A wonderful break

This morning was one of the nicest mornings we’ve had in a long time: no rain, not too much sun, heat, or fog, and a beautiful blue sky. Alicia had identified the Tour De Lakes as a promising option for an organized ride, and I wanted to push myself to increase my distance. We signed up for the 31 mile route, and I recruited a new med school friend (!) to join us for the ride. I am feeling good about my training, and am hoping that I can at least maintain where I’m at now. With the ride this morning, my May mileage is 113.5 miles, and all of 2011 is 129.90 miles. True to form, I’ve been tracking my progress on the Bike Journal rankings. There are lots and lots of riders who aren’t riding very much, so every time I log another ride I shoot up in the rankings. While there are folks at the top of the rankings who have already biked over 10,000 miles this year, I know that’s not really reasonable for me. Here is my progress since I started making notes:

Not too shabby…

In any case, the ride this morning ended up being just over 35 miles, and it was my fastest of the season (about 13.5 miles per hour, which is fast for me, but slow for most folks on road bikes). It was really wonderful to just be outside in some nice weather, and I’m keeping my fingers crossed for this to continue!

Cake!

I made a delicious cake for Ruti before she headed out to DC for much of the summer. I used the recipe from Smitten Kitchen without alterations. I’m not skilled enough to mess with real baking; I can alter a muffin recipe, but that doesn’t involve whipping egg whites and yolks separately, and folding a variety of items into said whipped eggs… In any case, it came out beautifully in spite of a few minor cracks in the cake as I rolled it.

As an aside, no, Ruti does not always wear pearls around the house. They look lovely though, don't they? The cake was clearly a special occasion...

Bienvenidas a Cali

Our first day in Cali confirmed what many a guidebook and discussion with Colombian friends had suggested: Cali is a business center. It is a business center that loves salsa, but it is a business center. There aren’t nearly as many conventional tourist attractions in Cali as in other cities we visited, but it had one in particular that was special for us. Alicia was born in Cali, and spent her first 3 months of life in a lovely orphanage there before her parents picked her up and brought her home. This was our first stop:

We had a brief tour with the director, and got to see kids playing and babies napping. The facility itself is really nice, and how has a public school that is attached and serves children in the the local community as well as the resident kids. We saw one baby who looked so much like Alicia’s baby pictures it was a little bit eerie, but we couldn’t take photos of the children, so you’ll have to take my word for it.

After our tour, we headed back to our hotel, which was one of my favorite of the trip, the Posada de San Antonio. It had a really nice courtyard with a fountain, and an incredibly helpful proprietor who helped us get the most out of our visit to the city.

We did walk around later and admired what our guidebook described as the best example of mudejar architecture in Colombia, the Cali cat sculpture (donated by a local artist) and the thought-provoking graffiti.

After about a week of travel, however, we were starting to tire, and we spent more time hanging around in the hotel in Cali than in any other city.

Medellín: Parte 2

More Colombia pictures…

Our last day in Medellín was one of my favorites of the trip. In another feat of public transit, we took the Metro to the end of the line and transferred to the Metro Cable, a system that is like a cross between a ski lift and a train car. The Metro Cable was built to connect the slums on the mountainside to services and jobs in the city center, but it has also proven to be a boon to tourism.

After the first Metro Cable ends near the outskirts of town on the side of the mountain, there is another Metro Cable, the special Cable Arví. It goes directly to a national park, called Parque Arví, where one can hike in the cloud forest (a high elevation rain forest), visit the butterfly house, and ride (?) the zip line (cable-flying, as it’s called in Spanish). The activities in the Colombian national parks are generally run by concession holders, rather than directly by a government entity, so while Parque Arví includes several small villages and a whole lot of inaccessible rain forest, we only visited Piedras Blancas, a smaller area that is developed for ecotourism a short bus ride from the entrance to the park. We’d been told that it was a 50-60 minute shuttle ride, and weren’t sure we’d be able to make it fit with the logistics of flying between cities, so we were pleased to find that it was actually a 15 minute walk/bus ride up the road from the park entrance.

Even before we entered the ecopark, we noticed the flooding. As I mentioned in my last post about the flooding near Medellín, this winter has been the worst in Colombian history. The river running through the park was higher than ever, and large swaths of the usual tourist areas were underwater.

We walked around the mariposario (butterfly house) for a bit, which was thankfully on high enough ground to avoid the flooding, admiring in particular the wide array of chrysalises hanging behind the glass of the laboratory-office area. The staff said that they go out each day and collect both larvae and chrysalises from the forest, and also release many of the butterflies that hatch in the house into the wild. All of the species they raise in the mariposario are native to the cloud forest.

