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Public Safety, Stanford Medicine Unplugged

Medical tips for holiday travel

Medical tips for holiday travel

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category

plane in skyThe holiday travel season is in full swing, and millions of people are off visiting their loved ones. So a seminar I recently attended on in-flight emergencies was quite timely.

I had been looking forward to the seminar, which was led by emergency medicine faculty members, all week. During the holidays, I have to travel on several different flights to get home, and occasionally, a flight attendant has asked on the loudspeaker if there is a doctor on-board. I was excited to finally be in the know.

Much of the conversation during the first part of the seminar focused on a New England Journal of Medicine article on how physicians should handle in-flight emergencies. It noted that the most common reported medical event during a commercial flight is fainting; the most fatal is a heart attack. Interestingly, heart attacks make up only 0.3 percent of in-flight emergencies, but they cause 86 percent of in-flight deaths.

For the second part of the seminar, emergency medicine faculty told us anecdotes about times when they had been called on during a flight – some stories were haunting, others interesting tidbits – and walked through three different simulations. The law about medical professionals helping people during in-flight emergencies is vague regarding medical students. But I know this: If a doctor is called during one of my upcoming flights, I sure hope someone onboard is more qualified than I am.

In all, I gathered several practical tips that could be helpful to readers. If you are traveling and concerned about in-flight medical events, please consider this:

  • Print or clearly write a list of medications you are currently taking. Include how often you take them and at what dose. Keep this readily accessible on the flight.
  • Make sure to travel with these medications in your carry-on in case your checked luggage is lost.
  • If you are traveling with someone you can confide in, make sure they know if you have any current illnesses. If not, please add this information to your list of medications.
  • If you have an allergy to any medication, please write this on your list. Write what kind of reaction you have, whether it is a tightening in your throat or a rash.
  • If you or a loved one does experience a medical event, stay calm.

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Education, Medical Schools, Stanford Medicine Unplugged

Considering premed? Some things to think about…

Considering premed? Some things to think about...

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

MatchDay14-Ever since I was little, people asked me if I would become a doctor like my dad. I wasn’t sure until I shadowed a doctor my freshman year of college. As soon as that happened, I started looking for guidance on how to choose between my many interests so that I could both be true to myself and become the best candidate for medical school that I could be.

I was lucky to have many great mentors who took the time to thoughtfully answer my questions, and now I’d like to pay it forward. For anyone in the early stages of premed that wants advice, here are my thoughts on certain areas.

Academics

  • Medical schools will likely want to see evidence that you’ll be able to keep up with the academic rigor of their program. This sounds obvious, but the way that you can demonstrate this is to do well in your classes as an undergraduate.
  • Don’t take more classes than you can master. There are many interesting courses available in college but you need to be strategic about giving yourself the time to excel in your classes and giving yourself time to just be.

Extracurriculars

  • Give yourself time to see what extracurriculars you gravitate towards naturally. When you find them, pick one or two and invest time and energy in them. Take them in interesting, unique directions:
    • If research is your thing, then ask interesting questions. Schedule time every few months to actually speak with the faculty overseeing your research.
    • If volunteering is your thing, then be a leader in your field. Identify a need that has not been filled or an organization that inspires you and work hard on that.
    • If you’re an athlete, then be a leader on the field and off. Be a mentor to younger teammates.
  • At the end of the day, medical schools want to see your leadership and legacy as an undergrad.

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Education, Global Health, Patient Care, Stanford Medicine Unplugged

From medicine to the mat: Learning self defense

From medicine to the mat: Learning self defense

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

cute karate girl“You hit me!” My sparring partner accused me from behind his hands. We were in a self-defense studio practicing what to do in a mugging situation.

At first I was supposed to mug my six-foot tall, athletically built male partner. He had no problem fending me off safely.

The trouble started when it was his turn to mug me. He stepped past my socially acceptable 3-foot bubble. I panicked. My legs crouched and I lunged forward. My palm drove into his nose.

The mugger stumbled back and suddenly he was my partner again, holding his face.

“Sorry, sorry,” I didn’t know what else to say.

He squared his shoulders and offered to try again. As long as I didn’t hit him.

