7 lbs 3 oz

I can’t tell you what my first memory is… In fact I’m not even sure I can pinpoint the age at which vivid recollection begins. Nonetheless my childhood, which in all reality is much more recent than it seems, is saturated with memories… many of which go on to make exceptional stories that continuously get circulated at family gatherings despite complaints of redundancy. For instance, no matter how old the story gets, my family can’t seem to forget the time I ran to third base instead of first after an excellent hit during my first tee-ball game. Then there are those memories that don’t have any hint of significance. You know? The ones that no one else remembers but you and they aren’t even worth the brain space. (I always wonder why we can’t have more control over our memory storing capabilities.) Anyway, many of my memories take place in the two story house sequestered between the bend of Valencia Street and the narrow stream that fed into the Gallinas River; the house with too many rooms to count in El Ancon where I slept more nights outside on the trampoline than in my bedroom, which I shared with my cousin Deidra; and in the old adobe house where my mother grew up in El Goosano, or as my step dad would say- ‘The Worm’. And many of my memories have to do with being a nerd.

I’ve always been enthusiastic for education. When I took care of my little sister and cousins, I would organize a game of school where I was the teacher and they were the students… often against their will. I won a calculator in elementary for scoring in the 99^th percentile on the standardized tests and my name has been printed in the Las Vegas Optic, my hometown newspaper, for making the A honor roll countless times (my dad has stacks of papers to prove it). So as you can see, I’ve been hitting the books most of my life, and most of my life (20 years to be exact) I have known exactly what I wanted to do: become a doctor. The desire goes back so far that my sister Jelly, in her mischievous and jolly toddler form, would proudly exclaim, “My sister wants to be a pedestrian when she grows up.” What she meant was pediatrician, but she was close enough. Once again, I can’t pinpoint that ‘Aha moment’ where the child version of me made up my mind for the rest of my life, but I can tell you that I’ve never drifted away from the idea, but rather at different ages it was continuously confirmed. One memory that stands out the most is when I was at Christian Camp with other teens from El Valle Del Cristo Church, where I’ve spent more Sundays than anywhere else. We were in Mountainair, NM and I was sitting in the large chapel where evening services were held. A pastor, whose voice still permeates my soul, was speaking and inspiring the youth to make decisions based on God’s plans. I remember the exact Bible scripture he used (it’s my favorite one to this day):

“For I know the plans I have for you,” declares the Lord. “Plans to prosper you and not to harm you, plans to give you hope and future.”

By this time in the talk, I started squirming in my seat and anxiety was quickly surging through ever molecule in my body. It was at that moment I began to feel convicted. I had never thought about God’s plans for me. I had decided to become a doctor and had never once prayed about it… Just seconds after these alarming thoughts raced through my mind, the pastor in his same memorable voice began speaking. I can almost guarantee you that he was looking straight at me and every word that left his mouth was for my ears. He began to preach that we don’t always know what we want to do with our lives, but all along the way God is blessing us with talents and gifts to succeed in areas he has planned for us. He said he gives healing hands to those he wants to be doctors. In astonishment, my whole future had been completely confirmed and I was even more fired up for pursuing my goals than ever before. So I continued to be a nerd, I graduated valedictorian of my high school class and received a full ride scholarship to the University of New Mexico where I lived among honors students in the Scholars Wing of Hokona Hall. Things were falling into place and I couldn’t be happier about pursuing my goals.

Now here I am finally doing what I set out to do years ago and I continue to make memories all along the way- one of which I am about to share with you, if you chose to read on J

“What size of gloves do you use?” he asked me as he comfortably sat in front of a neatly arranged table of medical instruments, which laid atop a sky blue chux pad.

“A small,” I said.

He stared.

I stared.

“She’s about a 6… maybe a 6.5,” my attending physician chimed in, while I nodded my head in humiliation. (I thought to myself- Gosh Sevy! You’ve only be in the OR for 5 minutes and you’re already making a fool of yourself!).

