The GTF - Over - Yourself - Puppet

Ever have those days when you feel like patting yourself on the back for things like doing the dishes? Or your past accomplishments seem good enough?  Your ego is swelled, and your trophies are what keeps your chin up?

Well then, have I got the thing for you!

You, my friend, need to go out and make yourself a GTF-Over-Yourself-Puppet.

Step 1: Find a pillow, a duffel bag or whatever.
Step 2: Decorate is with your A papers, your medals, your trophies, and whatever else that makes your nose stick up (a picture of yourself might be a good idea if you've ever found yourself buying yourself a drink).
Step 3: Play a ridiculously awesome 80s song.
Step 4: Jump over your puppet over and over until you've worked up a sweat.

Congratulations.  You have successfully gotten over yourself and are ready to get back to work.

This is what I do on those days when things don't feel like they're working out, when things just aren't going MY way, and when I feel down because maybe it's been a while since I've received a gold star.  This is what I do when I feel myself plateau and when I feel flat.  This is what I do when my own thoughts are so annoying with praise for so-called "good deeds."

I mean seriously, these are the days when I desperately need my mantra to be, "Get over yourself, and remember you're really a total dork...and don't you forget it!"

The trend is common in medical students.  We get smarter, we think we should get some kind of praise, we start to look down on others who might not be as smart, and we can lose perspective.  We can become comfortable with our state of knowledge.  We can think, "Well I did well on that one thing that one time, so I'm great and there's no reason to improve."

Ever have those days when you start treating others, maybe even patients, a little differently because you've accomplished something or won something? You get a little smug? Your identity is now linked to a medal?

You need to GTF over yourself.

And here's why.  Sure, you should be proud of your accomplishments. What you did is important, and hard effort deserves some acknowledgement, but when we link our identities to accomplishments, we're setting ourselves up for failure.  What if you didn't have the trophy? Are you still better than your neighbor? Does that prize you won make you a better human being? Really?  I don't think so.

Incentives for striving to do our best are great to motivate us into producing product, but it comes at a price if we don't keep ourselves and our motives in check.

Remember the scene from Titanic when the passenger could no longer buy a seat on the lifeboat? Money didn't matter anymore just like our silly papers and awards don't actually mean anything.  When you die, your accomplishments don't go with you.

All you can strive for is to leave a legacy that has made the world a better place.

Your trophies? Who cares? Your medals? Will they save you against a tiger in the jungle? Nope.
You know what does though: character, hard work, and commitment to making the world and our communities better (note: I probably exaggerated; I'm not really sure if these things will actually save you from a tiger).

Regardless, your spirit is what touches people, moves people, and has the ability to change people.  Trophies, awards and empty compliments don't move anyone.

Incentives might catalyze action and cause motivation, but it's empty if the incentive comes without purpose.

So today, if you're looking for credit, a pat on the back, get out the GTF-Over-Yourself-Puppet, start making a fool of yourself and get out and serve somebody.

DISCLAIMER: The only reason I know so much about this topic is because I need it.  I think I was born with an extra gene for arrogance, so I have to practice this technique.  I'm not claiming to be some saint of humility.  I'm just a human who sometimes just needs to find creative ways to stay humble.

P.S. Please feel free to leave your own GTF Over Yourself songs in the comment section below!  Maybe we can make a GTF over yourself soundtrack...stay tuned...

Shit works

It's moments like right now when I get really excited.  

I'm working on my routine work for my favorite class: complex emergencies and forced migration, and this video is assigned.

Simultaneously, I'm attempting to put together an IRB protocol for a trip to India this winter that addresses child malnutrition through a women's empowerment program.

The overall theme here is:

Step 1.) Focus on women

Step 2.) Solve problems

As my favorite OMM professor said to a doubtful group of students, "Shit works."  Then the crack was heard 'round the world.

(Shout out to PCOM Class of 2014 who helped raise over $1000 for CARE in the Live Below the Line Campaign in 2011.)