I nodded, trying to get focused. I was here for a reason. Many reasons actually. It had been a goal of mine to gain some level of proficiency in martial arts since I was little. When I grew up to be five feet three inches and too small to donate blood, I gave up on that particular goal.

Then this summer I spent a month volunteering in a hospital in Uganda. I saw more there than I have had time to process. There were real-life miracles, like when a patient survived after arriving with a blown pupil and an epidural hematoma. There were tragedies that I don’t know if I will ever shake off, such as the small child who died during rounds. There were also preventable snafus, like when one of my fellow volunteers was mugged walking home.

I had decided there were some tragedies I could protect myself from. Additionally, I had taken a year off from medical school to write a novel. The protagonist in my novel is highly trained in martial arts and I wanted to do some field research. When I returned from Uganda, I decided to throw my weight into self-defense classes every Monday and Wednesday evening.

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Education, Medical Schools, Mental Health, Stanford Medicine Unplugged

Free from school

Free from school

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category

Editor’s note: After today, SMS Unplugged will be on a limited publishing schedule until September.

girls running

Summer. It beckons with strawberry warm rays of sunlight, afternoons spent splashing in a pool, and the joys of watermelon-flavored popsicles. We, second-year medical students around the country, look out our windows and see children, newly freed from school, frolicking in the playground next door – and feel miserable. For this is the time when we are experiencing the worst of medical school.

We have completed the pre-clinical curriculum, some of us barely crawling across the finish line. We have spent weeks cramming for the USMLE, an exam described in no softer terms than “the most important exam you will take in your life.” And we are becoming familiar with a new kind of anxiety as we prepare to enter clinics for the first time. Or, rather, my classmates are – I chose to take time off between second and third year.

In the midst of Stanford-high expectations for our professional performance, we are seldom taught exactly how to take care of ourselves. I knew that I needed to change something halfway through second year when I found myself outlining a novel instead of studying during finals week. I nearly failed two exams. But I was happy.

I felt satisfied.

And so, I set about finding a way to incorporate more of writing into my medical school experience. Stanford has funding called Medical Scholars, which is set aside for every medical student to take a year off to work on a significant project or research experience. Their office willingly helped me apply for and receive this funding to work on my novel full-time for a year. I can’t imagine this level of support for an artistic endeavor from any other medical school. And so very soon, I too will be frolicking in the grass, newly freed from school.

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Education, Stanford Medicine Unplugged

Top 5 reasons medical students should do community service

Top 5 reasons medical students should do community service

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Arbor Free ClinicAs the process of applying to medical school, and then later residency, becomes hyper-competitive, us medical students often feel forced to pursue our passions only in ways that are “high-yield.” It may seem counterintuitive, but the further we go in our medical training, the more inertia we seem to have about giving our time and energy to the every day people in need. We’re so pressed for time from our participation in cutting-edge research, highly scalable health-policy work, and exciting start-ups, that we sometimes lose touch with the very people whose need first sparked our commitment to medicine.

We all know that helping people is the right thing to do. I don’t need to wax on about how we can be the people we want to be – how it’s a choice. This post is for the moments when we succumb to focusing solely on our resumes and our future applications. This post is about how using our skills as medical students to help people will actually help us professionally. It’s like when companies align their triple bottom line. We can do that, too.

And, so, the reasons:

1. To get individualized mentorship. The free clinics run by medical students have doctors who walk one or two pre-clinical students through the entire patient encounter – from taking the history to doing the physical to presenting the patient. This kind of one-on-one training is very rare.

2. To practice applying clinical skills. As a pre-clinical student in a free clinic, you actually get to do a physical exam on real patients rather than actors pretending to be ill. You get to work through a real-life clinical reasoning case and generate a differential.

3. To remember why you wanted to go to medical school. Medical school can be really hard, mostly because it may be the first time that you’re surrounded by peers who work just as hard as you do. But get back in touch with the desire to help people, which is what brought most of us to medicine in the first place, and you can replenish your sense of purpose as a medical student.