A few minutes, 4 to be exact, go by while I wash my hands alongside the doctor. We scrub methodically, each finger individually paying close attention to the nails and making sure to use half of the disinfecting sponge for one extremity and the other half for the other side. Dr. T. teaches me to begin at the fingers to work my way up to the elbows and then we rinse in a very technical manner making sure the water runs down our elbows rather than allowing the water to run back onto our hands. The whole hand washing procedure is such an art; however, one that lacks flexibility and free form. It’s an art, because throughout the entire process you become one with your hands and arms. You inspect your skin with such unusual acuity it’s likely that you would notice something you had never noticed before. You intensely pay attention to the direction the water flows and you don’t take for granted every instrument that you use along the way. It’s handwashing at an all new level.

From the sink, we march with purpose to the scrub nurse, who has all of our sterile gear ready for usage. I stand patiently with my very very clean hands pointing up and away from me, being extra careful not to contaminate them with anything. At this point I already have my scrubs on, my scrub cap (which looks like a disposable hat that a cafeteria lady would wear), and my shoe covers (the extra long ones, as the incredibly friendly third year student suggested before leaving). The friendly nurse takes a freshly opened baby blue gown and holds it outstretched so I can carefully and slowly slide into it, she then opens the sterile gloves and I systematically slide each hand in… I follow the steps exactly as I am instructed making certain to avoid error, as that result in beginning the process all over again. Then the fun part- tying the gown. One of the male scrub nurses comes over and quickly velcros the top of the gown, ties the inside, and then for the last, and most fun part, he grabs the small cardboard piece (and only the small cardboard piece to avoid contamination) as he looks at me and in a goofing voice says, ‘shall we dance?’ I spin around as I’ve witnessed all the others do, so as to securely wrap the final tie around my waste, and voila! I’m all scrubbed in.

At this point I’ve already introduced myself to the patient, a quiet and obviously worried woman who can’t be much older than me. I walk around the table to watch the epidural and the anesthesiologist takes an interest in me after noticing my UNM student ID. He begins showing off and talking about each injection, he explains his routine and points out how to find the landmarks on the human body that identify where the injection should occur. He rambles on and on and I take in every tid bit of information, grateful for his nice personality and willingness to teach. He moves quickly and makes small adjustments, 5, 10 and 15 angle changes to the needle trying to approximate his exact location within the spinal column. All the while, I glance back and forth between his hands as they handle the needle so comfortably and his face. I watch his eyes and the small tilting motions of his head and I know that not only has the needle penetrated the patient, but his mind has. For a long moment he doesn’t speak and it’s obvious that he is visualizing the needle’s position within the body, as if he has some sort of superhero x-ray vision… but rather he is relying only on years of experience, almost negligible changes in pressure, and input from the patient. I watch in awe as he can accomplish such an amazing task. I am also in awe as I recognize that medical technology is so advanced, we can insert a needle into the very highly protected space surrounding the spinal cord, a space that just over a century ago was normally closed off to any outside substances. While epidurals were discovered in 1901, it wasn’t until 1942 that it was actually used for this reason… so it is a very recent advancement in the continuously evolving medical field and I can’t help but think of this same procedure and how different it will be another century down the road.

For now though, only a few minutes have passed… the patient lies down after following specific instructions, so that her position is conducive to the procedure that is about to occur, the procedure that I am about to assist with! The entire team assembles themselves with three goals in mind: 1. They must stand where they can most comfortably carry out their job. 2. They must avoid tainting the sterile field or vice versa if they are sterile they must avoid being tainted. 3. And finally they must avoid getting in another person’s way. It’s a meticulous process, but one that naturally unfolds without too much complication. I take my place to the patient’s left, where I stand at the level of her belly… and then it begins.

At first I feel as if the procedure is rushed. The doctor’s hands move quickly, but smoothly. He calls out the names of different instruments and they are very swiftly placed into his hand. His eyes almost never leave the site of the incision. His hands, in contrast, whip back and forth exchanging one tool for the next. The first incision is made with a scalpel, which only penetrates the skin. At this point, , the scalpel is returned to its place on the silver table and he uses a tool that resembles a very small torch that allows the obstetrician to make very fine cuts through the superficial fascia layers and the subcutaneous fat and also burns small arteries that have been severed, so as to seal them shut. The fat is squishy, slimy and pale yellow and the fascia is a shiny white covering that is very thin, but also very tough. He is careful to stop cutting before he encounters muscle. It’s a delicate process, but his practice allows him to proceed rather hastily. When the muscle is reached, he prepares to use his next tool: brute force. (Yes, you read that last sentence correctly.) With his two hands, he rips the woman’s muscles apart to reveal the contents of the abdomen. It seems like a harsh maneuver, but all the while the patient quietly converses with her husband on the other side of the blue curtain.

