August 2006

First Day of a Long Journey

I've been preparing for my first day of medical school for many years and carefully planned my schedule for this opportunity. My experiences in my first day of classes exceeded my preparations and expectations. Here's a little about my first day:

I finished my last class requirements for medical school one year ago at a community college, and three years ago completed my last quarter of classes as an undergraduate student. I was a bit intimidated to begin the rigorous medical school schedule and balance taking multiple classes while pursuing my research interests and extracurricular activities. In addition, I was a bit fearful of having been out of school for so long and have been questioning whether I still have the mental edge to be a student again.

When we sat down for our first lecture in molecular biology, I remembered the emails warning us to prepare over the summer. We were assigned four chapters of reading in the Bible of Cell Biology: The Cell. I prepared in earnest, balancing my time with completing my biochemistry video lecture class. Yet I wondered; how much can one prepare for a class? What would be the expectations? How do you evaluate your progress in a binomial grading system of pass/fail?

My personal fears and concerns soon evaporated as we listened to our first lecturer. Dr. Gilbert Chu, one of our class molecular biology professors, was captivating and explained his expectations for the course. He would mark on the board when a question was asked by our class and would not finish his lecture until 10 questions were asked. I was impressed by his teaching style and was relieved to find that many students were already voicing questions that I was concurrently entertaining in my own mind.

Later that afternoon, we began our highly anticipated human anatomy class. My personal interests in human physiology and anatomy from a sports medicine standpoint are mirrored by the objectives of the course, simply stated as understanding the structure and related function of the human organism.

Before we began our dissection of our human cadavers, our professor Dr. Lawrence Mathers asked us to bow our heads and allow a moment of silence and reflection for the bodies that were donated for our learning purposes. I found the experience touching, humanistic, and appropriate, especially after we unveiled our cadaver. Our class is divided into teams of four that are each assigned a body. Upon unveiling, my group learned that we had a female cadaver that we would learn from over the next two quarters. After visiting a number of anatomy labs during the interview process, I found the actual experience of cutting and examining our cadaver to be much different than what I had expected. The preservation process makes the skin look like a brown paper bag, as the skin its has become taut and devoid of many wrinkles. Observing my cadaver, I wondered many things such as how did she die? Did she have a family? Husband? It also humbly reminded me of my mortal existence and the inevitable fate that I too will die someday.

Examining the chest cavity and actually touching human flesh were different that what I expected. On top of visual examination, we learned to use tactile cues when studying our cadavers. I found it fascinating to explore the difference between fat and muscle tissues. Fat at room temperature lies between a solid and liquid state, and we could compare the tissues through touch (fat tissue feels more slippery than muscle) as well as appearance (fat looks more yellow and white compared to major muscles that have a striated appearance and are predominantly red in the chest cavity).

At the conclusion of our first day of anatomy, the teaching assistants invited us to an informal discussion titled: Anatomy Unveiled. We heard from the teaching assistants about their experiences with the course and were invited to share our thoughts and feelings as we continued throughout the quarter. The most insightful comment came from one of the teaching assistants, a statement that will stay with me through the anatomy course: one of the most optimistic things that someone can do is to donate their bodies to teach the next generation of doctors.

After my first day of class, I feel incredibly happy about my choice to be educated at Stanford Medical School and I have the utmost faith in my professors and fellow future colleagues in the mark we will make in the field of medicine; we will not merely become doctors but will be cultivated to grow as humanistic healers.

Induction

White coats, stethoscopes, and scrubs don't make a doctor: they are an iconic start towards becoming a doctor. Rather, we face the challenge of being trained to a new way of thinking.

After returning from SWEAT, our class was physically tired from our grueling, grizzly hikes through the Sierra Wilderness. Yet, one of the lessons of medicine is that there is no rest for the weary. The following day we began our orientation. It spanned three days and included being addressed by faculty and staff about the curriculum. We know that we have an immense amount of work ahead of us over the next four or five years, but it was comforting to hear the passion that everyone spoke of their roles in our future education.

The highlight of our three-day orientation was the conclusion with the Stethoscope Ceremony. My family and girlfriend attended the ceremony. The evening included an outstanding dinner and the presentation of a personalized stethoscope for each student. Dean Pizzo addressed our class and reminded us of the challenges ahead of us in the field of medicine. Rather than merely discussing the long hours and years of training ahead, he spoke in a global sense and reminded us that our opportunity to enter the field of medicine was associated with a responsibility to educate the public about the disparities in our health care system and political forces that threaten progress in areas of science including evolution, stem cell research, and environmental protection.

