Nontraditional Medical Student

Since Taiwan

2009-07-23T08:27:00.000-07:00

Short update:

I've been relaxing and recovering since Taiwan, enjoying the few days of summer vacation I have before I start my elective class on Monday, "The Clinical Management of Obesity". I had a really great time in Taiwan and it's strange to be back in the U.S., a little. When I landed in Texas, it was remarkable how much bigger everything was than in Taiwan (the bathroom stalls have to be at least 2 times as large).

Anyway, thanks again to all my Taiwanese friends!

Last Days in Taiwan

2009-07-13T23:07:00.000-07:00

Hello folks,

I've reached my last day in Taiwan.

Here are some of my "goodbye" photos from Changhua.

This is my bellydancing class: they gave me a belt and a set of bellydancing clothes to encourage me to continue when I return to the US. Very sweet. Our teacher (center) looks like she's 20 but has a child that old! I couldn't believe it.

I randomly decided to perm my hair:

I went to Neurosurgery again. This is me with a piece of skull we're about to put back in:

My last night in Changhua. We went to sing karaoke.

I busted out "Yue Liang Dai Biao Wo De Xin," my one Chinese song.

The send off crew at the train station:

After arriving in Kaoshiung, my family took me to Kanting, the most southern tip of Taiwan. It was really beautiful, with brilliant colors and a vacation atmosphere.

My aunt and uncle had fun pretending to carry me on a traditional wedding palanquin.

We came back and the next day, we went to Mei Shan (Plum Mountain). The weather was MUCH cooler (we were above 1000 m from sea level). Taiwan really has diverse geography.

This is a swinging bridge over a gorge. It was far enough down that you probably could bungee jump off of it. It lead to a traditional village for Taiwanese aborigines (Austronesian people).

We just arrived from Mei Shan and I'm getting my bags ready for the plane tomorrow morning. I hope my luggage is not going to be overweight!

In Kaoshiung

2009-07-11T07:41:00.000-07:00

I have arrived in my family's home in Kaoshiung, having finished up in Changhua. I will be back in the US in a few days!! It has been a really great experience and I will fill in more later.

Funny Things About Taiwan, Part II

2009-07-07T00:46:00.000-07:00

1. The toilet paper is in packs, like Kleenex, instead of in rolls.

2. No toilet paper or anything other than what comes out of your body may be flushed down a toilet.

3. Even in the hosptial and in hotels, there are mostly squat-style toilets.

4. Apparently, it's not rude to answer your cell phone at any time: in meetings, patient appointments, etc (this goes for patients, docs and students alike).

5. They click their tounges at small children to get their attention (kind of like baby talk).

6. When speaking of death (or to represent it?), they curl and uncurl the first finger of their hands in a little bobbing motion. This is how the bus driver explained to me that Michael Jackson had died.

7. Taiwanese love beverages: you can find several drink shops on every street. They claim the origin of bubble tea and serve everything from kumquat or sour plum tea to coffee with gelatin and other unusual combinations. Surprisingly tasty (most of them)!

Some funny medical things:

8. A young doctor explained to me that they discard the idea that a BMI of <18.5 is underweight (esp. for women) and the ideal is about 17 (I wonder if there osteoporosis levels are higher). The medical guidelines for being overweight/obese are also not the same (though this is more official and not as cosmetically oriented): 24-27 is considered overweight in Taiwan, whereas in the U.S., 25-30 qualifies as overweight.

9. The social history includes checking for tobacco, alcohol and betelnut use.

10. Cancer is referred to as "C.A." ("shee-ay"), metastases are referred to as "meta," MRSA (Methicillin-resistant Staphylococcus aureus) is referred to as "mersa," and so on.

11. Mensturating women are not supposed to eat/drink anything cold; the belief is that the cold will cause your insides to contract and make any cramps or pain worse.

Another long weekend

2009-07-05T06:29:00.000-07:00

I had a busy, fun weekend. Friday night, the ladies from my bellydancing class took me out to a nightclub and dressed me for the occasion. We had a great time!

After minimal sleep, I got up the next morning and went to Si Tou, a mountain top park and forest, with a family I met (the twins). We saw a 2,800 year old tree and looked at the clouds touching the green mountain tops. I taught the kids how to sing "Twinkle Twinkle Little Star" and how to play "Sumo." They really liked it, but I'm not sure if their parents will enjoy all the noise later.... :)

This is the view from the skywalk, which was 7 stories up....

Today (Sunday), I woke up early and went to the hot springs with the family medicine doctors. We hiked a little, had a lecture and lunch, then soaked in the hot springs. There was one funny pool with little fishes that came to nibble the dead skin off of your feet. It tickled SO much!