Finally, it is my time to shine… ok ok not so much shining, more like holding the bladder out of the way. So I take the special bladder holding contraption, surely there’s a scientific term, but I can’t seem to think of it. I carefully grasp the bladder and then slide it down to reveal the shiny, muscular organ that we have been working to expose: The uterus! But not just any uterus, it’s a uterus with the special contents consisting of one amniotic sac, one placenta, and one baby in the breached position. It only takes one slow command from the doctor, a quick nod of the entire team’s head, the newly introduced neonatal team’s presence, and a quick slice of the uterus, and the grayish little creature meets the outside world for the first time. The entire time I am following every command that is directed at me. One hand continues to hold the bladder out of the way, the other grabs instruments when needed and performs simple tasks quickly. My eyes though are transfixed on the small limp being that is not so gingerly placed on the mother’s belly as the umbilical cord is unwrapped from around its neck- the reason it was breached and could not turn into the normal delivery position. It’s a boy. He’s a boy and he has a quiet cry. His skin is gray like the color of the stormy sky and there are spots of white goo like clouds that dot that stormy sky. As he lies face down on his mother’s belly, the only movement in his flaccid body is the barely visible heave of his trunk as he breathes in an out. Then the neonatal team swoops up this new little baby and my eyes once again fixate on the mother, my patient. Closing up our incisions is the time consuming part. All the while, I make sure to watch the suture technique as thread is weaved in and out of each layer making sure to create a tight seal; but my mind is multi-tasking and it can’t help but fill with excitement. If I had had one ounce less of control, I would have allowed that small tear that was building up in the corner of my eye to escape, but the heat of the moment consumed my tear and it evaporated into the full room where people moved around quickly attending to their tasks. The overwhelming joy, however, could not disappear. It was still there strongly resounding through my body and I embraced every minute.

In a week full of studying, lectures and frustration, I was blessed with an opportunity to not only witness, but to assist in a procedure that allowed a new life to join a world that I live in. He was a 7 pound, 3 ounce reminder of why I am so in love with the field of medicine and why I must continue to endure this obstacle called medical school.

Somewhere in Albuquerque, a family celebrated their first Christmas with a brand new baby boy and I can’t help but send happy thoughts in their directions. Happy holidays my dear friends and family.

A Wearer of the Backpack

I am 24 years old. Many of my friends are delving into careers and beginning families. As for me, I am still a wearer-of-the-backpack. It's a bright green, but not quite neon backpack ordinary in size but extraordinary in contents. It often contains the binder for the block that currently consumes my life- completion of the most recent one being GI/Nutrition/Metabolism... AKA a couple weeks learning everything there is to know about the intricacies of the gut and a few more weeks re-learning the ever tedious biochemical pathways and their beautifully designed connection. It's an Embark backpack- a brand I never heard of until I saw it in Target, but one that fittingly describes this backpack's purpose. Together we embark on a journey every weekday and sometimes weekend to learn medicine. It carries the highlighters I rarely use, because I feel they complicate my notes; a handful of white printer paper that lacks lines, so I can draw images without added distractions; my handy dandy lead pencil that I have used for over two years and it still serves me strongly; a stapler, a marker, and a few old receipts and gum wrappers. It also has a nice side pocket where my red and white coffee cup sits after I've devoured the freshly brewed coffee within the first hour of lecture.

I've been wearing a backpack for most of my life with the exception of my infancy and summer vacations. I once owned a blue Pooh backpack, a dark green one that I used throughout most of college, a nice black one in high school that I stuffed so much I tore a hole through it, and even one with a random McDonalds emblem that holds sentimental value because it belonged to my dear friend Justin. My shoulders are accustomed to backpacks. They've been trained to endure those horrendous days when my backpack is stuffed with everything but the kitchen sink to get me through long day. I'm a student, an ever diligent and ever studious wearer-of-the-backpack.