Where the girls at?

I had the privilege of going to one of those important doctor conferences last weekend in sunny SoCal. It was honestly a fantastic experience in many more ways than I expected it to be.

Although, I still have some lingering unfinished business with the said conference, and it starts with answering the question, "Where the girls at?"  Seriously, I walked into the opening plenary and 5/5 leadership positions are white men?

Research conference winners are 7/8 male students?

What year is this again?

I'm not saying I know the exact reasons for this occurring; however, a recent study out from Yale did just find that gender bias is occurring even in academic science, possibly explaining the lack of women rewarded for their research efforts.  But there are other reasons of course.  There are the choices women make and the same old excuses always made for the unbalanced scales in leadership. But, as Anne-Marie Slaughter points out in "Why Women Still Can't Have It All," the rules and culture need to be changed so women actually have a chance and are not forced to make the decisions most men simply don't.

I'm sure there are many more reasons, but the reasons don't matter as much as the lack of action taken to rectify the situation and the poor outcomes resulting from the shortcomings.  Less women means less female perspectives.  It means the balance in an organization is tipped.  It means nothing becomes easier for young professional women in the future because there are less women role models to look up to.  It means there are less women role models for even younger girls who aim to be doctors, or spokeswomen or whatever profession they aim.  It means the decisions world leaders are making lack female perspective, and I think history shows us what the world looks like when it is only run by men.  Grim is an understatement.

Granted, I was honored in more ways than one this weekend.  Our team's project may actually make a difference, which is the aim (I think) of all research.  Our goal is to stretch the status quo, and I think we may have planted a few seeds which is really all we can ask for, for now.

We dressed up, presented, put on the professional game face and delivered. We were poised, and we really did have it going on.

Regardless, there's still something lacking.  One can't help but feel a little bit like she intruded on a secret society of men... with their boy jokes and their male bonding. I won't mention egos because I know I have one too...but still... where the girls at?

There's something to be said about small talk when networking.  In Eastern countries, when you sit down to do work, you have tea, ask about the family and maybe a half an hour in, you start to discuss the project at hand.  In the US, small talk is said to be important.  I have to say, I think I'm damn well decent at small talk with women.  But with boys? Epic fail.  No, I don't play golf.   Football? Too many rules. No, I don't even watch sports...besides ice skating of course.

To be frank, I think I got stuck in that awkward adolescent stage, and I still stumble over my small talk with middle aged men.  This is inconvenient because they tend to be the majority at these kinds of conferences.  The result is that I'll talk only about the work because I have nothing else to relate to.  Unfortunately, women who are in the same position are accused of being abrasive, cold and dare I say, bitchy.  It's a catch 22 really.

Now, I'm sure I did fine. I put on the face and laughed at the jolly old jokes.  Luckily, I also had some good company too in order to bear the weight of my awkwardness, and my cynic hat really didn't come on until the way home.  Additionally, I am extremely grateful for the female trailblazers already in the field and will be sure to keep them close.

But, it is good to be home,  to take off the game face, indulge in the fall, and figuratively (I wish literally) play in the dirt and hang out with the worms as today became a baking/puzzle/reading day.

I know I will love the profession I have chosen once I'm actually in the field and talking to patients.  Until then, I feel like a large component of being a female in this profession requires having the game face on at all times, regardless of how draining it can become, and playing the game to get along in the boys' club.

To fix, to heal, to love

A tough lesson to learn for the medical student with the hero complex: to heal is not the equivalent to fixing as only one of them truly requires love.

They don't teach about this silly "love" concept in medical school.  As a matter of fact, it's a concept that is easily put out of the mind as the tables and graphs compile into a heaping mound of ways to fix.  We have choices as we go through this large pile of evidence.  We can fix at point A or B or C, never mind if the patient wants it.  I have followed the guidelines, I am fixing, no lawsuit for me!