4. To figure out what you like clinically. Most of us are either honest with ourselves about not knowing what kind of medicine we want to practice or fool ourselves into thinking we know what we want to do based on a few shadowing experiences. Either way, getting involved and taking an active role in patient care can help you determine whether you like cardiology versus neurology, or it can solidify the hunch you already had.

5. To get a leg up when applying to residency. A Harvard surgery resident recently talked about what gave her an advantage when she was applying to residency; her answer was both research and her involvement in free clinics. She said that because she worked in a free clinic every Thursday evening doing diabetic foot exams, she was more comfortable in a clinical setting, she was more self-guided as a clinical student, and therefore, she was more competent when she did her sub-I’s.

Most medical students have a competitive streak. When you do something, you want to be good at it. So set yourself up to be good at your clinical rotations. Set yourself up to be taken seriously as a doctor whether you plan to pursue research, policy, or entrepreneurship. Set yourself up by volunteering in your community’s free clinics.

Natalia Birgisson is a second-year student at Stanford’s medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo courtesy of Arbor Free Clinic

Infectious Disease, Stanford Medicine Unplugged

The bacteria that nearly killed my grandmother

The bacteria that nearly killed my grandmother

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Staphylococcus aureauMagnification 20,000“Hefur þú lært um Staphylococcus aureus?” I almost don’t recognize the bacteria name because my grandmother pronounces it differently in Icelandic.

“Já–” I’m about to translate my microbiology flashcard for her when she interrupts, her hands busy kneading the cookie dough and her eyes on my little sister near the oven.

That’s the bacteria that almost killed her eleven years ago, she tells me. I can hear her words building up. This is a story that has been waiting to be told often enough to be reconciled.

They did not know what was wrong with her. They thought maybe cancer, maybe tuberculosis – and I almost interrupt her story to tell her about Pott disease. That’s when tuberculosis from the lungs goes through the blood to the vertebrae and causes back pain, fever, night sweats and weight loss. I memorized the flashcard a few weeks ago.

My little sister stops doing handstands in the middle of the kitchen and comes to stand next to my chair. Together we watch Grandma roll the cookie dough as she continues talking.

It took the doctors a whole long time to figure out what was wrong with her. In the meantime, she was in so much pain from her back that she had to be on high doses of morphine. Codeine.

She could hear them yelling at each other in the next room, my great uncle and the other doctor. The two internists had very different approaches. My great uncle wanted to identify what was going on before putting her up for surgery. The other doctor yelled at him that he was going to wait so long the woman would die.

My grandma stops her cookie cutting and sits across from me. She looks at me for a moment over her glasses and tells me how terrifying it is to know that your doctors don’t know what’s wrong with you.

My poor great uncle, I tell her – he was just trying to make sure that they didn’t make you worse by operating.

My grandma nods and describes how when they finally did agree to have her undergo surgery, my great uncle called the best surgeon in town and had him come back early from vacation to operate on her the next day. And good thing too, for when they did, they found that three of her vertebrae had been turned to dust.

With an infection like that, the surgeon said she was hours away from death.

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Medicine and Society, Stanford Medicine Unplugged

Why I screamed when my boyfriend hugged me

Why I screamed when my boyfriend hugged me

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

black and white rocksI was checking my email when it happened. My boyfriend had texted me saying that he was late arriving to the airport. So I stood outside with my suitcase behind me and clicked to an email from my mother.

I didn’t notice until too late that someone had approached me, and I screamed when I saw a black man reach out to grab me from the corner of my eye. Before the sound reached my ears, I realized it was my boyfriend, excited to have surprised me. I unfroze my arms as quickly as possible and embraced him.

We never talked about it. In the car ride back to Stanford, where we were both seniors, we talked about our upcoming spring break. I wondered if he had noticed other people on the sidewalk turn to stare at us. I wondered if he would ever surprise me at the airport again.

Mostly though, I chewed on the newfound knowledge that I had prejudices. Would I have screamed if a white man had grabbed me? An Indian man? A Hispanic man? Probably. I knew girlfriends who had been assaulted by all of the above during our time in college.

Regardless though, the thought in my mind when I screamed was not fear of being assaulted, it was fear of a black man. And I’m so ashamed to put this to words. I am half white, half Hispanic and grew up with a family that values diversity. I have been blessed with friends of all different backgrounds. So if I, with a liberal, multicultural upbringing had a prejudiced reaction in a moment of stress, I shudder to imagine what lies dormant and unrecognized in other people’s minds.