Alicia had had her heart set on trying a zip-line while we were in Colombia, and I didn’t think we were going to be able to do it. When we realized that it was, in fact, available at Piedras Blancas, however, Alicia was thrilled and I agreed that it could be cool. One of the lines was partially underwater, but the other stretched happily across the river, so we did that next. (Sorry the video is sideways... I can't figure out how to change that.)

After a bit more walking around, we headed back into town, ready to pack up and fly to Cali for the third leg of our trip.

Whoa…

From Dose of Reality:

It’s hard to believe that the first real week of M3 year is finished. I’ve already learned an incredible amount, particularly about how to be assertive, and the particular conditions under which I am not good at it. As I was told to anticipate, I feel out of my element most of the time. What I didn’t expect, however, was how calm I feel about not knowing exactly what I’m supposed to do most of the time, and how willing I feel to be put in situations where I don’t know what to do. It’s as though sometime over the weekend of May 7th and 8th a switch flipped in my brain, and I understood the importance of trusting instructors to have a good sense of whether or not I’m ready for something, rather than trying to assess myself. Some examples:

• On my first day, I was terrified to do a well child exam by myself. I still don’t know the answers to a lot of the questions that parents ask, but when my preceptor suggested I go do one, I somewhat numbly agreed, and then went and did it. Lessons One and Two: No one expects you to have all the answers, and 6 month olds are pretty forgiving as you bumble through a physical exam. I was ready enough.
  
• During my first emergency medicine shift the plastic surgery intern asked if I would like to sew a stitch. I have never sewn a stitch on a person before, and was mostly certain that my craftiness would not help much in this arena. Nonetheless, I did it, and did a pretty nice job – turns out it’s not really that hard once the experienced person had closed up the muscle layer and lined everything up. Lesson Three: I don’t know yet how to distinguish between things I don’t know how to do and things I can’t be coached through.

In spite of the fact that things seem to be progressing reasonably well, I can also add an unfortunate Lesson Four to those I mentioned above: I am not good a being assertive when I feel lost, confused, and misguided. I am okay when I am only one or two of those things, but all three are not good. I am trying to volunteer to do new things and put myself out there for learning opportunities, but am also working not to beat myself up about feeling a little shy when I can’t even figure out who to ask where I should be and when!

At the end of this week, I feel more than a bit like Walt looks in this photo:

I’m starting to get the hang of it though, just in time for a complete change of pace next week…

Guatapé y La Piedra

More pictures from Colombia!

We took a short bus trip out from Medellín on our second day in the city. This was our closest encounter with the effects of La Niña, which has made this winter the rainiest in Colombia’s history. We had heard about mudslides in Envigado, a community just outside of Medellín, and about terrible flooding in rural areas around the country, but on this trip we saw sections of mountain highways covered with fallen dirt and trees and even a few places where the road itself had fallen down the mountain, washed away in the heavy rains. Though our bus trip was punctuated by having to get out and walk to another bus on the other side of the broken highway, we made it to La Piedra – The Rock – and hiked to the top.

It was stunningly beautiful.

At La Piedra we made friends with two Colombian travelers and shared a cab into Guatape, as well as lunch and a boat ride. They were outgoing and friendly, and it really made the day much more fun. I’d hoped to see Pablo Escobar’s old house, as well as the spire on the top of the church at the bottom of the lake (when they made the lake, they moved a small town to a new, higher altitude location and flooded the old one), but our guide had his mind made up that we were going to see the waterfall where the water leaves the lake, and shortly after we left shore it started pouring down rain.

Once back on shore, we made our way up to the bus and headed back to Medellín. En route, we admired the "zócalos" on the bottoms of the houses in Guatape:

The rain had washed out a few more roads, so the trip back to Medellín took about three times as long as it should have, but that gave me plenty of time to explain to the woman sitting next to me on the bus that I was, in fact, a girl, despite my short hair, and that no, I was not a Catholic. She magnanimously informed me that she believed that everyone had the right to their own beliefs, but that I was wrong if I didn’t believe in a single God. She proceeded to explain to me how evolution could not have possibly resulted in human beings, and that even if it had, God must have created the monkeys. It was enlightening? At least the time passed quickly…

MSTP7? M3?

From Dose of Reality:

The day has finally arrived. After finishing my dissertation in March, April flew by. I finished up paperwork, did some revisions, and went on vacation, returning home just in time for the start of M3 orientation. I was absolutely terrified, but also thrilled to be moving on. As much as I have enjoyed my doctoral work, I think most of us joined the MSTP because we couldn’t commit to doing just one thing, and I’ve been looking forward to applying my medical knowledge from oh-so-many-years ago!

The hard parts:

• As often as I repeat that I am an M3, I know I’m really an MSTP7, and I don’t know most of my classmates.
• In addition to feeling like an interloper in their class, it’s been 4 years since anyone asked me whether or not clindamycin or bactrim would cover a cutaneous strep infection in addition to possible staph. I don’t remember a lot of stuff.
• My schedule is not my own! I can hardly remember where I’m supposed to be when, because it is different every day, and I have no idea what the coming months will bring.