Hope everyone had a great 4th of July!

Neurosurgery!

2009-07-03T03:27:00.000-07:00

SUPER busy week! I went with Philip's old friend, Dr. C in Neurosurgery this week. He's very busy and runs through the hospital on rounds, and then down into surgery. I scrubbed in on 7 surgeries so far and have learned to staple wounds, use a scalpel, suction, remove bone, etc. I am only allowed to do non-dangerous things, so it doesn't make me nervous and I'm really glad I've been able to learn so much. So far, it's been much busier and much more hands on than previous weeks.
Today, I woke up at 6am for a pituitary tumor removal surgery scheduled at 7 am and kept going (with no break) until 2:30pm, then an hour break and onwards for a few more hours. Whew!

I'm definitely enjoying myself; I can't believe I only have one week left at Changhua.

Busy Weekend and Chinese Medicine

2009-06-29T03:27:00.000-07:00

This was a busy weekend for me. On Friday night, I went to the night market in Tai-Zhong. On Saturday, I ate dinner with Dr. W and Dr. K (a pediatric oncologist/hematologist and a pediatric geneticist/endocrinologist, respectively). They knew my brother when he was here 2 years ago. We ate traditional Hakka food (one of the ethnic groups in Taiwan) and drank pearl tea from the place where it was originally invented (in Tai-Zhong).

Sunday morning, my friend "Jenny" took me to eat sao bing you tiao, which is basically a flat sesame seed bread with a piece of fried dough inside, delicious! We then went around and visited the famous temples in Changhua that I had not seen yet. One is a 300 year old Confuscian temple, the other a 100 year old Japanese temple.

On Sunday, some friends took me to Sun Moon Lake (Re Yue Tang), which is one of the most famous spots in Taiwan. It's a beautiful mountain lake with a famous temple on an island in its center. It is the largest lake in Taiwan. I think I remember some photos my parents took of this many years ago; the traditional fishing boats are gone but it's still beautiful.

This is a famous old train station my friends said that my father would recognize.

Today, I went to the Chinese medicine clinic and learned a little about what they do. They ran several tests on me and it was a lot of fun.

Testing my voice:

Testing my heart rate variation:

Testing my pulse:

Testing my tounge:

Testing my energy meridians:

This is the chief resident (with a nurse) explaining to me that I have too much fire in my body. Thus, I get thirsty more easily, among other things.

Afterwards, I sat in on the Chinese medicine outpatient clinic and watched the doctor take pulses, perscribe medication, do acupuncture (alone or with flames or electricity, depending), bone/joint manipulation, the application of herbal plasters and the like. It was really interesting and I'm looking forward to going back tomorrow.

Tai-Zhong Night Market

2009-06-26T20:37:00.000-07:00

Just a few quick photos! Went to the Night Market in Tai-Zhong (more people, more modern)last night with some friends.

We enjoyed Taiwanese shaved ice (again!):

I need to remember to the "V" in my photos....super popular pose here.

Aaannnddd...here (in the middle) is the doctor that was a couple years behind my dad in medical school and knew both of my parents (at least by reputation..hahaha).

Neurology

2009-06-25T23:22:00.000-07:00

Hello folks,

I spent the last 2 days on the Neurology Ward, basically getting a glimpse of the things I will study this coming year (it's a lot). :) We rounded on patients and I got to go to the ICU and a few other special places to see specific patients. It's interesting and I'm enjoying myself but I don't think I want to be a Neurologist yet.

I went to Neurology outpatient ward and met a doctor who went to my dad's medical school and knew my father and my mother 30 years ago! Small world.

I get to learn about Chinese medicine and Neurosurgery next week.

Typhoon and Tai Zhong Clinic

2009-06-23T05:10:00.000-07:00

Hello folks,

I went back to the clinic in Tai Zhong today and had a great time. The doctor there, Dr. L (on the left) is very wise and a great teacher. The chief of Family Medicine (also Dr. L), came to pick me up. Since it was my last day at the clinic, we took some pictures:

Here are some photos from the small typhoon we had on Sunday and Monday. They say the wind was very small this time, but I still was impressed!

Hope you are all doing well.

Typhoon!

2009-06-21T01:20:00.001-07:00

By the way, we are definitely having a typhoon right now. It's not as scary as a tornado. Mostly really loud, strong wind and rain.

Night Market!

2009-06-20T22:33:00.000-07:00

Hello again!

This weekend has been a busy one for me.

Yesterday, I went out to a Taiwanese glass museum and then to the Great Buddha park to see the view of the city and an old WWII Taiwanese air plane.

