First Day

AH, I'm part of the medical team! (Island Med Student blog)

I'm writing to capture this sense of gratitude and appreciation for today, my first day on the wards in general medicine, and my first rotation ever. This is a day to remember! I'm working as part of the team at the Bronx Veteran Affairs hospital, and I'm feeling 1) relieved, 2) grateful for the education and support I've received, and 3) optimistic and hopeful about this rotation, and this year.

A couple of thoughts:

1) I cared for Mr. M, a patient with gangrene. True, I've taken the H&P (history and physical in med-speak) multiple times before, but this time I felt like I had a much more substantial role in making a difference for him. When he wanted a salad, I could try to find one for him, and go back and check to see if he'd gotten it. And I think he appreciated having a hand to hold during the blood draw. I hope I'll get to see him tomorrow again, if he's still here (he's scheduled for a surgery). He's not my assigned patient, but I'm feeling this sense of "myness" for him. 

2) I presented Mr. M's case to my intern (1st year resident), who seemed impressed by the completeness of my presentation, and gave a lot of good pointers. I'm excited to start doing things on my own: presenting to the attending, writing progress notes, drawing blood, really helping out the team--as soon as I can! It felt validating to have prepared for the H&P, and to be able to do well on it, and I'm going to work to get it better, fluent, and memorized. 

3) Tonight, I don't have to worry about studying. Yes, it'll be learning, but I'll be reading and learning on my own accord, to learn everything I can about my patient, and it feels real and meaningful.

4) I'm grateful to my intern for spending such a great deal of time with us medical students, spending two hours going through my presentation. I will make it a point to get better and smoother. I'm still quite loss at to what to expect in terms of the daily schedule, how to use the computer system, how to write progress notes; yet the laid-back atmosphere of the team and their expectations has put me much more at ease. Still, I want to take charge of my own learning and challenge myself so I can help the team and patients the best I can.

To communicate, present, learn, connect--art really is at the heart of medicine. 

Hello 2016, hello again!

"The Doctor" by Luke Fildes (Wikipedia)

It's been so long since I've written that I'm quite at a loss at how to start. So much has happened in the interim: I finished my Bachelor's in Psychology, went on to do my Master's in Music Studies, and am now in medical school, year two! With the transitions and medical school, this blog fell way to the side, for which I am making amends starting...now!

Where to start? I still can't quite grasp that I started this blog in June of 2010—I remember it was a summer day in Beijing between my freshman and sophomore year; I was interning in the marketing department of a seed company, and I had an impulse (it may have been too muggy to move much and too polluted to go outdoors), which resulted in The Birth of the Artistic Synapse. There, I decided "synapse" was an apt metaphor for connections, though at the time I hadn't known to what manner and extent those connections would play out.

This blog became about connections between ideas, thoughts across disciplines. Especially in music and psychology, and more generally in beauty and artistic perspectives toward unconventional subjects and objects, and in the world of living. It also became about connections to myself: what I want, what I love, and, why I am going into medicine (The Art of Medicine). It does me good to read that post again today, as embark on my very first clinical rotation next week in internal medicine.

But most importantly, this blog has made connections with others. Strangely enough, one reason it has been so hard for me to write again is the paradoxical knowledge that comes with readership: I am less at ease writing when I know others are reading; yet all the more reason to do so! You, readers, have delighted with me in neuro-analyzing Mona Lisa's smile, relating the works of Escher and Chopin to String Theory, and (mis)applying the Heseinberg Uncertainty Principle to love. You've even stuck around for infatuations with Organic Chemistry (a product of orgo-withdrawal). 

One message from a reader in particular struck me dearly, and left an impression. I think I was in my neurology block, when I received in a message in my inbox asking if I still wrote, especially now about life as a medical student, and referenced this blog in his new blog project: poeticlust.com. I'm touched I played even a slight role in someone else's blogging endeavor, and I'm writing this post, starting anew, with his words and encouragement in mind. He quotes Carl Sagan: “writing is perhaps the greatest of human inventions, binding together people who never knew each other.”

I think of how other blogs speak to me—Loose Signatures, The Feminist Spectator, Live Thoughts—whether a delightful thought, an unexplored topic, or a relatable personal experience, and I see how blogging matters—over time thoughts are better formed, emotions better understood, actions better intended.

Looking through my old posts, I do think my writing has helped me become a better version of myself. As I read, I am reminded of the wonder and delight present even in the face of tedious memorization so often necessary in medical school—I'd been there before, after all. And as I go forward, I think there is no better time than now, as I care for patients, in bringing out the best of medicine: the beauty of human life and connection. It's time that I write again, because I want to capture and preserve these moments; I want to always remember the artistry in our profession, and writing helps me do that. It helps me be a better self, and maybe, even, help others do the same.

I came across a post from exactly three years ago on this first of the year with the thought, "Our journey is right here, right now, and to discover we'll just have to keep our eyes open, new, and shining." There's nothing like the past to help us go forward, to help us learn what makes us tick and make the most of our learning. It's even better when shared with others. I'm excited to bring in the new year with you! It's going to be a good, growing 2016.

When a medical student goes to Alcoholics Anonymous

"My name is Erica and I'm an alcoholic"

is not something I could imagine myself easily sharing, much less in front of rows--at least ten rows filled--within the confines of the St. Aloysius Catholic Church, much less to follow that statement with a personal speech interjected with casual fluency interspersed with shouts from the crowd. Yet it is what I witnessed alcoholics do this Saturday evening. As a medical student non-alcoholic observing the proceedings of an Alcoholics Anonymous meeting, I was an outsider even before I stepped in. Crossing across the Harlem streets between Frederick Douglass St and 132nd St, I paused before the church with some uncertainty, before a man asked, 'Where you going, sweetie?" and as we both approached the entrance, I replied with awkward cheer, "here!"