The question is not whether we are prejudiced. We are. Every single one of us in some way or other categorizes people by how they look and assign a danger factor to them. It’s how we are biologically wired to survive in nature.

The question is what we are going to do about it. In the quiet of our own home when no one is watching, are we going to unpack our assumptions and examine how we can improve ourselves? Are we going to encourage each other to go out of our comfort zone, to open ourselves to ridicule for admitting that we are imperfect, to challenge ourselves to be better?

My boyfriend and I are no longer together. We are at separate medical schools and I know that one day, when we are doctors in our respective specialties, I may call him for advice on the health of a loved one. I know that I will trust him more than I trust many of my peers who happen to be white.

And it hurts me to know that sometimes, it won’t matter that he has a gentle soul. Sometimes, the world will see him as dangerous before even looking.

Ferguson has hit our nation, our people, hard because it lives in every home – black, white, yellow, red or brown. It’s not a controversy over hyper-reactive policemen or a history of slavery. It’s a slap in the face that every single one of us has to own up to our discriminatory thoughts and grow. Americans need to grow as people and as a people. We the people need to become a we, not an us and a them.

Natalia Birgisson is a second-year student at Stanford’s medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo by Chris_J

Education, Medicine and Literature

The book that made me go to medical school – and other good reads

The book that made me go to medical school - and other good reads

books - 560

Editor’s note: Over the last several months, numerous young Scope readers have inquired about which books they should be reading to prepare for a potential future in medicine. We asked medical student (and SMS-Unplugged contributor) Natalia Birgisson to offer some suggestions.

“In my business, you can lose big, but sometimes you win big, too.” So begins page 87 of the book that made me go to medical school. It was the summer after my freshman year of college and I was volunteering in an outpatient pediatric ward. In the span of a week, I had seen two babies die. A newborn died of complications from seizures right in front of me, and a two week old baby died of malnutrition as we watched him wither away in an incubator.

I couldn’t stand the feeling of being a part of a system that was cumbersome and ineffective, I couldn’t stand my heart breaking, and I wanted to want to be anything other than a doctor. I lay in bed the next day and looked around my rented tropical room for distraction. On the night table was a book left by the last guest, The Soul of Medicine: Tales from the Bedside by Sherwin Nuland, MD, and what I found in his collection of stories was solace, companionship, and hope. It is a compilation of stories, each chapter written by a doctor in a different specialty discussing his or her most memorable patient. If you’re interested in medicine, the reality of it, then I suggest taking Nuland up on his offer to glimpse the mark that medicine leaves on a doctor’s soul. I keep it next to my couch in case a lost friend ever happens upon it the way I did.

Mountains Beyond Mountains by Tracy Kidder was the next book that strongly influenced me. A detailed glimpse into the life story and accomplishments of Paul Farmer, MD, PhD, who not only serves as a role model for anyone interested in global health, but who has changed the world for the better in a tangible way. What I remember from this book is a short scene in which we learn that, at least during the time the journalist was shadowing him, Farmer saw his daughter only once a month. They say that part of a teenager’s angst is realizing that her parents are not perfect and being angry at them for their flaws. Well, Dr. Farmer, I’m still angry with you for missing out on your daughter’s childhood the way my dad did. And for the rest of my life, when I think about changing the world by saving peoples lives, it will be with the caveat of improving on the model that he lived by. Because to me, there’s no point in helping strangers if I’m hurting the ones I love.

Blue Collar, Blue Scrubs and Hot Lights, Cold Steel by Michael J. Collins, MD, were two medical memoirs that resonated strongly with me. I read these the summer that I was writing my medical school applications. Somehow, the application process has a way of making everyone feel incompetent or mediocre at best. And here was a guy who decided to take post-bachelor classes as a construction worker, carpool to medical school, and marry the love of his life before starting residency at the Mayo Clinic. Almost every page of his books had me laughing or crying as I rooted for him.