We then had fun posing with different statues:

Afterwards, we went to "Dog Shit" Night Market (no joke about the name...not sure why they wanted to make it so appealing), and I had a GREAT time!! It's super hot and humid but night markets are so much fun! They have lots of wonderful and weird things to eat, many games to play and little things to buy.

This is a handmade mini version of Plinko, where you roll a marble up the side of this board and it makes its way down a labyrinth of nails. You have to get one marble in each slot at the bottom and you win a prize!

I won 3 drinks. One of them is asparagus flavor. I can't wait! ;)

I had fun shooting baskets. They are SO FAST here, shooting with left and right hands to get the most baskets possible in the shortest amount of time.

This was so much fun! I wish we had night markets in the US!

Tai-Zhong Clinic and Health Screening

2009-06-19T19:27:00.000-07:00

I spent a long day Wednesday at a Family Medicine Clinic in Tai-Zhong and had a really great day, learning a lot. The doctor there is about my father's age and quite knowledgable and kind. He saw a whole range of patients: from children and factory workers to lawyers, a German scuba diver and a prostitute. Dr. L is also an expert in acupuncture and has studied it for more than 20 years. In Taiwan, doctors have the option of studying either Western medicine (Xi Yao) or Chinese medicine (Zhong Yao) or both. He noted that if you take only the Western medicine route, most doctors do not also study acupuncture as he did.

He had some interesting things to say about specialties and choosing what you want to do. We discussed why he had chosen Family medicine over some other specialty and he told me it was because he was interested in many things and wanted to have broad knowledge, rather than focusing a lot on one area/organ system. I said that in America, I have heard some people that think primary care doctors are "Jack[s] of all trades but Master[s] of none" and I asked him what he thought about that with regard to Taiwan. I liked his answer, however simple and logical it was: he said, every doctor has areas in which he/she excels and areas in which he/she is weak. A specialist may have very deep knowledge of one area, but is more or less at the expense of some other area of medicine and we need folks to cover all bases. A primary care doctor should be particularly skilled at integrating the different organ systems, the history, the personality/lifestyle of the patient and the different medications he or she has recieved. He said the tragedy in medicine as a profession is when a doctor does not know what his or her skills and limitations are; you must know your own capabilities and work within them to be effective both as a primary care and a a subspecialty doctor.

Yesterday, I went with a busful of hospital staff to a factory here that makes Nike and New Balance shoes. We did health screenings for 80 factory workers in 3 hours. Whew! Every 3 years, a group of nurses, technicians and doctors go to a factory and do a basic health screening for all their workers. This includes weight, visual acuity, blood pressure, chest X-Rays, blood and urine workups, hearing tests, and a short physical exam. It was very efficient and even with set-up, clean-up and driving, we were back to the hosptial in 4 hours.

For lunch, there was a drug rep who talked to us about statins and cholesterol levels, much like in the US. Fortunately, the powerpoint had a lot of English on it with graphs. Otherwise, I think his fast talking and medical jargon would have left me lost.

It's really gratifying to see that I actually did learn something this past year in medical school; quite a lot, really, when you consider where I started from! :)

After getting off, a friend and I went to eat Taiwanese "ice" (not cream), which is basically shaved ice topped with red bean, flavored rice and sweet tofu. It's very refreshing and delicious. Later, she and I went to a big night market and walked around looking at people and thing to buy and eating snacks (Taiwanse love small snack and drink stands). I tried stinky tofu and I have to say, I think it tastes about as good as it smells! (You were right, RV!)

Now I've got some homework to do. :)

10 Funny Things About Taiwan

2009-06-17T04:27:00.000-07:00

10. Old men have 2 prerequisites: crazy spider eyebrows and at least 1 fingernail more than 2 cm long.

9. It's harder to fall off of a motorscooter than it looks (I was worried).

8. They collect food scraps to feed to small pigs and/or dogs, depending on who you ask.

7. Tomatoes are actually treated as fruit here (novel idea).

6. I look more like my dad in America (or Europe) and more like my mom in Taiwan (who knew?).

5. The Taiwanese calender works exactly like the Gregorian calendar, except that the year and era are different. (We are now in year 98...I think)*

4. They worry you might get cold if the temperature drops below 32 degrees Celsius.

3. Being tan is considered coarse and ugly for a girl; women here go all out to avoid the sun. In some ways, it's like being in Paris a century ago: parasols are all the rage.

2. Closing your eyes and crossing your fingers when crossing a really busy street in hopes that you won't get hit actually works; Taiwanese drivers are used to dodging.

