Saturday evening I enjoyed watching The Dave Matthews Band perform at Shoreline Ampetheatre with Kate. It was a really tough week, as I've been spending nearly every waking minute studying with classmates and did not have many opportunities to see Kate in a relaxed setting. The band was amazing (interesting fact on Dave Matthews: despite growing up in South Africa during Apartheid, he started a multi-racial band). Personally, the violinist Boyd Tinsley impressed me the most during the performance, though it's hard to explain the passion and zeal that he played during the concert that made him the most memorable to me.

After this brief respite from studying, Sunday was a challenging day. With quizzes due and half our 4-week quarter completed, there was so much to review. Fortunately, my classmates came to the rescue and made the day fly by with multiple study groups for anatomy, cell and molecular biology. I know that the term 'fly' should not apply to studying, but it seemed so perfect working with my fellow students to conquer the unknown and to teach each other the concepts.

My prediction is holding true - Stanford is fostering collaboration between students in mastering the material. If only the world could approach its problems and work with the same goal in mind...

ABC is currently showing the reruns, so we made an open invitation to the class to come by and enjoy some home-cooked brownies and watch the show. It was a pretty relaxing way to spend the evening watching people act as doctors on television while we concurrently are learning how to act as doctors. So everyone, actors and students alike, is learning how to act like doctors. Who knew we had so much in common!

A few avid viewers (from left): Jess, Luiz, Philippa, me, Kate, and Alana

While I agree that the content is valuable, what has really frightened me is the details that the material has covered. I'm not proficient at using a microscope, I haven't studied precursor cell types, and my basic knowledge in DNA replication and repair is basic. To be more specific, it's difficult to read EM, to understand microsatallite instability of DNA, and to learn 10-15 anatomical structures each time you study a cadaver.

After a pretty rough night, I decided to ask my classmates how they felt about the material, and I was relieved to find that everyone, even students with a microbiology background, was struggling with the material. It's not just me - we the students are being asked to learn a great volume of knowledge.

Sleep matters (little)
I have always loved caffeine. I'm a habitual coffee drinker and enjoy the morning cup of java. Yet, I find myself returning for a second dose in the afternoon, and reaching for the dark chocolate espresso beans (if you haven't tried these, they are VERY tasty) a bit too often. I evaluated my sleep patterns and found that I have been getting six to seven hours a night, well below the eight to nine hour average I maintained before starting classes.

Polling my fellow students, I was admittedly relieved to learn that I was doing well with my sleep. People on average reported getting a mean of five to six hours (range = 4 - 7, N=8), well below the recommended value of eight hours per night. Even more disconcerting is that we're only in the second week of classes! Fortunately, we've got time to adjust and become more efficient in our efforts, so that we can take care of ourselves and maximize our learning potential. I've put in my 45 miles of running this week, so I've got a good start on keeping physically fit. Now, if I can just find that one additional hour in the day to sleep...

The orientation to becoming medical students is over
True, we had a week set aside to travel to the Sierras for SWEAT, came back to hear the faculty and professors introduce us to the curriculum and inspire us about our educational opportunities, and get our bearings before classes began on Wednesday. However, we've learned about additional classes (a.k.a training) that are required for our practice of medicine. For instance, most of the class learned how to draw blood, take blood pressure measurements, and started on our CPR training last Wednesday.

I guess I can say that my experiences have left me feeling overwhelmed by the breadth of knowledge required to practice medicine. Fortunately, my classmates seem to concur, and I find it unlikely that Stanford would choose 86 students that are incapable of meeting the task. I find strength in my classmates and know that this too will pass.

Going into medical school, I decided that I would make a goal to qualify for the 2008 Olympic Trials in the 10,000 meters. I'm throwing that goal out there for everyone to see, as I've learned in sports psychology that a good goal-setting strategy is to publicly post your goals. I've looked at my running as an extension to my life as a student, and my current career projection lands me somewhere in the specialty of sports medicine.

Yet, I am not Superman, as I have humbly learned my first week of classes. Eight hours of sleep is hard to come by as our schedules are filled with classes (and last week by orientation materials), and life continues to go on while we are students. We have bills to pay, friendships and relationships to maintain, and occasionally we need to take out the garbage. Today I've plowed through the drifts of papers and emails that have cluttered my room and mind. I'm going to go for a leisurely run this afternoon, lift weights, and do some core-strength exercises. In addition, I'm going to spend some quality time with my girlfriend who has been very supportive but has seen little of me due to the week's demanding schedule. Most importantly, I'm going to take a moment to remember that I'm human and need to satiate my needs for nourishment of the body, mind, and soul.

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.

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

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)

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)

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

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.