I am, more specifically, a second year medical student.
"I am a second year."
"I AM a second year."
I like the way those five little words roll of my tongue. I love the descriptive second in that sentence. Being a second year med student is so much better than being a first year med student, but of course it's a stepwise process and you must endure the first year to get to the second... that's what makes each year more special. With each increase in numerical value comes a whole year of great experiences and knowledge... and even, as bold and maybe naive as it is to say, wisdom.

Some rare occasions, far and few between, allow you to interact with members of other cohorts. For example, our newest class, which is an elective chosen by second and third years, is called Exploring Positive Psychology Through Cinema. This class is comprised of about half second years and half third years. While in class on a late Tuesday afternoon, I begin to recognize the differences between us and them, first the obvious ones and then the not-so-subtle variations. Firstly, we sat completely segregated with not a single person out of place. The eastern half of the room was my class and the western side had the third year class members. It was as if an imaginary equator dotted across the room and each of us knew where we belonged. They appeared more sophisticated in their ties and collared shirts, and slacks and button up blouses. They're shoes were your typical Danskos or another commonly used brand by people who are inevitably on their feet all day. We, easterners, wore jeans and casual, but nice shirts. We didn't all have our School of Medicine badges attached to a visible pocket, but they were certainly in a backpack pocket or at the bottom of a purse. We had papers out and pencils ready in the event we should need to jot down notes. We had come prepared with our homework assignments in hand and possibly a copy in our backpack for our own records (or maybe that was just me). Not a single one of the third years had a piece of paper in front of them and they didn't pull their pencils out of their scrub or white coat pocket. We were different from each other... It wasn't about being smarter or better dressed. It wasn't about taking notes or being overly eager to turn in assignments. It was more. They were a step closer to a goal that we all so desperately desired, but a goal that feels more realistic for them, a goal that is in their near future, not ours. We have an enormous and overwhelming hurdle ahead of us: the first step in our board examinations. This obstacle prevents us from embracing the end goal. We haven't been on the wards, or worked 80 hours work weeks. They do it almost daily. They've already passed their first set of boards.

And then there's the polar opposite. Last week, I volunteered at the Immigration Clinic (a place where immigrants applying for citizenship can get required physical exams free of charge). It was a clinic I had volunteered for before, a clinic that inspires me, and a clinic where you learn the stories of people coming to America for more opportunities. This might sound cliche, but it's exactly what I've heard, what I've witnessed, and what continues to drive my patriotism. It was here that I was the "older, wiser" student, the one closer to the MD, the one with more experience under the belt. I was in charge of the physical exam and a first year student was shadowing me. The tables were turned and I unknowingly wore my white coat a little more comfortably. I handled our medical equipment with more ease and when it came time to looking in my patient's ears I maneuvered my tools into the ear canal effortlessly. It was a task that nearly a year ago terrified me. I instructed and demonstrated physical exam techniques throughout the encounter, offering tidbits of info to the patient, and ensuring that the first year was following along. It was a humbling moment, a moment when you realize how far you've come in only a year's time. It was reassuring that time is actually moving forward despite the long hours in the library that almost make you certain that time does not advance, but rather the second hand moves like that of the shorter and thicker hour hand, one slow tick at a time.

In the end, I've found my place cozily in the second year of my medical school curriculum. I am nearly half way through my 7th block and only have one more left. I exude more confidence when I'm volunteering at the local high school doing pig dissections and when I talk about my research to an interested colleague. I'm growing, one step at a time, and I'm headed in a direction where I'll eventually be able to get rid of my ever faithful backpack... but until then I'll wake up tomorrow just before 7am. I'll grind my pinon coffee beans and start the coffee machine, load my backpack, throw it over my shoulders and head to the third row, second seat of the auditorium.