1. Imagine: it's a hot summer day and suddenly you hear music coming from a truck that's rolling slowly down the street; you watch as people run out to meet it. If you're hoping it's for ice-cream, both you and Beethoven will be disappointed. It's the Taiwanese garbage truck! People run out of their houses and give the man riding on the back their trash and he tosses it in.

*This is because the Republic was founded in 1911.

As for the rest, I'm heading to Tai-Zong tomorrow to go to a clinic there and next week I get to go to the Chinese medicine department!

Rain, Temples and Humidity

2009-06-14T05:38:00.000-07:00

Saturday:

So, no night market yesterday as a result of frequent torrential downpours of short duration. Oh well, I still got to ride on a motorscooter (but this time to Ja-Le-Fu, Carrefour = the French version of Wal-mart that seems to be ubiquitous in Asia). My friend D picked me up at my dorm on her motorscooter and we went to her family's house. They took me along to go shopping. It was quite an adventure. Their household consists of her mother, eldest sister, twin sister, twin sister's husband, twin sister's child, eldest sister's 2 children, other sister living in Taipei's daughter, one more child whose origins I am unsure of, and a cousin from Indonesia. Most of us got into their car (tight squeeze, no kidding) and drove to the Carrefour. It was very crowded and crazy but fun all the same. We went back to their house and a few of us went out to dinner. D's twin sister's husband's brother owns a very unique Egyptian restaurant here, complete with belly dancers and pictures of Florence, Italy on the walls. :) It was fun and our rice was served in carefully crafted pyramids. My camera died, or otherwise I definitely would have posted a photo of that.

Sunday

Today, I was not sure what I was going to do other than maybe wander around Changhua by myself and explore. However, when I was eating my morning mango over the sink, I struck up a conversation with another girl who was getting her breakfast. She invited me to go out with her and a couple of friends to Lu Kang, a town full of ancient temples and houses. I happily accepted and we ended up meeting her boyfriend there, who is a native of the place and gave us a very nice tour. I wish I could describe to you exactly how hot and humid it is here; those of you who have been to Alabama (or live there now) probably have some idea what I'm talking about. As soon as I step out of the house, I start sweating buckets.

Afterwards, we went to a unique cafe made of an out-of-commission bus on the hills overlooking the city and I drank fresh watermelon juice, which is a popular drink here. The weather had turned a little cooler and more humid (I didn't think it was possible); we saw a storm rolling in from the distance. The rain hit us a few minutes later.

The final stop of the evening was at a Belgian cafe that served waffles, Chimay, fries and sandwiches. They had a better selection of Belgian beer than we do in Alabama. RV would have been impressed.

Overall, a much more exciting day than I had anticipated.

This coming week, I am still on the Hospice Ward.

Short update and catch-up on photos

2009-06-13T00:14:00.000-07:00

Friday, I went with the head of the Family Medicine department and a nurse to do the Hospice home care rounds. We saw two elderly cancer patients, both of whom lived at home with their families and seemed well taken care of. Doctors in Taiwan still do home visits for many patients and it was interesting to see the procedure. The environment seemed friendlier vis-a-vis a clinical visit, which I think must definitely make it easier on the patients.

Here are a few other photos from last week:

My dad and RV during our bike ride through Kaoshiung:

The train station for the high speed train that took us from Kaoshiung to Taipei in 1.5 hours (verses the 8 hours it used to take my dad when he was a child).

This is a normal train station (not the high speed one) that you usually take between cities:

Here are some photos from THIS week:

This is the hospital at which I work:

Here is my dormitory; it's made for 4 but so far I am the only one. You have to bring your own "mattress," which is essentially about an inch and half of padding topped by bamboo slats that you can buy at the local store. I'm getting used to it. :)

This is the view from my room:

The most famous site to see in Changhua is definitely the Great Buddha, which is a huge statue of Buddha atop a hill in the middle of the city. Surrounding the Buddha is a very peaceful park with temples and coi ponds.

I wish you all a pleasant weekend. I'm going to Changhua's largest night market tonight with a friend I met this past week; she's picking me up on her motor scooter. Should be fun!

First day on the job.

2009-06-11T03:08:00.000-07:00

This morning I woke up early to take the bus to the hospital and then find and eat breakfast there, then take another bus to the Hospice Ward. I met with Dr. T who is a resident in Family Medicine. He showed me around and we saw a couple of patients, whose charts he gave me to study. We had a long discussion about the differences between Taiwan's Universal Health care program and the U.S. health care system.

It seems that in Taiwan, because things are relatively cheap for the patients, they tend to "doctor shop" and hop around from one doc to the next for 2nd, 3rd, 4th opinions and more medications. Often patients here will get medications for their other family members while they are at the doctor's. The patients here seem to have a lot of power; if they are unhappy, they will either sue or complain to the goverment health care system.