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Ebola, Global Health, Infectious Disease, Patient Care, Stanford Medicine Unplugged

The hand-sanitizer dilemma: My experiences treating patients in Uganda

The hand-sanitizer dilemma: My experiences treating patients in Uganda

Ugandan hospital - smallSMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

A thick green glob landed on my scrub top at the same time that the first drop of sweat rolled down the small of my back. I tried not to grimace and discretely walked over to the hand-sanitizer dispenser. But like every other hand sanitizer I had tried, this one was empty. Yesterday I had also discovered that the only bathroom in the hospital had no toilet paper. It was 7 AM, and I would be using my pocket toilet-paper stash to clean off sputum from the hacking patient that apparently all the doctors knew to avoid standing in front of. The day was off to a good start.

How, I wondered as we continued rounding, did doctors respond to this dilemma – having to care for patients without being able to fully protect themselves – when they were in health centers treating Ebola. I tried not to think about what I would tell my parents if I developed rare infectious symptoms in a few days. We were in Uganda, countries away from the Ebola outbreak, but there were still plenty of infectious agents we could and probably were exposing ourselves to.

Just as I was wracking my brain for the names of the bacteria and viruses that might be deadly, I noticed one of the doctors rest his hand on a patient’s shoulder. And it dawned on me that the real dilemma was not about what I, who had access to the best medical care, might pick up, but rather about what I might pass from patient to patient.

It’s ironic that in the U.S., patients have to remind doctors to reach out and touch their shoulder or hand at an appropriate time – to make patients feel that the doctor connects with them on a human level. Yet here in Uganda, the  doctors know when to reach out to their patients, they know how to talk to the patient’s family. My clinical-skills professors would love to see this.

But if the hand-sanitizer dispenser was empty for me, it was empty for the  Ugandan doctors as well. We were told as first-year medical students that we would fail our “Practice of Medicine” final if we forgot to sanitize our  hands upon entering our standardized patient’s room. So what were we to do when we had more than twenty patients in one room, each with at least two family members, and no hand sanitizer for anyone? How many of these dozens  of people were walking around with my hacking patient’s sputum on them as  well?

The doctors certainly could be spreading infectious agents. But given the proximity of patients on the wards, those very same infectious agents had likely already been spread between the patients overnight – before we even arrived that morning. I couldn’t help but wonder which was more important to the patients who had a 50 percent chance of survival: to feel that their doctor was treating them as a human being or to increase their chance of survival by a negligible margin? How big or small would the margin introduced by the doctor’s touch have to be to tip the scale one way or another?

Before I could finish thinking through my ethical dilemma, we left the ward to scrub in for surgery. There I found the only working hand-sanitizer dispenser.

Natalia Birgisson is a second-year student at Stanford’s medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo of Ugandan hospital by Natalia Birgisson

Stanford Medicine Unplugged

How to get a student-friendly room for under $100

How to get a student-friendly room for under $100

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Natalia in her roomTo all the incoming med students wanting ideas on how to set up their rooms with the staggering debt of higher education, here’s what I suggest:

  • $13.38 for 32 sq feet of “Thrifty White Hardboard Panel Board,” but we can call it your new best friend. Home Depot
  • $10 for screwdriver and screws. Home Depot
  • $10.79 for dry erase markers, eraser, and spray. Office Depot
  • $4.99 for a 3 pack of scented candles in glass holders. Ikea
  • $2.98 for 300 pack of matches. Home Depot
  • $8.99 for a plastic storage box that fits under most beds – reserve that for the pile of discarded clothes, papers, and notes that you don’t have time to clean up until after finals. Ikea
  • $14.99 for a basic night stand. Let’s be real, you’re going to study late into the night on your bed and fall asleep. Set yourself up with a nightstand so you don’t have to drool on the laptop you were using. Ikea
  • $6.99 for a table lamp to go on your night stand. Ikea
  • $9.99 for curtains – color so it feels like home. Ikea
  • $7.96 for curtain rod set. Ikea
  • $4.99 for the Swedish meatballs. Ikea

Total: $91.06 with room for tax

You’re welcome.

Natalia Birgisson will soon start her second year at Stanford’s medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo courtesy of Natalia Birgisson

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