in her husband's cardiology practice.

"Hey doc, she's really good." My attending looks around, confused. The patient points to me. "She knows how to explain things so that I can understand!" Attending: "Oh, she has to be good. She's a Michigan medical student." (Thanks, Doc)

"You better be here when I come back! I only want to see you." Sorry, I'm rotating off - and I'm just a med student.

even when i don't know the answers to questions when i'm getting pimped, i know that i'm good with - and take good care of - patients. clinic is also a lot more fun than i thought (props to all you people in primary care!)