The exciting and nice parts:

• Everyone is really friendly and seems to appreciate that I’m willing to admit when I don’t know something. (This happens often – I like to think of myself as much-appreciated rather than under-prepared).
• The clinical refresher course and M3 shadowing have helped a lot. I wouldn’t go so far as to describe them as giving me a leg up on my colleagues, but would definitely say that I don’t feel nearly as behind as I would have if I hadn’t had them!
• Starting with pediatrics, and particularly outpatient pediatrics, was a great choice. Happy babies don’t care how long it takes you to pin them down as long as you look in their ears quickly, and it’s hard to stay in any kind of bad mood when someone is gurgling and cooing at you while you listen to their lungs.

Now that I’m officially back in the medical school, I’m planning to post a bit more frequently, and to try to connect what I’ve been doing for the past for years in Public Health with the medicine I’m learning now. You know, just a little something on the side during this most relaxing of years… Wish me luck!

Medellín: Parte 1

I know I’ve been back for more than a week now, but I thought more description and photos from the trip would be appreciated… I’ll post them as I can, following the course of our trip.

Our first day in Medellín was a bit of a bust due to weather and the Botanical Gardens being closed on Mondays, but we nonetheless had a nice time. It was exciting to be in a city with good Metro coverage, particularly as we had to recalculate our plans after discovering that the gardens were closed for maintenance. The elevated stations also provide nice views of the city and the surrounding mountains:

Botero was born in Medellín, so we were fully expecting the plaza of rotund statues outside the Museo de Antioquia, our destination post-garden disappointment. (For those unfamiliar with Colombian geography and cosmology, Medellín is located in the state of Antioquia – pronounced “anti-okie-a” - whose inhabitants are called paísas. They are widely reputed to consider themselves more cosmopolitan and independent than other Colombians.) The museum was really quite nice, featuring not only a large collection of Botero’s work, but also other contemporary artists from Latin American and around the world.

After the museum and a bit of a nap at the hostel, we headed over to a Lonely Planet recommended seafood restaurant. We split an absolutely delicious entree of rice with seafood, and called it a night.

I’m back!

From AMSA On Call

Post #8 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

Yesterday marked the start of my outpatient pediatrics rotation, the first of my third year of medical school, and the end of this series of posts on my transition from doctoral work in the School of Public Health to my third year clerkships. As I interacted with my M3 colleagues during general orientation last week, and pediatrics orientation yesterday morning, I was struck by the overall high level of anxiety. In spite of my perception that everyone (except maybe the other returning MD/PhD students) should be calmer than me because of their more recent completion of things like clinical competency assessments and Step 1 of the USMLE, all of us were talking nervously about seeing real patients, presenting histories and physicals in the inpatient and outpatient setting. Many of us noted with some trepidation that we don’t do any pediatric exams during our first two years of medical school. While I still believe that many of my colleagues were much more prepared than they believed themselves to be, orientation was nonetheless an important reminder that no matter how large or small the period of time between the pre-clinical and the clinical years of medical school, the jump in expectations (both self-imposed and outlined in the ever present learning objectives for each rotation) is daunting. None of us felt truly ready for the challenges that Monday afternoon would bring.

Despite all this, Monday afternoon was great. I can only speak for myself, as I haven’t had much time to debrief with other students, but although I didn’t have all of the answers at my patients’ well-child exams, or ask all of the questions I needed to at sick visits, I made it through and presented what I did know to an understanding and friendly attending. I tried not to hesitate to ask questions and highlight the gaps in my own knowledge. In some ways, I think that doctoral work was great preparation for the wards. Who better, after all, than a PhD student to give a succinct outline of what is known, highlight the gaps, and attempt to make a conclusion anyway? At the same time, I felt myself struggling as I dusted off my medical vocabulary, only to find it a little rusty and perhaps a bit smaller than last time I trotted it out, and I often came up blank as I tried to expand my differential diagnosis.

Looking forward, I see a lot of reading and asking of clarifying questions as my rotation progresses. Just in the past few days I have absorbed a great deal in clinic, and am recognizing the value of applied and practical learning structured around the patients I see. I think my time away will ultimately make me a better doctor, but first, I’ve got to get to studying!

Home!

We made it safely home from Colombia, and I start orientation for my M3 year tomorrow. I’ve started writing some posts about the rest of our days in Medellín and Cali, and will continue to post them as I get a chance. In the flurry of errands I ran today, I picked up the following items:

• A bound copy of my dissertation
• New glasses
• Less than stunningly attractive but wildly comfortable (and wipe-offable) clogs

I’d consider the day a success, and am looking forward to tomorrow and getting a better sense of what I’m in for over the next year…