He challenged us to engage in discourse with the public and to think of these issues in a global sense. Being at a top-notch institution and living in California, a state that has publicly funded a stem-cell initiative, it would be easy to be complacent and insulated from global challenges. I was proud of Dean Pizzo and the way he spoke of Stanford as an institution that is globally aware and engaged in world issues.

After the ceremony, our SWEAT group (The Grizzled Sloths) found each other for a picture opportunity. In addition, my house (composed of Alana Frost, Jessica Telleria, and me) took additional pictures wearing our scrubs, white coats, and stethoscopes. Although we looked the part of doctors, our orientation suggested we have a long way to go.

The Grizzled Sloths (from left): Ariel, Luiz, Jason, me, Philippa, and Jason

My roommates and me (from left): Jess, me, and Alana

Are You Grizzled? SWEAT Part II

Two of the hard realities of spending three days in the wilderness are that running water only comes from a stream and deodorant is synonymous with bear attacks. As a result, personal hygiene suffers greatly. Despite these inconveniences, our group grew closer and more grizzled together.

Now what is the definition of grizzled? From a game show parody on "Saturday Night Live" called Who's More Grizzled?, the term grizzled is defined as being the roughest, toughest, most hardbitten old-timers around. At the conclusion of the first day, we learned that someone forgot to pack toothpaste for our group. Before departing Stanford, we were warned that anything with fragrance (including deodorant and toothpaste) could attract wildlife, specifically bears. When we prepared for bed the first evening, we learned that our toothpaste rations had not been prepared. We could attempt to contact a different group that was traveling counter-clockwise on our trail loop, but we would not cross their path until the next day. Unfortunately, that meant we would have to go without brushing our teeth for the nigh. Little did we know, the next day held much greater challenge for us.

After backpacking for four miles our second day, we stopped at our lakeside campsite. Each person was traveling with two Nalgene bottles, and we filled them daily by using a water filter. The resulting water resembled tap water (it would be a stretch to call the water quality and taste identical). When we attempted to re-fill our water bottles at the lake, we learned that the pump was failing to function properly due to a faulty filter. The lake water needed some form of cleaning performed, as giardia is common. Giardia is a parasite that causes one of the most common forms of water disease. Side effects include diarrhea and intestinal distress. With one day of backpacking ahead and three meals remaining to prepare before we reached the trailhead, we needed to engineer a new method to prepare potable water. Our solution was to filter the water using one side of a clean t-shirt and then boil it for five minutes. Our water may have been clean, but it tasted horrible – like drinking bitter water with ash (I'm pretty sure that some of our filtration left remaining debris in our final product).

In addition to concerns regarding giardia, we learned that bats were traveling over the surface of our previous lake. Tyler astutely pointed out that bats are the leading carriers of rabies. This made the idea of bathing in the lake extremely unappealing and added to our failing hygiene. Combined with our trail travels and day hike to Elephant Rock (see photo), we decided to amend our group name to the grizzled sloths.

At the conclusion of our backpacking trip the third day we were filthy, dehydrated, smelly, and starving. When we sat down at Lake Alpine Lodge at the trailhead and finally saw ourselves in mirrors, we were impressed by our transformed images. The discussion arose regarding who was the most grizzled. Ariel and Philippa had the most cuts and bruises on their legs. In addition, Ariel's white t-shirt had a splotchy-brown appearance, giving her the edge on Philippa. However when Jason took off his hat to reveal a dirt-line that separated his exposed face to his hat, he was the hands-down favorite of our group as being the most grizzled member of our team. As we sat down and enjoyed a pitcher of beer, ate burgers and fries, and joked together, no one in our group seemed to mind this transformation.

Our group at Elephant Rock (from left): Ariel, Philippa, Jason, David, me, Tyler, Luiz, Lisa

The Grizzled Sloths after three-days backpacking, including Wendy (purple shirt) and Greg (third from right)

Ten Strangers, Swedish Fish, and Bear Bags lost in the Wilderness

Stanford has a unique orientation program to acquaint our class of 86 medical school students. Our program is called SWEAT, and it's the most unique ice-breaker that I have ever experienced.