A Man's Routine & A Child's Lesson

He is to this day the noblest man I have ever met. He was the strongest rock, yet he had the gentlest smile. He spoke softly for the most part and was well known for clearing his throat with a little cough before answering the phone, but his voice held a sense of importance. It was captivating. It was truth. His words were spoken fluidly and surprisingly softly, often intertwined with Spanish phrases, and he was likely to finish most sentences with a little smirk and a flash of his envied straight teeth. He was my Grandpa Gurule.

He was also known for being a man of habit. For instance, I could count on him to cheerfully greet me, “Mi Pancha, mi consentida,” when I entered his house and then quickly offer me some cookies or a soda. Growing up in the house about two dozen steps away, I had learned his routines. It wasn’t challenging, because he did the same thing every day, in the same order, never skipping a beat. He would wake early like most men of his generation, walk through the curved hallway between his room and the kitchen passing the washer and dryer and a pantry that was always full on the way and he would slowly shuffle across the kitchen to the large set of windows that covered the front of the house and he would open the blinds. It was the first task to be completed every day. That’s how you knew if he was awake yet. Then straight to the bathroom to prepare for the day ensuring to pay extra special attention to those beautiful teeth I mentioned earlier. He would undoubtedly emerge cleanly shaven, with the wisps of hair that circled the crown of his head neatly in place, with khaki pants, which later in his life were supported with striped suspenders, and a collared short-sleeved shirt. The rest of the day included watching the news and maybe some crazy wrestling on the Spanish channel, drinking a glass of cold water from the jug he faithfully filled every day in the refrigerator, spending hours in his beautifully kept garden (only after putting on his fedora that sat on the long hutch in the dining room), eating meals with too much salt, making a fresh batch of tortillas that were perfectly round and pudgy, and sitting on the porch quietly watching traffic pass (I always wondered where his mind took him). A man of habit, a man you could say I’ve grown to be like. My parents and other family members often tease me, because I am so different from everyone in my family. When I remind them that I am just like my grandpa, they nod their heads in agreement and we become silent and a smile spreads over our faces. He was a good man.

The few weeks leading up to the start of school, I began to dread the work that was in store for me- the hours I would spend in the library before tests to retain the biochemical pathways found in the body, the weeks I would spend studying for my first set of board exams, and the months that would unquestionably be jam-packed with sequential lectures, tutorials, and so much more. I dread it, I’m dreading it right now, but on the contrary, I am craving the routine. I crave the life of having a full schedule, meetings to attend, things to do and people to meet. I enjoy being busy and waking up each morning with an already formulated to do list. I like knowing that at 5 pm I will be on my way to the gym and following that I will be preparing dinner. I know that sometime in the day, I will spend a few minutes talking to my mom on the phone, a few more minutes checking and replying to emails, and even more minutes tending to my very own garden (with only a couple of squash plants remaining).

Routine, planners, appointments and reminders- It’s a life I’ve chosen for myself and a life I’ve grown to love.

Bring it on med school!

Crumbs

8 weeks have come to an end, a bittersweet and abrupt end. Just like baking a pie, much time and preparation is involved, then a beautiful dessert is created and enjoyed, and before you know it all that’s left is a plate with crumbs and dribbles of fruit filling. My piece of PIE was no different. I spent some time arranging and anticipating the experience, then I was beginning to feel like I was getting into the groove of a beautiful experience, and now I’m back in Albuquerque enjoying a much needed two week break before school begins. My plate is left with crumbs of medical knowledge and new relationships filling my heart.

The last week was incredible. I saw much of the same stuff with a bit more fluff- including two fish hook removals (the forest opening up was the beginning of fish hook injury season) and a really deep splinter removal. Upon anesthetizing a woman’s arm, I felt a sense of comfort that would have felt foreign only a month ago. And while keeping a young boy preoccupied with small talk of sports and school, I felt like I could also offer comfort to a patient in need. I was rewarded with a huge hug from the big brown and teary eyed kiddo.