It is easy to become fixated on the fixing.  It is what we learn how to do in medical school; unfortunately, the art of healing is often forgotten and left to a student's own pursuits and drive during and beyond their formal education.   It's selfish really.  It can become a sense of control for us.  We must be the saviors of the world! If not us, who?  It is narcissistic even.  We are the martyrs of the world giving up our young lives to pursue saving lives.

And how dare you sick patient for not accepting the fixing I am practicing on you! Don't you know how lucky you are to be blessed with such an educated being able to fix you?

Sounds real loving, right?

I learned this lesson deeply this past weekend.  Sometimes the most loving and the most selfless act might be to let go and not intervene because in order for healing to truly occur, patients must choose it.  So often we forget that healing is a choice.  The physician can open the door, but opening the door is the majority of our role in the healing process.  Ultimately, it us up to the  patient to walk through it when they are ready.  Until then, we must wait and relinquish our neurotic compulsion to control the world.  We must let the love and healing start within the patient, for only when one learns to love oneself, can she find herself worth getting up and walking through the door.

Only then, and only when they feel moved to do so, will they walk through, and then we must be waiting on the other side with open arms, without judgement, and without the question, "What took you so long?"

The truth is everyone has their time, and it is devastating to know that some people are self-destructing when the door is open right in front of them.  We can sell the attractiveness of what awaits patients on the other side until we are blue in the face, but we also have to understand that what lies on the other side can be scarier than death to patients. It is the unknown; it is anything but the status quo.  And even though the status quo might be deadly, it also might be comfortable.  It is a form of disingenuous identity they have adopted, but it is theirs, and it is only theirs to change.

This is the hardest thing to do as a friend, a medical student and as a daughter: to let go and relinquish control, to love without the compulsion to fix, and to wait for the healing to begin from the inside.  We know the risks.  We know what can happen when people hit rock bottom, but sometimes it's that rock bottom that propels people to move through the door.  We have to be patient.  I have to be patient.  To love without fixing in order for healing is one of the hardest lessons I'm learning, and I only pray that the work done on the inside to get my loved ones and future patients onto the other side happens before rock bottom becomes a death sentence.

Justice is Health

As a doctor in training, we often hear “horror stories” of the patient or patient’s loved one, who goes a little off the deep end when they receive an unfortunate diagnosis or a fatal prognosis.  It’s a defense mechanism.  It’s the patient’s way of trying to comprehend, “Why me?”  They urgently seek an etiologic agent and subsequently try to bring it to justice.  “It must have been that thing I ate that day when we ate at that picnic 7 months ago...it must be because the government poisoned the air in my neighborhood...I just read a study linking lightbulbs to my condition!”  Absurd as some of this sounds, when anyone tries to answer the question, “ Why me?” we all come up with an amusing at times, but limitless array of answers.

However, as physicians we know that definitively pointing at a cause for a disease is nearly impossible and takes years of study. (For instance,  it took decades to definitively link smoking to lung cancer.)  Therefore, for the majority of suffering seen in the clinical setting, there is not one guilty culprit that we can lock up and ensure never causes harm again.  On the contrary, there are usually many suspects, and sometimes these suspects even intersect on their path to causing disease.  While this makes epidemiology pretty interesting (for epidemiologists), it is frustrating for patients.  Similarly, in the court system, trials are long, and any suspect which leaves reasonable doubt of guilt is acquitted.   While the suspect may be watched more closely, the victim cannot be prescribed an intervention to simply eliminate it.

This poses a problem for patients and all providers.  This means illness is not just; by definition, it is not fair.  Justice, or the concept of fairness, is what patients seek out though.  They immediately ask themselves, “Why me?” “What did I do to cause this?” Numerous cultures blame disease on other factors that do not fit into the Western bio-medical model.  Health is sometimes defined by you and your family’s good fortune and social status while disease might be caused because you dishonored your god or family.  They link disease to a specific cause, and they explain symptoms as something you might deserve. They seek a way to explain it and make it fair.  While we in the U.S. might not agree, what stands true is that across all cultures, we instinctively strive to pin down the cause of disease because we desperately want it to be fair. We want to lock the culprit away or at least prevent any reason for a disease-causing agent to get us.  Furthermore,when both patients and providers feel  justice is unobtainable, we can become anxious, depressed, angry, isolated, and suicidal.  