On August 23rd, we assembled at the Dean's Courtyard of the medical school to meet our first-year classmates. As an optional exercise, SWEAT (Stanford Wilderness Experience Active orientation Trips) is one week before we begin classes and consists of three days of backpacking and wilderness exploration in the Sierra Nevada. Our class had the highest turnout for SWEAT in the event's history, with nearly 90% of our class attending. We ranked our hiking experience levels and were randomly placed into groups that were balanced to have people of all abilities equally represented. Two medical school students led each group. Our leaders were Tyler Hillman and Greg Allen, both in their third year of SWEAT. Our group had been assigned the name sloths, a species most closely related to the anteater and aardvark that is also known for excessive sleepiness. In contrast, every other group had much more common names, including monkeys and tigers. However, our group proved to be extraordinary. Here's our story from day one of our journey together.

After waking up at 5 am and departing Stanford at 6 am, we traveled nearly 4 hours to the trailhead of Silver Valley Campground, and backpacked three hours to Rock Lake. After reaching our campsite, we were humored to find that our dinner was composed of 'burritos', consisting of beans, cheese, and tortillas. However, someone forgot to bring the cheese, and we also learned that our pot for cooking had a hole in the side. Our talented collection of incoming med students discussed solutions to fix our main cooking pot for the three-day journey. Solutions included cooking baked-beans in the pot to create a tight 'bean layer', using sap from nearby trees, using tortillas, or using a pot top. I brought Swedish Fish for the trip, a red gummy candy. After a short silence, Ariel suggested we use the Swedish fish to plug the hole. Surprisingly, the pot held water and my candy helped salvage our cooking plans!

Later that evening, we went to hang our bear bag. For those unfamiliar with this term, a bear bag is created by throwing a carabineer (a metal clip) over a branch of a tree attached to a rope. The branch is used to hang a bag with all the food and any other items with a fragrance. The other requirements are that the bag must hang 11 feet from the ground and must be away from the trunk of the tree to prevent bears from climbing (brown bears are apparently notorious for their climbing skills). Unfortunately the people responsible for initially setting up the bear bag only had moonlight and flashlights to lead our group to the site, and we soon found our group lost. Tyler, Greg, Luis, David, Jason, and I went to help hang the bags while Ariel, Wendy, Philippa, and Lisa waited at our campsite. However, not only could we not find the bear bag, but we also could not locate our campsite to backtrack. We yelled out to the ladies, but got no response (apparently they thought the noises were 'non-human' and did not respond to our calls of help). So we walked, lost in the wilderness for an hour, looking for a rope hanging from a tree with a 'unique bark pattern' and no clue as to our initial campsite. However, we finally crossed a path we recognized, found the missing carabineer, hung the bear bag, and got back to the campsite by 1:00 am. We did have a fun time wandering together and a good laugh about our 'non-human' voices being unrecognizable.

The Sloths (from left): Tyler, me, Philippa, Jason, Wendy, Lisa, Luiz, David, and Greg

Our cooking pot 'patch-job' with Swedish Fish (in red)

Heal Me, Elmo

Medicine is a demanding discipline, but you can't always take yourself seriously, especially the summer before you start. Therefore, my 26th birthday party needed a youthful theme, and the solution came from a character from Sesame Street: Elmo.

For most of the summer, I have been making the transition into medical school. This has included a 37-hour DVD lecture series in biochemistry, complete with online examinations, and 230 pages of text spanning four chapters of molecular biology. Obviously, Stanford takes its preparations seriously for its incoming medical school students.

Combined with my experiences during the application process, interviews to medical schools, financial aid, revisit weekends, and making a geographical decision that largely dictates where I will eventually practice medicine, I wanted a reminder not to take myself too seriously with every decision that I made.

This came in the form of my 26th birthday party. Returning from a three day trip to Mexico with my girlfriend Kate ONeill, we decided that a Latin Theme party would be fun. This included the usual drinks (Margaritas, Corona beer, and Mojitos), a home-made chocolate ice cream cake, and a pinata.

We visited La Costana, a Mexican-market and self-proclaimed home of the best burritos in Mountain View, California (they really are the best!). The market had quite a selection of artistic creations in paper mache, but my eyes became fixed on the red and furry Elmo pinata. As I looked at Elmo with his silly grin, I kept thinking about the Tickle-Me-Elmo commercials and all the parodies with Elmo, including the Simpsons episode Missionary Impossible where Sesame Street characters chase Homer Simpson for making a prank phone call into a PBS fundraiser and Elmo pops out around the corner and candidly states: Elmo knows where you live.