My experience was more than an opportunity to learn medicine and biological processes, but rather it was a time to gain hands on experience with fancy technical stuff, talking to patients, and working through problems like a detective. It was a wonderful time and of equal importance, it was great to be home with family and friends. To share a room full of princess décor with my 6 year old sister and sleep on a twin sized trundle was an experience that I didn’t see coming, but truly cherished nonetheless. I loved being home in a community where my family lives, where I could attend Zumba classes at the local community center (an old renovated bar) and take a jog at the local high school track. It was very fulfilling to complete a community project on nutrition education that will hopefully continue to be used in the clinic. Everything was memorable and definitely worthwhile.

Ordinary Solutions for Extraordinary Problems

In one room, I was seeing a Rastafarian man. He complained of not feeling well and needing us to “flush his body of the bad feeling.” He had already visited a health food store and a chiropractor in search of a cure, but decided after significant weight loss that it was about time for some western medicine. He was a pleasant man, a strong presence, and an artistic soul. With his lanky and thin arms, he gracefully added movement to each statement. It was very exuberant, but natural and smooth at the same time. I often asked questions and got strange replies. For example, when I asked when he returned from his home country, he began to tell me about the food he ate back home and how delicious it was. And when I proceeded to ask the same question again, he replied, “I go home often, I’m a performer and enjoy making my music back home.” My attempt failed not once, but twice and I explained what had happened to my preceptor when I left the room. He asked the question a third time and still did not get a reply. It happened often… I imagine, because for every question there is more than an answer. There was a story. Various cultural interaction, which I have witnessed, often take time to provide details and offer background to every story and every statement. It was different for me, but I enjoyed it. I once again felt like a Sherlock Holmes in the making. After the interview, I began the physical examination. Since he complained of abdominal pain and diarrhea, I thought it would be fitting to listen to bowel sounds and palpate the abdomen. I asked my new and jolly friend to lie on top of the examination table. He lifted his shirt and I was surprised by an umbilical hernia the size of half a fist. I could see very active peristalsis beneath the thin layer of skin. It looked like hundreds of creepy crawly worms running amuck. I had never witnessed anything like this and was startled… I later found out that it could be quite normal with a hernia in that spot. As I gently placed the stethoscope on his belly, I heard very loud grumbling similar to water quickly coming out of a jug. He was later diagnosed with an H. pylori infection, described by the lab tech as the most impressive positive test she ever did. We gave him our western medicine, said our long good-byes, and encouraged him to drink his tea concoction that he was convinced settled his stomach. His problems were complex, but could be easily treated. But out ordinary treatment wasn’t the answer to his reluctant use of western medicine, his unwillingness to visit a doctor in a timely manner, or his fear that the bacteria had also spread to his brain. They were just pills in a bottle that would invisibly extinguish bacteria, but do no more. Our drugs are far from overachievers, but rather do the minimum to aid our patients.

In another room, I met with a woman in her late 20s along with a nurse I’ve grown very fond of. The women brought along her new baby boy who had only laid eyes on our world a week ago. We were seeing this baby, because of his label as a “high risk newborn.” He had this title, because his mother, who had tattoos covering her arms and neck, had used cocaine while pregnant and the newborn was brought into this world addicted to a drug that ends lives. While in the room, the new mother answered a phone call and explained that her boyfriend was in jail and she didn’t get calls often, so she had to answer. My heart wrenched and in that short time that she spoke on the phone a million ideas ran through my mind. How this baby was already so disadvantaged, a step behind the starting line, and how he would have to work hard to make up for a poor beginning. How he didn’t have any control over his situation and how his parents’ struggles would affect every day of his life. I was saddened by the entire situation and I said a silent prayer for the new family, for new beginnings and for happy endings. For this woman, we prescribed suboxone, a medication that can be successful in treating opiate addictions. Once again it was an ordinary pill that would ease the physical symptoms of withdrawals and help ease cravings, but it would do no more. It wouldn’t take her boyfriend out of jail and wipe his slate clean. It wouldn’t teach a mother responsibility and patience. And it wouldn’t give this baby a pure welcome into a world that he deserved.

Our ordinary medications do no more than they are designed to do. They work wonders and ease pain of the muscles and joints, but do not heal pain within the soul or heart. They calm overactive intestines and prevent infection in wounds, but they can’t calm someone out of anger or prevent heartache and sorrow. They have limits and only our passion and words can begin to penetrate all the other problems that need solutions.