Alternatively, I have also seen the lack of fairness surface as symptoms just as I have seen symptoms manifest in a quest for justice.  I saw it in court when I was 12.  One of my family members suffered GI symptoms, headaches, lack of sleep and anxiety when things were just not fair and out of her control.

I wanted to understand this, and maybe that experience propelled me into attempting to understand social justice and its effects on health.

Why do some places get Tb, HIV, and cholera, while other places do not?  Why do poor people get certain diseases, and rich people simply don’t?  Why in the U.S. are some areas healthy and some not?  What unfairness happened to this person that made their health so poor?  

Granted, I understand there is personal responsibility involved in health, but that goes for people with the education, resources and belief system that certain behaviors do in fact increase your health and prevent disease.  Most importantly, people who take personal responsibility for their own health know they are worthy of good health in the first place and know they are capable of leading healthy lives.  For those that do not lead healthy lifestyles, poor education, lack of resources, poor self-efficacy and lack of feeling worthy all contribute to poor outcomes.  Lack of resources and poor education is what we can control to a large extent at a population level, where self-efficacy and self-worth can be targeted at an individual level. Either way, isn’t it just unfair that someone might not know about clean water and have access to it, and is subsequently why they are exposed to cholera? Isn’t it just as unfair that an adolescent might not have anyone to reinforce their self-worth and teach them healthy habits so that they might learn to lead healthy and happy lives?  It is this basic unfairness leading to poor health that sets me off.

To summarize, social justice determines health outcomes on a population level, and fairness at an individual level heavily influences the health of that individual.

At the Survivors of Torture and Trauma Project, a project of a refugee resettlement agency I am currently interning at, I see this everyday. For example, both mental and physical health symptoms are not alleviated until a rapist is put to justice.  For my clients, symptoms will not go away until they fully realize asylum, and they feel safe from the treacherous circumstances of which they fled.  Sometimes asylum is granted, and an ounce of fairness is reached, although it really does little to compensate for the trauma endured.  However, healing must progress otherwise, despite the lack of fairness.  In some cases, clients can at least find refuge, a place where healing can start while true justice might never be achieved.

Today I went to court again - flashback from half my life ago.  I was sitting as the case manager with my client’s three adolescent girls.  I could see it.  The mother’s testimony through the interpreter, the roundabout questioning common for those fluent in the legal system and foreign to me. 

In medicine, if I want to know something, I look it up or I simply ask what I want to know from a patient.  In the courtroom, if you want to know something from a respondent, apparently, the “best” way is to fire twenty questions that kinda not really narrow in on what you want the person to say, and if they don’t say exactly what you want to hear, well...we will see what happens when the verdict is made.

Confusion, unfairness, trauma, tears.  No one should have to see the strongest person you know, your hero, your mother, go through that.  It’s not fair.  It’s not fair to the mother,  and it’s not fair to the daughters, but it happened today.

As future physicians, we encounter injustice everyday, and we must fight it.

How do you fight injustice? You advocate. 

Because reaching justice by finding criminals and removing them alleviates symptoms and disease, whether it be the pneumonia causing bacterium, poverty (an etiologic cause of numerous ailments), or a trauma- causing suspect. You advocate for disease causing agents' removal so that they cannot cause more harm and damage. 

However, while we must advocate, we also must strive to heal despite lingering injustice.

For those whom injustice has already violated, we need to build that patient or population up stronger and help them develop their own resilience so they can find their own justice within themselves and begin to heal.

World Malaria Day!

Progress...

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Finals Anthem

...started making a checklist but it got too long...so please enjoy my 

abstractfinaltermpaperfinalpresentation anthem while I figure it out...

it's good to be a 90's kid