Dr. T did not seem to optimistic about the position of doctors in Taiwan: the cost of practicing is getting higher and higher, while the compensation is getting lower. He printed off several articles from Taiwan newspapers for me about different "frivilous" lawsuits in which the doctors got blamed for a patient's death even when their actions did not cause the death. Interesting conversation, but I'll be sure to have more before I figure out what I really think on the subject.

We had lunch with the nurses and Dr. T bought me lunch. I was quite embarrassed, for I had my money ready but he beat me to it. So far I have met two residents (Dr. T and Dr. H), both of whom are in their early 30s and are married with little children. This seems to be the typical age progression here as men still have to serve in the Taiwanese army for 2 years after graduation.

That afternoon, the attending doctor, Dr. S, came and we did rounds on the Hospice Ward patients. They are all terminal patients who are there for palliative care only. Most of them had several family members around to talk to the doctor and take care of their loved ones. It was quite touching.

I saw an elderly woman with hepatic encephalopathy (there are many cases of hepatocellular carinoma here) and her husband and daughter were holding her and stroking her arms and legs and speaking softly to her to calm her because she didn't really know where she was.

I saw a late-middle aged man with liver cancer who was bright yellow from jaundice. He had 6 family members there to talk to the doctor and take care of him. His older sister was there and she just stroked his hand and struggled to hold back the tears pouring down her cheeks while he clutched her hand anxiously. I was close to tears myself, though I suppose it's because I was paying more attention to what they were doing than what the doctor was saying because it was in Taiwanese (the doctors here use Mandarin with some English words between themselves but almost always use Taiwanese with the patients).

Making patient care decisions here is very much a family affair. As a physician, you must discuss with the family in detail before any decision is made. Another complicating factor is that it is considered bad luck and bad manners to tell a patient that they are dying directly. To get admission to the Hospice Ward, you have to meet certain criteria and be DNR (Do Not Resuscitate), but sometimes due to this delicacy in explanation, the patients who end up in the Hospice Ward may not necessarily know why they are there or what exactly the DNR means.

Also, there is a large problem with getting people to leave the hospital. Since it is relatively cheap to the patients to be there, they often prefer to stay rather than paying for in-home care or a nursing home. Many families are also reticient to take their loved ones home because they feel that the care the doctors and nurses give is better than what they could give themselves. Mostly, this involves teaching a family member how to give the medication appropriately, but it can be daunting.

Tomorrow, I am meeting the team to head off into the community for Hospice Home Care. It is very important for many Taiwanese that their family members die at home, in peace. Therefore, much is done so that this can happen. Often, if a terminal patient techinically expires in the hospital, they will be resuscitated and driven home, then taken off of respiration there.

Photos from the first week in Taiwan

2009-06-09T17:58:00.000-07:00

Hello everyone!

Here are some photos from the week of travel I spent with my dad and RV in Taiwan.

While we were in Kaoshiung, we stayed in a really nice apartment that belongs to a family friend .

We spent a really nice day riding bicycles along the "Love River" in Kaoshiung. It was hot and humid, but then it started raining a little bit and it was really refreshing. We biked to my dad's old medical school and saw the dormitory where he and my mother met: Luke Hall.

After that, we biked to a ferry that took us to another island, where RV ate stinky tofu (which he didn't like, despite the fact that they say "smells bad tastes goooood"). Then he ate squid on a stick, which he did really like. We biked to the ocean and watched it for awhile before returning back to the apartment.

The next day, we took the train to Tai-Dong, where my dad's cousin lives. But more on that later.

Arrived in Changhua City Taiwan

2009-06-09T03:33:00.000-07:00

My father and RV just dropped me off in Changhua City, Taiwan after a weeklong whirlwind tour of the island, visiting relatives and seeing the sites. I will be living in a dormitory a short bus ride away from the hospital. It is full of other people doing clerkships at Changhua Chistian Hospital (CCH) as well.

The dormitory was quiet bare when we arrived, so Dad helped me go out and purchase a mattress, bed linens, toilet paper, every little and large necessary item. Now I'm all settled in and looking forward to my orientation tomorrow. I have forgotten a good deal of Chinese from when I was living in Beijing, so it's a little intimidating. Everyone speaks very quickly, mixes in Taiwanese and then looks at me expectantly. Hahaha.

The neighborhood I am living in is much like other parts of Taiwan. Lots of apartment buildings, narrow streets, small shops, cars parked randomly on the side of the road, motor scooters, etc. I like how busy it is and how much is going on ("hen re nao").

I'll try to upload some photos tomorrow from our trip of last week.