The party was a smash, and so was Elmo. My first procedure was to fill Elmo with tootsie-roll pops and tootsie-rolls. After making an incision, I filled his head with candy and bandaged the hole. For the party, we got a Sponge Bob Squarepants foam bat so that everyone could take a shot at their favorite Sesame Street Character. After 20 guests arrived and socialized, we moved like an angry mob into the backyard and strung up Elmo the pinata. Everyone took a good shot at Elmo, but the little red dude was resilient to our shots. Even first year roommate Alana, a former national-caliber softball player from Williams, made great contact, but the best we did was to jar a few pieces of candy.

Finally, we decided to try using a PVC pipe that was previously being used for massage therapy (force placed on a massage roller under a muscle group can result in myofascial release). My neighbor Josh took one swing and decapitated Elmo, but for fun I decided to play-doctor and did my best to repair him. From my surgical techniques and the poor outcome for Elmo, Stanford Medical School has its work cut out for them.

Despite being blugeoned by a Sponge-Bob Squarepants foam bat,
Elmo still loves us

About Me

I'm a 26 year old student-athlete-researcher originally from Richland, Washington. The phrase above describes my pathway to the Bay Area and evolution into Stanford Medical School.

I grew up in Eastern Washington and as a youth was the stereotypical uncoordinated-nerdy-trying-to-fit-in kid. My parents instilled the values of hard work in the classroom, though they encouraged me to play sports and stay active, as my family has a poor track record with cardiovascular health (stroke, heart attack, cardiovascular disease, etc.)

I tried all sports at a young age, though the sports for the 'in-crowd' were limited to ball sports. Tragically, my lack of coordination made me inept at most of these pursuits, including soccer, basketball, and baseball. What I did love was getting to run with the ball, and that translated into a new pursuit of running cross country and track in middle school and high school, eventually achieving a pseudo-jock status when I started placing at national competitions and making the World Junior Cross Country team as a senior in high school.

Growing up in Eastern Washington, I was lucky to be surrounded by a very scientific community. I grew up just five miles from the Hanford Site, a location that developed much of the nuclear technology during World War II and has since transformed into a major cleanup project. In defense of my hometown, it should be noted that the background radiation levels were lower than our northern counterparts from Spokane, a town that has more background radition from naturally -occurring radon isotopes. My high school, Hanford High School, was blessed with great science and math teachers that helped cultivate my interests.

Now how did this pseudo-jock-nerd from Eastern Washington become transplanted into the rich, intellectual institution of Stanford?

My running interests were recognized by Vin Lananna, the coach at Stanford. He had developed a number of national championship teams and individuals at Stanford, and I was honored to be contacted and visited by him. On my recruiting trip, my collegiate heroes of track and field were all present at practice and very approachable during my visit. As for the school, I knew I was not making a sacrifice by choosing to attend Stanford. Hmmm, top-notch academics coupled with a winning coach? Where should I go to school but Stanford:)

At Stanford, the work ethic and scientific background I had developed in high school made me prepared for the classroom, but I initially struggled with the high-level performances demanded by my sport.

After a two year 'adjustment period' and some serious soul-searching, I found purpose again in my running. The Sports Medicine department helped me turn the corner on the constant fatigue I was experiencing from pushing myself over the edge with my athletics.

Don Chu, the head of the training room, became a father figure to me and inspired me to seek out answers for why I was facing my health problems. I did make the turn around and finished my college carreer with five All-American Awards and three NCAA Team Championships.

As a post-collegiate, I finished 9th at the Olympic Trials in 2004 but became injured and have been fighting again to regain health and pursue my running interests. Again, many doctors and specialists from the sports medicine community have come to my aid. These tangible experiences have confirmed and provided direction in my career goals of becoming a sports medicine specialist.

As I started asking the difficult questions with my health, I found research to be especially appealing. My susceptibility to heat exhaustion led to two years of research in thermal regulation, culminating in a thesis exploring the relationship between lowering core body temperature and associated physical performance gains.

In the past three years, my research has taken a different route, this time to neuroimaging and studying cognitive deficits. In John Desmond's Lab at Stanford I studied the effects of mild traumatic brain injury on collision sport athletes using fMRI.

Following that experience, I worked in Allan Reiss's Lab at Stanford studying two different genetic disorders: Williams Syndrome and Narcolepsy with Cataplexy. The latter of the disorders is the anecdotal material of cocktail parties, a largely unknown sleep disorder where excessive mirth/humor can trigger a sleep episode.

So now I find myself again at Stanford, running each day for fitness and competition, while pursuing my research and academic interests in medicine. I feel at home.