At the entrance

Certainly he was not the first person to raise an eyebrow at my entrance--I, an Asian American twentysomething carrying my backpack, felt quite conspicuous in the midst of the middle-aged mostly black crowd. Thinking back to my visit to the Frick Collection earlier in the day, I started to reflect that my feeling of awkwardness was something these people experienced daily in entering the kind of 'white spaces' which have unconsciously become so natural for me. 

Despite feeling rather out-of-place, I also felt a great sense of camaraderie in the crowd--so that rather than feeling like an uninvited stranger at an official meeting, I felt like a new acquaintance joining a close-knit group of friends, whose inside jokes went over my head. And rather than a therapy session in which I imagined myself as a wallflower, I found myself smiling and nodding along with the shared stories like a (somewhat-clueless) audience member at a comedy show.

For their stories were reminiscent of those from The Moth radio hour where members of the public share gripping personal tales with a receptive audience--they were fun, casual, personal; they elicited laughter and cheers from the crowd; they were told with flair and comedic effect. A man with a blazer and T-shirt went up in front of the crowd, half-grunting half-laughing, "I am certified NUTS!" (laughter from the crowd) "I know I'm crazy," and, referring to his alcoholism, "I know I gotta get out." He goes on, "Alcohol removes," and with dramatic pointing, "Table.... Leg... (laughter). Brain... Kidney... Liver." And a woman with camouflage cap and shirt announces in clear, stately tones, "If it weren't for AA, I wouldn't be here today." 

The last speaker was celebrating her 14th Anniversary--that is to say, it was her 14th year as part of AA, and celebrated with candles and cake. She spoke with flair, spunk: "I was loud. I'm still loud. " And then, sincerely, "My baby teaches me to be better. You all teach me to be better." And, "Others help us see what we don't see in ourselves." As I approached her after the session, along with many others who expressed their congratulations, she turned to me with a bright smile and extended arms--"Are you new?"

I left with the feeling I get when I attend mass at a church and religion I don't "belong to," and why I attend in the first place: that the world is a better place, and can become a better place. That despite our differences, we all seek to be better. And that matters, for alcoholics and for me. 

Psychologists use smartphones to measure ethics

What would you do if you could divert a train to save five men but kill one man as a result? Would you do so? What if you had to push that man in front of the train to save the others?

Psychologists often use these kinds of “trolley problems” on test subjects using desk computers in their laboratories to study our moral reasoning. But recently a study published in the journal Science went beyond hypothetical questions into real life. Psychologists now have a sophisticated lab tool for examining morality not just in the lab, but in everyday life: the smartphone.

In the study, 1252 participants of varying ages, ethnicities, and educational levels from the US and Canada texted—in their homes, in the streets, wherever they happened to be. At five random points each day, they would receive a survey by text message, and they would briefly describe the moral or immoral acts they had committed, been the target of, witnessed, or learned about (e.g., through gossip, news, and the internet) within the last hour. From the texts, the researchers were able to measure the frequency and content of moral and immoral acts.

They found that people who were non-religious committed about as many moral acts as those who were religious. And liberals reported more moral acts of fairness, liberty and honesty, while conservatives reported more moral acts of loyalty, authority, and purity. Committing a moral act was associated with a greater sense of purpose, and being the target of a moral act was associated with higher levels of happiness.

Overall, moral acts were reported just as often as immoral acts, but there were some interesting imbalances. Acts committed by the self or received from others were more than twice as likely to be moral than immoral. The opposite case emerged for learned-about acts: they were more than twice as likely to be immoral. The use of smartphones allowed researchers to examine interactions in real-life time, which previously had not been possible in the laboratory. This allowed them to examine how one moral act determined the occurrence of another throughout the day.

Their findings provided evidence for a kind of moral slacking that psychologists call “self-licensing”: people who commit a moral act early in the day are less likely to do so later on, and more likely to commit an immoral act. But there was also evidence for what psychologists call “moral contagion”: people who receive a moral act are more likely to commit a moral act themselves later that day. Self-licensing and moral contagion are amenable to social intervention. So we may be able to alter moral behavior by intervening in the moral course of people’s days.

Researchers foresee the ability to use the smartphone not only for data collection, but to provide interventions to increase self-discipline. According to the original paper, “Given these different mechanisms, it seems important to find out more about how the principles of moral contagion can be used in public policy interventions, and how moral slacking may be prevented.” The study is one of the first of its kind to study ethics outside of the laboratory. More studies will need to be done, but this one has made striking entrance into the real world.

It collected an impressive number of 13,240 responses, substantially more than most psychology studies. The larger the number of responses, the better that sample represents the general population of interest. This allows for robust results and generalization across large populations. But since participants were sampled exclusively from the West (US and Canada), researchers weren’t able to examine how cultures differ in their prioritization of moral values across cultures – a subject of great interest to moral scientists.

Still, the study provides evidence that controlled but artificial laboratory findings also apply to people’s everyday moral experiences. Although the findings are tentative, they provide important areas for further research, and new methods to do so in real-time, everyday situations. “I think of this as a first look of how morality plays out in real life,” says Dr. Brian Nosek, a psychologist at the University of Virginia. “The first telescopes didn’t tell us everything about the galaxy, but they gave us a tantalizing sense of what’s out there.”